OB2 Puerperal Infections Quiz

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Questions and Answers

What primarily causes the pelvic infections in postpartum women?

Mycoplasma species present in the uterus

Viruses transmitted during labor

Bacteria indigenous to the normal genital tract (correct)

Fungi that proliferate post-delivery

Which leukocyte count is considered elevated during postpartum recovery?

10,000 - 15,000 cells/mL

5,000 - 10,000 cells/mL

Over 30,000 cells/mL

15,000 - 30,000 cells/mL (correct)

What is a critical factor that allows previously non-pathogenic bacteria to become pathogenic after delivery?

Absence of leukocytes in the uterus

The surgical procedures performed during delivery

Presence of hematomas and devitalized tissue (correct)

Sterilization of the amniotic fluid prior to labor

In cases of moderate to severe pelvic infections after delivery, what is the preferred method of treatment?

IV broad-spectrum antibiotics Signup and view all the answers

What characterizes the typical microbiological profile of infections that occur postpartum?

Polymicrobial infections with both aerobes and anaerobes Signup and view all the answers

What infection involves the decidua and myometrium in postpartum women?

Metritis Signup and view all the answers

Which of the following treatments is primarily effective for infections after vaginal deliveries?

Ampicillin + Gentamicin Signup and view all the answers

What is the predominant cause of puerperal fever among postpartum women?

Puerperal infection Signup and view all the answers

In which scenario is Gentamicin considered a substitute due to renal insufficiency?

In severe sepsis from intra-abdominal infections Signup and view all the answers

When does fever typically onset in women experiencing abdominal wound dehiscence post-emergency cesarean section?

24 to 48 hours after surgery Signup and view all the answers

What is the most common cause of fever in the puerperium?

Puerperal infection Signup and view all the answers

Which of the following factors can lead to puerperal infection?

High maternal obesity Signup and view all the answers

Which of the following conditions can be classified under complications of uterine infections?

Abdominal wound dehiscence Signup and view all the answers

At what temperature is puerperal fever diagnosed?

≥ 38°C Signup and view all the answers

What is a potential complication from an abdominal incisional infection?

Septic pelvic thrombophlebitis Signup and view all the answers

Which statement accurately describes the causes of puerperal fever?

It can be caused by both infective and non-infective factors. Signup and view all the answers

What is a likely microbiological consideration for puerperal infections?

Any bacterial infection of the genital tract. Signup and view all the answers

What is a significant predisposing factor for abdominal wound dehiscence in postpartum patients?

Obesity Signup and view all the answers

What is a primary cause of uterine subinvolution after delivery?

Retained placental fragments Signup and view all the answers

Which symptom is most indicative of acute pyelonephritis postpartum?

Dysuria and flank pain Signup and view all the answers

What is the best preventative measure for atelectasis after delivery?

Deep breathing exercises Signup and view all the answers

Which treatment is indicated for managing uterine subinvolution?

Antibiotics and uterotonics Signup and view all the answers

What symptom should raise suspicion for a urinary tract infection in the postpartum period?

Dysuria and inability to void Signup and view all the answers

What complication may occur within the first 24 hours after a cesarean section?

Puerperal fever Signup and view all the answers

In the context of postpartum care, what condition is least likely to occur due to normal physiological changes?

Urinary tract infection Signup and view all the answers

Which of the following best describes the clinical presentation of uterine subinvolution?

Larger and softer uterus Signup and view all the answers

What is a likely reason for a postpartum patient to experience unbearable hypogastric pain six hours after delivery?

Overdistended bladder Signup and view all the answers

What is the most appropriate management for an overdistended bladder in a postpartum patient?

Insert indwelling Foley catheter Signup and view all the answers

Which day postpartum is associated with a higher risk of developing a uterine infection?

3rd post-operative day Signup and view all the answers

What could be the most probable diagnosis in a primigravid who develops fever despite intravenous antibiotics several days postpartum?

Ovarian abscess Signup and view all the answers

What does the presence of foul-smelling lochia indicate in a postpartum patient?

Often no infection present Signup and view all the answers

What type of pathogens are commonly responsible for pelvic infections post-delivery?

Indigenous bacteria from the urogenital tract Signup and view all the answers

Why might a postpartum woman experience persistent fever despite antibiotic treatment?

Infection may be polymicrobial Signup and view all the answers

What common misconception about postpartum infections can hinder effective treatment?

Assuming all foul-smelling lochia indicates infection Signup and view all the answers

Study Notes

Introduction

Puerperal infections manifest during the postpartum period, often requiring prompt identification and management.

Puerperal Fever

Defined as a fever of 38°C or higher during the puerperium.
Caused by infective factors (e.g., infections) and non-infective factors (e.g., normal response post-delivery).

Puerperal Infection

Most common source of fever in the puerperium.
Can result from any bacterial infection in the genital tract post-delivery, typically accompanied by scant odorless lochia.
Leukocytosis (15,000 - 30,000 cells/mL) is common, but can differentiate from infection as delivery increases leukocyte count.

Microbiology

Pathogens usually derive from indigenous bacteria present in the normal genital tract.
Infections are primarily polymicrobial, involving both aerobes and anaerobes.
Occasional severe Group A Beta Hemolytic Streptococcal infections can lead to a high maternal mortality rate of 90%.

Extragenital Causes of Puerperal Fever

Differential diagnosis for puerperal infection should include:
- Respiratory Complications: Pulmonary atelectasis from hypoventilation.
- Urinary Tract Infections: Uncommon postpartum but can occur; need for aseptic technique during catheterization is emphasized.

Treatment

Mild Metritis: Treated with oral or intramuscular antimicrobials.
Moderate to Severe Infections: Requires intravenous broad-spectrum antibiotics.
Treatment should target both aerobes and anaerobes due to the polymicrobial nature of infections.

Uterine Subinvolution

Characterized by arrest or delay in uterine involution due to retained placental fragments or infection.
Presents as prolonged lochial discharge and irregular or excessive bleeding with a larger, soft uterus on examination.
Managed using antibiotics and uterotonics like ergonovine and methylergonovine.

Complications of Uterine Infection

Includes:
- Abdominal incisional infections.
- Necrotizing fasciitis.
- Ovarian abscess/adnexal infection.
- Peritonitis.
- Septic pelvic thrombophlebitis.

Clinical Management Scenarios

For abdominal wound dehiscence post-cesarean, fever typically begins within the first few days post-operation.
In cases of urinary retention leading to overdistended bladder postpartum, management focuses on drainage via catheter.

Key Points on Infection and Fever Diagnosis

Infection types include:
- Metritis: Infection of the decidua and myometrium.
- Puerperal infections: Systematic diagnosis is crucial for effective treatment.

Important Treatment Notes

Pathogen treatment requires understanding the polymicrobial nature and usually involves dual targeting of known infectious agents.
Detection of fever in relation to timing and clinical condition post-delivery is critical in dictating appropriate management strategies.

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Description

Test your knowledge on puerperal infections and disorders of the puerperium in this OB2 module. This quiz covers key concepts and clinical considerations pertinent to obstetrics. Perfect for medical students and professionals looking to reinforce their understanding.