PUERPERAL SEPSIS, CHORIOAMONITIS Flashcards
Sepsis
is one of the leading causes of _________ ————- death not only in developing countries but in developed countries as well
• It is an important public health problem contributing to significant maternal morbidity and mortality
preventable maternal
Peuperal sepsis -
An infection of _________ which occurs as a complication of _________ usually within _____ days is termed as puerperal sepsis.
genital tract
delivery
10 days
Peuperal sepsis -
According to The World Health Organization (WHO), puerperal sepsis is defined as the infection of the ________ occurring at _______ or within _________ of the _________ period
genital tract
at labor
42 days
postpartum
Puerperal sepsis is commonly due to
- __________
- _______________
- ___________________ or a combination of all these when it is called as ______________
Endometritis
Endomyometritis
Endoparametritis
pelvic cellulitis
Known risk factors of Puerperal sepsis
Antepartum factors
Malnutrition and anaemia
_________ labour
Premature ________________________
Prolong _________________ > _____ hours
(Low or High?) socio economic status
Lack of antenatal care
_______ during late pregnancy
Preterm; rupture of the membrane
rupture of the membrane ; 18 hours
Low; Coitus
Known risk factors of Puerperal sepsis
Intrapartum factors
Frequent vaginal __________
Premature _______ of the membrane
Prolong ________
_____________________
________ operative delivery
___________ – antepartum or postpartum
Retained ____________ or _________
_____________ delivery
examination; rupture
labour; Chorioamnionitis
Traumatic; Haemorrhage
bits of placental tissue ; membranes
Caesarean
Mode of transmission leading to peuperal sepsis
• Endogenous:due to organism _______________________________
(Aerobic or Anaerobic?) ________ which is predominant pathogen.
• Autogenous:Bacteria from _______________
__________ ———- Group ——, ____,__________ are important.
Present in the vagina and cervix
Anaerobic streptococci
some other part of the body
Streptococcus haemolyticus
Group A, E coli, staphylococci
Mode of transmission leading to peuperal sepsis
• ______genous
• ______genous
• _____genous
Endo
Auto
Exo
Mode of transmission leading to peuperal sepsis
Exogenous: where infection is contracted from ___________________ e.g hospital , hands of health care workers etc
_______ ________ __________, _______ are important.
sources outside the patient
Beta haemolytic streptococci, E coli
Pathophysiology of Peuperal sepsis
The primary sites of infection are:
• __________
• __________
• __________
• __________
The infection is neither __________ to the site or __________ to distant sites.
• Perineum
• Vagina
• Cervix
• Uterus
localised ;spread
Septicaemia
There is high raise of _________ with _____, severe ________.
Blood culture is (positive or negative ?)
temperature
rigor
headache.
positive
Grades of puerperal sepsis
Grade 1 Infection is (localized or Widespread?) within the _________
Grade 2 Infection involving the _________
Grade 3 Generalized infection with complications like _______
localized; uterine cavity
parametrium
peritonitis, septic
Pathogenesis Of peuperal sepsis
•The lacerations on the _________ , _________, _________ is often infected by organisms due to presence of _________ or _________.
• The wound become _________, _________ and there is associated _________ discharges.
• Diabetes, obesity, low nutritional status is the other high- risk and symptoms factors for wound infection
perineum, vagina, cervix
blood clot or dead space.
red, swollen ; seropurulent
Pathogenesis Of peuperal sepsis
_________ (placental implantation site) , ______ lacerated wound , ________ wound or ________ lacerated wound are the favourable sites for bacterial growth and multiplication.
Endometrium
cervical
Vaginal wound
perineal
Clinical presentation Of peuperal sepsis
Symptoms
Onset is usually ____ days after delivery (in severe cases in ________)
Fever with ______ and _____
Generalized malaise
Headache
Nausea, anorexia, vomiting
_______ smelling discharge (_____)
2-3 days ; 24 hours
chills and rigor
Foul ;lochia
Clinical presentation Of peuperal sepsis
General examination
______ appearance
Fever (101-102-degree F, rarely higher)
Shock
Skin _________ or _______
____ tenderness suggest ______________
Imaging – CXR, Abd-pelvic USS,
Toxic
eruption or jaundice
Calf ; deep vein thrombosis
Causative agents Of peuperal sepsis
• Aerobic microorganism
_________ __________ Group A, ______, beta haemolytic __________ , ________ streptococci, staphylococci, klebsiella,
•Pseudomonas, gonococci
Streptococcus haemolyticus Group A
E coli
beta haemolytic streptococci
non-haemolytic streptococci
Causative agents Of peuperal sepsis
• Anaerobic microorganism
• Anaerobic __________ , Cl. welchi, _____, _________ , _________
streptococci
tetani
mycoplasmas
chlamydia
Laboratory diagnosis Of peuperal sepsis
To confirm the diagnosis – full —————
•__________ /_______ swab : M/C/S
•________ M/C/S
• CBC - haemoglobin, WBC total /differential count
• ESR
•____________ to rules out malaria
•Blood culture
sepsis work up
High vaginal; cervical
Urine
Peripheral smear
COMPLICATIONS Of peuperal sepsis
•________
•______________ , shock
•________: pelvic, sub phrenic, sub hepatic •Septic pelvic ___________
•Death: septicaemia, shock, ____ gangrene, ______
Peritonitis
Septicaemia
Abscess:
thrombophlebitis
gas ; tetanus
Chorioamnionitis
Historically, infection of the ________ , ________, or both was termed “chorioamnionitis.”
Although this term remains in common use, the term “________ infection” (IAI) is also commonly used since infection often involves the ________, ________, ________, or ________ as well as the fetal membranes.
chorion ; amnion
intra- amniotic infection ; amniotic fluid
fetus ; umbilical cord ; placenta
Pathogenesis Of Chorioamnionitis
_________ of ________ flora through the ________ is the most common pathway to IAI.
Uncommonly, the pathway to IAI is __________ as a result of _________________ (eg, ____________ ) infecting the __________ space or from contamination of the ____________ as a result of an invasive procedure (eg, fetoscopy).
Infection from the peritoneum via the __________ has also been postulated but is likely rare.
Subsequent activation of the maternal and fetal _____________ systems generally leads to _______ and/or _______________
cervicovaginal flora ; cervical canal
hematogenous ; maternal bacteremia
Listeria monocytogenes ; intervillous space
amniotic cavity
fallopian tubes ; inflammatory response
labor ; rupture of membranes.
PATHOGENESIS Of Chorioamnionitis
Local host factors likely play a role in facilitating or preventing infection.
The ________ ,______, and _________ provide barriers to ascending and transplacental infection, while _______________ removes barriers.
There is some evidence that the fetal membranes have ___________ activity.
cervical mucus plug, membranes, and placenta
rupture of membranes
antimicrobial activity.
PATHOGENESIS Of Chorioamnionitis
Cells within fetal membranes appear to mediate _______ immune responses through activation of _________ receptors, key modulators of the ________ immune response that recognize components of _________ and ________.
__________ in the vagina may induce changes in the flora that impair the virulence of pathogenic organisms.
innate ; toll-like receptors
innate ; bacteria and viruses.
Lactobacilli
Risk factors Of Chorioamnionitis
Longer __________ and _________________ may be the most important risk factors for IAI.
Several other obstetric factors have been associated with an increased risk for IAI, including multiple _________________ (especially with ruptured membranes), cervical insufficiency, _____parity, ________-stained amniotic fluid, internal fetal or uterine monitoring, presence of genital tract ____________ , alcohol and tobacco use, and previous IAI.
length of labor
length of ruptured membranes
digital vaginal examinations
nulliparity ; meconium
pathogens
Risk factors Of Chorioamnionitis
An increasing number of digital examinations may be a consequence of ________ rather than _________________ , particularly prior to ___________.
longer labor
independent risk factor
membrane rupture.
There is strong evidence of an increased risk of IAI in pregnancies exposed to mechanical methods of cervical ripening versus prostaglandins
T/F
F
There is no strong evidence of an increased risk of IAI in pregnancies exposed to mechanical methods of cervical ripening versus prostaglandins; however, trials typically excluded women with ruptured membranes.
Clinical presentation
IAI often occurs in women with premature rupture of membranes (PROM) but can occur with intact membranes, especially in laboring women.
The key clinical findings, which are nonspecific, and their frequencies are as follows : Fever (100 percent).
WBC >12,000/mm3 or >15,000/mm3) (70 to 90 percent).
Maternal tachycardia >100/min (50 to 80 percent).
Fetal tachycardia >160/min (40 to 70 percent).
Uterine tenderness (4 to 25 percent).
Bacteremia is most common when IAI is associated with group
•
B Streptococcus or Escherichia coli infection (bacteremia in 18 and 15 percent of cases, respectively).
•
•
Purulent or malodorous amniotic fluid.
IAI may be subclinical, which by definition does not present with the above clinical findings. Subclinical infection may manifest as preterm labor with intact membranes or as preterm premature rupture of membranes (PPROM).
Clinical presentation
IAI often occurs in women with premature rupture of membranes (PROM) but can occur with intact membranes, especially in laboring women.
The key clinical findings, which are nonspecific, and their frequencies are as follows : Fever (100 percent).
WBC >12,000/mm3 or >15,000/mm3) (70 to 90 percent).
Maternal tachycardia >100/min (50 to 80 percent).
Fetal tachycardia >160/min (40 to 70 percent).
Uterine tenderness (4 to 25 percent).
Bacteremia is most common when IAI is associated with group
•
B Streptococcus or Escherichia coli infection (bacteremia in 18 and 15 percent of cases, respectively).
•
•
Purulent or malodorous amniotic fluid.
IAI may be subclinical, which by definition does not present with the above clinical findings. Subclinical infection may manifest as preterm labor with intact membranes or as preterm premature rupture of membranes (PPROM).
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