Introduction
Puerperal pelvic infection
Puerperal fever
>38ºC more than 24 hours after delivery.
At least 2 of the first 10 postpartum days.
Treatment
Broad-spectrum empiric IV antibiotics (eg, clindamycin and gentamicin) until patients have been afebrile for 48 hours (24 hours for chorioamnionitis)
Uterine infection
C-sec?? RR 25. ??? ??, ??? ??, ???? PROM
Mixed? ?? ??? Anaerobic, ?? Peptostreptococcus – m/c
Clinical features
- Uterine fundal tenderness
- ??, ??, ???? ??? ? ???(??? ??? ?? ?)
- Membrane rupture? prologed labor? ??
- Endometritis
- Infection of the decidua
- Endomyometritis
- Endoparametritis
Diagnosis
????? ???. ??? x. WBC??? ???? ?? ??.
Treatment
- Mild?? Oral ???, severe?? IV ???. ??? 2-3? ?? ???
- Clindamycin + Gentamycin for pelvic infection following C-sec
- Should be continued until the patient is afebrile for >24 hours.
Prevention
- Incision???? ?, ?? ?? ??? ???? ???.
- Ampicillin (or Vanco) + Cephalosporin
Complications of Uterine and Pelvic Infections
Wound dehiscence
- More common in obese patients, those who are immunocompromised, and those with increased intraabdominal straining (eg, excessive lifting, cough)
- Superficial
- With an intact rectus fascia. Within the first postoperative week
- Secondary to abnormal subcutaneous fluid buildup (eg, seroma)
- ? Regular dress changes
- Deep (fascial)
- Involves rectus fascia (ie, nonintact)
- Results in exposure of the intraabdominal organs to the external environment.
- ? Surgical emergency
Abdominal Incisional Infections
Risk factors
Obesity, emergency surgery (eg, inaadequatae skin antisepsis or antibiotic prophylaxis)
Clinical manifestations
Wound induaration and erythema.
Edema, subcutaneous fluid accumulation, and increased peri-incisional pain.
Treatment
1st generation cephalosporins (eg, cephalexin)
Necrotizing Fasciitis
Adnexal Abscesses and Peritonitis
Parametrial Phlegmon ???? ????
Section ?? ?? ? Parametrium? ??.
??? ??? surgery ??
Pelvic abscess? ?????.
72hr IV anti?? fever ??? ??.
?????? ?? IV ??? ??? ??.
CT-directed needle drainage, Colpotomy (open?? ? ??)
Septic Pelvic Thrombophlebitis
Pelvic infection leads to infection of the vein wall and intimal damage, leading in turn to thrombogenesis. The clot is then invaded by micro-organisms.
FIGURE 37-6
Septic pelvic thrombophlebitis: uterine and parametrial infection may extend to any pelvic vessel as well as the inferior vena cava. The clot in the right common iliac vein extends from the uterine and internal iliac veins and into the inferior vena cava. The ovarian vein septic thrombosis extends halfway to the vena cava.
FIGURE 37-7
Septic ovarian vein thrombosis—contrast-enhanced computed tomography scan. A. Enlarged right ovarian vein filled with low-density thrombus (black arrow). Contrast is seen in ureter (white arrow). R = lower pole, right kidney.
B. Coronal image demonstrates enlarged right ovarian vein filled with low-density thrombus (arrows).
Treatment
Broad-spectrum antibiotics and anticoagulation with heparin for 7-10 days.
Perineal Infections
Infection of the Perineum, Vagina, and Cervix
?? ?? ?? ??? open wound, remove suture, IV ???
??, ??, scrub wound ?? 2?
?? ?? ?? ??? ???? delayed suture ?? ??.
Toxic Shock Syndrome
Acute febrile illness with severe multisystem derangement, 10-15%
Tampon ??? ??
Supportive + anti + ?? wound debridement, hysterectomy ??
Breast infections
Engorgement
i. 3-5? ?, Milk leakage, pain
ii. Supportive care
Mastitis
i. 10? ?, unilateral, ? sign.
ii. S.aureus? ?? ??, ?? ??!
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