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Questions and Answers
Which of the following complications is characterized by an infection of the endometrium?
Which of the following complications is characterized by an infection of the endometrium?
What factor increases the likelihood of infections when performing a hysterotomy in comparison to a regular cesarean section?
What factor increases the likelihood of infections when performing a hysterotomy in comparison to a regular cesarean section?
For which scenario is puerperal infection most commonly observed?
For which scenario is puerperal infection most commonly observed?
What is the main concern associated with perineal lacerations during childbirth?
What is the main concern associated with perineal lacerations during childbirth?
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What is indicated by the term 'dead fetus' in the context of obstetrics?
What is indicated by the term 'dead fetus' in the context of obstetrics?
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What is the most common cause of persistent fevers after childbirth?
What is the most common cause of persistent fevers after childbirth?
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What temperature is typically associated with bacteremia or endotoxemia in the postpartum period?
What temperature is typically associated with bacteremia or endotoxemia in the postpartum period?
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In which scenario should antibiotics be stopped to resolve postpartum fever?
In which scenario should antibiotics be stopped to resolve postpartum fever?
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What is a recommended time frame for administering antibiotics prior to surgery in a non-elective cesarean?
What is a recommended time frame for administering antibiotics prior to surgery in a non-elective cesarean?
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Which of the following is a risk factor for incisional infection after cesarean delivery?
Which of the following is a risk factor for incisional infection after cesarean delivery?
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What is a common complication that may arise due to an improperly cleansed abdomen during a cesarean section?
What is a common complication that may arise due to an improperly cleansed abdomen during a cesarean section?
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What is indicated for several cases following a cesarean section?
What is indicated for several cases following a cesarean section?
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What timeframe is observed for wound infection in more than 90% of women after a cesarean section?
What timeframe is observed for wound infection in more than 90% of women after a cesarean section?
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Which of the following is essential for peroperative prophylaxis in obstetrics?
Which of the following is essential for peroperative prophylaxis in obstetrics?
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What is a potential outcome of septic pelvic thrombophlebitis associated with a cesarean section?
What is a potential outcome of septic pelvic thrombophlebitis associated with a cesarean section?
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How long can a cling film dressing, such as Tegaderm, be left in place postoperatively?
How long can a cling film dressing, such as Tegaderm, be left in place postoperatively?
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Which of these complications is NOT typical after a cesarean section?
Which of these complications is NOT typical after a cesarean section?
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What is one of the several complications that can arise from a cesarean section?
What is one of the several complications that can arise from a cesarean section?
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What is frequently the first symptom of adynamic ileus?
What is frequently the first symptom of adynamic ileus?
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Which of the following is a controversial treatment for adynamic ileus?
Which of the following is a controversial treatment for adynamic ileus?
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What signifies tissue necrosis in the context of perineal infections?
What signifies tissue necrosis in the context of perineal infections?
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Which risk factors are associated with increased susceptibility to perineal infections?
Which risk factors are associated with increased susceptibility to perineal infections?
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What is a likely consequence of disrupting the anal sphincter during delivery?
What is a likely consequence of disrupting the anal sphincter during delivery?
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What might be used during delivery to manage bleeding while suturing a laceration?
What might be used during delivery to manage bleeding while suturing a laceration?
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What type of rash is associated with the symptoms described?
What type of rash is associated with the symptoms described?
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Study Notes
Puerperal Complications
- Puerperal infections are bacterial infections of the genital tract after delivery.
- Puerperal fever is defined by a temperature of 38.0°C (100.4°F) or higher.
- Puerperium is the stage after delivering the baby, lasting approximately 6 weeks.
- Infections are reduced by the advent of antibiotics.
Puerperal Fever
- Persistent fevers after childbirth are commonly caused by genital tract infections.
- Spiking fevers above 39°C (102.2°F) within 24 hours postpartum suggest possible virulent pelvic infection from Group A Streptococcus.
- Factors contributing to puerperal fever include breast engorgement urinary infections episiotomy/abdominal incisions perineal lacerations post-cesarean respiratory complications.
- Infection can arise from the episiotomy, spreading to the vagina then uterus.
Uterine Infection
- Endometritis: Infection of the endometrium (lining of the uterus).
- Endomyometritis: Infection of the endometrium and uterine muscles.
- Endoparametritis: Inflammation involving the uterine serosa (covering).
- Uterine infections (metritis) can escalate into pelvic cellulitis.
Predisposing Factors for Uterine Infection
- Route of delivery (cesarean section > vaginal delivery).
- Mode of delivery (operative > spontaneous).
- Operative deliveries (e.g., forceps, vacuum) are more traumatic increasing the risk of infection.
- Hysterotomy is riskier than regular cesarean.
Other Risk Factors
- Prolonged labor.
- Ruptured membranes.
- Multiple cervical examinations (limit to 6).
- Internal fetal monitoring.
- Low socioeconomic status.
- General anesthesia.
- Young maternal age.
- Nulliparity.
- Prolonged labor induction.
- Chorioamnionitis.
- Obesity.
- Meconium-stained amniotic fluid (important but not a factor except with rupture).
Signs and Symptoms of Uterine Infection
- Fever is the most important diagnostic criterion.
- Abdominal pain and parametrial tenderness are common findings.
- Leukocytosis (15,000-30,000 cells/µl) can occur but is influenced by cesarean delivery.
- Foul-smelling lochia (vaginal discharge) isn't always indicative of infection.
Treatment of Uterine Infection
- Oral or intramuscular antibiotics may suffice for vaginal delivery.
- Severe infections necessitate intravenous antibiotics and hospitalization.
- Improvement usually occurs within 48-72 hours.
- Persistent fever after this time requires stronger antibiotics and investigation.
- Prophylactic antibiotics reduce infection rates during cesarean delivery, but less supported for vaginal deliveries.
Abdominal Incisional Infections
- Common cause of persistent fever after metritis.
- Infection may extend from superficial wound infection.
- Risk factors include obesity, diabetes, and corticosteroid use.
- Symptoms usually appear on the 4th day post-delivery.
- Treatment includes antibiotics, wound care, and potentially surgical debridement.
Necrotizing Fasciitis
- Rare, severe, and high-mortality infection.
- Polymicrobial or caused by a single virulent species like group A Streptococcus.
- Infection spreads to abdominal layers.
- Early diagnosis (within 3-5 days) and surgical debridement, with broad-spectrum antibiotics, and intensive care are critical.
Peritonitis and Adnexal Abscesses
- Adnexal abscess (infection of fallopian tubes).
- Often arises from uterine infections or intraoperative events.
- Diagnosis often requires surgery (drain the abscess) and antibiotics.
Septic Pelvic Thrombophlebitis
- Rare complication in the modern era.
- Usually follows an extension of venous thrombosis.
- Diagnosis is challenging, utilizing CT or MRI.
- Treatment involves antimicrobial therapy (controversial use of heparin).
Perineal Infections
- Grade 4 episiotomy has a high infection rate due to sphincter disruption.
- Perineal lacerations can be infected through bacteria in anal canal.
- Treatment includes close observation and broad-spectrum antimicrobials.
- Wound debridement may be necessary.
Toxic Shock Syndrome
- Acute multisystem illness with high fatality.
- Associated bacterial toxin (TSST-1 from Staphylococcus aureus).
- Symptoms include fever, headache, confusion, rash, nausea, vomiting.
- Prompt treatment is critical, though prevention is better.
Breast Infections (Mastitis)
- Accounts for approximately 3% of postpartum cases.
- Risk factors include nursing difficulties and cracked nipples.
- Usually unilateral.
- Infection starts with engorgement then inflammation.
- Treatment includes antibiotics (dicloxacillin first-line), supportive measures (warm compresses, pumping).
- Breastfeeding can continue during treatment.
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Description
This quiz covers the critical aspects of puerperal complications, focusing on infections that can occur in the genital tract after childbirth. You'll learn about puerperal fever, its symptoms, causes, and the role of antibiotics in reducing these infections. Test your knowledge on the various types of uterine infections as well.
