Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 14#

A 23-year-old G2P1 develops chorioamnionitis during labor and is started on ampicillin and gentamicin. She requires a cesarean delivery for arrest of active phase labor.

What is the most optimal way to reduce her chance of developing postoperative endometritis?

A. Add 2 g of cefazolin to her antibiotic regimen
B. Add clindamycin 900 mg IV to her antibiotic regimen
C. Continue her antibiotics for 1 week following delivery
D. She only needs to add a third antibiotic agent if she develops a fever postpartum
E. Add vancomycin 1 g IV to her antibiotic regimen

Correct Answer is B

Comment:

Postpartum endometritis is much more common after cesarean delivery, and the infection is commonly polymicrobial. Fever is the most common criteria for the diagnosis. The addition of anaerobic coverage to the primary antibiotic regimen of ampicillin and gentamicin has reduced the rates of postcesarean endometritis. Ideally, this should be given preincision as part of antibiotic prophylaxis for cesarean delivery, and should consist of either clindamycin 900 mg IV or metronidazole 500 mg IV. There is not conclusive evidence regarding the optimal duration of therapy postpartum; however, based on limited studies, it is reasonable to continue antibiotics for one more postpartum dose following delivery.