Gynecology and Reproductive Sciences Rutgers Robert Wood Johnson then monitoring symptoms that infrequently occur after a condition in the newly delivered patient. Talking to and examining the new mother is essential for clinicians to identify and treat complications that are the most common causes of pregnancy- related death--among them, infection/sepsis and postpartum hemorrhage. These complications are responsible for approximately 14 percent and 11 percent, respectively, of maternal deaths in the United States, according to the Centers for Disease Control and Prevention. non-tender, and should have decreased in size such that it can be abdominally palpated at or near the umbilicus within 24 hours of delivery. Vaginal discharge consisting of blood, fragments of decidua, and mucus (lochia rubra) will be present on the woman's perineal pad after delivery. occurring in about 50 percent to 60 percent of women within the first 24 hours of delivery. However, although the majority of women expe- rience this temperature elevation, health care providers should not automatically give medication to lower the fever without first talking to the patient and then examining her. Temperature elevation can herald a more critical process that is evolving, Dr. Gilmandyar stressed. occurs in 1 percent to 3 percent of women after vaginal deliveries, and 5 percent to 15 percent after Cesarean deliveries consideration when thinking about the appropriate course of antibiotic treatment before cultures and sensitivities are known, Dr. Gilmandyar noted. delivery, are young, had a prolonged ROM (rupture of membranes) prior to the delivery, have a pre-existing vaginal infection, have had multiple vaginal exams, and have maternal diabetes, anemia, or HIV. Symptoms usually include fever, increased white blood cell count, and uterine tenderness, with the tenderness more pronounced at the fundal site, rather than the incision site. common regimen being clindamycin (900 mg every eight hours) and gentamycin (1.5 mg/kg intravenously every eight hours or 5 mg/kg every 24 hours). This treatment is typically 90 percent to 97 percent effective, Dr. Gilmandyar said. In the case of Group B Strep (GBS) colonization, ampicillin should be added to the regimen, she said. Clinical improvement of the patient's symptoms should be seen within 48 to 72 hours. If symptoms do not improve, the patient should be reevaluated for another possible source of infection. The antibiotic regimen should also be reevaluated as well. Pharmacologic treatment should continue until the patient is fever-free for 24 hours. percent of patients will develop an delivery is characterized by fever, uterine tenderness, erythema of the incision, and induration around the incision. Risk factors for wound infections include diabetes, chorioamnionitis, steroid use, prolonged ROM, obesity, poor surgical technique, immunosuppression, and low develop a complication that requires immediate care. Physicians and other health care providers may need to frequently monitor the woman's vital signs over an extended period of time to get a global picture of what may be occurring, especially if a complication is evolving. And, the clinician must be sure to examine the patient before deciding on management. Management should never be based on assumptions of what the most common reason for a particular symptom is--the patient has to have a thorough medical history taken and a targeted examination that addresses the areas of concern. |