Manual extraction of the placenta (placement of provider’s hand into the uterus to remove the placenta or portions — does NOT include a single bimanual exam or “sweep” of clots ×1):
- •No abx for bimanual exam or “sweep.”
- •True manual extraction or extraction of retained placenta → metronidazole 500 mg IV × 1.
- •If has NOT gotten abx for GBS → add Ampicillin 2 g IV × 1 in addition to metronidazole.
PP MVA / D+C (instrumentation of the uterus after delivery using metal curette or MVA device):
- •Metronidazole 500 mg IV × 1.
- •If has NOT received abx for GBS → add Ampicillin 2 g IV × 1.
Bakri balloon / intrauterine balloon:
- •Metronidazole 500 mg IV × 1.
- •If has NOT received abx for GBS → add Ampicillin 2 g IV × 1.
OASIS:
- •Single dose of 2nd-generation cephalosporin (what was used in the only RCT).
Intraamniotic infection (IAI):
- •Ceftriaxone 2 g IV q24h + Flagyl 500 mg IV q8h.
- •Vaginal delivery: no further abx needed.
- •CS — before incision: add Ancef 2 g + azithromycin 500 mg.
- •Postpartum: 1 further dose of Amp 2 g IV + 1 dose of Flagyl 500 mg IV.
- •Fever within 1 hour of delivery is likely IAI (not “new endometritis”) → single dose of ceftriaxone/flagyl if SVD, or single dose of amp/gent/flagyl if CS.
Endometritis (NEW uterine infection >1 hour after delivery, OR persistent fevers >2 hours postpartum with IAI dx):
- •Ceftriaxone 2 g IV q24h + Flagyl 500 mg IV q8h — until afebrile for 24 hours, then d/c all antibiotics.
- •If continued fevers → add Ampicillin 2 g IV q6h.