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Antepartum,intrapartum and

postpartum fever.
M2 2009
Pr. Fomulu / Dr. Nana
29/04/2009

Antepartum, intrapartum and postpartum


fever.
General objectives:
Student should be able to correctly
manage the different causes of fever in
pregnancy.

Antepartum, intrapartum and postpartum


fever-1.
Specific objectives:
Adequately take good history in a woman presenting with

fever in pregnancy and the puerperium.


Name the causes of fever in each of the trimesters of

pregnancy and postpartum.


Adequately treat fever according to the different diagnosis.
Discuss some complications of fever in pregnancy and the

puerperium.
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Antepartum, intrapartum and postpartum


fever-2.

Plan:

Definition.
General measures.
Causes of fever first trimester.
Causes of fever second trimester.
Causes of fever third trimester.
Causes of fever intrapartum.
Causes of fever postpartum.
Complications of fever in pregnancy.

Antepartum, intrapartum and postpartum


fever-3.
Definition:
Temperature 38 `C.(ampit, rectal).
General measures:
Encourage bed rest.
Encourage fluid intake.
Use measures to reduce temperature (fan, warm baths,
drugs).
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Antepartum, intrapartum and postpartum


fever-4.
First trimester:
Symptoms -genito-urinary, LMP, history of pregnancy,
foul-smelling discharge, abdominal pain, dysuria,
urgency, rigors,
Muscle/joint pain, headache.
Chest pain, cough productive or not.
Vomiting, diarrhoea, constipation, loss of appetite,
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Antepartum, intrapartum and postpartum


fever-5.
Signs:
General state of consciousness.
Look for jaundice, palor of conjunctivae.
Signs of early pregnancy,
Signs of meningeal irritation.
Chest examination.
Loin tenderness, size spleen, liver.
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Antepartum, intrapartum and postpartum


fever-6.
Second and third trimester:
Complete history as above, check loss of liquor.
Complete physical examination.

Antepartum, intrapartum and postpartum


fever-7.
Possible diagnosis:
o First/second trimeters

- related to pregnancy, induced abortion,


-depending on symptoms and signs, malaria, typhoid, pneumonia,
hepatitis, meningitis, AIDS, appendicitis ? Pyelonephritis etc.
o Third trimester:

-related to pregnancy, chorioamnionitis,


-Depending on symptoms/signs, pyeonephritis, malaria,
appendicitis etc.

Antepartum, intrapartum and postpartum


fever-8.
o Intrapartum:
-Check fever before admission, state of membranes,
consciousness, duration of labour, colour and odour of
liquor etc.
-Complete physical examination, insisting maternal and
foetal parameters.
-Diagnosis same as for third trimester, chorioamnionitis,
malaria, eclampsia etc.
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Antepartum, intrapartum and postpartum


fever-9.
o Postpartum or puerperium:
Puerperal sepsis, risk factors, prolonged ROM, perineal tears,
manual delivery placenta, placenta/ membrane retention,
immune depression, C/S, uterine atony, diabetes, sicklers,
cardiac patients etc.
Puerperal fever, fever occurring in the puerperium but not a
direct consequence of delivery ? Pneumonia, DVT,
thrombophlebitis, malaria, typhoid, pyelonephritis, appendicitis
etc.
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Antepartum, intrapartum and postpartum


fever-10.
Treatment:
General measures, as above reduce
temperature, increased fluid intake, bed rest.
Paraclinical test
- non specific, FBC,CRP, ESR.
- specfic, depends on etiology.
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Antepartum, intrapartum and postpartum


fever-11.
Etiologic: accordingly,
Septic or induced abortion, ATBs, evacuate the uterus,
councelling.
Malaria, severe thus parenteral with quinine.
Pyelonephritis hospitalisation, IV fluids, ATBs
Placenta retention, hospitalisation, ATBs, evacuation.

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Antepartum, intrapartum and postpartm


fever-12.
Complications of fever:
Maternal-coma, septicaemia, death.
Foetal- IUGR, premature delivery and
prematurity, SBs, IUDs.

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Antepartum, intrapartum and postpartum


fevers-13.
Conclusion:
Fever in pregnancy has varied causes.
Good history and physical examination is
paramount to good diagnosis and treatment.
Inadequate treatment may cause major
complication to the mother and the foetus.
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