Postpartum Endomyometritis

Question 0

Endomyometritis? When to suspect it?

Answer 0

Infection of the decidua, myometrium, and sometimes parametrial tissues

Fever 2 days after C-section

Question 1

Endomyometritis – etiology? Best therapy?

Answer 1

Ascending infection of vaginal organisms (anaerobic predominance)

Gentamicin + clindamycin

Question 2

Septic pelvic thrombophlebitis

Answer 2

Bacterial infection of pelvic venous thrombi, usually involving ovarian vein

Question 3

After anabiotic treatment, fever resolves when? If no resolution, suspect? Treatment? If still no resolution, management?

Answer 3

48 hours

Enterococcal infection – add ampicillin

CT scan of abdomen and pelvis (looking for abscess or infected hematoma)

Question 4

Other possible cause of fever after C-section? Occurs when?

Answer 4

Wound infection. Postoperative day 4

Question 5

Treatment for wound infection?

Answer 5

Surgical opening of wound (Examine for necrotizing fasciitis)

Add antimicrobial agents,

Question 6

Signs of septic pelvic thrombophlebitis? Mechanism? Confirm diagnosis with? Treatment?

Answer 6

1. Hectic fever but well appearing
2. Palpable pelvic mass

Infection at public implantation site spreads to ovarian venous plexus

CT/MRI

Antimicrobial therapy and heparin

Question 7

Patient with postpartum fever – rule out?

Answer 7

1. Pulmonary – cough/atelectasis?
2. Pyelonephritis – CVA tenderness/dysuria?
3. Mastitis – breast engorgement/tenderness?
4. wound infection – induration/erythema/drainage?
5. Endometritis – tender/foul-smelling lochia?

Question 8

Most commonly isolated organism in Endomyometritis?

Answer 8

Bacteriodies