Mehl. other OBGYN infections 12-13 (1)

Question 1

Chorioamnionitis. definition?

Answer 1

Infection of the uterus during pregnancy.

Question 2

Chorioamnionitis. greatest risk factor?

Answer 2

Greatest risk factor is ROM >18 hours.

Question 3

Chorioamnionitis. cause?

Answer 3

Cause is usually polymicrobial.

Question 4

Chorioamnionitis. Tx?

Answer 4

ampicillin + gentamicin +/- clindamycin.

Question 5

Endometritis. definition?

Answer 5

Infection of the uterus after pregnancy

Endometritis = “Postpartum endometritis” for all intents and purposes.

Question 6

Endometritis. CP?

Answer 6

Can present as fever, uterine tenderness, and foul-smelling lochia within a few days of delivery.

Question 7

Endometritis. cause?

Answer 7

Cause is usually polymicrobial.

Question 8

Endometritis. Q will say?

Answer 8

Q will say woman had C-section two days ago + now has fever + lower abdo pain +/- foul-smelling lochia –> answer = postpartum endometritis; chorioamnionitis is wrong answer because she’s not pregnant anymore.

Question 9

Endometritis. Tx?

Answer 9

Tx = ampicillin + gentamicin +/- clindamycin.

Question 10

Endometritis. USMLE also wants you to be aware of what is “normal post-operative course” versus endometritis.

Answer 10

For example, the NBME Q can say something like, woman had Caesar two days ago + temp 99.3 F + incision site mildly erythematous + two inguinal lymph nodes are palpable and tender –> answer = “normal post-operative course.”

Surgery is trauma, and the immune system will generate a natural response to it.

Palpable lymph nodes can be a normal response to inflammation and surgery.

Question 11

Septic pelvic thrombophlebitis. definition?

Answer 11

Formation of infected blood clots in the pelvic veins (umbrella term for uterine and ovarian veins).

Question 12

Septic pelvic thrombophlebitis. risk factor?

Answer 12

Endometritis is big risk factor.

Question 13

Septic pelvic thrombophlebitis. differential?

Answer 13

Differentiated from endometritis in that it causes persistent pelvic pain and fever despite administration of antibiotics.

Question 14

Septic pelvic thrombophlebitis.

Answer choice shows up quite a bit on Obgyn forms, so know it exists.

Answer 14

.

Question 15

Puerperal sepsis. definition?

Answer 15

Generalized term for sepsis occurring after childbirth.

Question 16

Puerperal sepsis. CP?

Answer 16

Presentation is variable; causes high fever, chills, tachycardia, and low BP.

Question 17

Puerperal sepsis.

Q might list both puerperal sepsis and septic pelvic thrombophlebitis as answer choices. Remember that SPT is pelvic pain unresponsive to antibiotics; puerperal
sepsis is actual sepsis due to a number of causes, but often endometritis.

Answer 17

.

Question 18

Toxic shock syndrome. Cause?

Answer 18

Caused by TSST superantigen of S. aureus.

Question 19

Toxic shock syndrome. risk factors? HY

Answer 19

Tampon use, or vulvovaginal/perineal skin infections are HY etiologies.

For non- Obgyn Qs, cotton nasal packing also HY.

Question 20

Toxic shock syndrome. immuno mechanism?

Answer 20

Toxin bridges MHC-II on macrophages with T cell receptor on CD4+ T cells, causing macrophages to release cytokines leading to shock.

Question 21

Toxic shock syndrome.

Shows up on Obgyn material where they ask most likely cause of death in TSS, and the answer is ARDS. Slightly unusual answer, but I don’t know what to tell ya.

Answer 21

.

Question 22

UW. Septic pelvic thrombophlebitis. table. 6 risk factors?

Answer 22

cesarean delivery; pelvic surgery; endometritis; PID; pregnancy; malignancy

Question 23

UW. Septic pelvic thrombophlebitis. Notes/table. Several factors predispose postpartum patients to thrombosis?
tipo pathophysiology

Answer 23

a. Hypercoagulable state of pregnancy
b. Pelvic venous stasis and dilation
c. Endothelial damage from INFECTION and/or TRAUMA during delivery
nu tai mazdaug virchov triad

Question 24

UW. Septic pelvic thrombophlebitis. table. CP?

Answer 24

fever unresponsive to abs;
no localizing signs/symptoms
negative infectious evaluation
diagnosis of exclusion

Question 25

UW. Septic pelvic thrombophlebitis. table. tx?2

Answer 25

anticoagulation
broad-spectrum abs

Question 26

UW Chorioamnionitis. table. risk factors?6

Answer 26

Prolonged rupture of membranes (>18h)
Preterm premature rupture of membrane
Prolonged labor
Internal fetal/uterine monitoring devices
Repetitive vaginal examinations
Presence of genital tract pathorgens

Question 27

UW Chorioamnionitis. table. Diagnosis?

Answer 27

Maternal fever + >=1 of the following:
a) fetal tachycardia (>160k/min)
b) maternal leukocytosis
c) purulent amniotic fluid

Question 28

UW Chorioamnionitis. table. management?

Answer 28

Broad spectrum abs (ampicilin+ gentamincin +/- clindamycin)

Delivery (buvo prierasas, kad not c section, but augment labor/induce)

Question 29

UW Chorioamnionitis. table. complications?2

Answer 29

Maternal: postpartum hemorrhage, endometritis
Neonatal: preterm birth, pneumonia, encephalopathy

Question 30

UW Chorioamnionitis. notes. CP?

Answer 30

Nausea, vomiting, UTERINE FUNDAL TENDERNESS