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Puerperal fever

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-{{Merge to|Puerperal fever|date=September 2011}}
+ #REDIRECT [[Puerperal fever]] {{R from merge}}
-{{Multiple issues|orphan =April 2010|wikify =April 2010|confusing =April 2010|copyedit =April 2010|refimprove =September 2010|howto =September 2010}}
-'''Another name for''': [[Puerperal fever]]
-temperatures in the '''postpartum fever''' reach 100.4F(38.0) or higher. The fevers occur on any two of the first 10 days postpartum, exclusive of the first 24 hours.
-==Incidence==
-postpartum fever occurs after vaginal delivery in 1% of cases but after cesarean delivery in up to 30% of cases.
-==Bacterial pathogenesis==
-ascending polymicrobial genital flora may be anaerobic, aerobic, gram -ve, or gram +ve.
-==Etiology and risk factors==
-causes ( listed in order of decreasing frequency ) include endometritis, urinary tract infection, pneumonia\atlectasis, wound infection, and septic pelvic thrombophlebitis. Septic risk factors for each eitiologic condition are listed in order of the postpartum day(PPD) on which the condition generally occurs.
-* PPD 0: atlectasis risk factors include general anesthesia, cigarette smocking, and obstructive lung disease.
-* PPD 1-2: urinary tract infections risk factors include multiple catheterization during labor, multiple vaginal examinations during labor, and untreated bacteriuria.
-* PPD 2-3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.
-* PPD 4-5: wound infection risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examination during labor.
-* PPD 5-6: septic pelvic thrombophlebities risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal delivery.
-* PPD 7-21: mastitis risk factors include nipple trauma from breastfeeding.
-==Clinical findings and management==
-[[Atelectasis]]: mild to moderate fever, no changes or mild rales on chest auscultaion.
-'''management''': pulmonary exercises, ambulation.
-[[Urinary tract infection]] : high fever, malaise, costovertebral tenderness, positive urine culture.
-'''management''': antibiotics as per culture sensitivity (cephalosporine 1-2 g parentral q6hr).
-[[Endometritis]]: moderate fever, exquisite uterine tenderness, minimal abdominal findings.
-'''management''': multiple agent IV antibiotics to cover polymicrobial organisms: (clindamycin 900&nbsp;mg q8hr, gentamicin 500&nbsp;mg everyday, addition of ampicillin 1–2 g IV q6hr if no response, no cultures are necessary.
-[[Wound infection]]: persistent spiking fever despite antibiotics, wound erythema or flactuance, wound drainage.
-'''management''': antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure.
-[[Septic pelvic thrombophlebitis]]: persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.
-'''management''': IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values.
-[[Mastitis]]: unilateral, localized erythema, edema, tenderness.
-'''management''': antibiotics for cellulitis, open and drain abscess if present.
-<ref>high-yield for gynecology and obstetrics</ref>
-<ref>USMLE step2 CK for gynecology and obstetrics</ref>
-==Reference==
-{{Reflist}}
-{{DEFAULTSORT:Postpartum Fever}}
-[[Category:Childbirth]]