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I have completed bits of my EM training from India. Currently I am boarded with credentials from Christian Medical College, Vellore and also from the prestigious Royal College of Emergency Medicine, UK.  I am currently working in London as an A&E doctor, trying to appreciate the differences in the practise and culture of Emergency Medicine across different healthcare systems. I have always been an avid FOAMed supporter because FOAMed played an indispensable role during the days of my initial training. Through this blog, I aspire to disseminate knowledge and stay up to date with the EM literature. 

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
     England

     @EMDidactic

  

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