Medical Complications In Pregnancy
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Medical Complications In Pregnancy

on

  • 6,127 views

Medical complications in pregnancy...

Medical complications in pregnancy...

Statistics

Views

Total Views
6,127
Views on SlideShare
6,117
Embed Views
10

Actions

Likes
1
Downloads
319
Comments
0

2 Embeds 10

http://www.slideshare.net 9
http://www.onlydoo.com 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Medical Complications In Pregnancy Presentation Transcript

  • 1. MEDICAL CONDITIONS COMPLICATING PREGNANCY
  • 2. DIABETES MELLITUS
  • 3. DEFINITION OF TERMS
    • OVERT DIABETES
    • - those known to have diabetes mellitus
    • before pregnancy
    • GESTATIONAL DIABETES
    • - those diagnosed during pregnancy
  • 4. CLASSIFICATION DURING PREGNANCY
    • CLASS ONSET FBS 2-HR PP GL THERAPY
    • A1 Gestational <105 mg/dl <120 mg/dl Diet
    • A2 Gestational >105 mg/dl >120 mg/dl Insulin
  • 5. CLASSIFICATION DURING PREGNANCY
    • CLASS AGE/ONSET DURATION VASCULAR THERAPY
    • (Years) DISEASE
    • B Over 20 < 10 None Insulin
    • C 10 – 19 10 – 19 None Insulin
    • D Before 10 > 20 Benign Insulin
    • Retinopathy
    • F Any Any Nephropathy Insulin
    • R Any Any Proliferative Insulin
    • Retinopathy
    • H Any Any Heart Insulin
  • 6. GESTATIONAL DIABETES
    • carbohydrate intolerance of variable severity with onset or first recognition during pregnancy
    • disorder of late gestation
    • disorder induced by pregnancy:
    • from exagerrated physiological changes
    • in glucose metabolism
    • Type 2 DM unmasked during pregnancy
  • 7.
    • A 23 yr old markedly obese primigravida at 12 weeks gestation seeks consultation for her first prenatal check-up. She denies any family history of diabetes mellitus. As part of prenatal work-up, you would:
    • A. take a 50 gm glucose challenge test as soon as possible
    • B. order for 50 gm glucose challenge test at 24-28 weeks
    • C. take a 100 gm oral glucose tolerance test as soon as possible
    • D. order for a 100 gm oral glucose tolerance test at 24-28 weeks
  • 8. WHO to screen ?
  • 9. GDM - SCREENING
    • RISK FACTORS
    • Age over 30
    • Family Hx of DM
    • Prior macrosomic, malformed or stillborn infant
    • Obesity
    • Hypertension
    • Glucosuria
  • 10. WHEN to screen ?
  • 11. RECOMMENDED SCREENING STRATEGY BASED ON RISK ASSESSMENT FOR DETECTING GDM
    • LOW RISK
    • Blood glucose testing not routinely required if all of the ff characteristics are present:
    • Member of ethnic grp w/ low prevalence of GDM
    • No known DM in 1 st degree relative
    • Age less than 25 yrs
    • Weight normal before pregnancy
    • No Hx of abnormal glucose metabolism
    • No Hx of poor obstetrical outcome
  • 12. RECOMMENDED SCREENING STRATEGY BASED ON RISK ASSESSMENT FOR DETECTING GDM
    • AVERAGE RISK
    • Perform blood glucose testing at 24-28 wks:
    • Hispanic
    • African
    • Native American
    • South or East Asian origin
  • 13. RECOMMENDED SCREENING STRATEGY BASED ON RISK ASSESSMENT FOR DETECTING GDM
    • HIGH RISK
    • Perform blood glucose testing as soon as feasible . If normal, repeat at 24-28 wks or at any time pt has SSx suggestive of hyperglycemia:
    • Marked obesity
    • Strong family Hx of type 2 DM
    • Prior gestational diabetes
    • Glucosuria
  • 14. HOW to screen ?
  • 15. GDM - SCREENING
    • 50-g GLUCOSE CHALLENGE TEST
    • > 140 mg/dl or > 130 mg/dl
    • – proceed to 100 gm 3 Hr Oral Glucose Tolerance Test
  • 16. GDM - SCREENING
    • 100-gm ORAL GLUCOSE TOLERANCE TEST (OGTT)
    • TIME NDDG CARPENTER & COUSTAN
    • (1979) (1989)
    • Fasting 105 95
    • 1 hour 190 180
    • 2 hours 165 155
    • 3 hours 145 140
    • GDM is dxed with 2 or > abn values.
  • 17.
    • A 23 yr old markedly obese primigravida at 12 weeks gestation seeks consultation for her first prenatal check-up. She denies any family history of diabetes mellitus. As part of prenatal work-up, you would:
    • A. take a 50 gm glucose challenge test as soon as possible
    • B. order for 50 gm glucose challenge test at 24-28 weeks
    • C. take a 100 gm oral glucose tolerance test as soon as possible
    • D. order for a 100 gm oral glucose tolerance test at 24-28 weeks
  • 18. GDM - ADVERSE EFFECTS
    • MACROSOMIA
    • Excessive fat deposition on shoulders/trunk
    • Predisposes to shoulder dystocia
    • Maternal hyperglycemia  transfer of excess glucose to fetus  stimulate fetal insulin secretion which is a potent growth factor
    • HYPOGLYCEMIA at birth
  • 19. MACROSOMIA Pathogenesis
  • 20.
    • Fetal effects of persistent maternal fasting hyperglycemia include:
    • A. macrosomia
    • B. postterm pregnancy
    • C. oligohydramnios
    • D. hypoglycemia
  • 21. GDM - MANAGEMENT
    • Type A1 – diet alone
    • Type A2 – diet + insulin
    • DIET
    • Goals: 1. to provide the necessary nutrients for
    • mother and fetus
    • 2. to control glucose levels
    • 3. to prevent starvation ketosis
    • EXERCISE
    • upper body cardiovascular training
  • 22.
    • Recommended postpartum follow-up for patients with gestational diabetes consists of:
    • A. daily blood sugar monitoring
    • B. fasting blood sugar on day of discharge
    • C. 50 gm glucose challenge test 1 week postpartum
    • D. 75 gm oral glucose tolerance test 6 weeks postpartum
  • 23. GDM - PROGNOSIS
    • 50% risk of developing overt DM w/in 20 yrs
    • Evaluate with 75-gm OGTT – 6-12 wks pp
    • TIME NO DIABETES IMPAIRED DIABETES
    • GL. TOL.
    • Fasting < 115 < 140 >/= 140
    • ½, 1, 1-½ All < 200 1 value >/= 200 1 value >/=200
    • 2 hr < 140 140 – 199 >/= 200
    • If 75-g OGTT is normal – take FBS yearly
  • 24.
    • Recommended postpartum follow-up for patients with gestational diabetes consists of:
    • A. daily blood sugar monitoring
    • B. fasting blood sugar on day of discharge
    • C. 50 gm glucose challenge test 1 week postpartum
    • D. 75 gm oral glucose tolerance test 6 weeks postpartum
  • 25. OVERT DIABETES
    • Pregestational diabetes
    • Known diabetics before pregnancy
  • 26.
    • The diagnosis of overt diabetes is most probable in the gravida with which of the ff OGTT results (Fasting-1hr-2hr-3hr post glucose load – mg/dl):
    • A. 100 – 190 – 170 – 130
    • B. 90 – 195 – 140 – 120
    • C. 95 - 180 - 155 - 140
    • D. 130 - 170 - 160 - 135
  • 27. OVERT DIABETES
    • DIAGNOSIS DURING PREGNANCY
    • RBS >200 mg/dl + Sx: polyuria, polydipsia, wt loss
    • Fasting glucose > 125 mg/dl
    • Strong likelihood in pts with:
    • strong family Hx of DM
    • previous large infants
    • persistent glucosuria
    • unexplained fetal losses
  • 28.
    • The diagnosis of overt diabetes is most probable in the gravida with which of the ff OGTT results (Fasting-1hr-2hr-3hr post glucose load – mg/dl):
    • A. 100 – 190 – 170 – 130
    • B. 90 – 195 – 140 – 120
    • C. 95 - 180 - 155 - 140
    • D. 130 - 170 - 160 - 135
  • 29. OVERT DIABETES
    • EFFECTS ON FETUS
    • ABORTION – poor glycemic control
    • HbA1c > 12%
    • persistent pre-prandial glucose level > 120 mg/dl
    • MALFORMATIONS
    • Type 1 – 5-10% incidence
    • from poorly controlled DM preconceptionally and in early pregnancy
  • 30. OVERT DIABETES
    • EFFECTS ON FETUS
    • UNEXPLAINED FETAL DEATH
    • HYDRAMNIOS
    • from fetal polyuria
    • RESPIRATORY DISTRESS
    • from prematurity
    • HYPOGLYCEMIA
    • from hyperplasia of fetal B-islet cells
  • 31. OVERT DIABETES
    • EFFECTS ON FETUS
    • HYPOCALCEMIA
    • HYPOBILIRUBINEMIA
    • prematurity
    • polycythemia with hemolysis
    • CARDIAC HYPERTROPHY
    • INHERITANCE OF DM
    • Diabetic Mother – 1-3% risk
    • Diabetic Father – 6%
    • Diabetic Father and Mother – 20 % risk
  • 32. OVERT DIABETES
    • EFFECTS ON MOTHER
    • DIABETIC NEPHROPATHY
    • inc. when HbA1c > 10%
    • microalbuminuria  overt proteinuria
    •  HPN  end-stage renal dse
    • DIABETIC RETINOPATHY
    • after 7 yrs – 50% chance of dev.
    • after 20 yrs – 90%
    • DIABETIC NEUROPATHY
  • 33. OVERT DIABETES
    • EFFECTS ON MOTHER
    • PREECLAMPSIA
    • not related to glucose control
    • KETOACIDOSIS
    • result of: hyperemesis gravidarum
    • use of B sympathomimetic drugs
    • (tocolytics)
    • infections
    • use of corticosteroids
    • INFECTIONS – 80%
  • 34. OVERT DIABETES MANAGEMENT
    • PRECONCEPTION
    • HbA1c – expresses an ave. of circulating
    • glucose for the past 4-6 wks
    • - assess metabolic control
    • - > 10% - inc. risk for malformations
    • Folate – 400 ug/day
    • - to decrease neural tube defects
  • 35. OVERT DIABETES MANAGEMENT
    • PREGNANCY
    • Blood glucose monitoring
    • Precise fetal age determination
    • LMP, FH, FHT, U/S
    • Well established EDC – to assess accurately
    • macrosomia, hydramnios, FGR
    • Diet
    • Insulin
  • 36. PULMONARY DISORDERS
  • 37. NORMAL CHANGES IN PREGNANCY
  • 38. PULMONARY TUBERCULOSIS
  • 39. TUBERCULOSIS
    • Organism: Mycobacterium tuberculosis
    • DIAGNOSIS
    • Symptoms: cough w/ minimal sputum
    • low-grade fever
    • hemoptysis
    • weight loss
  • 40. TUBERCULOSIS
    • DIAGNOSIS
    • Lab: Chest Xray
    • cavitations
    • mediastinal lymphadenopathy
    • extent of dse may be masked by lung compression
    • Sputum exam – acid-fast bacilli
  • 41.
    • Recommended initial treatment of active tuberculosis during pregnancy is:
    • A. INH, Ethambutol, Rifampin
    • B. INH, Ethambutol, Pyrazinamide, Rifampin
    • C. INH, Rifampin, Streptomycin
    • D. INH only
  • 42. TUBERCULOSIS
    • MANAGEMENT
    • Isoniazid + Rifampicin + Ethambutol for a minimum of 9 months (WHO: + Purazinamide x 6 months)
    • EFFECT ON PREGNANCY
    • Preterm delivery
    • Low birthweight
    • Perinatal death
    • Neonatal tuberculosis – rare, fatal
    • Route: hematogenous
    • aspiration of inf secretion at del unlikely if Rxed
  • 43.
    • Recommended initial treatment of active tuberculosis during pregnancy is:
    • A. INH, Ethambutol, Rifampin
    • B. INH, Ethambutol, Pyrazinamide, Rifampin
    • C. INH, Rifampin, Streptomycin
    • D. INH only
  • 44. URINARY TRACT DISORDERS
  • 45.
    • Which of the ff laboratory values is not normal during pregnancy and suggests an underlying renal disease:
        • A. Urinalysis: glucose +
        • B. mild right hydronephrosis on ultrasound
        • C. serum creatinine – 1.2 mg/dl
        • D. Urinalysis: protein - trace
  • 46. NORMAL CHANGES IN PREGNANCY
    • Increased renal size
    • Dilatation of pelves, calyces and ureters
    • - not to be mistaken for obstructive uropathy
    • - predispose to serious upper urinary tract infections
    • Increased GFR and RPF
    • - Serum creatinine and urea nitrogen decrease
  • 47. DIAGNOSTIC TESTS
    • Urinalysis
    • glucosuria
    • orthostatic proteinuria
    • Serum creatinine
    • > 0.9 mg/dl – suspect intrinsic renal dse
    • Ultrasonography
    • Intravenous pyelography
    • if indicated, one-shot pyelogram
    • Cystoscopy
    • Renal Biopsy (?)
  • 48.
    • Which of the ff laboratory values is not normal during pregnancy and suggests an underlying renal disease:
        • A. Urinalysis: glucose +
        • B. mild right hydronephrosis on ultrasound
        • C. serum creatinine – 1.2 mg/dl
        • D. Urinalysis: protein - trace
  • 49. URINARY TRACT INFECTION
  • 50.
    • Acute Uncomplicated Cystitis is most likely in this case:
    • A. A 26-year-old G1P0 with fever,
    • dysuria and flank pains
    • B. A 35-year-old G3P2 with hematuria
    • and colicky right flank pain
    • C. An 18-year-old G3P0020 with
    • dysuria, urinary frequency & yellow-
    • green vaginal discharge
    • D. A 28-year-old G2P1 with dysuria and
    • urinary urgency
  • 51. URINARY TRACT INFECTIONS
    • ASYMPTOMATIC BACTERIURIA
    • DIAGNOSIS
    • Clean-voided specimen containing >100,000 org/ml
    • MANAGEMENT
    • Nitrofurantoin (or Ampicillin, Amoxycillin, Cephalosporin)
    • If untreated, 25% develop acute Sxtic infection.
  • 52. URINARY TRACT INFECTION
    • CYSTITIS AND URETHRITIS
    • DIAGNOSIS
    • Symptoms: dysuria
    • urgency
    • urinary frequency
    • Lab: UA – pyuria, bacteriuria, hematuria
    • MANAGEMENT
    • Ampicillin (or Sulfonamides,Nitrofurantoin, Cephalosporin)
  • 53. URINARY TRACT INFECTION
    • ACUTE PYELONEPHRITIS
    • Leading cause of septic shock during pregnancy (endotoxemia)
    • More common after mid-pregnancy
    • Uslly right-sided
    • Uslly an ascending infection from lower UTI
  • 54. URINARY TRACT INFECTION
    • ACUTE PYELONEPHRITIS
    • DIAGNOSIS
    • Symptoms: fever
    • shaking chills
    • aching pain – lumbar areas
    • P.E.: costovertebral angle tenderness
    • Lab: UA – leukocytes in clumps
    • Urine culture – E. coli 77%
    • Klebsiella pneumoniae 11%
    • Enterobacter / Proteus 4%
  • 55. URINARY TRACT INFECTION
    • ACUTE PYELONEPHRITIS
    • MANAGEMENT
    • Hospitalization
    • Urine and blood cultures
    • CBC, Serum creatinine, and electrolytes
    • Rpt in 48 hrs
    • Chest Xray – if w/ dypnea or tachypnea
    • Monitor V/S, urine output (FBC)
    • IV crystalloid to establish UO to 30 ml/hr or >
  • 56. URINARY TRACT INFECTION
    • ACUTE PYELONEPHRITIS
    • MANAGEMENT
    • Antimicrobial therapy
    • Ampicillin + Gentamycin
    • or Cephalosporins
    • Intravenous
    • Change to po when afebrile – 7-10 days
    • Urine culture 1-2 wks after completion of Rx
    • 30-40% - recurrent infection
  • 57.
    • Acute Uncomplicated Cystitis is most likely in this case:
    • A. A 26-year-old G1P0 with fever,
    • dysuria and flank pains
    • B. A 35-year-old G3P2 with hematuria
    • and colicky right flank pain
    • C. An 18-year-old G3P0020 with
    • dysuria, urinary frequency & yellow-
    • green vaginal discharge
    • D. A 28-year-old G2P1 with dysuria and
    • urinary urgency
  • 58. THYROID DISORDERS
  • 59. NORMAL CHANGES IN PREGNANCY
    • Moderate thyroid enlargement
    • - glandular hpl and vascularity
    • Inc. uptake of radioiodine by maternal thyroid
    • Inc. total serum thyroxine and triiodothyronine
    • Inc. thyroid binding globulin
  • 60. HYPERTHYROIDISM
    • DIAGNOSIS:
    • Tachycardia
    • Thyromegaly
    • Failure to gain weight despite normal or increased food intake
    • Marked elevation of plasma thyroxine
    • Elevated sleeping pulse rate
    • exophthalmos
  • 61. GRAVE’S DISEASE
    • Most common cause of thyrotoxicosis in pregnancy
    • Autoimmune process associated with thyroid stimulating antibodies
    • Autoantibodies mimic thyrotropin and stimulate thyroid function
  • 62.
    • A 37 yr old G2P1 12 weeks gestation presents for her first prenatal check-up. She had been diagnosed with Grave’s disease and maintained on propylthiouracil. Currently, she is euthyroid. Which of the ff statements is appropriate in counseling this patient:
    • She must discontinue PTU because it is associated with leukopenia.
    • Infants born to mothers on PTU may develop goiter and be clinically hypothyroid.
    • PTU does not cross the placenta.
    • Thyroid storm is a common complication in pregnant women with Graves disease.
  • 63. GRAVE’S DISEASE
    • MANAGEMENT
    • Medical
    • Propylthyouracil / Methimazole
    • readily cross placenta & induce
    • fetal hypothyroidism & goiter
    • dose depends on total serum
    • thyroxine level which should
    • be in upper N range for preg
  • 64.
    • A 37 yr old G2P1 12 weeks gestation presents for her first prenatal check-up. She had been diagnosed with Grave’s disease and maintained on propylthiouracil. Currently, she is euthyroid. Which of the ff statements is appropriate in counseling this patient:
    • She must discontinue PTU because it is associated with leukopenia.
    • Infants born to mothers on PTU may develop goiter and be clinically hypothyroid.
    • PTU does not cross the placenta.
    • Thyroid storm is a common complication in pregnant women with Graves disease.
  • 65. GRAVE’S DISEASE
    • MANAGEMENT
    • Surgical – Subtotal Thyroidectomy
    • after thyrotoxicosis is under control or pt nearly euthyroid
    • done in 2 nd tri or early 3 rd tri
    • elective
    • Indications:
    • 1. women who cannot adhere to
    • medical Rx
    • 2. women in whom drug therapy is toxic
  • 66. GRAVE’S DISEASE
    • EFFECT ON PREGNANCY
    • Higher incidence of preeclampsia
    • heart failure
    • EFFECT ON NEONATE
    • Neonatal thyrotoxicosis
    • fr transplacental passage of maternal thyroid stimulating ab
  • 67. HYPOTHYROIDISM
    • DIAGNOSIS
    • Absence of normal rise in serum thyroxine
    • Increased thyrotropin level
    • Uncommon in pregnancy because associated with infertility
  • 68. HYPOTHYROIDISM
    • EFFECT ON PREGNANCY
    • Inc. incidence of abortion, SB, LBW
    • preeclampsia
    • placental abruption
  • 69. HYPOTHYROIDISM
    • EFFECT ON NEONATE
    • Usually healthy
    • Simple Colloid goiter w/o hypothyroidism – no effect
    • Severe hypothyroidism sec. to maternal radioiodine Rx during pregn  destruction of fetal thyroid  cretinism
  • 70. HYPOTHYROIDISM
    • MANAGEMENT
    • Thyroid hormones
    • dose adjusted so that serum thyrotropin level is w/in N range
  • 71.
    • Thyroid function tests showing an elevated serum thyrotropin, normal serum thyroxine and normal triiodothyronine in an asymptomatic woman at 14 weeks gestation is diagnostic of:
        • A. Hypothyroidism
        • B. Hyperthyroidism
        • C. Subclinical hypothyroidism
        • D. Subclinical hyperthyroidism
  • 72. PUERPERAL INFECTION
  • 73. 10 days post cesarean section, a 23 yr old primipara complains of fever of 3 days duration associated with hypogastric pain. Temp – 40 C. Breasts are slightly tender. Pelvic exam shows tenderness over the area of the uterus and parametria. The most likely consideration is: A. Breast engorgement B. Acute pyelonephritis C. Metritis with pelvic cellulitis D. Septic pelvic thrombophlebitis
  • 74. PUERPERAL MORBIDITY
    • temperature 38 C or higher, the temperature to occur on any 2 of the 1 st 10 days postpartum, exclusive of the first 24 hrs, and to be taken by mouth by a standard technique at least 4x daily
    • JOINT COMMITTEE ON MATERNAL WELFARE
  • 75. Differential Diagnosis of Puerperal Fever
    • Genital tract infection
    • Respiratory complications
    • Pyelonephritis
    • Breast Engorgement
    • Bacterial Mastitis
    • Thrombophlebitis
    • Incisional wound abscess
  • 76. Respiratory Complications
    • - seen within the 1 st 24 hours
    • - in women delivered by cesarean section
    • - use of general anesthesia
    • Atelectasis
    • Aspiration pneumonia
    • Bacterial pneumonia
  • 77. Pyelonephritis
    • SSx: bacteriuria / pyuria
    • costovertebral angle tenderness
    • spiking temperature
    • Clinical Dx: Urinalysis
    • U/S
    • Rx: Antibiotics
  • 78. Breast Engorgement
    • 15 % of all postpartum women
    • Fever rarely goes > 39 C
    • Fever – not longer than 24 hrs
  • 79. Thrombophlebitis
    • SSx:
    • painful swollen leg
    • calf / femoral angle tenderness
    • Mgt: Heparin
  • 80. Uterine Infection
    • Infection involving the decidua, myometrium and parametrial tissues
    • Metritis with Pelvic
    • Cellulitis
  • 81. Uterine Infection
    • The route of delivery is the single most significant risk factor for the development of postpartum uterine infection.
    • Incidence of Metritis:
    • ff C/S 13 – 50%
    • ff vaginal delivery 1.3 – 2.6%
  • 82. Risk Factors for Metritis
    • Prolonged labor
    • Prolonged membrane rupture
    • Multiple cervical examination
    • Use of internal fetal monitoring
    • Intraamniotic infection
    • Bacterial colonization of lower genital tract
    • Group B streptococcus Mycoplasma hominis
    • Chlamydia trachomatis Gardnerella vaginalis
  • 83. Bacteria Responsible for Genital Tract Infections
    • Aerobes
    • Grp A, B and D streptococci
    • Enterococcus
    • Gram (-) bacteria – E. coli, Klebsiella and Proteus sp
    • Staphylococcus aureus
    • Gardnerella vaginalis
    • Anaerobes
    • Peptococcus sp Clostridium sp
    • Peptostreptococcus sp Fusobacterium sp
    • Bacteroides fragilis Mobiluncus sp
    • Others
    • Mycoplasma sp Chlamydia trachomatis Neisseria gonorrhea
  • 84. Clinical Course
    • Fever
    • Chills
    • Abdominal pain / tenderness
    • Foul-smelling lochia
    • B hemolytic streptococci – scanty odorless lochia
    • Leukocytosis – 15,000 – 30,000/cu mm
  • 85. Treatment
    • BROAD SPECTRUM ANTIBIOTICS
    • Clindamycin + Gentamycin
    • most widely studied regimen
    • 90 – 97% efficacy
    • plus ampicillin – if enterococcal infection suspected
    • Aztreonam – if with renal insufficiency
  • 86. Causes of Persistent Fever Despite Antibiotic Rx
    • Wound infection
    • Peritonitis
    • Parametrial phlegmon
    • Pelvic abscess
    • Septic Thrombophlebitis
  • 87. Wound Infection
    • 3 – 5% post C/S
    • 2% - with prophylactic antibiotics
    • SSx: fever
    • erythema, wound discharges
    • Rx: antibiotics
    • surgical drainage
  • 88. Risk Factors for Wound Infection
    • Obesity
    • Diabetes
    • Corticosteroid therapy
    • Immunosuppression
    • Anemia
    • Poor hemostasis with hematoma formation
  • 89. Peritonitis
    • Route: lymphatics
    • SSx: severe abdominal pain
    • bowel distension – ileus
    • Rx: antibiotics
    • fluid and electrolyte replacement
    • decompression
    • surgery – bowel lesion
    • uterine incisional necrosis
  • 90. Parametrial Phlegmon
    • Dx: parametrial induration
    • unilateral
    • uterus fixed on
    • one side
    • Rx: antibiotics
    • surgery – uterine incisional necrosis
  • 91. Pelvic Abscess
    • Dx: fluctuant broad ligament mass
    • Rx: Drainage
    • Colpotomy
  • 92. Septic Thrombophlebitis
    • Route: hematogenous
    • Pathogenesis:
    • placental site infection 
    • thrombosed myometrial vs
    • SSx: enigmatic fever
    • lower abd’l / flank pain
    • tender mass beyond the cornu
  • 93. Infections of Perineum, Vagina and Cervix
    • Rx: Drainage
    • Antibiotics
    • Analgesics
    • Foleybag catheter
    • Repair
  • 94. 10 days post cesarean section, a 23 yr old primipara complains of fever of 3 days duration associated with hypogastric pain. Temp – 40 C. Breasts are slightly tender. Pelvic exam shows tenderness over the area of the uterus and parametria. The most likely consideration is: A. Breast engorgement B. Acute pyelonephritis C. Metritis with pelvic cellulitis D. Septic pelvic thrombophlebitis
  • 95.
    • Please visit:
    • http://crisbertcualteros.page.tl