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Year 4 - Obstetrics > Puerperal Pyrexia > Flashcards

Puerperal Pyrexia Flashcards

1
Q

What is puerperal pyrexia?

A

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

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2
Q

What is the importance of puerperal sepsis?

A

It is a major cause of maternal mortality worldwide

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3
Q

How many woman die annually per year of puerperal sepsis?

A

75,000

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4
Q

Where do most of the deaths from puerperal sepsis occur?

A

In low income countries

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5
Q

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

A

0.29 / 100,000

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6
Q

What are the causes of puerperal pyrexia/

A
  • Urinary tract infection
  • Genital tract infection
  • Mastitis
  • Post-op infection following C-section
  • DVT
  • Other infections
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7
Q

What bacteria cause 95% of post-partum UTIs?

A
  • E. Coli
  • Proteus
  • Klebsiella
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8
Q

What can cause genital tract infection in the postpartum period?

A
  • E. Coli
  • Other anaerobes
  • Group A streptococcus
  • Staphylococcus spp.
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9
Q

What bacteria usually causes mastitis?

A

Staphylococcus spp.

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10
Q

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

A

8%

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11
Q

What other infections can cause puerperal sepsis?

A

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

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12
Q

Why are the symptoms important in puerperal sepsis?

A

Because they may help localise where the source of infection is

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13
Q

What are the symptoms of UTI

A
  • Frequency
  • Dysuria
  • Haematuria
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14
Q

When may a UTI present with rigors?

A

If there is pyelonephritis

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15
Q

What are the symptoms of genital tract infection?

A
  • Tender, bulky uterus
  • Prolonged bleeding/pink or discoloured lochia
  • Painful, inflamed perineum
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16
Q

What are the symptoms of mastitis?

A
  • Flu-like symptoms
  • Painful, hard, red breast with possible abscess
  • Nipple trauma and cellulitis
17
Q

What are the symptoms of post-LCSC infection?

A
  • Painful, red suture line
  • Deep tenderness on palpation
  • Lochia pink/discoloured
18
Q

What are the symptoms of DVT?

A

Painful and swollen calf

19
Q

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

A
  • When the membranes ruptured
  • Length of labour
  • Instrumentation used
  • Sutures required
  • If placenta was complete
  • If any bleeding during or after delivery
20
Q

What investigations should be done in suspected puerperal sepsis?

A
  • High vaginal swab
  • Urine culture and microscopy
  • Other swabs as necessary, e.g. wound swabs, throat swabs
  • FBC
  • Blood cultures x2
  • Ultrasound scan
21
Q

When might ultrasound scan be required in suspected puerperal sepsis?

A

To assist in diagnosis of retained products of conception

22
Q

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

A

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

23
Q

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

A

Ice packs

24
Q

What is recommended when severe sepsis is suspected?

A

IV administration of broad-spectrum antibiotics within 1 hour

25
Q

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

A

Taking specimens

26
Q

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

A

No

27
Q

What antibiotic regime is recommended in sepsis?

A

Combination of piperacillin/tazobactam, or a carbapenum + clindamycin

28
Q

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

A

Provides broadest ranges of treatment

29
Q

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

A

At an early stage

30
Q

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

A

Breastfeeding limits the use of some anti-microbials

31
Q

When is IV immunoglobulin recommended in puerperal sepsis?

A

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

32
Q

What analgesia should be avoided in cases of puerperal sepsis?

A

NSAIDs

33
Q

Why should NSAIDs be avoided in cases of puerperal sepsis?

A

As they inhibit the ability of polymorphs to fight GAS infection

34
Q

What do the possible complications of puerperal sepsis depend on?

A

The site

35
Q

What complications are common to all sites of puerperal sepsis?

A
  • Septicaemia
  • Pulmonary embolism
  • Disseminated intravascular coagulation
  • Pneumonia
36
Q

What are the specific complications of puerperal genital tract sepsis?

A
  • Abscess formation
  • Adhesions
  • Peritonitis
  • Haemorrhage
  • Subsequent infertility
37
Q

What are the specific complications of puerperal urinary tract sepsis?

A
  • Pyelonephritis

- Renal scarring

38
Q

What are the specific complications of puerperal mastitis?

A

Formation of breast abscess

39
Q

What measures can be taken to avoid puerperal sepsis?

A
  • 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

Year 4 - Obstetrics (61 decks)

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