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OB 2 Midterms > Puerperal Infection > Flashcards

Puerperal Infection Flashcards

1
Q

Puerperal infection

Secondary to hypoventilation

A

Atelectasis

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2
Q

Atelectasis best prevented by

A

Coughing and deep breathing q4 for 24 hours

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3
Q

Atelectasis

Most seen in

A

First 24 hours following delivery

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4
Q

Puerperal infection

Uncommon complication because of normal postpartum diuresis

A

UTI

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5
Q

Puerperal complication

15% of breastfeeding mothers (Do not breast feed daw sabi niya pero iba sa ppt)
o Can result to mastitis or an abscess

A

Breast engorgement

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6
Q

Breast engorgement Brief temp elevation which rarely exceeds 39°C usually last

A

<24 hours

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7
Q

Uterine Infections CS>Vaginal Delivery

A

 Endometriosis
 Endomyometritis
 Endoparametritis
 Metritis w/ pelvic cellulitis: most appropriate term to be used

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8
Q

Predisposing Factors for Uterine Infection

A

 CS > vaginal delivery (The most significant factor is still the route of delivery)
 CS has 25 fold increase in infection related mortality rate vs vaginal delivery
 CS more readmissions for wound complications & endometritis

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9
Q

Puerperal infection

Temperature of puerperal fever which occurs on any day. In. 2-10 days postpartum. Exclusive of the first 24 hours

A

38 degree C or higher

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10
Q

Puerperal infection

Febrile women within 24 hours after vaginal delivery had pelvic infections

A

20%

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11
Q

Puerperal infection

Febrile previous CS

A

70%

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12
Q

Puerperal infection

Within 24 hours pelvic infection caused by group A or B strep

A

High spiking fever 39C or higher

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13
Q

Puerperal infection complications

A

Atelectasis
UTI
Breast engorgemnt

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14
Q

Metritis with pelvic cellulitis

A

Myometrium and parametrial tissue

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15
Q

Vaginal delivery

Membrane rupture and labor

A

Prolonged

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16
Q

Metritis in vaginal delivery

A 
Prolonged membrane rupture and labor
Multiple cervical examination ( don't do IE q1 or 30 minutes)
Internal fetal monitoring
Intra amniotic infection
Manual removal of placenta
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17
Q

Metritis ceasarian section

How many fold of increase infection related mortality

A

25 fold

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18
Q

Metritis ceasarian section

Decreases the incidence of infection by 65-75%

A

Single dose peri operative antimicrobial prophylaxis

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19
Q

Group A B hemolytic strep causes

A

Toxic shock like syndrome

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20
Q

More common in microbiology

A

Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA)

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21
Q

Bacteriology

Aerobes

A 
Group A, B D strep
Enterococcus
G- E. Coli, klebsiella, proteus
Staph aureus
Staph epidermis
Gardnerella vaginalis

Take note, kung wala dito it means anaerobes

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22
Q

Bacteriology in Metritis

Others

A

Mycoplasma
Chlamydia trachomatis
Neisseria gonorrhea

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23
Q

Causative bacteria in Metritis

Most are from

A

Normal cervical flora

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24
Q

Causative bacteria in Metritis

Bacteria that colonize the cervix and vagina gain access to

A

Amniotic fluid during labor

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25
Q

Causative bacteria in Metritis

Become pathogenic within

A

Hematoma and devitalized tissues

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26
Q

Causative bacteria in Metritis

Usually sterile before membrane rupture

A

Uterine cavity

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27
Q

Causative bacteria in Metritis

Provides passageway for bacteria to causes ascending infection

A

PROM

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28
Q

Pathogenesis of Metritis

Vaginal delivery

A

Involves placental implantation site,
Decidua
Adjacent myometrium
Cervicovaginal lacerations

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29
Q

Pathogenesis of Metritis

CA

A

Infected surgical incision

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30
Q

Pathogenesis of Metritis

Bacteria in cervix and vagina gain access to the

A

Amniotic fluid during labor and postpartum

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31
Q

Pathogenesis of Metritis

In postpartum, they invade

A

Devitalized uterine tissues

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32
Q

Metritis clinical course

Most significant factor for the diagnosis of post partum infection.

A

Fever

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33
Q

Metritis clinical course

Suggest presence of bacteremia or endotoxemia

A

Chills

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34
Q

Metritis clinical course

Others

A

Pulse rate follows the temperature curve
Abdominal pain
Parametrial tenderness
Foul smelling lochia

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35
Q

Metritis clinical course

Lochia would not always represent infection. Lochia persist usually until

A

2months post partum

Rubra, serosa,alba

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36
Q

Metritis clinical course

Leucocytosis

A

15,000 - 30,000

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37
Q

Treatment for Metritis

Mild cases

A

Oral antibiotics (no need to admit the patients)

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38
Q

Treatment for Metritis

Moderate to severe

A

Parenteral therapy

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39
Q

Complication that cause persistent fever in Metritis

A 
Parametrial phlegmous
Surgical incisional and pelvic abscess
Infected hematomas
Septic pelvic thrombophlebitis
Bacteria resistant to initial treatment
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40
Q

Choice of antimicrobial in Metritis

Vaginal delivery

A

Ampicillin plus gentamicin (90%)

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41
Q

Choice of antimicrobial in Metritis

CS delivery
Gold standard

A

Clindamycin plus gentamycin (95%)

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42
Q

Choice of antimicrobial in Metritis

Gentamycin is

A

Nephrotoxic

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43
Q

Choice of antimicrobial in Metritis

In CS
It with sepsis syndrome or suspected enterococcus infection

A

Gold standard plus ampicillin

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44
Q

Antimicrobial treatment in Metritis

If you suspect enterococcal

A

Ampicillin

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45
Q

Antimicrobial treatment in Metritis

For renal insufficiency

A

Clindamycin plus aztreonam

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46
Q

Antimicrobial treatment in Metritis

More expensive

A

Extended spectrum penicillins

47
Q

Antimicrobial treatment in Metritis

Used if there is infection

A

Cephalosporin

Cefotetan
Cefoxitin
Cefotoxime

48
Q

Antimicrobial treatment in Metritis

Added to regimens for S aureus (especially if there is MRSA)

A

Vancomycin

49
Q

Antimicrobial treatment in Metritis

Reserved for special indications
1st line of infection specialist

A

Carbapenems

50
Q

Antimicrobial treatment in Metritis

Good anaerobic coverage

A

Metronidazole + ampicillin + gentamycin

Metro talaga pinak

51
Q

Prevention of infection Metritis

single agent prior to CS

A

Ampicillin or first gen cephalosporin

52
Q

Prevention of infection Metritis

Reduced

A

Rate of post OP infection after CS
Rate of post operative endometrisis (70-80%)
Abdominal incision infection rate

53
Q

Prevention of infection Metritis

Surgical technique

A

Lifting the uterus out of the abdomen

54
Q

Prevention of infection Metritis

Type of incision in obese

A

Bikini

55
Q

Prevention of infection Metritis

Others

A

Changing of gloves after delivery of placenta
Single vs two layer uterine closure
Peritoneal closure

56
Q

Abdominal incisional Infection

A

MC cause of antimicrobial failure

57
Q

Abdominal incisional Infection

Risk factor dahil mabagal ang healing of wound process

A

Obesity and diabetes

58
Q

Abdominal incisional Infection

Risk factor

Bagsak ang hemoglobin kaya pinapa continue ang Iron for 3 months

A

Corticosteroid therapy
Immunosupresion
Anemia

59
Q

Abdominal incisional Infection

Other risk factors

A

Poor Hemostasis

Hematoma formation

60
Q

Abdominal incisional Infection

Fever

A

4th post OP day

61
Q

Abdominal incisional Infection

Excision would present

A

Wound erythema and discharge

62
Q

Abdominal incisional Infection

Treatment

A

Antimicrobial
Surgical drainage
Careful inspection to ensure that the abdominal fascia is intact

63
Q

Abdominal incisional Infection

Disruption of burst abdomen- refers to separation of the wound involving the fascial layer

A

Wound dehiscence

64
Q

Abdominal incisional Infection

Wound dehiscence occurs on the

A

5th day accompanied by serosanguinous discharge

65
Q

Abdominal incisional Infection

Wound dehiscence

Treatment

A

Secondary closure of the incision in the operation room with adequate anesthesia, (hindi mo kaya ma treat to under local anesthesia)

66
Q

Abdominal incisional Infection

Necrotizing fascitis

A

Rare but More serious

67
Q

Abdominal incisional Infection

Necrotizing fascitis

May involve abdominal incision in

A

CS

Episiotomy sites and laceration

68
Q

Abdominal incisional Infection

Necrotizing fascitis

Risk factors

A

Diabetes
Obesity
Hypertension

69
Q

Abdominal incisional Infection

Necrotizing fascitis

Causative agents

A

Poly microbial
Normal vaginal flora
Group A
Beta hemolytic strep

70
Q

Abdominal incisional Infection

Necrotizing fascitis

Involves

A

Skin
Superficial and deep subcutaneous tissues
Abdominal fascial layer

71
Q

Abdominal incisional Infection

Necrotizing fascitis

It may involve the muscle

A

Myofascitis

72
Q

Abdominal incisional Infection

Necrotizing fascitis

Treatment

A

Early diagnosis
Surgical debridement
Broad spectrum antibiotics
Intensive care

73
Q

Abdominal incisional Infection

Peritonitis

A

Rare post CS

74
Q

Abdominal incisional Infection

Peritonitis

Cause by

A

Uterine incisional necrosis and dehiscence

75
Q

Abdominal incisional Infection

Peritonitis

1st symptoms

A

Fever accompanied by adynamic ileus

76
Q

Abdominal incisional Infection

Peritonitis

Maybe due to a

A

Ruptured adnexal abscess or inadvertent bowel injury

77
Q

Abdominal incisional Infection

Peritonitis

Contribute appreciably to fluid and electrolytes loss

A

Vomiting
Diarrhea
Fever

78
Q

Abdominal incisional Infection

Peritonitis

Treatment

A

Supportive, NGT

Surgery- drainage of abscesses to relieve mechanical stres

79
Q

Abdominal incisional Infection

Rare in the puerperum
Caused by a rent in the ovarian capsule
Unilateral
Present 1-2 weeks postpartum

A

Adnexal infections

80
Q

Intensive parametrial cellulitis chat is intensive and forms an area of induration within the leaves of the broad ligament to the pelvic sidewall

A

Parametrial Phlegmon

81
Q

Parametrial Phlegmon

Fever persist for

A

> 72 hours despite IV antimicrobial

82
Q

Parametrial Phlegmon

Most often unilateral and most common form of extension is

A

Laterally

83
Q

Parametrial Phlegmon

Cause

A

Necrosis and separation

84
Q

Parametrial Phlegmon

Fever resolves after

A

5-7 days of IV antibiotic

85
Q

Parametrial Phlegmon

Surgery (pelvic cleanup) for severe

A

Cellulitis,
Ileus
Peritonitis

86
Q

Parametrial Phlegmon suppurative -> forms a fluctuant broad ligament mess that may point above the poupart ligament

A

Pelvic abscess

87
Q

Pelvic abscess

Amenable to needle drainage FNAB directed by CT scan

A

It will dissect anteriorly

88
Q

Pelvic abscess

Surgical drainage by colpotomy incision

A

Posteriorly to rectovaginal septum

89
Q

Extend along venous routes and cause thrombosis

A

Septic pelvic thrombophlebitis

90
Q

Septic pelvic thrombophlebitis

A

Lymphangitis often coexist
Usually unilateral
Iliofemoral vessels

91
Q

Septic pelvic thrombophlebitis

Incidence

A

1: 9000- vaginal deliveries
1: 8000 - CS. More common

92
Q

Septic pelvic thrombophlebitis

Pathognomonic sign

A

Enigmatic fever

93
Q

Septic pelvic thrombophlebitis

Pain develop on the 2nd and 3rd post partum day

A

Ovarian vein thrombophlebitis

94
Q

Septic pelvic thrombophlebitis

Diagnosis and treatment

A

Ct scan,MRI
Heparin challenge test
Antibiotic broad spectrum

95
Q

Infections of perineum, vagina and cervix

Episiotomy dehiscence

Associated factors

A

Infection
Coagulation disorders,
Smoking
HPV

96
Q

Infections of perineum, vagina and cervix

Episiotomy dehiscence

Symptoms

A

Local pain
Dysuria
Urinary retention
Purulent discharge, fever

97
Q

Infections of perineum, vagina and cervix

Episiotomy dehiscence

Extreme cases

A

Entire vulva become edematous, ulcerated and covered with exudate

98
Q

Infections of perineum, vagina and cervix

Infected directly by extension from the perineum
Mucosa becomes red and swollen, then necrotic and slough off of the area
Results in lymphangitis

A

Vaginal laceration

99
Q

Infections of perineum, vagina and cervix

+ infection-> deep laceration extend to the broad ligament -> cause lymphangitis, parametritis and bacteremia.

A

Cervical laceration

100
Q

Infections of perineum, vagina and cervix

Treatment

A

Drainage/removal of sutures
Broad spectrum antimicrobials
Local wound care
Early repair after infection subsides and there is pink granulation tissue

101
Q

Two types of episiotomy

A

Midline

Mediolateral

102
Q

Infections of perineum, vagina and cervix

Rare but fatal
Ususally do not cause symptoms until 3-5 afterward
Involves muscle and fascia
Complicate vulvar infections in diabetic and immunocompromised women

A

Necrotizing fascitis

103
Q

Acute febrile illness with severe multisystem derangement

A

Toxic shock syndrome

104
Q

Toxic shock syndrome

Cause fatality rate

A

10-15%

105
Q

Toxic shock syndrome

May develop

A

Renal failure
Hepatic failure
DIC and circulatory collapse

106
Q

Toxic shock syndrome

Commonly caused by

A

S. Aureus or strep

107
Q

Parenchymal infection of the mammary gland

A

Breast infections

Suppurative mastitis

108
Q

Breast infections Suppurative mastitis

Symptoms

A

3rd-4th week

Hard and red

10% of mastitis develop abscess

109
Q

Breast infections Suppurative mastitis

MC resistant strains

A

S aureus esp the Methcillin

110
Q

Breast infections Suppurative mastitis

Mngt

A

Start therapy before suppurations
Cultured expressed milk
Continue BF but not in affected area bec og engorgement and edema
HIV not contraindicated
but with mastitis
HIV RNA levels increase so donot breast feed

111
Q

Breast infections Suppurative mastitis

Meds

A

Dicloxacillin
Erythromycin if allergic to antibiotic
Pen resistant to vancomycin
10-14 days

112
Q

Breast abscess

Suspected if fever persists after

A

2-3 days of treatment or mass become palpable

113
Q

Breast abscess treatment

A

Surgical drainage under general anesthesia

Sonographic guided needle aspiration under local anesthesia (80-90% effective)

114
Q

Lethal Triad of Maternal Death in the 2th Century

A

o Puerperal infection
o Preeclampsia
o Obstetric hemorrhage

OB 2 Midterms (1 decks)

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