Obstetrics > Puerperal Pyrexia > Flashcards

Puerperal Pyrexia Flashcards

(39 cards)

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1
Q

What is puerperal pyrexia?

A

Presence of fever (38 or above) in a woman within 6 weeks of her having given birth

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2
Q

What is the importance of puerperal sepsis?

A

It is a major cause of maternal mortality worldwide

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3
Q

How many woman die annually per year of puerperal sepsis?

A

75,000

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4
Q

Where do most of the deaths from puerperal sepsis occur?

A

In low income countries

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5
Q

What is the incidence of death from genital tract sepsis in the UK?

A

0.29 / 100,000

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6
Q

What are the causes of puerperal pyrexia/

A
  • Urinary tract infection
  • Genital tract infection
  • Mastitis
  • Post-op infection following C-section
  • DVT
  • Other infections
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7
Q

What bacteria cause 95% of post-partum UTIs?

A
  • E. Coli
  • Proteus
  • Klebsiella
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8
Q

What can cause genital tract infection in the postpartum period?

A
  • E. Coli
  • Other anaerobes
  • Group A streptococcus
  • Staphylococcus spp.
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9
Q

What bacteria usually causes mastitis?

A

Staphylococcus spp.

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10
Q

What is the risk of infection following LSCS in the UK?

A

8%

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11
Q

What other infections can cause puerperal sepsis?

A

Infections common to all, e.g. viral infection or chest infection

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12
Q

Why are the symptoms important in puerperal sepsis?

A

Because they may help localise where the source of infection is

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13
Q

What are the symptoms of UTI

A
  • Frequency
  • Dysuria
  • Haematuria
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14
Q

When may a UTI present with rigors?

A

If there is pyelonephritis

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15
Q

What are the symptoms of genital tract infection?

A
  • Tender, bulky uterus
  • Prolonged bleeding/pink or discoloured lochia
  • Painful, inflamed perineum
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16
Q

What are the symptoms of mastitis?

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A
  • Flu-like symptoms
  • Painful, hard, red breast with possible abscess
  • Nipple trauma and cellulitis
17
Q

What are the symptoms of post-LCSC infection?

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A
  • Painful, red suture line
  • Deep tenderness on palpation
  • Lochia pink/discoloured
18
Q

What are the symptoms of DVT?

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A

Painful and swollen calf

19
Q

What do you need to determine when taking a history from someone with suspected puerperal sepsis?

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A
  • When the membranes ruptured
  • Length of labour
  • Instrumentation used
  • Sutures required
  • If placenta was complete
  • If any bleeding during or after delivery
20
Q

What investigations should be done in suspected puerperal sepsis?

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A
  • High vaginal swab
  • Urine culture and microscopy
  • Other swabs as necessary, e.g. wound swabs, throat swabs
  • FBC
  • Blood cultures x2
  • Ultrasound scan
21
Q

When might ultrasound scan be required in suspected puerperal sepsis?

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A

To assist in diagnosis of retained products of conception

22
Q

What general measures should be taken in the management of puerperal sepsis?

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A

Rest and adequate fluid intake are required, particularly for mothers who are breastfeeding

23
Q

What may be helpful for pain relief from perineal wounds or mastitis?

24
Q

What is recommended when severe sepsis is suspected?

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A

IV administration of broad-spectrum antibiotics within 1 hour

25
What should antibiotics be commenced after when there is a suspicion of sepsis?
Taking specimens
26
Should you wait until the results of specimens are available until giving antibiotics in suspected sepsis?
No
27
What antibiotic regime is recommended in sepsis?
Combination of piperacillin/tazobactam, or a carbapenum + clindamycin
28
What is the advantage of the combination of antibiotics given in sepsis?
Provides broadest ranges of treatment
29
When should the advice of a consultant microbiologist be sought in puerperal sepsis?
At an early stage
30
Why should the advice of a microbiologist be sought at an early stage in puerperal sepsis?
Breastfeeding limits the use of some anti-microbials
31
When is IV immunoglobulin recommended in puerperal sepsis?
In severe invasive streptococcal or staphylococcal infection, if other therapies have failed
32
What analgesia should be avoided in cases of puerperal sepsis?
NSAIDs
33
Why should NSAIDs be avoided in cases of puerperal sepsis?
As they inhibit the ability of polymorphs to fight GAS infection
34
What do the possible complications of puerperal sepsis depend on?
The site
35
What complications are common to all sites of puerperal sepsis?
- Septicaemia - Pulmonary embolism - Disseminated intravascular coagulation - Pneumonia
36
What are the specific complications of puerperal genital tract sepsis?
- Abscess formation - Adhesions - Peritonitis - Haemorrhage - Subsequent infertility
37
What are the specific complications of puerperal urinary tract sepsis?
- Pyelonephritis | - Renal scarring
38
What are the specific complications of puerperal mastitis?
Formation of breast abscess
39
What measures can be taken to avoid puerperal sepsis?
- Any GAS infection identified during pregnancy should be treated aggressively - Catheterisation should be avoided where possible - Perineal wounds should be cleaned and sutured as soon as possible after delivery - All blood losses and the completeness of the placenta should be recorded at deliveries
Obstetrics
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