Puerperal infections

Question 1

Triad causes of maternal death

Answer 1

pre eclampsia
Obstetrical hemorrhage
infections

Question 2

fever may be considered puerperal if

Answer 2

it occurs b/n birth and 10d postpartum

temp of 38 or higher on any 2 days during this period

Question 3

extrapelvic causes of puerperal fever

Answer 3

Breast engorgement

bacterial mastitis

Question 4

mother developed fever 2 days postpartum. PE showed bilateral breast tenderness and nodules were noted upon palpation. Treatment for this px would include

Answer 4

this is breast engorgement; treatment includes binders
cold compress
analgesics

Question 5

diff btn breast engorgement and bacterial mastitis

Answer 5

BM is unilateral and occurs later (3/4th week pp)

usu caused by S. aureus

Question 6

treatment for mastitis includes

Answer 6

Dicloxacilin
erythromycin (pen sensitive)
vancomycin (pen resistant)

Question 7

4 Ws sources of pp fever

Answer 7

Wind: atelectasis
Water: UTI
Wound/Womb: cellulitis/endometritis
Walking: thrombophlebitis

Question 8

Resp infections (wind) is common in

Answer 8

post CS seen int the 1st 24hrs after delivery

Question 9

atelectasis may be prevented by

Answer 9

routine coughing and dep breathing

Question 10

post partum pneumonia may be due to

Answer 10

proliferation of normal flora distal to obstructing mucous plugs

Question 11

Treatment for UTI postpartum

Answer 11

broad spectrum ab

Question 12

what kind of anesthesia would increase the risk for UTI postpartum

Answer 12

Epidural

Question 13

what kind of anesthesia would increase the risk for atelectasis postpartum

Answer 13

generalized

Question 14

single most significant risk factor for the dev of metritis

Answer 14

Route of delivery

Question 15

most common serious complication of the puerperium

Answer 15

uterine infections (metritis with pelvic cellulitis)

Question 16

gold standard for the treatment of endometriosis puerperium

Answer 16

clindamycin+gentamycin

Question 17

fatal sequelae of thrombophlebitis

Answer 17

Pulmo embolism

Question 18

treatment for thrombophlebitis

Answer 18

early ambulation

Question 19

px developed fever 3 days postpartum. PE showed tenderness in the calf area specifically in the femoral triangle this disorder is usually caused by

Answer 19

venous stasis and treatment is early ambulation

Question 20

most common cause of antimicrobial failure in women treated for metritis

Answer 20

skin incision infection

Question 21

Treatment for the separation of fascial layer that resulted from infections not early recognized.

Answer 21

Surgical debridement and fascial closure; antibiotics

Question 22

area of indurations in broad ligament due to spread of uterine infection

Answer 22

phlegmon

Question 23

Fibrous connective tissue in front of cervix and

laterally extends between layers of broad lifament

Answer 23

parametrium

Question 24

treatment for parametrial phlegmon

Answer 24

antibiotics for abosrption of induration;

hysterectomy for uterine dehiscence

Question 25

what is the pathogenesis of septic pelvic thrombophlebitis

Answer 25

bacterial infection of uterine incision or in the implantation site (decidua) + venous thrombosis of the myometrium

Question 26

px experience sudden chills 2 days after delivery temp increased from 36.8-38.9 C. She also complained of Left flank to lower abdominal pain. PE showed Tender rope-sausaged shaped abdominal mass. What is the best diagnostic tool to this case.

Answer 26

This is septic pelvic thrombophlebitis.
Pelvic CT or MRI is the best diagnostic tool.
Treatment: Imipenem 7-30 days

Question 27

Delayed episiotomy dehiscence occurs after 3-4 months, why is that so?

Answer 27

to allow revascularization and resolution of cellulitis and infection

Question 28

most serious of wound infections

Answer 28

necrotizing fascitis

Question 29

Deep soft tissue infection of muscle and fascia of the perineum. Rare but fatal.
Ris factors would include

Answer 29

(necrotizing fascitis)
RF:
DM - d/t poor wound healing
Obesity
HPN

Question 30

Treatment for Necrotizing fascitis would include

Answer 30

Ab: Clinda + B lactam

Wide surgical debridement and fascial closure unrrofing and excision of abdominal thigh or buttocks fascia

Question 31

Acute febrile illness char by multisystem organ derangement

Answer 31

TSS

Question 32

A 16-year-old primipara is brought to the emergency
room three days after having a vaginal delivery.
The girl is confused and lethargic. Her mother
reports that she has had a fever at home associated
with nausea, vomiting, diarrhea, and headache.
During examination, you note very mild uterine
tenderness and a diffuse macular erythematous rash.
The patient is hypotensive, tachycardic, and febrile.
Laboratory studies reveal leukocytosis, transaminitis,
prolongation of her partial thromboplastin time
(PTT), and an elevated creatinine level. Which of
the following is the most likely diagnosis?

Answer 32

TSS

Question 33

Potential cause of postpartum fever manifesting

from 5th day after delivery

Answer 33

thrombophlebitis

Question 34

Most important criterion for the diagnosis of

postpartum metritis

Answer 34

FEVER