Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Postpartum Endometritis and Sepsis

—

In one line

·Infection in the uterus lining after delivery, usually from bacteria that climbed up during birth.

—

Normal physiology

·After birth, the uterus shrinks from the size of a watermelon back down to a pear, the cervix closes tight, and the raw spot where the placenta was attached heals over. The womb flushes out leftover blood and tissue for a few weeks while staying clean inside.

—

What goes wrong

·Bacteria from the vagina climb up into the raw, open uterus and infect the lining, especially when surgery, long labor, or manual placenta removal give germs an easy highway in.

—

Hallmark signs

·Fever (usually 100.4°F or higher) starting 1–3 days after delivery
·Lower belly pain or tenderness over the uterus
·Foul-smelling vaginal discharge (lochia)
·Heavy vaginal bleeding (more than a normal period)
·Fast heart rate (tachycardia, over 100 beats per minute)
·Chills or shaking
·Feeling very weak, confused, or short of breath
·Blood pressure dropping (systolic under 90 mmHg) or very low urine output

—

Red flags · escalate now

·Confusion, extreme sleepiness, or trouble staying awake (sign that the brain is not getting enough oxygen)
·Blood pressure under 90/60 or very fast breathing (over 24 breaths per minute)—signs of septic shock
·Skin that looks mottled, cold, or bluish, or urine output that stops or drops way down (kidneys and circulation failing)
·Severe belly pain that spreads, or belly becomes hard and rigid (infection may be spreading beyond the uterus into the abdomen)

—

Workup

·Complete blood count (CBC) with differential
·Blood cultures × 2 sets from separate sites before starting antibiotics
·Endometrial tissue culture or uterine cavity swab during manual exploration or curettage (if done)
·Serum lactate level
·Pelvic ultrasound (transvaginal or transabdominal)
·CT of the abdomen and pelvis with IV contrast (if ultrasound is not clear or fever persists despite 48–72 hours of antibiotics)
·Urinalysis and urine culture
·Chest X-ray (if respiratory symptoms or low oxygen saturation)

—

Treatment

·IV clindamycin 900 mg every 8 hours PLUS IV gentamicin 5 mg/kg (based on actual body weight) once daily, OR single-agent IV ampicillin-sulbactam 3 g every 6 hours or piperacillin-tazobactam 3.375 g every 6 hours
·Continue IV antibiotics until the mom has been fever-free for at least 24–48 hours and clinical signs (uterine tenderness, a fast heart rate (tachycardia)) are improving; do NOT switch to oral antibiotics in the hospital
·Add IV ampicillin 2 g every 4–6 hours if no improvement after 48–72 hours of clindamycin plus gentamicin, to cover Enterococcus species
·Pelvic ultrasound (or CT if ultrasound is not clear) within 48–72 hours if fever persists despite appropriate IV antibiotics
·Percutaneous (through the skin) or transvaginal ultrasound-guided drainage of pelvic or uterine abscess if imaging shows a drainable fluid collection
·Manual exploration of the uterus and curettage (scraping) under anesthesia if imaging or clinical suspicion points to retained placental tissue
·IV heparin (unfractionated) or therapeutic-dose low-molecular-weight heparin (enoxaparin 1 mg/kg every 12 hours) if imaging shows septic pelvic thrombophlebitis (clots in the ovarian or uterine veins) or if fever persists > 5–7 days despite antibiotics and no abscess/retained tissue is found
·Sepsis resuscitation bundle if the mom meets sepsis criteria (fever or hypothermia, heart rate > 90, respiratory rate > 20 or PaCO₂ < 32 mmHg, white blood cell count > 12,000 or < 4,000, plus suspected infection) with organ dysfunction (lactate ≥ 2 mmol/L, systolic blood pressure < 90 mmHg, altered mental status, urine output < 0.5 mL/kg/hour): give 30 mL/kg IV crystalloid fluid bolus within the first 3 hours, measure lactate, start vasopressors (norepinephrine first) if mean arterial pressure < 65 mmHg after fluids, and obtain blood cultures before antibiotics

—

NCLEX trap

·Start IV clindamycin plus gentamicin RIGHT NOW. Waiting lets bacteria multiply in the uterus and spill into the blood. Early antibiotics stop sepsis before organs shut down. Delay kills.
·Give IV antibiotics through the vein first. The infection is deep inside the uterus lining and needs strong medicine flowing through the whole bloodstream to reach it. Oral pills are too slow and too weak for this. You switch to pills only after fever is gone for 48 hours and mom is clearly getting better.
·Foul-smelling discharge plus fever equals bacteria multiplying in the uterus until proven otherwise. Normal lochia (the blood and tissue that flows out after delivery) has a slight smell but never a strong rotten odor. A foul smell means infection. Check temperature, heart rate, and press gently on the uterus to see if it hurts.
·If fever does not drop after 48 hours of IV antibiotics, get a pelvic ultrasound or CT scan. You are looking for a pocket of pus (an abscess) hiding in the pelvis that antibiotics cannot reach. If you find one, it must be drained with a needle or surgery. Antibiotics alone cannot clear trapped pus.
·Fever plus a tender uterus plus foul discharge means uterus infection until proven otherwise. Breast problems (engorgement, mastitis, cracked nipples) do not make the uterus hurt when you press on the belly and do not make lochia smell bad. Do the focused exam: check the breasts AND press on the uterus AND look at the discharge.
·Keep IV antibiotics running until the fever has been gone for a full 48 hours and mom feels clearly better. Then switch to oral antibiotics to finish a 10–14 day total course. Stopping early lets hidden bacteria bounce back and cause sepsis again.

—

Install Maldek by Hill as an app — studies work even offline