Peripartum Fevers

Intrapartum

Differential diagnosis for Temp >38.0C

• Epidural fever (transient), DVT/PE (if prolonged IOL or limited mobility), UTI, Intraamniotic infection (with or without ROM), etc

Chorioamnionitis aka IAI aka Triple-I (intrapartum intraamniotic Infection)

• One temp >39.0C
• One temp 38.0C-39.0C AND one or more risk factors
• Two temps >38.0C 30+ mins apart

Tx: the standard is Ampicillin/Gentamycin until delivery. Tylenol prn temp>38C, IVF for maternal/fetal tachycardia, cooling blanket if needed to decrease temp.

If mild PCN allergy: Ancef/Gent

If severe PCN allergy: gent/clinda or gent/vanc

If vaginal delivery: No evidence that continued abx postpartum provide benefit.

If c-section: Add clindamycin to Amp/Gent.

Continue at least 1 dose postpartum. Clinical judgment on when to d/c. Some do 1 dose, some 24hrs afebrile, until clinical improvement, etc.

Postpartum

Wind – PNA, atelectasis, URI

Womb – Endomyometritis — Gent/Clinda x 24hrs afebrile

Wound – Superficial wound infection, cellulitis — eval for collection, probe wound/fascia if able

Water – UTI, Pyelo — get UA

Walking – DVT/PE

Weening – Engorgement or mastitis

Wonder drugs