Puerperal Pyrexia

Question 1

What is puerperal pyrexia?

Answer 1

Presence of fever (38 or above) in a woman within 6 weeks of her having given birth

Question 2

What is the importance of puerperal sepsis?

Answer 2

It is a major cause of maternal mortality worldwide

Question 3

How many woman die annually per year of puerperal sepsis?

Answer 3

75,000

Question 4

Where do most of the deaths from puerperal sepsis occur?

Answer 4

In low income countries

Question 5

What is the incidence of death from genital tract sepsis in the UK?

Answer 5

0.29 / 100,000

Question 6

What are the causes of puerperal pyrexia/

Answer 6

• Urinary tract infection
• Genital tract infection
• Mastitis
• Post-op infection following C-section
• DVT
• Other infections

Question 7

What bacteria cause 95% of post-partum UTIs?

Answer 7

• E. Coli
• Proteus
• Klebsiella

Question 8

What can cause genital tract infection in the postpartum period?

Answer 8

• E. Coli
• Other anaerobes
• Group A streptococcus
• Staphylococcus spp.

Question 9

What bacteria usually causes mastitis?

Answer 9

Staphylococcus spp.

Question 10

What is the risk of infection following LSCS in the UK?

Answer 10

8%

Question 11

What other infections can cause puerperal sepsis?

Answer 11

Infections common to all, e.g. viral infection or chest infection

Question 12

Why are the symptoms important in puerperal sepsis?

Answer 12

Because they may help localise where the source of infection is

Question 13

What are the symptoms of UTI

Answer 13

• Frequency
• Dysuria
• Haematuria

Question 14

When may a UTI present with rigors?

Answer 14

If there is pyelonephritis

Question 15

What are the symptoms of genital tract infection?

Answer 15

• Tender, bulky uterus
• Prolonged bleeding/pink or discoloured lochia
• Painful, inflamed perineum

Question 16

What are the symptoms of mastitis?

Answer 16

• Flu-like symptoms
• Painful, hard, red breast with possible abscess
• Nipple trauma and cellulitis

Question 17

What are the symptoms of post-LCSC infection?

Answer 17

• Painful, red suture line
• Deep tenderness on palpation
• Lochia pink/discoloured

Question 18

What are the symptoms of DVT?

Answer 18

Painful and swollen calf

Question 19

What do you need to determine when taking a history from someone with suspected puerperal sepsis?

Answer 19

• When the membranes ruptured
• Length of labour
• Instrumentation used
• Sutures required
• If placenta was complete
• If any bleeding during or after delivery

Question 20

What investigations should be done in suspected puerperal sepsis?

Answer 20

• High vaginal swab
• Urine culture and microscopy
• Other swabs as necessary, e.g. wound swabs, throat swabs
• FBC
• Blood cultures x2
• Ultrasound scan

Question 21

When might ultrasound scan be required in suspected puerperal sepsis?

Answer 21

To assist in diagnosis of retained products of conception

Question 22

What general measures should be taken in the management of puerperal sepsis?

Answer 22

Rest and adequate fluid intake are required, particularly for mothers who are breastfeeding

Question 23

What may be helpful for pain relief from perineal wounds or mastitis?

Answer 23

Ice packs

Question 24

What is recommended when severe sepsis is suspected?

Answer 24

IV administration of broad-spectrum antibiotics within 1 hour

Question 25

What should antibiotics be commenced after when there is a suspicion of sepsis?

Answer 25

Taking specimens

Question 26

Should you wait until the results of specimens are available until giving antibiotics in suspected sepsis?

Answer 26

No

Question 27

What antibiotic regime is recommended in sepsis?

Answer 27

Combination of piperacillin/tazobactam, or a carbapenum + clindamycin

Question 28

What is the advantage of the combination of antibiotics given in sepsis?

Answer 28

Provides broadest ranges of treatment

Question 29

When should the advice of a consultant microbiologist be sought in puerperal sepsis?

Answer 29

At an early stage

Question 30

Why should the advice of a microbiologist be sought at an early stage in puerperal sepsis?

Answer 30

Breastfeeding limits the use of some anti-microbials

Question 31

When is IV immunoglobulin recommended in puerperal sepsis?

Answer 31

In severe invasive streptococcal or staphylococcal infection, if other therapies have failed

Question 32

What analgesia should be avoided in cases of puerperal sepsis?

Answer 32

NSAIDs

Question 33

Why should NSAIDs be avoided in cases of puerperal sepsis?

Answer 33

As they inhibit the ability of polymorphs to fight GAS infection

Question 34

What do the possible complications of puerperal sepsis depend on?

Answer 34

The site

Question 35

What complications are common to all sites of puerperal sepsis?

Answer 35

- Septicaemia - Pulmonary embolism - Disseminated intravascular coagulation - Pneumonia

Question 36

What are the specific complications of puerperal genital tract sepsis?

Answer 36

- Abscess formation - Adhesions - Peritonitis - Haemorrhage - Subsequent infertility

Question 37

What are the specific complications of puerperal urinary tract sepsis?

Answer 37

- Pyelonephritis | - Renal scarring

Question 38

What are the specific complications of puerperal mastitis?

Answer 38

Formation of breast abscess

Question 39

What measures can be taken to avoid puerperal sepsis?

Answer 39

- Any GAS infection identified during pregnancy should be treated aggressively - Catheterisation should be avoided where possible - Perineal wounds should be cleaned and sutured as soon as possible after delivery - All blood losses and the completeness of the placenta should be recorded at deliveries