Table 551

APPROACH TO POSTPARTUM FEVER

Evaluate for pulmonary etiology: Cough? Atelectasis?

Evaluate for pyelonephritis: Costovertebral angle tenderness? Dysuria? Pyuria?

Evaluate for breast engorgement: Are breasts engorged, tender, red?

Evaluate for wound infection: Is the wound indurated, erythematous? Is there drainage ?

Evaluate for endometritis: Is the uterus tender? Foul-smelling lochia?

If endometritis, begin intravenous gentamicin and clindamycin.

If no response in 48 hr. re-evaluate and if endometritis is still considered, add ampi-

cillin for enterococcus coverage.

If no response after 48 hr of triple antibiotics, re-evaluate (especially look for wound infection). Consider CT imaging to assess for abscess, hematoma, or septic pelvic thrombophlebitis.

and look well; sometimes they have a palpable pelvic mass. The diagnosis may be confirmed by computed tomographic (CT) scan or magnetic resonance imaging. Treatment includes both antimicrobial and heparin therapy.

Other considerations in a febrile postpartum woman include pyelonephritis (fever, flank tenderness, leukocytes in the urine), pelvic abscess or infected pelvic hematoma, and breast engorgement (Table 55-1).

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