Managing Complications in Pregnancy and Childbirth: - IAWG

S-112 Fever after childbirthMANAGEMENTMETRITISMetritis is infection of the uterus after delivery and is a major cause ofmaternal death. Delayed or inadequate treatment of metritis may resultin pelvic abscess, peritonitis, septic shock, deep vein thrombosis,pulmonary embolism, chronic pelvic infection with recurrent pelvic painand dyspareunia, tubal blockage and infertility.• Transfuse as necessary. Use packed cells, if available (page C-23).• Give a combination of antibiotics until the woman is fever-free for48 hours (page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours;- If fever is still present 72 hours after initiating antibiotics, reevaluateand revise diagnosis.Note: Oral antibiotics are not necessary after stopping IVantibiotics.• If retained placental fragments are suspected, perform a digitalexploration of the uterus to remove clots and large pieces. Useovum forceps or a large curette if required.• If there is no improvement with conservative measures and thereare signs of general peritonitis (fever, rebound tenderness,abdominal pain), perform a laparotomy to drain the pus.• If the uterus is necrotic and septic, perform subtotal hysterectomy(page P-103).PELVIC ABSCESS• Give a combination of antibiotics before draining the abscess andcontinue until the woman is fever-free for 48 hours (page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.