Managing Complications in Pregnancy and Childbirth: - IAWG

Fever after childbirthS-117• Remove infected skin or subcutaneous sutures and debride thewound. Do not remove fascial sutures.• If there is an abscess without cellulitis, antibiotics are not required.• Place a damp dressing in the wound and have the woman return tochange the dressing every 24 hours.• Advise the woman on the need for good hygiene and to wear cleanpads or cloths that she changes often.WOUND CELLULITIS AND NECROTIZING FASCIITIS• If there is fluid or pus, open and drain the wound.• Remove infected skin or subcutaneous sutures and debride thewound. Do not remove fascial sutures.• If infection is superficial and does not involve deep tissues, monitorfor development of an abscess and give a combination ofantibiotics (page C-35):- ampicillin 500 mg by mouth four times per day for 5 days;- PLUS metronidazole 400 mg by mouth three times per day for 5days.• If the infection is deep, involves muscles and is causing necrosis(necrotizing fasciitis), give a combination of antibiotics untilnecrotic tissue has been removed and the woman is fever-free for48 hours (page C-35):- penicillin G 2 million units IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours;- Once the woman is fever-free for 48 hours, give:- ampicillin 500 mg by mouth four times per day for 5 days;- PLUS metronidazole 400 mg by mouth three times per dayfor 5 days.Note: Necrotizing fasciitis requires wide surgical debridement.Perform secondary closure 2–4 weeks later, depending onresolution of infection.