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My MRCOG Part 2 > Module 9 - GTG 64b - Bacterial Sepsis Following Pregnancy > Flashcards

Module 9 - GTG 64b - Bacterial Sepsis Following Pregnancy Flashcards

1
Q

Define puerperal sepsis.

A

Genital tract sepsis that occurs up to 6 weeks post natal.

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2
Q

What is the most common focus of puerperal sepsis?

A

Endometritis.

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3
Q

Define sepsis.

A

Life threatening systemic reaction to infection in which there are systemic manifestations as a result of infection.

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4
Q

Define severe sepsis.

A

Infection + organ dysfunction or tissue hypo-perfusion.
(lactate 4+).

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5
Q

Define septic shock.

A

Presence of hypotension despite adequate fluid replacement.
If inotropes are required, move the patient to ITU.

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6
Q

Who is at increased risk of sepsis?

A

Obese, diabetic, immunocompromised, anaemic women.
Close contact with GAS positive patient.

PID, vaginal discharge, PROM, RPOC.

Procedures eg perineal repair, amniocentesis, LSCS, cervical cerclage.

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7
Q

What is the ‘other’ name for GAS?

A

Group A Streptococcus

(Streptocuccus pyogenes).

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8
Q

What are the most common causative organisms for puerperal sepsis?

A

GAS
E Coli
Staph. aureus
Strep. pneumoniae

(also think MSRA).

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9
Q

What is the resistance rate to cephalosporins and beta lactams?

A

12%

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10
Q

What proportion of pharyngitis is viral vs baterial?

A

90% viral
10% bacteria

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11
Q

What criteria are used to diagnose pharyngitis?

A

Centor criteria.

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12
Q

What are the most common causative organisms to cause regional anaesthetic site infections?

A

Staph. aureus
streptococcus
Gram negative rods.

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13
Q

What can happen to temperature of a patient if they are septic?

A

Pyrexial
Hypothermic
Normothermic!

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14
Q

What are the red flags for sepsis?

A

Pyrexia >38 (or <35)
RR>20
Chest or abdominal pain
Rash
Offensive discharge

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15
Q

Which analgesic medication should be avoided in septic patients and why?

A

NSAIDs
(Impedes polymorphs to fight GAS).

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16
Q

Define early puerperal sepsis.

A

<12 PN

Likely to be streptococcal eg GAS.

17
Q

Within what time frame should abx given if sepsis is suspected?

A

Within 1 hour

18
Q

What is the risk of fluid replacement in puerperal sepsis?

A

Post natal women can develop pulmonary oedema more frequently.

19
Q

Within what timeframe should lactate be measured when sepsis is suspected?

A

Within 6 hours.

20
Q

Above what lactate value indicates severe sepsis / tissue hypo-perfusion?

A

4+

21
Q

What clinical features will be present if a patient presents with abscess or pus infection?

A

Thrombocytosis (raised pl)
Rising CRP
Swinging pyrexia

22
Q

What combination of antibiotics gives the broadest spectrum cover?

A

PipTaz (or carbapenem)
and Clindamycin.

23
Q

What antibiotics can be prescribed for MSRA?

A

Vancomycin or teicoplanin.

24
Q

What group of bacteria is covered with metronidazole?

A

ANaerobic

25
Q

A maculopapular or blaching rash that develops after starting antibiotics is likely caused by what?

A

Bacterial exotoxins
(NOT allergy).

26
Q

In bacterial sepsis, when is IVIG indicated?

A

Severe strep/staph that has not responded to other treatments.

27
Q

What is the mechanism of action for IVIG in bacterial sepsis?

A

Immunomodulatory.
Neutralises exotoxin’s super-antigen effects.
Inhibits TNF and IL

28
Q

When does IVIG have no advantage in treatment?

A

Endotoxin producing bacteria.

29
Q

When is IVIG contra-indicted?

A

Congenital deficiency of immunoglobulin A.

30
Q

If GAS is isolated in mum OR baby, who should be treated?

A

Both should be treated for GAS.

31
Q

Why is it important to monitor for GAS in breastfed babies?

A

Because GAS can be passed in breast milk.

32
Q

Which 2 bacterial infections warrant prophylactic antibiotics for close contacts?

A

GAS
N Meningitidis.

33
Q

What is the difference between TTTS and STSS?

A

TTTS = staphylococcal

STSS = streptococcal.

My MRCOG Part 2 (37 decks)

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