Post-Partum Pyrexia

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Post-partum pyrexia refers to body temperature of 38°C or more on 2 or more occasions during the first 10 days of the puerperium excluding the first day. Risk factors include prolonged labour, prolonged premature rupture of membranes, retained placental tissue, instrumental deliveries and birth canal injuries.

Cause

  • Malaria
  • Uterine infection (endo-myometritis)
  • Perineal Infections (e.g. infected episiotomy)
  • Breast problems (engorgement, mastitis, abscess formation)
  • Urinary tract infection
  • Respiratory tract infection

Symptoms

  • Fever
  • Other symptoms as related to cause 

Signs

  • Fever
  • Other symptoms as related to cause 

Investigations

  • FBC
  • RDT
  • Blood film for malaria parasites
  • Blood for culture and sensitivity 
  • Urine for culture and sensitivity 
  • High vaginal swab 
  • Fasting or Random Blood Glucose
  • Pelvic scan to exclude retained products of conception or pelvic abscess

TreatmentTreatment Objectives

  • To identify and treat the underlying cause 

Non-pharmacological treatment

  • Examination under anaesthesia with possible uterine curettage for retained products of conception
  • Encourage frequent emptying of breasts if cause is due to engorgement
  • Incision and drainage for breast and perianal abscess 

Pharmacological treatment 

Breast problems - mastitis/abscess

Evidence Rating: [A]

  • Flucloxacillin, oral, 500 mg 6 hourly for 5-7 days

Endo-myometritis and perineal infections

Evidence Rating: [B]

  • Amoxicillin + Clavulanic Acid, IV, 600 mg-1.2 g 8 hourly for 72 hours 

And

  • Metronidazole, IV, 500 mg 8 hourly for 72 hours 

Then

  • Amoxicillin + Clavulanic Acid, oral, 625 mg-1 g 12 hourly for 7 days

And

  • Metronidazole, oral, 400 mg 8 hourly for 7 days 

Referral CriteriaRefer all cases of severe sepsis to hospital for management.