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Drug and Brestfeeding

April 20, 2009 2 comments

Whether you regularly take an over the counter remedy or need a special prescription, the breastfeeding mom should consult her doctor and pharmacist before utilizing any type of drug. The pharmacist is of particular importance, as they possess the most up to date information on drug reactions. A call to your pediatrician provides excellent advice on the potential negative reactions to your infant and what side effects to look for. Typically if the drug is safe for a baby to consume, it is also safe for the nursing mother to take.

Before treating with a medical drug, there are some important factors to consider. The first is how necessary the medicine is for the woman. In every instance, the woman and her doctor will weigh the benefits to the mother verses the impact to the infant. The seriousness of the disease will lead to the decision whether medication should be administered or not.

The age of the baby also weighs heavy into this discussion. As a baby grows, so does their digestive system, lowering the risk for adverse reactions to drugs. The most critical time period is from birth to two months. If possible, try to delay consuming any drugs until after that age. Once a child is six months, the risks drop dramatically. Be particularly careful if you have a baby with special needs or premature. Partner closely with your doctor in this scenario.

The history of a drug is also another factor: the longer the history, the longer the time to complete all research and trials. Also, the type of drug and how it is administered affects the concentration in the breast milk. The sustained-release medications maintain a consistent dose leading to higher concentrations in breast milk and should be avoided if possible. Administering the drug as a pill verses an injection is also preferred for the same reasons. Timing the use of medication can reduce the absorption in the breast milk. Always take medication immediately after nursing and/or before a long stretch of sleep, if possible.

Even when a drug is highly toxic for the infant, nursing can still continue. Work closely with your doctor to find a system to postpone breastfeeding temporarily: anything from pumping milk ahead of time or temporarily pumping and dumping the milk until the drug has run its course.

Common Medications

With all drugs, always check with your doctor, pediatrician and pharmacist first. While most medications can be safely used while nursing, some are extremely toxic.

Acne Products: Topical creams are typically the safest, with benzoyl peroxide, clindamycin and erythromycin the best choices.

Anesthetics: Most general anesthetics are safe once the effects of the drug have worn off. For local anesthetics, the current recommendation is to wait four hours after the drug is administered before nursing.

Antibiotics: Drugs for infections typically reach the breast milk in only small quantities. Most varieties are safe but always let your doctor know you are breastfeeding and the age of your baby, as some can cause problems for young infants. While using an antibiotic and breastfeeding watch for adverse reactions in your baby such as diaper rash, thrush or diarrhea.

Anticonvulsants: As this class of medication is often long acting, breastfeeding moms should use with caution. Partner closely with your pediatrician if you are prescribed these drugs, and monitor your baby’s blood to determine any negative affects on her body.

Antidepressants: As postpartum depression is common, antidepressants can be a necessity for a nursing mom. Luckily a few types are known to be particularly safe, such as amitriptline, sertralin and paroxetine. Be sure to discuss the best choices with your personal physician.

Antifungals: Clotrimazole, miconazole and fluconazole are potent, low-risk drugs used to fight yeast infections while breastfeeding.

Pain Medications: Acetaminophen and ibuprofen are the pain drugs of choice while breastfeeding. The rest should be completely avoided, including aspirin, unless absolutely necessary.

Cold and Allergy Medications: Avoid combination products to reduce the unnecessary drug exposure common in these medications. Nasal sprays are preferable to pills as they reach the milk in significantly lesser quantities. Most antihistamines are safe for the baby, but may cause a reduction in milk supply for mom. Decongestants are preferable in the nasal sprays, but pseudoephadrine in small doses, after your infant is six weeks old, is normally acceptable.

Gastrointestinal Drugs: Most drugs in this class are not absorbed into the bloodstream and therefore do not appear in breast milk. The most effective and safe versions are antacids, bulk-forming laxatives, and stool-softeners.

Sedatives: All drugs in this category will make the infant sleepy along with the mother. The safest class of sleep medications is the barbiturates as they cause only occasional drowsiness.

More Breastfeeding and Drugs

There are many reasons to avoid recreational drugs while breastfeeding that go beyond the negative affects on your baby. Trying to be a good parent while high or sedate is a difficult task. Recreational drugs consumed by a nursing woman have been shown to directly harm or cause fatalities to their infants. There are no safe levels of the following drugs, and if a woman chooses to nurse, she must also choose to remain clean.

Amphetamines: This class of drugs will inhibit the mother’s milk supply and over stimulate the baby causing excessive fussiness and sleeplessness.

Cocaine: Extremely toxic to infants and can lead to excessive crying and convulsions.

Marijuana: Builds up in a woman’s fat stores and can transfer to breast milk even when the mom is not actually smoking. Has been linked to delayed muscular development in infants.

Foods to avoid while breastfeeding

April 17, 2009 3 comments

There is technically no foods that breastfeeding woman must avoid. However some foods can cause mild reaction such as spicy foods, cabbage, chocolate and foods high in C concentrate. It will depend on your own body and the sensitivity of your baby.

Foods such as cabbage, garlic, chilli & curry may cause your baby to experience discomfort with wind. Although there is no research to support this, centuries of mothers will agree that keep these foods to a minimum if you want a good nights sleep. Some strongly flavoured foods may change the taste of your milk, although babies enjoy a variety of breast milk flavours, if you baby suddenly becomes fussy at the breast after you eat particular foods (for example garlic) you be best to avoid that food while breastfeeding. However you baby’s tolerance may improve as he/she gets older so you may be able to re-introduce that food.

Other foods & drinks to watch out for are; pineapple/juice (being the worst offender) and other vitamin C rich fruits such as oranges, tomatoes, grapefruit and lemon, that can cause your baby to get a nappy rash. If you think something you are eating is affecting your baby, you may need to do a bit of detective work to figure out the cause of the sensitivity. If you are not sure, try cutting the food out of your diet for up to a week to see if things improve. If avoiding the food causes a nutritional imbalance, seek professional advise before removing from your diet.

Moderate your caffeine intake, a small amount is fine, but too much can interfere with your baby’s sleep, or make him/her fussy. Keep in mind that caffeine is found in some sodas, teas, and over-the-counter medicines, as well as in coffee. Having an occasional social drink will not hurt your baby, but may make him/her sleepier than usual. To a sleep deprived mother this may sound like a solution, however it is more likely to unsettle your baby and lead to poor feeding which may result in your baby waking more during the night.

Categories: Woman Health Tags: , ,

Mothers and Children Benefit From Breastfeeding

April 17, 2009 1 comment

For most women, breastfeeding is biologically possible. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. Also, research indicates that women who breastfeed may have lower rates of certain breast and ovarian cancers.
A common reason cited for not planning to breastfeed is that the mother will be returning to work. Women are a significant part of the work force. One out of three women will return to work within 3 months of giving birth and two out of three women will return to work within 6 months of giving birth. Many mothers will return within 6 weeks or even sooner.
Until recently, when breastfeeding mothers returned to work, they faced the challenge of maintaining an adequate milk supply. But many employers have discovered that accommodating employees who breastfeed is good business. The Office on Women’s Health in the US Department of Health and Human Services notes that the health benefits to mother and baby conveyed by breastfeeding translate into reduced costs to employers due to lower health care costs, de-creased absenteeism, enhanced productivity, improved employee satisfaction, and a better corporate image.

It is feasible for women to breastfeed in many work environments. Accommodating breastfeeding is not complicated, but as with other work-site issues, clarifying mutual expectations and understanding local policy will minimize concerns. The key needs are basic: time, a location in which to pump or express the breast milk, and employer-employee communication. When child care is on-site or nearby and schedules are supportive, breastfeeding can continue seamlessly.
Both babies and mothers gain many benefits from breastfeeding. As we are seeing across our country, more employers are providing support for nursing mothers. I appreciate the American Dietetic Association’s position that food and nutrition professionals have an essential role in promoting and supporting breastfeeding. I urge American Dietetic Association members to reaffirm this role as they join in creating and supporting pathways for working mothers to continue breastfeeding

Categories: Woman Health

Breast Care during Pregnancy

April 17, 2009 2 comments

During pregnancy the size of the bust increases. The breasts sometimes loose their firmness and the shape is changed. This change in size is not due to breastfeeding. But even if it does change because of breastfeeding one should be rest assured that the baby is getting what is best suited for him/her. The size of the breast remains increased till breastfeeding is carried on. Once feeding is stopped then the size returns back to the original size.

Women with smaller breasts will be happy to hear this and will not like to refrain from breastfeeding. The increase in bust size can be noticed immediately. The maximum increase takes place during the initial three months.

The size of the bust cannot be predicted during pregnancy. In some cases the enlargement is enormous. Women with smaller breasts can avoid wearing bra during pregnancy. But as the bust size increases bra should be worn so that they are well supported and stretch marks can also be avoided. Women with larger breasts should take care of their breasts and prevent the stretching of ligaments which might eventually lead to unshaped breasts. If proper care of the breasts is taken during pregnancy then feeding the baby also becomes easier. Let us see how proper care of the breasts can be taken.

Many women learn the technique of breastfeeding quite easily. Many find it difficult to feed their baby as they feel pain inn their breasts. This happens because proper care of the breasts was not taken during pregnancy. Actually breastfeeding is never painful. Improper feeding techniques lead to pain and discomfort. If one experiences discomfort during feeding the doctor should be consulted immediately or the help of a midwife can also be taken. If proper care of the breasts is not taken, then a number of problems can arise. Nipples tend to crack if the baby is not positioned correctly during feeding and care of the breasts is not taken. If we wear a bra with poor-fitting it can result in clogged ducts. The appearance of such problem should be avoided and even if it appears immediate help should be sought.

1step

Let us how we can take care of our breasts during pregnancy so that we do not feel discomfort later on while breastfeeding.

2step

Inspection of the breasts should be done on a regular basis. Any changes in the colour and appearance should be taken seriously. If the breast creams does not suit the skin its application should be stopped without delay.

3step

The breasts should not be allowed to remain damp. Dampness leads to cracked nipples. If breast pump are used then the direction of using the pump in a proper manner should be followed. Excessive pumping should be avoided.

4step

The breasts should be washed only with water. The maternity or nursing bra should be of a good quality. The size should be checked properly. Taking a little time off from daily routine to care for the breasts will help in the long run.

Categories: Woman Health Tags: , ,

Postmenopause Bleeding

May 13, 2008 4 comments

Definition

Postmenopausal bleeding is bleeding from the reproductive system that occurs six months or more after menstrual periods have stopped due to menopause.

Description

Menopause, the end of ovulation and menstrual periods, naturally occurs for most women age 40-55 years. The process of ending ovulation and menstruation is gradual, spanning one to two years.

Postmenopausal bleeding is bleeding that occurs after menopause has been established for at least six months. It is different from infrequent, irregular periods (oligomenorrhea) that occur around the time of menopause.

Many women experience some postmenopausal bleeding. However, postmenopausal bleeding is not normal. Because it can be a symptom of a serious medical condition, any episodes of postmenopausal bleeding should be brought to the attention of a woman’s doctor.

Women taking estrogen (called hormone replacement therapy or HRT) are more likely to experience postmenopausal bleeding. So are obese women, because fat cells transform male hormones (androgens) secreted by the adrenal gland into estrogen.

Causes and symptoms

Postmenopausal bleeding can originate in different parts of the reproductive system. Bleeding from the vagina may occur because when estrogen secretion stops, the vagina dries out and can diminish (atrophy). This is the most common cause of bleeding from the lower reproductive tract.

Lesions and cracks on the vulva may also bleed. Sometimes bleeding occurs after intercourse. Bleeding can occur with or without an associated infection.

Bleeding from the upper reproductive system can be caused by:

  • hormone replacements
  • endometrial cancer
  • endometrial polyps
  • cervical cancer
  • cervical lesions
  • uterine tumors
  • ovarian cancer
  • estrogen-secreting tumors in other parts of the body

The most common cause of postmenopausal bleeding is HRT. The estrogen in the replacement therapy eases the symptoms of menopause (like hot flashes), and decreases the risk of osteoporosis. Sometimes this supplemental estrogen stimulates the uterine lining to grow. When the lining is shed, postmenopausal bleeding occurs. Most women on HRT usually take the hormone progesterone with the estrogen, and may have monthly withdrawal bleeding. This is a normal side effect.

About 5-10% of postmenopausal bleeding is due to endometrial cancer or its precursors. Uterine hyperplasia, the abnormal growth of uterine cells, can be a precursor to cancer.

Diagnosis

Diagnosis of postmenopausal bleeding begins with the patient. The doctor will ask for a detailed history of how long postmenopausal bleeding has occurred. A woman can assist the doctor by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any medications she is taking, especially any estrogens or steroids.

After taking the woman’s history, the doctor does a pelvic examination and Pap test. The doctor will examine the vulva and vagina for signs of atrophy, and will feel for any sign of uterine polyps. Depending on the results of this examination, the doctor may want to do more extensive testing.

Invasive diagnostic procedures

Endometrial biopsy allows the doctor to sample small areas of the uterine lining, while cervical biopsy allows the cervix to be sampled. Tissues are then examined for any abnormalities. This is a simple office procedure.

Dilatation and curettage (D & C) is often necessary for definitive diagnosis. This is done under either general or local anesthesia. After examining the tissues collected by an endometrial biopsy or D & C, the doctor may order additional tests to determine if an estrogen-secreting tumor is present on the ovaries or in another part of the body.

Non-invasive diagnostic procedures

With concerns about the rising cost of health care, vaginal probe ultrasound is increasingly being used more than endometrial biopsy to evaluate women with postmenopausal bleeding. Vaginal ultrasound measures the thickness of the endometrium. When the endometrial stripe is less than 0.2 in (5 mm) thick, the chance of cancer is less than 1%. The disadvantage of vaginal ultrasound is that it often does not show polyps and fibroids in the uterus.

A refinement of vaginal probe ultrasound is saline infusion sonography (SIS). A salt water (saline) solution is injected into the uterus with a small tube (catheter) before the vaginal probe is inserted. The presence of liquid in the uterus helps make any structural abnormalities more distinct. These two non-invasive procedures cause less discomfort than endometrial biopsies and D & Cs, but D & C still remains the definitive test for diagnosing uterine cancer.

Treatment

It is common for women just beginning HRT to experience some bleeding. Most women who are on HRT also take progesterone with the estrogen and may have monthly withdrawal bleeding. Again, this is a normal side effect that usually does not require treatment.

Postmenopausal bleeding due to bleeding of the vagina or vulva can be treated with local application of estrogen or HRT.

When diagnosis indicates cancer, some form of surgery is required. The uterus, cervix, ovaries, and fallopian tubes may all be removed depending on the type and location of the cancer. If the problem is estrogen- or androgen-producing tumors elsewhere in the body, these must also be surgically removed. Postmenopausal bleeding that is not due to cancer and cannot be controlled by any other treatment usually requires a hysterectomy.

Prognosis

Response to treatment for postmenopausal bleeding is highly individual and is not easy to predict. The outcome depends largely on the reason for the bleeding. Many women are successfully treated with hormones. As a last resort, hysterectomy removes the source of the problem by removing the uterus. However, this operation is not without risk and the possibility of complications. The prognosis for women who have various kinds of reproductive cancer varies with the type of cancer and the stage at which the cancer is diagnosed.

Prevention

Postmenopausal bleeding is not a preventable disorder. However, maintaining a healthy weight will decrease the chances of it occurring.

Key Terms

Dilation and curettage (D & C)
A procedure performed under anesthesia during which the cervix is opened more (or dilated) and tissue lining the uterus is scraped out with a metal, spoon-shaped instrument or a suction tube. The procedure can be used to diagnose a problem or to remove growths (polyps).
Endometrial biopsy
The removal of uterine tissue samples either by suction or scraping; the cervix is not dilated. The procedure has a lower rate of diagnostic accuracy than D & C, but can be done as an office procedure under local anesthesia.
Endometrium
The tissue lining the inside of the uterus.
Fibroid tumors
Non-cancerous (benign) growths in the uterus. These growths occur in 30-40% of women over age 40, and do not need to be removed unless they are causing symptoms that interfere with a woman’s normal activities.
Osteoporosis
The excessive loss of calcium from the bones, causing the bones to become fragile and break easily. Postmenopausal women are especially vulnerable to this condition because estrogen, a hormone that protects bones against calcium loss, decreases drastically after menopause.

Bartholin’s gland cyst

May 13, 2008 2 comments

Definition

A Bartholin’s gland cyst is a swollen fluid-filled lump that develops from a blockage of one of the Bartholin’s glands, which are small glands located on each side of the opening to the vagina. Bartholin’s gland cysts and abscesses are commonly found in women of reproductive age, developing in approximately 2% of all women.

Description

The Bartholin’s glands are located in the lips of the labia that cover the vaginal opening. The glands (normally the size of a pea) provide moisture for the vulva area. A Bartholin’s gland cyst may form in the gland itself or in the duct draining the gland. A cyst normally does not cause pain, grows slowly, and may go away without treatment. It usually ranges in size from 0.4-1.2 in. (1-3 cm), although some may grow much larger.

If infected, a Bartholin’s gland cyst can form an abscess that will increase in size over several days and is very painful. In order to heal, a Bartholin’s gland cyst usually must be drained.

Causes and symptoms

A Bartholin’s gland cyst occurs if the duct becomes blocked for any reason, such as infection, injury, or chronic inflammation. Very rarely a cyst is caused by cancer, which usually occurs only in women over the age of 40. In many cases, the cause of a Bartholin’s gland cyst is unknown.

Symptoms of an uninfected Bartholin’s gland cyst include a painless jump on one side of the vulva area (most common symptom) and redness or swelling in the vulva area.

Symptoms of an abscessed Bartholin’s gland include:

  • pain that occurs with walking, sitting, physical activity, or sexual intercourse
  • fever and chills
  • increased swelling in the vulva area over a two- to four-day period
  • drainage from the cyst, normally occurring four to five days after the swelling starts

Abscesses may be caused by sexually transmitted bacteria, such as those causing chlamydial or gonococcal infections, while others are caused by bacteria normally occurring in the vagina. Over 60 types of bacteria have been found in Bartholin’s gland abscesses.

Diagnosis

A Bartholin’s gland cyst or abscess is diagnosed by a gynecological pelvic exam. If the cyst appears to be infected, a culture is often performed to identify the type of bacteria causing the abscess.

Treatment

Treatment for this condition depends on the size of the cyst, whether it is painful, and whether the cyst is infected.

If the cyst is not infected, treatment options include:

  • watchful waiting by the woman and her health care professional
  • soaking of the genital area with warm towel compresses
  • soaking of the genital area in a sitz bath
  • use of non-prescription pain medication to relieve mild discomfort

If the Bartholin’s gland is infected, there are several treatments available to treat the abscess, including:

  • soaking of the genital area in a sitz bath
  • treatment with antibiotics
  • use of prescription or non-prescription pain medication
  • incision and drainage, i.e., cutting into the cyst and draining the fluid (not usually successful, as the cyst often reoccurs)
  • placement of a drain (Word catheter) in the cyst for two to four weeks so fluid can drain and prevent reoccurrence of the cyst
  • marsupialization
  • window operation
  • use of a carbon dioxide laser to open the cyst and heat the cyst wall tissue so that the cyst cannot form a sac and reoccur
  • incision and drainage, followed by treatment with silver nitrate to burn the cyst wall so the cyst cannot form a sac and reoccur
  • removal of the entire Bartholin’s gland cyst, if the cyst has reoccurred several times after use of other treatment methods

During surgical treatment, the area will be numbed with a local anesthetic to reduce pain. General anesthesia may be used for treatment of an abscess, as the procedure can be painful.

In a pregnant woman, surgical treatment of cysts that are asymptomatic should be delayed until after delivery to avoid the possibility of excessive bleeding. However, if the Bartholin’s gland is infected and must be drained, antibiotics and local anesthesia are generally considered safe.

If the cyst is caused by cancer, the gland must be excised, and the woman should be under the care of a gynecologist familiar with the treatment of this type of cancer.

Alternative treatment

If a Bartholin’s gland cyst has no or mild symptoms, or has opened on its own to drain, a woman may decide to use watchful waiting, warm sitz baths, and non-prescription pain medication. If symptoms become worse or do not improve, a health care professional should then be consulted.

Infected Bartholin’s glands should be evaluated and treated by a health care professional.

Prognosis

A Bartholin’s gland cyst should respond to treatment in a few days. If an abscess requires surgery, healing may take days to weeks, depending on the size of the abscess and the type of surgical procedure used. Most of the surgical procedures, except for incision and drainage, should be effective in preventing recurring infections.

Prevention

There are few ways to prevent the formation of Bartholin’s gland cysts or abscesses. However, as a Bartholin’s gland abscess may be caused by a sexually transmitted disease, the practice of safe sex is recommended. Using good hygiene, i.e., wiping front to back after a bowel movement, is also recommended to prevent bacteria from the bowels from contaminating the vaginal area.

Key Terms

Marsupialization
Cutting out a wedge of the cyst wall and putting in stitches so the cyst cannot reoccur.
Sitz bath
A warm bath in which just the buttocks and genital area soak in water; used to reduce pain and aid healing in the genital area.
Window operation
Cutting out a large oval-shaped piece of the cyst wall and putting in stitches to create a window so the cyst cannot reoccur.
Word catheter
A small rubber catheter with an inflatable balloon tip that is inserted into a stab incision in the cyst, after the contents of the cyst have been drained.

Puerperal Infection

May 13, 2008 Leave a comment

Definition

The term puerperal infection refers to a bacterial infection following childbirth. The infection may also be referred to as puerperal or postpartum fever. The genital tract, particularly the uterus, is the most commonly infected site. In some cases infection can spread to other points in the body. Widespread infection, or sepsis, is a rare, but potentially fatal complication.

Description

Puerperal infection affects an estimated 1-8% of new mothers in the United States. Given modern medical treatment and antibiotics, it very rarely advances to the point of threatening a woman’s life. An estimated 2-4% of new mothers who deliver vaginally suffer some form of puerperal infection, but for cesarean sections, the figure is five-10 times that high.

Deaths related to puerperal infection are very rare in the industrialized world. It is estimated three in 100,000 births result in maternal death due to infection. However, the death rate in developing nations may be 100 times higher.

Postpartum fever may arise from several causes, not necessarily infection. If the fever is related to infection, it often results from endometritis, an inflammation of the uterus. Urinary tract, breast, and wound infections are also possible, as well as septic thrombophlebitis, a blood clot-associated inflammation of veins. A woman’s susceptibility to developing an infection is related to such factors as cesarean section, extended labor, obesity, anemia, and poor prenatal nutrition.

Causes and symptoms

The primary symptom of puerperal infection is a fever at any point between birth and 10 days postpartum. A temperature of 100.4°F (38°C) on any two days during this period, or a fever of 101.6°F (38.6 °C) in the first 24 hours postpartum, is cause for suspicion. An assortment of bacterial species may cause puerperal infection. Many of these bacteria are normally found in the mother’s genital tract, but other bacteria may be introduced from the woman’s intestine and skin or from a healthcare provider.

The associated symptoms depend on the site and nature of the infection. The most typical site of infection is the genital tract. Endometritis, which affects the uterus, is the most prominent of these infections. Endometritis is much more common if a small part of the placenta has been retained in the uterus. Typically, several species of bacteria are involved and may act synergistically–that is, the bacteria’s negative effects are multiplied rather than simply added together. Synergistic action by the bacteria can result in a stubborn infection such as an abscess. The major symptoms of a genital tract infection include fever, malaise, abdominal pain, uterine tenderness, and abnormal vaginal discharge. If these symptoms do not respond to antibiotic therapy, an abscess or blood clot may be suspected.

Other causes of postpartum fever include urinary tract infections, wound infections, septic thrombophlebitis, and mastitis. Mastitis, or breast infection, is indicated by fever, malaise, achy muscles, and reddened skin on the affected breast. It is usually caused by a clogged milk duct that becomes infected. Infections of the urinary tract are indicated by fever, frequent and painful urination, and back pain. An episiotomy and a cesarean section carry the risk of a wound infection. Such infections are suggested by a fever and pus-like discharge, inflammation, and swelling at wound sites.

Diagnosis

Fever is not an automatic indicator of puerperal infection. A new mother may have a fever owing to prior illness or an illness unconnected to childbirth. However, any fever within 10 days postpartum is aggressively investigated. Physical symptoms such as pain, malaise, loss of appetite, and others point to infection.

Many doctors initiate antibiotic therapy early in the fever period to stop an infection before it advances. A pelvic examination is done and samples are taken from the genital tract to identify the bacteria involved in the infection. The pelvic examination can reveal the extent of infection and possibly the cause. Blood samples may also be taken for blood counts and to test for the presence of infectious bacteria. A urinalysis may also be ordered, especially if the symptoms are indicative of a urinary tract infection.

If the fever and other symptoms resist antibiotic therapy, an ultrasound examination or computed tomography scan (CT scan) is done to locate potential abscesses or blood clots in the pelvic region. Magnetic resonance imaging (MRI) may be useful as well, in addition to a heparin challenge test if blood clots are suspected. If a lung infection is suspected, a chest x ray may also be ordered.

Treatment

Antibiotic therapy is the backbone of puerperal infection treatment. Initial antibiotic therapy may consist of clindamycin and gentamicin, which fight a broad array of bacteria types. If the fever and other symptoms do not respond to these antibiotics, a third, such as ampicillin, is added. Other antibiotics may be used depending on the identity of the infective bacteria and the possibility of an allergic reaction to certain antibiotics.

Antibiotics taken together are effective against a wide range of bacteria, but may not be capable of clearing up the infection alone, especially if an abscess or blood clot is present. Heparin is combined with the antibiotic therapy in order to break apart blood clots. Heparin is used for five-seven days, and may be followed by warfarin for the following month. If the infection is complicated, it may be necessary to surgically drain the infected site. Infected episiotomies can be opened and allowed to drain, but abscesses and blood clots may require surgery.

Prognosis

Antibiotic therapy and other treatment measures are virtually always successful in curing puerperal infections.

Prevention

Careful attention to antiseptic procedures during childbirth is the basic underpinning of preventing infection. With some procedures, such as cesarean section, a doctor may administer prophylactic antibiotics as a preemptive strike against infectious bacteria.

Key Terms

Abscess
A pus-filled area with definite borders.
Blood clot
A dense mat formed by certain components of the blood stream to prevent blood loss.
Cesarean section
Incision through the abdomen and uterus to facilitate delivery.
Computed tomography scan (CT scan)
Cross-sectional x rays of the body are compiled to create a three-dimensional image of the body’s internal structures.
Episiotomy
Incision of the vulva (external female genitalia) during vaginal delivery to prevent tissue tearing.
Heparin
A blood component that controls the amount of clotting. It can be used as a drug to reduce blood clot formation.
Heparin challenge test
A medical test to evaluate how readily the blood clots.
Magnetic resonance imaging (MRI)
An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
Postpartum
Referring to the time period following childbirth.
Prophylactic
Measures taken to prevent disease.
Sepsis
The presence of viable bacteria in the blood or body tissues.
Septic
Referring to the presence of infection.
Thrombophlebitis
An inflammation of veins accompanied by the formation of blood clots.
Ultrasound examination
A medical test in which high frequency sound waves are directed at a particular internal area of the body. As the sound waves are reflected by internal structures, a computer uses the data to construct an image of the structures.
Warfarin
A drug that reduces the ability of the blood to clot.
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