Department of Reproductive Health and Research (RHR), World Health Organization
Managing Complications in Pregnancy and Childbirth
A guide for midwives and doctors
Section 1 - Clinical Principles
Infection during pregnancy and the postpartum period may be caused by a combination of organisms, including aerobic and anaerobic cocci and bacilli. Antibiotics should be started based on observation of the woman. If there is no clinical response, culture of uterine or vaginal discharge, pus or urine may help in choosing other antibiotics. In addition, blood culture may be done if septicaemia (bloodstream invasion) is suspected.
Uterine infection can follow an abortion or childbirth and is a major cause of maternal death. Broad spectrum antibiotics are often required to treat these infections. In cases of
unsafe abortion and non-institutional delivery, anti-tetanus prophylaxis should also be provided
Performing certain obstetrical procedures (e.g. caesarean section, manual removal of placenta) increases a woman’s risk of infectious morbidity. This risk can be reduced by:
Prophylactic antibiotics are given to help prevent infection. If a woman is suspected to have or is diagnosed as having an infection, therapeutic antibiotics are more appropriate.
Give prophylactic antibiotics 30 minutes before the start of a procedure, when possible, to allow adequate blood levels of the antibiotic at the time of the procedure. An exception to this is caesarean section, for which prophylactic antibiotics should be given when the cord is clamped after delivery of the baby. One dose of prophylactic antibiotics is sufficient and is no less effective than three doses or 24 hours of antibiotics in preventing infection. If the procedure lasts longer than 6 hours or blood loss is 1 500 mL or more, give a second dose of prophylactic antibiotics to maintain adequate blood levels during the procedure.
PROVIDING THERAPEUTIC ANTIBIOTICS
For the treatment of metritis, combinations of antibiotics are usually continued until the woman is fever-free for 48 hours. Discontinue antibiotics once the woman has been
fever-free for 48 hours. There is no need to continue with oral antibiotics, as this has not been proven to have additional benefit. Women with blood-stream infections, however,
Rapid initial assessment