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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, January 29, 2018

Postpartum Endometritis

Any postpartum women presenting with persistent fever of >38.0C should be assumed to have a genital tract infection until proven otherwise. Other common sources of fever include respiratory tract infection, UTIs, mastitis, and thrombophlebitis. However, Pelvic infection is the most common serious complication of the puerperium.

Risk factors of Postpartum Endometritis

  • Cesarean Section
  • Multiple Gestation
  • Younger maternal age
  • Prolonged labour and PROM
  • Internal fetal monitoring
  • Digital examination 
  • Immunocompromised state

Common Bugs (reside in the bowel and colonize the perineum, vagina, and cervix) 
  • Gram-positive and gram-negative aerobes, anaerobes
  • Chlamydia trachomatis, and Neisseria gonorrhoea
  • Gardnerella vaginalis is isolated more often in younger women. 
  • MRSA

Many infections are polymicrobial
Clinical Presentation
  • Fever 38.0C 
  • Foul-smelling loch
  • Leukocytosis
  • Tachycardia
  • Uterine tenderness

ED Management
  • ABC
  • General Sepsis Care (Fluids, Antibiotics, Cultures, Septic Screen). Combination of Ampicillin or Clindamycin plus gentamicin is sufficient for 90% of patients
  • Drainage of abscesses and purulent material or debridement of necrotic tissue 
  • OBGYN Consultation 
Complications of endometritis include parametrical spread of infection, pelvic abscesses; infected hematomas; septic pelvic thrombophlebitis; necrotizing fasciitis; and peritonitis. 

Posted by:

     Lakshay Chanana
     Speciality Doctor
     Northwick Park Hospital
     Department of Emergency Medicine



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