2026 Obstetrics 2 Lecture Notes PDF

PCC SOM PCC SOM 2026 OBSTETRICS 2 F.04 PUERPERAL COMPLICATIONS...

PCC SOM PCC SOM 2026 OBSTETRICS 2 F.04 PUERPERAL COMPLICATIONS 2026 OBSTETRICS 2 F.04 PUERPERAL COMPLICATIONS OBSTETRICS 2 LECTURE UTERINE INFECTION o Hysterotomy has more infections than regular CS LECTURER: Donna Belle Borbe, MD, FPOGS  Fetus is already Dead fetus DATE: November 29, 2024 Endometritis Infection of the endometrium (lining of the uterus) C  Common in preterm babies ( NSD Puerperal  Perineal lacerations Ex. E. Coli from anus o Using mask − Approximately 6 weeks after giving birth o More infection with regards to CS compared to  Significant hysterotomy extension  Post-cesarean respiratory complications normal spontaneous delivery (NSD). Puerperium  Young maternal age − a stage wherein the mother has delivered the W’s APA Pe : o CS: Possible infection with abdomen and vagina. o Do not know how to take care of oneself. baby. Wind: Atelectasis, pneumonia, aspiration, Post surgical fever o NSD: Possible infection through perineum →  Nulliparity Considerations to avoid puerperal infection. pulmonary embolism Wind: didnt exercise breathing. Resp splinting vaginal canal → endometrium o Inexperience water: dehydration − Prenatal check up Water: Urinary tract infection (UTI) wound: infection 3. Type of delivery: Operative > Spontaneous  Prolonged labor induction walk: px not moving. Mobilization Wound: Wound infection o Operative delivery not only includes CS but also  Chorioamnionitis − Delivery Wonder drug Walking: Venous thromboembolism (VTE) or S More traumatic: includes forceps and vacuum. o Presence of infection in the membrane pulmonary embolism lacerations o More trauma in the delivery canal → predisposing  Obesity PUERPERAL FEVER Wonder drug: Drug fever, infection from area for infections using operative delivery.  Meconium-stained amniotic fluid 38 % indwelling lines, or a reaction to blood product  Thus, more infection with regards to operative o Unruptured:0 Sterile if kept inside the membrane  Defined by a temperature of 38.0 °C (100.4°F) or compared to spontaneous birth - higher. (If lesser: not puerperal fever) o Ruptured: foreign body in the endometrium, 4. If Hysterectomy (opening of the uterus) or cesarean uterus and its surroundings → nidus for infection  Most persistent fevers after childbirth are caused by Breast fever section was done Hysterotomy: dead fetuses genital tract infection. Rarely exceeds 39°C in the first few postpartum → bacterial proliferation o Indication:  Spiking fevers > 39°C within the first 24 hours e days and usually lasts 39°C suggest bacteremia or antibiotics. o Can be given 30 minutes to 1 hour prior to surgery o Superficial wound infection went inside that g endotoxemia o Drug-side effects or during cord clamping. caused the metritis o Bacteremia or endotoxemia > 39’ C  Stop antibiotics to resolve the fever.  The observed benefit applies to both elective and  Higher dose or stronger antibiotics must be non-elective cesarean (emergency deliveries) INCISIONAL INFECTION RISK FACTORS given Discharged home after being afebrile for at least 24 delivery. hours, and further oral antimicrobial therapy is not  Obesity  Abdominal pain and parametrial tenderness are  As noted from preliminary data, antimicrobial may needed.  Diabetes (low immune system) elicited on abdominal and bimanual examination decrease pelvic infection rates after operative vaginal However, if you are giving oral antimicrobial  Corticosteroid therapy during infection delivery. agents, complete the 7 days therapy.  Immunosuppression  Leukocytosis may range from 15,000 to 30,000  Insufficient data on the use of prophylactic  Anemia cells/μL but recall that cesarean delivery itself raises antimicrobials on-lower infection rates after o correct this prior to discharge. For patient having the leukocyte count. spontaneous vaginal delivery,- repair of all ANTIMICROBIAL REGIMENS FOR PELVIC abdominal infections, this anemia correction helps  Although an offensive odor can develop, many episiotomies, or - manual extraction of the placenta INFECTIONS FOLLOWING CESAREAN DELIVERY in faster wound recovery of the patient. women have foul-smelling lochia without evidence o Insufficient data for vaginal delivery but for both Regimen Comments  Hypertension for infection and vice versa. elective and non-elective CS, they will give o Sometimes, even without offensive odor, it Clindamycin + C Gold standard, ”90–97% efficacy, prophylactic antibiotics.  Hematoma formation from inadequate hemostasis connotes infection. gentamicin once-daily gentamicin dosing - o According to a study, they no longer give 4th day 20 acceptable CLINICAL MANIFESTATIONS  Some other infections, notably caused by group A β- prophylactic antibiotics especially in Grade 1 hemolytic streptococci, may be associated with scant, Plus Triple therapy episiotomy and even after delivery.  Usually cause persistent fever or fever that begins on odorless lochia Ampicillin added to regimen with approximately on the fourth day. o Lochia: Discharge of mother after delivery sepsis or suspected enterococcal Various Prophylactic Methods for Decreasing  The wound is erythematous and drains pus. o If it gives an offensive odor, check on leukocytes, infection Pelvic and Wound Infection Rates Following Delivery CBC and sepsis. Clindamycin+ aztreonam insufficiency O Gentamicin substitute for renal C+ A Route Method Study Results CAUSATIVE AGENTS o But not all mother with odorless discharge Route Delivery Peripartum Limited evidence  Generally, the same as those isolated from amniotic * predisposes to no infection. Extended- Piperacillin, piperacillin/tazobactam, antimicrobials may reduce risk ~ fluid at cesarean delivery, hospital acquired spectrum ampicillin/sulbactam, - cillin Episiotomy Perioperative Insufficient pathogens. TREATMENT penicillin ticarcillin/clavulanate prophylaxis evidence o Group A Streptococcus, S. epidermidis  Vaginal delivery Cephalosporins Cefotetan, cefoxitin, cefotaxime, Operative Peripartum Limited evidence o Oral or intramuscular antimicrobial agent may be · Cef- ceftriaxone O vaginal delivery antimicrobials may reduce risk - TREATMENT Vancomycin added to other regimens for Cesarean Perioperative Decreased 70-  Antimicrobials and surgical drainage and sufficient ORAL/ Im suspected Staphylococcus aureus X admsyn C o May not be admitted delivery antimicrobial 80% debridement of devitalized tissue.  Moderate to severe infections infections prophylaxis  Twice daily wound care o intravenous therapy with a broadspectrum N Metronidazole metronidazole has excellent anaerobic Cesarean Skin Decreased o Morning and in the evening + ampicillin + coverage antibiotic regimen is indicated /admsyn (2-36) mAG delivery preparation incidence  Primary wound intention, secondary wound closure o Admit the patient (2 to 3 days) gentamicin or vacuum assisted wound closure. o Improvement occurs in 48 to 72 hours. Carbapenems Imipenem/cilastatin, meropenem, o Primary wound intention  Persistent fever (after 48- 72 hours) ertapenem; all reserved for special COMPLICATIONS OF UTERINE AND PELVIC  Recommended; allow the wound to close itself. o Parametrial phlegmon indications INFECTIONS o Secondary wound closure or vacuum assisted  An area of intense cellulitis (painful) at the site  Infections following vaginal delivery, as many as 90 Complication  Metritis responds to antimicrobial treatment within wound closure of the uterus; ball of abscess o Abdominal incisional or pelvic abscess with percent of women respond to regimens such as ampicillin plus gentamicin. of superficial wound infxn [ C 48-72 hours in >90% of women.  Advised in some certain cases. o Vacuum assisted wound closure  In some of the remainder, any of several regards to cesarean section complications may arise. These include:  Tegaderm o hematoma due to not well cleansed abdomen PERIOPERATIVE PROPHYLAXIS Wound dressing that is not replaced up to o Wound infection o Septic pelvic thrombophlebitis in the area of blood  The use of periprocedural antibiotics is common in o Phlegmon or abscess one week Tegaderm: can change after 1 wk vessels around the uterus obstetrics.  Complex pelvic infection o Septic pelvic thrombophlebitis NOTE TAKER: ✔SANGDAAN | BALAO-AS | MABANTA | 📑📑MARTINEZ Page 3 | 8 NOTE TAKER: ✔SANGDAAN | BALAO-AS | MABANTA | 📑📑MARTINEZ Page 4 | 8  PCC SOM PCC SOM 2026 OBSTETRICS 2 FASCIAL DEHISCENCE F.04 PUERPERAL COMPLICATIONS PERITONITIS AND ADNEXAL ABSCESSES 2026 OBSTETRICS 2 F.04 PUERPERAL COMPLICATIONS  A serious complication of abdominal surgery *** Around the Uterus (kumalat na) pentonitis  With the advent of antimicrobial therapy, the TREATMENT  Bowel evisceration can be a comorbid.  Infrequently occurring metritis & mortality rate and need for surgical therapy is diminished.  Close observation and broad-spectrum antimicrobial  Presents within the first 7 to 10 postoperative days  Adnexal abscess therapy  Dehiscence is a surgical emergency o infection from the fallopian tube or uterus admetal  Septic phlebitis arises as an extension along venous  Wound debridement would be necessary if with o Intestines can be strangulated  Almost always is preceded byC metritis, especially moscess routes and may cause thrombosis. purulence or pus coming out of the wound, and there o Loss of blood circulation  Gangrene  Death of cases with uterine necrosis and dehiscence  Lymphangitis often coexists is necrotic tissue visible, could be closed by the organ o Complications or spread of infection from the  Ovarian veins may become involved because they secondary intention.  High Mortality Risk uterus. drain the upper uterus and therefore the placental Primary Intention Secondary Intention  Usually this is caused by infections.  May stem from a ruptured adnexal abscess or an implantation site Healing following close Healing by granulation C FASCIA Strongest layer of the abdominal layer inadvertent intraoperative bowel injury during caesarean section, perforative appendicitis. SIGNS AND SYMPTOMS application of the wound by sutures Excessive loss of tissue  Prompt surgical treatment is usually indicated  Except for chills and occasional lower quadrant pain, If your suture on the fascial layer and the fascia o Drain the abscess women with septic thrombophlebitis usually lack TOXIC SHOCK SYNDROME would dehisce, it allows the bowel to o Give antibiotics symptoms.  An acute febrile illness with severe multisystem eviscerate meaning the bowel and other derangement organs will come out and if it comes out it can CAUSATIVE ORGANISMS DIAGNOSIS  Has a case-fatality rate of 10 to 15 percent. choke or obstruct the bowel.  Virulent strains of group A B-hemolytic streptococci  Difficult to diagnose or similar organisms  Confirmed by pelvic CT or MR imaging USUAL FINDINGS NECROTIZING FASCIATIS  Fever  Hard to treat. SIGNS AND SYMPTOMS TREATMENT  Headache  Uncommon severe wound infection  Severe pain  Antimicrobial treatment  Mental confusion  Associated with high mortality rates  May involve abdominal incisions, may complicate episiotomy or other perineal lacerations. -  Frequently, adynamic ileus o First symptom  Treatment with Heparin is controversial o May not be very useful in these cases  Diffuse macular erythematous rash  Nausea  Marked bowel distention  Vomiting  Tissue necrosis around the wound is significant. PERINEAL INFECTIONS  Watery diarrhea  Risk Factors: PARAMETRIAL PHLEGMON  Episiotomy infections are uncommon  Marked hemoconcentration o Diabetes obesity and hypertension  Intense parametrial cellulitis forming an area of  If the anal sphincter is disrupted at delivery (Grade 4  Advice during delivery: Sometimes, gauze is used to CAUSATIVE ORGANISMS broad ligament C induration—a phlegmon—within the leaves of the episiotomy infection), the subsequent infection rate is higher and is likely influenced by intrapartum pack the blood in the vagina while suturing the laceration. DO NOT FORGET TO REMOVE THE PACK.  Polymicrobial Otherwise, the patient will suffer toxic shock  These infections are considered when fever persists antimicrobial treatment o Organisms that make up the normal vaginal flora syndrome. longer than 72 hours despite intravenous  Perineal laceration infection may be complicated by  Single Virulent Bacterial Species  Renal failure followed by hepatic failure, antimicrobial therapy dehiscence due to presence of bacteria coming from o Group A beta-hemolytic streptococcus disseminated intravascular coagulation, and  Usually unilateral the anal canal.  Rarely encountered pathogens cause necrotizing circulatory collapse may progress in rapid sequence.  Fever resolves in 5-7 days  Other factors for separation include coagulation infections. CSurgery is reserved if uterine incisional necrosis is disorders, smoking, and human papillomavirus  During recovery, the rash covered areas desquamate.  Infection may involve skin, superficial and deep  This can be treated, but as much as possible, suspected. infection. subcutaneous tissues and any of the abdominopelvic prevention is better than cure. o Do not perform surgery if uterine incisional  No data suggests that dehiscence is related to faulty fascial layers necrosis is not indicated. Evaluated thru repair.  Some cases, muscle also is involved CAUSATIVE ORGANISMS ultrasound. o Myofasciatis  Antibiotics are sufficient enough to treat this. FREQUENT SYMPTOMS Staphylococcal exotoxin :S  Symptoms noted until 3 to 5 days after delivery  Persistent puerperal infections can be evaluated Toxic shock syndrome toxin 1 ppI  Local pain using computed tomography (CT) or magnetic  Dysuria with or without urinary retention (TSST-1) cause the clinical TREATMENT - resonance (MR)-imaging.  Purulent discharge manifestations by provoking  Early diagnosis Staphylococcus aureus  Fever profound endothelial injury.  Source control should be by surgical debridement. SEPTIC PELVIC THROMBOPHLEBITIS  Vulvar edema A very small amount of TSST-1  Antimicrobials (broad spectrum)  Suppurative thrombophlebitis was a frequent  Ulcerated wound covered with exudate can activates T cells to create  Intensive care complication in the pre-antibiotic era, and septic a “cytokine storm” embolization was common. NOTE TAKER: ✔SANGDAAN | BALAO-AS | MABANTA | 📑📑MARTINEZ Page 5 | 8 NOTE TAKER: ✔SANGDAAN | BALAO-AS | MABANTA | 📑📑MARTINEZ Page 6 | 8  PCC SOM PCC SOM 2026 OBSTETRICS 2 F.04 PUERPERAL COMPLICATIONS 2026 OBSTETRICS 2  F.04 PUERPERAL COMPLICATIONS 6.Which factor is LEAST associated with an increased risk C Methicillin Resistant S. What must be done: Sonography is usually diagnostic. Aureus (MRSA)  Warm the affected breast of incisional infections following cesarean delivery? Rare complication: TSS caused by S. aureus Group A Beta- Strep TTS  Pumping can alleviate this A. Obesity hemolytic  When nursing bilaterally, it is best to begin B. Hematoma formation streptococcal infection CAUSATIVE AGENTS sucking on the uninvolved breast C. Early ambulation postpartum Clostridium sordelli  This allows let down to commence before D. Corticosteroid therapy and novyi colonization moving to the tender breast.  S. aureus >>>>>>>>>>>>>>>>>>>>END