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Puerperal Flashcards

1
Q

Define dystocia

A

includes any discorder that may be encountered during pregnancy which may cause complication

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2
Q

What are the top 3 causes of maternter dealth before the 20th century?

A

Puerperal Complications

. Pre-exclampsia
. OB Hemorrhages
. Puerperal infections

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3
Q

What are the major complication that account for nearly 75% of all maternal deaths?

A 
. Infections (post-partum)
. Severe bleeding (post-partum)
. High blood pressure
. Complications from delivery
. Unsafe abortion
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4
Q

Define puerperal fever

A

Any temperature elevation of 38C or highter which occur on any 2 of the first 10 days postpartum

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5
Q

This percentage of women are febrile in the first 24 hours of peurperium after vaginal birth

a. 20%
b. 30%
c. 50%
d. 70%

A

a. 20%

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6
Q

This percentage of women are febrile in the first 24 hours of peurperium after CA

a. 20%
b. 30%
c. 50%
d. 70%

A

d. 70%

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7
Q

Febrile patient with 40C fever responds to medicine and returns. She delivered vaginally 8 hours ago. What do you suspect is the cause of fever?

A

High spiking fever, 39C or higher, developing within the first 24 hours after birth may be associated with a very virulent pelvic infection caused by either group A or group B streptococcus

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8
Q

Common causes of puerperal infection

A
  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
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9
Q

Febrile pt with 38C presents with red, stretch, shiny skin over breasts. When will you tell the patient the fever will abate? What is the treatment?

A

. Temp <39C
. Fever abates w/n 24 hours
. Treat by expressing milk

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10
Q

Puerperal fever due to urinary tract infection is common/not common. Why?

A

Not common due to normal diuresis during post partum (reaction to increased plasma volume during pregnancy)

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11
Q

You suspect the pt has puerperal fever due to acute pyelonephritis. What other clinical signs do you look for?

A

. CVA (costovertebral angle) tenderness

. Nausea and vomiting

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12
Q

Febrile pt underwent CS with general anesthesia. What puerpral complication are we concerned with and how is it treated?

A

Atelectasis usually follow an abdominal delivery. The mucus plug is higher in the alveoli and may be related to hypoventilation

Treat by: immediate ambulation, coughing, and deep breathing

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13
Q

Uterine infections have historically been known as:

What is the current accepted term?

A

. Puerperal sepsis, endometritis, endoparametritis

. Metritis with pelvic cellulitis

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14
Q

What is the most common cause of infection after childbirth?

  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
A
  1. uterine infections

Metritis with pelvic cellulitis

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15
Q

What are common factors of uterine infection regardlesss of route of delivery?

A

. Membrane rupture
. Prolong labor
. Multiple cervical examination
. Internal fetal monitoring

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16
Q

What predisposiing factors to uterine infection associated with NSVD?

A

. Intra amniotic infection

. Manual removal of placenta

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17
Q

Why do we perform IE only as needed? What is the underlying cause?

A

Bacteria will penetrate and can cause LGTI

. Group B streptococcus
. C trachomatis
. Mycoplasma hominis
. Ureaplasma urealyticum
. Gardnerella vaginalis
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18
Q

Other than route of dlivery, what are other risk factors for uterine infections?

A 
. Socioeconimic status
. Poor nutrition
. LGTI
. General anesthesia
. Multifetal gestation
. Young maternal age
. Nulliparity
. Obesity
. Meconium stained AF
19
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-positive species. What are the possible bacterial infections?

A

. Group a, b, c, d streptococci
. Enterococcus
. Staphylococcus aureus
. Staphylococcus epidermis

20
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-negative species. What are the possible bacterial infections?

A

. Escherichia coli
. Klebsiella
. Proteus species

21
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is inconclusive for gram positive and negartive species. What are the possible bacterial infections?

A

. Gardnerella vaginalis

22
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is anaerobic. What are the possible bacterial infections?

A

. Cocci - peptostretococcus and peptococcus species

. Other clostridium bacteriodes and fusobacterium species, mobiluncus species

23
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is neither aerobic or anearobic. What are the possible bacterial infections?

A

. Mycoplasma
. Chlamydia
. Neisseria gonorrhea

24
Q

Inoculation of uterine incision provides aerobic/anaerobic conditions

25
What are factors affect virulence of metritis?
. Polymicrobial . Hematomas . Devitalized tissue
26
What tissue is often devitalised during delivery?
. Cervix . Vagina . Uterine cavity
27
The uterine cavity is normally sterile. By what route does it become contaminated?
. Labor . Delivery . Multiple manipulations
28
What are the usual sites involved in metritis following normal delivery?
. Placental implantation site . Decidua . Adjacent myometrium . Cervicovaginal lacerations
29
What are the usual sites involved in metritis following cesarian section?
. Placental implantation site . Decidua . Adjacent myometrium . Uterine incision site
30
What is the clinical course of metritis? Which is the least clinically significant?
. Fever >38 . Chills . Pulse rate follows the temperature curve . Parametrial tenderness . (possible) foul lochia . Leucocytosis - least clinically significant as there is leucocytosis in normal pregnancy
31
A pt with metritis experiences chills. What is the cause?
chills due to excretion of endotoxin and bacteriolysis
32
A febrile pt with metritis presents with no spiking fever that responds well to medicine. What treatment would you prescribe? A. Oral antibiotics B. Parenteral antibiotics
A. Oral antibiotics
33
A febrile pt with metritis presents with cellulitis and parametrial involvement. What treatment would you prescribe? A. Oral antibiotics B. Parenteral antibiotics
B. Parenteral antibiotics
34
Choice of antibiotics is the same for vaginal delivery and CS. T/F
FALSE
35
What is the choice of antimicrobials for vaginal delivery? A . Ampicillin + Gentamycin B . Clindamycin + gentamycin C . Clindamycin + Aztreonam D . Metronidazole + Ampicillin + Gentamicin
A . Ampicillin + Gentamycin
36
What is the choice of antimicrobials for CS? Under what circumstance would you add a 3rd anti-microbial? A . Ampicillin + Gentamycin B . Clindamycin + gentamycin C . Clindamycin + Aztreonam D . Metronidazole + Ampicillin + Gentamicin
B . Clindamycin + gentamycin - ampicillin with sepsis or suspected enteroccocal infection
37
(Perioperative/postoperative) antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections
Perioperative antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections
38
What causes toxic shock syndrome in metritis?
group A and B haemolytic strep
39
What surgical techniques help prevent infection?
. Preoperative vaginal cleasing . Allowing the placenta to separate spontaneously . Exteriorizing the uterus . Close subcutaneous tissue in obese women
40
What are the complications of abdominal incisional infection? (6)
``` . Wound infection . Wound dehiscence . Necrotizing fascitis . Peritonitis . Adnexal infection . Parametral phlegmon ```
41
What is the most common cause of antrimicrobial failure?
wound infection
42
What are risks of wound infection?
``` (factors inhibiting wound healing) . Obesity . Uncontrolled diabetes . Corticoid therapy . Immunosuppressions . Anemia . Poor hemostasis ```
43
What is the treatment for wound infection of abdominal incisional infection?
. Antimicrobials . Surgical drainage . Careful inspection of the abdominal fascia

Patho OB (12 decks)

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