post partum fever

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post partum fever

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virgola82
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06/11/07 - 04:52 PM

Three days ago you delivered a 40 yo G1P1 by C-section. The indication for operative delivery was failure to descend after 2h of pushing. Labor was also significant for prolonged rupture of membranes. The patient had an epidural, which was removed the day following delivery. The nurse pages you to come and see the patient on the postpartum floor because she has a fever of 102°F and is experiencing shaking chills. Her BP is 120/70 and her pulse rate is 120. She has been eating a regular diet without difficulty and had a normal bowel movement this morning. She is attempeing to breast feed but says her milk has not come yet. On physical exam her breast are mildly engorged and tender bilaterally. Her lungs are clear. her andomen is tender over fundus, but no rebound tenderness is present. Her incision has some serous drainage at the right apex, but no erythema is noted. Which of the following is the most appropriate initial treatment?

A. oral Bactrim

B. oral Dicloxacillin

C. oral Ciprofloxacin

D. IV gentamicin

E. IV Cefotetan

Justice
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06/12/07 - 11:12 AM

E. IV Cefotetan

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sprint123
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06/17/07 - 07:18 PM

Third generation Cs TO COVER FOr gram negatives and anaerobes--Wound infection-->Cefotetan--Wats the answer virgola?

Sayulita
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06/17/07 - 07:43 PM

E.- IV Cefotetan

all other antibiotic may cause a undesired reaction on the breast milk and ultimetly on the newborn

young_doc
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06/17/07 - 11:27 PM

sprint123 wrote:
Third generation Cs TO COVER FOr gram negatives and anaerobes--Wound infection-->Cefotetan--Wats the answer virgola?

Though I agree with your choice of antibiotics, i don't agree with your diagnosis. Serous drainage without erythema at the site of the wound is highly unlikely to be a wound infection.

This patient probably has Endometritis as a complication of her C-section. (fever + tenderness over the fundus)

The ideal antibiotics here would be a combination of Genta or Ampicillin + Clinda (to cover aerobes like E.Coli & Entercoccus, and to cover anaerobes)

The only drug of the list that would do this is Cefotetan.

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virgola82
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06/18/07 - 11:53 AM

The answer is cefotetan

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