Postpartum Infections: Diagnosis and Management

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Questions and Answers

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?

Blood culture

Sonogram (correct)

Urine analysis

Culture from perineal pad

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?

Oxytocic agent Signup and view all the answers

Why is it important for patients to take the full course of antibiotics prescribed for endometritis?

To prevent tubal scarring and interference with future fertility Signup and view all the answers

What instruction is important to give to patients before hospital discharge regarding endometritis?

Instruct about signs and symptoms of endometritis Signup and view all the answers

What is the main cause of Disseminated Intravascular Coagulation (DIC) in the context of postpartum complications?

Clotting deficiency due to vascular injury Signup and view all the answers

What is the conventional method of detecting infection during the puerperium?

Elevated white blood cell count Signup and view all the answers

What are the symptoms associated with Endometritis, as described in the text?

Dark brown lochia and foul odor Signup and view all the answers

How do bacteria typically gain access to the uterus in cases of Endometritis?

Through the vagina Signup and view all the answers

What is indicated by a white blood cell count increase to 20,000 to 30,000 cells/mm3 in a postpartal woman?

Normal postpartum response to stress Signup and view all the answers

What is one of the risks associated with Retained Placental Fragments postpartum?

Postpartum hemorrhage Signup and view all the answers

What is one of the gravest complications of childbearing and a major cause of death from puerperal infection?

Peritonitis Signup and view all the answers

How does the infection spread in puerperal peritonitis?

Through the lymphatic system or directly through the fallopian tubes or uterine wall Signup and view all the answers

Where may an abscess form in puerperal peritonitis, and why?

In the cul-de-sac of Douglas, because this is the lowest point of the peritoneal cavity and gravity causes infected material to localize there Signup and view all the answers

What are the key assessment findings in puerperal peritonitis?

Rigid abdomen, abdominal pain, high fever, rapid pulse, and vomiting Signup and view all the answers

What is the therapeutic management for puerperal peritonitis?

All of the above Signup and view all the answers

How can puerperal peritonitis affect future fertility?

It can lead to scarring and adhesions in the peritoneum, which can separate the fallopian tubes from the ovaries and prevent ova from easily entering the tubes. Signup and view all the answers

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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Description

This quiz covers the diagnosis and therapeutic management of postpartum infections, specifically focusing on endometritis. Topics include using sonogram for confirming placental fragments, sterile vaginal swab culture, antibiotic therapy, oxytocic agents, and pain management.