Prise en charge des infections du post-partum

Post-partum endometritis are frequent and account for the fifth cause of maternal death. This disease is preventable and effective treatments are available. Streptococcus agalactiae is the primary pathogen implicated. The clinical diagnosis is usually easy and involves pelvic pain, fever and abnormal lochia. Whenever antibiotic treatment provides no clinical improvement, or in case of doubt on the vacuity of the uterus, an ultrasound exam must be performed. Likewise, a CT scan or a MRI will be performed in case of persistent fever in search of a pelvic abscess requiring a drainage, or of a pelvic thrombophlebitis. Thromboplebitis requires heparin for the duration of antibiotic therapy, or oral anticoagulants for at least 3 months in case of pulmonary embolism or extension to the vena cava. The recommended antibiotic regimen combines clindamycin with gentamicin (once daily) intravenously. In case of contraindication or breastfeeding, other regimens may be prescribed. Adequate duration of treatment has not been evaluated and a switch to oral antibiotics after clinical improvement brings no benefit. Antibioprophylaxy (mostly cephalosporins) is recommended in cases of cesarean section (at skin incision), while it is debated in case of assisted delivery or of 3rd and 4th degree perineal tears.