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.