Managing Complications in Pregnancy and Childbirth: - IAWG

Fever after childbirthS-113• If the abscess is fluctuant in the cul-de-sac, drain the pus throughthe cul-de-sac (page P-69). If the spiking fever continues, performa laparotomy.PERITONITIS• Provide nasogastric suction.• Infuse IV fluids (page C-21).• 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 necessary, perform laparotomy for peritoneal lavage (wash-out).BREAST ENGORGEMENTBreast engorgement is an exaggeration of the lymphatic and venousengorgement that occurs prior to lactation. It is not the result ofoverdistension of the breast with milk.BREASTFEEDING• If the woman is breastfeeding and the baby is not able to suckle,encourage the woman to express milk by hand or with a pump.• If the woman is breastfeeding and the baby is able to suckle:- Encourage the woman to breastfeed more frequently, usingboth breasts at each feeding;- Show the woman how to hold the baby and help it attach;- Relief measures before feeding may include:- Apply warm compresses to the breasts just beforebreastfeeding, or encourage the woman to take a warmshower;- Massage the woman’s neck and back;