Types of Postpartum Infections

Endometritis

■ A postpartum uterine infection involving the decidua, myometrium, and parametrial tissue

■ Also called metritis with pelvic cellulitis, endomyometritis, and endopara-metritis

■ Typically develops postpartum day 2 to 3

■ Treat with IV antibiotics (gentamicin and clindamycin) until patient is afebrile for 24 to 48 hours.

Endometritis is relatively uncommon following vaginal delivery, but a major problem after C-section.

Following delivery, the bladder and lower urinary tract remain somewhat hypotonic ^ residual urine and reflux.

Wound infection occurs in 4 to 12%% of patients following C-section.

Antibiotic prophylaxis with IV cefazolin is commonly employed.

The more extensive the laceration/incision, the greater the chance of infection and wound breakdown.

Urinary Tract Infection

■ Caused by catheterization, birth trauma, conduction anesthesia, and frequent pelvic examinations

■ Presents with dysuria, frequency, urgency, and low-grade fever

■ Rule out pyelonephritis (costovertebral angle tenderness, pyuria, hematuria).

■ Obtain a urinalysis and urinary culture (E. coli is isolated in 75% of postpartum women).

■ Treat with appropriate antibiotics.

Cesarean Section Wound Infection

■ Fever that persists to the fourth or fifth postoperative day suggests wound infection.

■ Wound erythema and tenderness several days after surgery

■ Obtain Gram stain and cultures from wound material.

■ Wound should be drained, irrigated, and debrided.

■ Antibiotics should be given if extensive infection is suspected.

Episiotomy Infection

■ Look for pain at the episiotomy site, disruption of the wound, and a necrotic membrane over the wound.

■ Rule out the presence of a rectovaginal fistula with a careful rectovagi-nal exam.

■ Open, clean, and debride the wound to promote granulation tissue formation.

■ Sitz baths are recommended.

■ Reassess for possible closure after granulation tissue has appeared.

Mastitis

Affects 1 to 2% of postpartum women

Two types: Epidemic (nosocomial) and nonepidemic:

■ Epidemic mastitis is caused by infant acquiring Staphylococcus aureus in his nasopharynx from the hospital. Mother presents on day 2 to 4 with fever and breast tenderness. Treat with penicillin and isolate from other patients.

■ Endemic (nonepidemic) mastitis presents weeks or months after delivery, usually during period of weaning. Mother presents with fever, systemic illness, and breast tenderness. Treat with penicillin or di-cloxacillin. Continue breast feeding.

Breast engorgement (painful, swollen, firm breasts) is not mastitis (due to infection) and is normal during the second to fourth postpartum day. Treat with supportive bra, 24-hour demand feedings, and ice packs if not breast feeding.

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