Procedure Ready: Ob/Gyn7 Jan 2018

Peripartum Fevers

A fever during or after delivery triggers a critical differential. This episode covers the intrapartum workup – from epidural fevers to chorioamnionitis (Triple-I) – along with antibiotic regimens by PCN allergy status, and the postpartum fever mnemonic (the W's) to systematically identify the source.

Show Outline:

Intrapartum Fever Differential – Epidural fever (transient), DVT/PE (prolonged IOL or limited mobility), UTI, intraamniotic infection (with or without ROM)
Chorioamnionitis / Triple-I Criteria
- One temp >39.0°C
- One temp 38.0–39.0°C plus risk factors
- Two temps >38.0°C 30+ mins apart
Treatment – Ampicillin/Gentamicin until delivery. Tylenol prn, IVF for tachycardia, cooling blanket as needed. Mild PCN allergy: Ancef/Gent. Severe: Gent/Clinda or Gent/Vanc.
After Vaginal Delivery – No evidence that continued abx postpartum provide benefit
After C-Section – Add clindamycin to Amp/Gent. Continue at least 1 dose postpartum; clinical judgment on duration.
Postpartum Fever Differential (The W's)
- Wind – PNA, atelectasis, URI
- Womb – Endomyometritis
- Wound – Infection, cellulitis
- Water – UTI, pyelo
- Walking – DVT/PE
- Weaning – Engorgement, mastitis
- Wonder drugs

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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