eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Postpartum Infections: Differential Diagnoses & Workup

Author: Andy W Wong, MD, Resident Physician, Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital
Coauthor(s): Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Aug 10, 2009

Differential Diagnoses

Appendicitis
Pyelonephritis
Breast abscess
Tuboovarian Abscess
Cellulitis
Urinary Tract Infection, Female
Deep vein thrombosis
Vaginitis
Pelvic Inflammatory Disease

Other Problems to Be Considered

Endometritis
Mastitis
Retained products of conception
Septic pelvic phlebitis

Workup

Laboratory Studies

Laboratory studies are directed at elucidating the severity of illness as well as the etiology of the infection. Mild cases of mastitis usually do not require laboratory investigation. Wound infections and infections of the genital tract makes it more difficult to ascertain the extent of involvement. Laboratory studies should include the following:

  • Complete blood count
  • Electrolytes
  • Blood cultures, if sepsis is suspected
  • Urinalysis, with cultures and sensitivity tests
  • Cervical or uterine cultures
  • Wound cultures, if appropriate
  • Lactate, if sepsis suspected

Imaging Studies

  • Pelvic ultrasonography may be helpful in detecting retained products of conception, pelvic abscess, or infected hematoma.
  • Contrast-enhanced CT or MRI are useful in establishing the diagnosis of septic pelvic thrombosis.10
  • In some cases, a contrast-enhanced CT examination of the abdomen and pelvis may be helpful if concurrent concern is present for other non-pregnancy–related abdominal/pelvic sources of the infection (eg, appendicitis, colitis).

More on Pregnancy, Postpartum Infections

Overview: Pregnancy, Postpartum Infections
Differential Diagnoses & Workup: Pregnancy, Postpartum Infections
Treatment & Medication: Pregnancy, Postpartum Infections
Follow-up: Pregnancy, Postpartum Infections
References
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References

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  2. Yokoe DS, Christiansen CL, Johnson R, Sandu KE, et al. Epidemiology of and Surveillance for Postpartum Infectious. Emerg Infect Dis. Sep-Oct 2001;7(5):837-41. [Medline].

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  5. Schwartz MA, Wang CC, Eckert LO, Critchlow CW. Risk factors for urinary tract infection in the postpartum period. Am J Obstet Gynecol. Sep 1999;181(3):547-53. [Medline].

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  7. Atterbury JL, Groome LJ, Baker SL, Ross EL, Hoff C. Hospital readmission for postpartum endometritis. J Matern Fetal Med. Sep-Oct 1998;7(5):250-4. [Medline].

  8. Newton ER, Prihoda TJ, Gibbs RS. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet Gynecol. Mar 1990;75(3 Pt 1):402-6. [Medline].

  9. Maharaj D. Puerperal Pyrexia: a review. Part II. Obstet Gynecol Surv. Jun 2007;62(6):400-6. [Medline].

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  11. Chaim W, Burstein E. Postpartum infection treatments: a review. Expert Opin Pharmacother. Aug 2003;4(8):1297-313. [Medline].

  12. [Guideline] American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. Sep 2001;108(3):776-89. [Medline].

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  19. Del Priore G, Jackson-Stone M, Shim EK, Garfinkel J, Eichmann MA, Frederiksen MC. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis. Obstet Gynecol. Jun 1996;87(6):994-1000. [Medline].

  20. French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. 2002;CD001067. [Medline].

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Further Reading

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Keywords

postpartum infection, endometritis, puerperal infection, postsurgical wound infections, perineal cellulitis, mastitis, retained products of conception, urinary tract infections, UTI, septic pelvic phlebitis, pyelonephritis, genital tract infections, thrombosis, perineal cellulitis, episiotomy, respiratory complications from anesthesia

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Contributor Information and Disclosures

Author

Andy W Wong, MD, Resident Physician, Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital
Andy W Wong, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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