This guideline from the RCOG covers management of post-natal sepsis (i.e. in the first 6/52 after delivery).
Causes of sepsis following pregnancy
In women presenting with infection postnatally, especially consider the following possible causes:
- Cellulitis (eg around cannulas or caesarean section scars)
- Necrotising fasciitis (beware excruciating pain with little outward sign of a problem)
Red flags in the postnatal period
The advice is that if any of these are present, the lady should be referred back to hospital:
- Temp > 38
- Pulse > 90
- RR > 20
- Abdo / chest pain
- Diarrhoea and/or vomiting
- Uterine or renal angle pain
- Generally unwell or undue anxiety or distress
Contacts of Group A Sepsis
- Normally chemoprophylaxis would be used only if there had been 2 or more cases. In post-natal or neonatal cases, only 1 case is needed before chemoprophylaxis is advised. Close contacts would be treated (e.g. members of same household, boyfriends and girlfriends, students sharing a dormitory or university students sharing a kitchen). Normally close contacts would be identified and contacted by HPA / microbiology. What antibiotic is used will depend on sensitivities etc in the case, so seek advice.
- Healthcare workers only need chemoprophylaxis if there has been direct contamination (e.g. needlestick/respiratory droplets).