Antenatal & maternal medicineFree in the app
Postnatal problems
Secondary PPH, puerperal sepsis, mastitis and engorgement.
Source: RCOG GTG 52, 64b · NICESecondary PPH (24 h to 12 weeks)
| Usual cause | Endometritis with or without retained tissue. Ultrasound is unreliable. |
|---|---|
| Treatment | Ampicillin plus metronidazole; add gentamicin if septic. Senior surgeon for any evacuation. |
Puerperal sepsis
| Organisms | Group A strep and E. coli. |
|---|---|
| Treatment | Blood cultures, then IV broad-spectrum antibiotics within 1 hour plus clindamycin for strep toxin. |
| Contacts | Prophylaxis for close contacts of invasive group A strep. |
Mastitis
FlucloxacillinFirst line500 mg four times a day for 7–14 days.⚠ Keep breastfeeding, including from the affected side.
CefalexinMild penicillin allergy1 g three times a day (local doses vary).
ClarithromycinSevere penicillin allergy500 mg twice daily.⚠ Abscess: ultrasound-guided aspiration.
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