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In the case of endometritis, why is sterile vaginal swab preferred over a perineal pad for diagnostic culture?
In the case of endometritis, why is sterile vaginal swab preferred over a perineal pad for diagnostic culture?
- To identify vaginal infections
- To detect urinary tract infections
- To check hormonal levels
- To prevent contamination from external sources (correct)
What is the recommended diagnostic method for confirming the presence of placental fragments that could cause infection?
What is the recommended diagnostic method for confirming the presence of placental fragments that could cause infection?
- Blood culture
- Sonogram (correct)
- Urine analysis
- Culture from perineal pad
Which antibiotic is specifically mentioned for treating endometritis based on culture results?
Which antibiotic is specifically mentioned for treating endometritis based on culture results?
- Amoxicillin
- Ciprofloxacin
- Azithromycin
- Clindamycin (correct)
Apart from antibiotics, what else may be prescribed to encourage uterine contraction in endometritis cases?
Apart from antibiotics, what else may be prescribed to encourage uterine contraction in endometritis cases?
Why is it important for patients to take the full course of antibiotics prescribed for endometritis?
Why is it important for patients to take the full course of antibiotics prescribed for endometritis?
What instruction is important to give to patients before hospital discharge regarding endometritis?
What instruction is important to give to patients before hospital discharge regarding endometritis?
What is the main cause of Disseminated Intravascular Coagulation (DIC) in the context of postpartum complications?
What is the main cause of Disseminated Intravascular Coagulation (DIC) in the context of postpartum complications?
What is the conventional method of detecting infection during the puerperium?
What is the conventional method of detecting infection during the puerperium?
What are the symptoms associated with Endometritis, as described in the text?
What are the symptoms associated with Endometritis, as described in the text?
How do bacteria typically gain access to the uterus in cases of Endometritis?
How do bacteria typically gain access to the uterus in cases of Endometritis?
What is indicated by a white blood cell count increase to 20,000 to 30,000 cells/mm3 in a postpartal woman?
What is indicated by a white blood cell count increase to 20,000 to 30,000 cells/mm3 in a postpartal woman?
What is one of the risks associated with Retained Placental Fragments postpartum?
What is one of the risks associated with Retained Placental Fragments postpartum?
What is one of the gravest complications of childbearing and a major cause of death from puerperal infection?
What is one of the gravest complications of childbearing and a major cause of death from puerperal infection?
How does the infection spread in puerperal peritonitis?
How does the infection spread in puerperal peritonitis?
Where may an abscess form in puerperal peritonitis, and why?
Where may an abscess form in puerperal peritonitis, and why?
What are the key assessment findings in puerperal peritonitis?
What are the key assessment findings in puerperal peritonitis?
What is the therapeutic management for puerperal peritonitis?
What is the therapeutic management for puerperal peritonitis?
How can puerperal peritonitis affect future fertility?
How can puerperal peritonitis affect future fertility?
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Study Notes
Puerperal Infections
- Can be caused by placental fragments
- Factors:
- Infection of the reproductive tract in the postpartal period
- Bacteria gain access to the uterus through the vagina and enter the uterus either at the time of birth or during the postpartal period
Endometritis
- Infection of the endometrium
- Assessment:
- Hyperthermia (temperature over 100.4°F (38°C)) for two consecutive 24-hour periods
- Uterus is not well contracted and is painful to touch
- Lochia is dark brown and has a foul odor
- Therapeutic Management:
- Antibiotics (e.g. Clindamycin)
- Oxytocic agent (e.g. methylergonovine) to encourage uterine contraction
- Increase fluid intake
- Analgesic for pain relief
- Sitting in a semi-Fowler’s position or walking encourages lochia drainage by gravity and helps prevent pooling of infected secretions
- PPEs when handling patient
- Hand washing before and after handling pads
- Instruct about the signs and symptoms of endometritis before hospital discharge
- Reiterate to take the full course of antibiotics prescribed
- Can lead to tubal scarring and interference with future fertility
- Placenta accreta: Balloon occlusion of the internal iliac arteries
- Hysterectomy: Last option
Peritonitis
- Infection spreads from the uterus through the lymphatic system or directly through the fallopian tubes or uterine wall to the peritoneal cavity
- Assessment:
- Rigid abdomen
- Abdominal pain
- High fever
- Rapid pulse
- Vomiting
- Therapeutic Management:
- Peritonitis is often accompanied by a paralytic ileus (a blockage of inflamed intestines)
- Requires insertion of a NGT to prevent vomiting and to rest the bowel
- Intravenous fluid or total parenteral nutrition will then be necessary
- Analgesics
- Intravenous antibiotics
- Can interfere with future fertility because it can leave scarring and adhesions in the peritoneum, which separate the fallopian tubes from the ovaries
Thrombophlebitis
- Phlebitis is inflammation of the lining of a blood vessel (Endothelium)
Postpartum Hemorrhages
- Disseminated Intravascular Coagulation (DIC) is a deficiency in clotting ability caused by vascular injury
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