Billing Card for Consulting Work - Hopkins Medicine
Postpartum Fever OB-GYN 101 Facts Card ©2003 Brookside Press
Maternal febrile morbidity is classically defined as temperatures exceeding 100.4 on at least two occasions, at least 6 hours apart.
For patients with an obvious infection and high fever, localizing signs and septic in appearance, begin treatment immediately without waiting for the 6-hour definition to be fulfilled.
Cultures from the urine and vagina (and sometimes blood) can be useful. Similarly, a chest x-ray, may identify a pulmonary cause for the fever..
Examine the patient, looking for localizing signs that will guide you in your therapy. Check for:
• Uterine tenderness, suggesting a uterine or endometrial source
• Flank tenderness, suggesting pyelonephritis
• Breast tenderness and redness, suggesting mastitis
• Perineum tenderness and redness, with wound infection
• Rales, rhonchi or wheezes, suggesting a respiratory source
• Calf tenderness, suggesting deep vein thrombophlebitis
Treat any specific source. However, in many situations, there is risk of multiple sources. Good choices for such therapy include:
• Ampicillin 2 gm IV Q 6 hours, plus gentamicin 1.5 mg/kg (loading dose) and 1.0 mg/kg Q 8 hours, plus clindamycin 900 mg IV Q 6 hours
• Ampicillin/sulbactam 3 gm IV Q 4-6 hours
• Mezlocillin 4 g IV Q 4-6 hours
• Piperacillin 3-4 g IV Q 4 hours
• Ticarcillin/clavulanic acid 3.1 gm IV Q 6 hours
• Cefotetan 1-2 g IV Q 12 hours
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