generation cephalosporins

PUERPERAL COMPLICATIONS 
 PUERPERAL FEVER
 Temperature of 38.0°C (100.4°F) or higher
 Persistent fevers after childbirth are caused by genital tract infections
 Spiking fevers 39°C or higher that develops within the first 24 hours
postpartum- associated with virulent pelvic infection caused by GABHS
 Other causes of puerperal fever:
 Breast engorgement
 Infections of the urinary tract
 Of perineal lacerations, and of episiotomy or abdominal incisions,
 Respiratory complications after cesarean delivery
 Incidence of fever is lower in breastfeeding women
 BREAST FEVER: rarely exceeds 39°C in the first few postpartum days
and usually lasts <24 hours.
 RENAL INFECTION: fever (first sign), costovertebral angle tenderness,
nausea and vomiting
 ATELECTASIS: is caused by hypoventilation following abdominal
delivery. Best prevented by coughing and deep breathing on a fixed
schedule following surgery

 UTERINE INFECTIONS
 Endometritis, Endomyometritis, and Endoparametritis
 It is because infections involves not only the decidua but also the
myometrium and parametrial tissues (METRITIS WITH PELVIC
CELLULITIS)
 Due to morbidity following hysterotomy, single-dose perioperative
antimicrobial prophylaxis is recommended for all women undergoing
cesarean delivery
 Risk factors following surgery: Prolonged labor, Membrane rupture,
Multiple cervical examinations, and Internal fetal monitoring
 Women with lower socioeconomic status frequently present with pelvic
infections
 Bacterial colonization of the lower genital tract:
 Group B streptococcus
 Chlamydia trachomatis
 Mycoplasma hominis
 Ureaplasma urealyticum
 Gardnerella vaginalis
 Other factors associated with an increased infection risk:
 General anesthesia
 Cesarean delivery for multifetal gestation
 Young maternal age and nulliparity
 Prolonged labor induction
 Obesity
 Meconium-stained amnionic fluid
 Intraamnionic cytokines and C-reactive protein: markers of infections
 FEVER is the most important criterion for the diagnosis of postpartum
metritis
 Temperatures commonly are 38-39°C
 Chills + Fever: suggest bacteremia or endotoxemia
 Complaint of abdominal pain and parametrial tenderness elicited
on abdominal and bimanual examination
 Leukocytosis 15,000- 30,000 cells/μL
 Offensive odor may develop; some have foul-smelling lochia without
evidence for infection
 GABHS- associated with scant, odorless lochia
TREATMENT:
 Nonsevere metritis: oral or intramuscular antimicrobial agent
 Moderate- Severe metritis: intravenous therapy with a broad-
spectrum antimicrobial regimen
 Improvement follows in 48-72 hours; Persistent fever after this interval
mandates a careful search of refractory pelvic infection
 PARAMETRIAL PHLEGMON: an area of intense cellulitis
 An abdominal incisional or pelvic abscess or infected hematoma;
 Septic pelvic thrombophlebitis
 Discharged home after afebrile for at least 24 hours, and further oral
antimicrobial therapy is not needed
 AMPICILLIN + GENTAMICIN: GOLD STANDARD
 Once-daily Gentamicin dosing + Ampicillin added to regimen with
sepsis syndrome or suspected enterococcal infection
 NEPHROTOXICITY & OTOTOXICITY: with gentamicin esp in
diminished glomerular filtration
 CLINDAMYCIN + AZTREONAM (a monobactam compound with
activity similar to aminoglycosides): gentamicin substitute for renal
insufficiency
 Others recommend a combination of clindamycin and a second-