Puerperal Flashcards
Define dystocia
includes any discorder that may be encountered during pregnancy which may cause complication
What are the top 3 causes of maternter dealth before the 20th century?
Puerperal Complications
. Pre-exclampsia
. OB Hemorrhages
. Puerperal infections
What are the major complication that account for nearly 75% of all maternal deaths?
. Infections (post-partum) . Severe bleeding (post-partum) . High blood pressure . Complications from delivery . Unsafe abortion
Define puerperal fever
Any temperature elevation of 38C or highter which occur on any 2 of the first 10 days postpartum
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. 20%
This percentage of women are febrile in the first 24 hours of peurperium after CA
a. 20%
b. 30%
c. 50%
d. 70%
d. 70%
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?
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
Common causes of puerperal infection
- genital tract infections
- breast engorgement
- uti
- atelectasis (respiratory distorder)
- uterine infections
- acute pyelonephritis
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?
. Temp <39C
. Fever abates w/n 24 hours
. Treat by expressing milk
Puerperal fever due to urinary tract infection is common/not common. Why?
Not common due to normal diuresis during post partum (reaction to increased plasma volume during pregnancy)
You suspect the pt has puerperal fever due to acute pyelonephritis. What other clinical signs do you look for?
. CVA (costovertebral angle) tenderness
. Nausea and vomiting
Febrile pt underwent CS with general anesthesia. What puerpral complication are we concerned with and how is it treated?
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
Uterine infections have historically been known as:
What is the current accepted term?
. Puerperal sepsis, endometritis, endoparametritis
. Metritis with pelvic cellulitis
What is the most common cause of infection after childbirth?
- genital tract infections
- breast engorgement
- uti
- atelectasis (respiratory distorder)
- uterine infections
- acute pyelonephritis
- uterine infections
Metritis with pelvic cellulitis
What are common factors of uterine infection regardlesss of route of delivery?
. Membrane rupture
. Prolong labor
. Multiple cervical examination
. Internal fetal monitoring
What predisposiing factors to uterine infection associated with NSVD?
. Intra amniotic infection
. Manual removal of placenta
Why do we perform IE only as needed? What is the underlying cause?
Bacteria will penetrate and can cause LGTI
. Group B streptococcus . C trachomatis . Mycoplasma hominis . Ureaplasma urealyticum . Gardnerella vaginalis
Other than route of dlivery, what are other risk factors for uterine infections?
. Socioeconimic status . Poor nutrition . LGTI . General anesthesia . Multifetal gestation . Young maternal age . Nulliparity . Obesity . Meconium stained AF
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?
. Group a, b, c, d streptococci
. Enterococcus
. Staphylococcus aureus
. Staphylococcus epidermis
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?
. Escherichia coli
. Klebsiella
. Proteus species
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?
. Gardnerella vaginalis
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?
. Cocci - peptostretococcus and peptococcus species
. Other clostridium bacteriodes and fusobacterium species, mobiluncus species
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?
. Mycoplasma
. Chlamydia
. Neisseria gonorrhea
Inoculation of uterine incision provides aerobic/anaerobic conditions
anaerobic
What are factors affect virulence of metritis?
. Polymicrobial
. Hematomas
. Devitalized tissue
What tissue is often devitalised during delivery?
. Cervix
. Vagina
. Uterine cavity
The uterine cavity is normally sterile. By what route does it become contaminated?
. Labor
. Delivery
. Multiple manipulations
What are the usual sites involved in metritis following normal delivery?
. Placental implantation site
. Decidua
. Adjacent myometrium
. Cervicovaginal lacerations
What are the usual sites involved in metritis following cesarian section?
. Placental implantation site
. Decidua
. Adjacent myometrium
. Uterine incision site
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
A pt with metritis experiences chills. What is the cause?
chills due to excretion of endotoxin and bacteriolysis
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
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
Choice of antibiotics is the same for vaginal delivery and CS.
T/F
FALSE
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
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
(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
What causes toxic shock syndrome in metritis?
group A and B haemolytic strep
What surgical techniques help prevent infection?
. Preoperative vaginal cleasing
. Allowing the placenta to separate spontaneously
. Exteriorizing the uterus
. Close subcutaneous tissue in obese women
What are the complications of abdominal incisional infection? (6)
. Wound infection . Wound dehiscence . Necrotizing fascitis . Peritonitis . Adnexal infection . Parametral phlegmon
What is the most common cause of antrimicrobial failure?
wound infection
What are risks of wound infection?
(factors inhibiting wound healing) . Obesity . Uncontrolled diabetes . Corticoid therapy . Immunosuppressions . Anemia . Poor hemostasis
What is the treatment for wound infection of abdominal incisional infection?
. Antimicrobials
. Surgical drainage
. Careful inspection of the abdominal fascia
