Slide 1

Fever is defined as a temperature of 38°C or more during pregnancy or labor or after childbirth. The diagnosis is made by evaluating the patient for accompanying signs or symptoms.

Slide 3

These are procedures where there is high potential for contamination. During any of these procedures, if infection is diagnosed, treat the infection.

Slide 4

• Give antibiotics before procedure when able.

• Studies have shown no difference between giving one dose or 24 hours worth of doses.

Slide 6

Ampicillin or first generation cephalosporins are adequate prophylaxis.

Slide 7

The most important principles to remember if an established infection develops are to:

• Use broad spectrum antibiotics (different from those used for prophylaxis)

• Give adequate doses

• Continue treatment for an adequate duration via the proper route

• Re-evaluate the patient.

For additional information, please refer to Managing Complications in Pregnancy and Childbirth manual.

Polymicrobial nature of pelvic infections require multiple antibiotics.

Slide 8

Start giving antibiotics through IV. If woman is fever free for 48 hours, continue giving antibiotics by mouth.

Slide 9

The differential is wide, and includes pregnancy-related problems, such as septic abortion and amnionitis, and other problems, such as acute pyelonephritis, pneumonia, hepatitis, malaria and typhoid.

Slide 11

Pyelonephritis can result in preterm labor, acute respiratory distress syndrome and sepsis. It is easy to treat. For dose information, see Managing Complications in Pregnancy and Childbirth manual.

Slide 12

Prophylaxis for the remainder of the pregnancy is recommended to prevent recurrent infection. It is easy and inexpensive to treat with amoxicillin and nitrofurantoin.

Slide 14

Manual vacuum aspiration has been very successful in managing septic abortion. It has been shown to reduce hospital stay and costs and improve survival and reduce bleeding, pain and infection.

Slide 15

Treatment should be given promptly intrapartum. Treatment reduces neonatal and maternal morbidity and does not mask newborn infection. 

Slide 16

Best choice: ampicillin and gentamicin

Slide 17

If vaginal delivery, stop treatment. If cesarean section, treat with antibiotics until fever free for 48 hours.

Slide 19

Studies have been done to assess the safety of aminoglycosides in pregnancy and look at congenital defects, particularly deafness and problems with renal function.

Slide 20

No congenital anomalies were detected.

Once daily dosing of gentamicin has proven to be very effective in adults treated for various infection. Studies have been done to determine effectiveness and safety in neonates and have found them to be safe in newborns born at full term (no renal or hearing problems and less monitoring required). The regimen cannot be unequivocally recommended in newborns born prematurely.

Slide 21

Again, the differential remains wide.

Slide 22

Many factors related to labor contribute to postpartum sepsis, particularly regarding the management of the labor and treatments given. The infection can be further complicated by thromboembolic events or coagulopathy.

Slide 23

Health service factors also affect the development of postpartum sepsis, especially regarding the availability of drugs and blood to treat the patient and adequately trained personnel to administer treatments.

Slide 25

The same general principles for treating infection apply:

• Stabilize the patient

• Start broad spectrum antibiotics

• Examine for causes/sources of infection

• Continue to watch the patient closely.

Slide 26

Give broad spectrum antibiotics and remember that route and adequate duration are essential.

Slide 28

• Broad spectrum regimens are essential.

• 24 hour dosing of gentamicin is effective, and is also cheaper.

Slide 29

• Prevention is the best way to deal with infection.

• Clean delivery is important.