PUERPERAL SEPSIS, CHORIOAMONITIS

Question 1

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

Answer 1

preventable maternal

Question 2

Peuperal sepsis -

An infection of _________ which occurs as a complication of _________ usually within _____ days is termed as puerperal sepsis.

Answer 2

genital tract

delivery

10 days

Question 3

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

Answer 3

genital tract

at labor

42 days

postpartum

Question 4

Puerperal sepsis is commonly due to

1. __________
2. _______________
3. ___________________ or a combination of all these when it is called as ______________

Answer 4

Endometritis

Endomyometritis

Endoparametritis

pelvic cellulitis

Question 5

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

Answer 5

Preterm; rupture of the membrane

rupture of the membrane ; 18 hours

Low; Coitus

Question 6

Known risk factors of Puerperal sepsis

Intrapartum factors

Frequent vaginal __________
Premature _______ of the membrane
Prolong ________
_____________________
________ operative delivery
___________ – antepartum or postpartum
Retained ____________ or _________
_____________ delivery

Answer 6

examination; rupture

labour; Chorioamnionitis

Traumatic; Haemorrhage

bits of placental tissue ; membranes

Caesarean

Question 7

Mode of transmission leading to peuperal sepsis

• Endogenous:due to organism _______________________________

(Aerobic or Anaerobic?) ________ which is predominant pathogen.

• Autogenous:Bacteria from _______________
__________ ———- Group ——, ____,__________ are important.

Answer 7

Present in the vagina and cervix

Anaerobic streptococci

some other part of the body

Streptococcus haemolyticus

Group A, E coli, staphylococci

Question 8

Mode of transmission leading to peuperal sepsis

• ______genous
• ______genous
• _____genous

Answer 8

Endo

Auto

Exo

Question 9

Mode of transmission leading to peuperal sepsis

Exogenous: where infection is contracted from ___________________ e.g hospital , hands of health care workers etc

_______ ________ __________, _______ are important.

Answer 9

sources outside the patient

Beta haemolytic streptococci, E coli

Question 10

Pathophysiology of Peuperal sepsis

The primary sites of infection are:
• __________
• __________
• __________
• __________
The infection is neither __________ to the site or __________ to distant sites.

Answer 10

• Perineum
• Vagina
• Cervix
• Uterus

localised ;spread

Question 11

Septicaemia
There is high raise of _________ with _____, severe ________.

Blood culture is (positive or negative ?)

Answer 11

temperature

rigor

headache.

positive

Question 12

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 _______

Answer 12

localized; uterine cavity

parametrium

peritonitis, septic

Question 13

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

Answer 13

perineum, vagina, cervix

blood clot or dead space.

red, swollen ; seropurulent

Question 14

Pathogenesis Of peuperal sepsis

_________ (placental implantation site) , ______ lacerated wound , ________ wound or ________ lacerated wound are the favourable sites for bacterial growth and multiplication.

Answer 14

Endometrium

cervical

Vaginal wound

perineal

Question 15

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 (_____)

Answer 15

2-3 days ; 24 hours

chills and rigor

Foul ;lochia

Question 16

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,

Answer 16

Toxic

eruption or jaundice

Calf ; deep vein thrombosis

Question 17

Causative agents Of peuperal sepsis
• Aerobic microorganism

_________ __________ Group A, ______, beta haemolytic __________ , ________ streptococci, staphylococci, klebsiella,
•Pseudomonas, gonococci

Answer 17

Streptococcus haemolyticus Group A

E coli

beta haemolytic streptococci

non-haemolytic streptococci

Question 18

Causative agents Of peuperal sepsis

• Anaerobic microorganism
• Anaerobic __________ , Cl. welchi, _____, _________ , _________

Answer 18

streptococci

tetani

mycoplasmas

chlamydia

Question 19

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

Answer 19

sepsis work up

High vaginal; cervical

Urine

Peripheral smear

Question 20

COMPLICATIONS Of peuperal sepsis

•________
•______________ , shock
•________: pelvic, sub phrenic, sub hepatic •Septic pelvic ___________
•Death: septicaemia, shock, ____ gangrene, ______

Answer 20

Peritonitis

Septicaemia

Abscess:

thrombophlebitis

gas ; tetanus

Question 21

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.

Answer 21

chorion ; amnion

intra- amniotic infection ; amniotic fluid

fetus ; umbilical cord ; placenta

Question 22

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 _______________

Answer 22

cervicovaginal flora ; cervical canal

hematogenous ; maternal bacteremia

Listeria monocytogenes ; intervillous space

amniotic cavity

fallopian tubes ; inflammatory response

labor ; rupture of membranes.

Question 23

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.

Answer 23

cervical mucus plug, membranes, and placenta

rupture of membranes

antimicrobial activity.

Question 24

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.

Answer 24

innate ; toll-like receptors

innate ; bacteria and viruses.

Lactobacilli

Question 25

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.

Answer 25

length of labor

length of ruptured membranes

digital vaginal examinations

nulliparity ; meconium

pathogens

Question 26

Risk factors Of Chorioamnionitis

An increasing number of digital examinations may be a consequence of ________ rather than _________________ , particularly prior to ___________.

Answer 26

longer labor

independent risk factor

membrane rupture.

Question 27

There is strong evidence of an increased risk of IAI in pregnancies exposed to mechanical methods of cervical ripening versus prostaglandins

T/F

Answer 27

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.

Question 28

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).

Question 29

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).

Question 30

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