MANAGEMENT OF POSTPARTUM ENDOMETRITIS

PRINCIPLE

 Non severe metritis after vaginal delivery :

Oral / IM antimicrobial agent
 Moderate-severe metritis:
IV therapy with broad spectrum antibiotic
 In case of persistent fever – find out another existing complication
(parametrial phlegmon, abdominal incision abcess, pelvic abcess, infected hematoma,
septic pelvic thrombophlebitis)
 May be discharged after afebrile for at least 24 hours. No further oral antimicrobial
therapy needed.
PHARMACOLOGICAL TREATMENT: ANTIBIOTIC CHOICES

 Clindamycin + Gentamicin
Gold standard, efficacy: 90-97%
 Clindamycin + Gentamicin + Ampicillin
jika ada gejala sepsis dan suspek infeksi enterococci
 Clindamycin + Cephalosporin
Untuk pasien dengan gangguan
 Clindamycin + Aztreonam (monobactam) ginjal / resiko gangguan ginjal
 Extended spectrum penicillin
 Metronidazole + ampicillin + gentamycin
metronidazole efektif terhadap bakteri gram negatif
 Carbapenem (imipenem)
hanya digunakan untuk indikasi khusus
PHARMACOLOGICAL PROPERTIES
CLINDAMYCIN

 MoA: menghambat sintesis protein dengan berikatan pada subunit 50S ribosom
 Spektrum antibakteri: Bakteri gram positif; MRSA, streptococcus, bakteri anaerob
 Sediaan: Oral/IV
 Farmakokinetik:
a.Distribusi: konsentrasi tinggi di tulang dan urin
b. metabolisme: hepatic (bile)
 Adverse effect: skin rash, diarrhea
GENTAMICIN

 Golongan: Aminoglycosides
 MoA: berikatan pada subunit ribosom 30S, menghambat pembentukkan ribosom fungsional dan menyebabkan unit
ribosom 30S membaca kode genetik yang salah
 Spektrum antibakteri: broadspectrum; bakterisidal terhadap bakteri aerobik gram negatif termasuk bakteri
multidrug resistant
 Farmakokinetik
a. Absorpsi : - (administration: parenteral)
b. Distribusi : terdistribusi pada cairan tubuh, menembus plasenta, distribusi ke CSF kurang efektif
c. Eliminasi : urin (90%)
 Adverse effect
Ototoxicity, nephrotoxicity, muscular paralysis, allergic reaction
DILATATION AND CURRETAGE (D&C)
PRE OPERATIVE

 Patient evaluation: sonography

 Consent
 Patient preparation
Cervical dilation by hygroscopic dilators and prostaglandin
antibiotic prophylaxis
 INTRAOPERATIVE
 Anesthesia and patient positioning
Anesthesia: general anesthesia, paracevical block plus intravenous sedation, IV sedation only
Position: dorsal lithotomy, bladder is drained, vulva and vagina are surgically prepared
 Uterine sounding
measure the depth and inclination of uterine cavity prior dilatation
 Cervical dilatation
 INTRAOPERATIVE
 Uterine evacuation
cannula inserted into endometrial cavity
 Sharp curretage
POSTOPERATIVE

 Recovery cepat
 Intercourse abstinence
THANKS