114 Obstetrics and Gynecology Board Review •••
❍ Virtually all postpartum patients with septic shock have a source of infection requiring surgical drainage.
What microorganisms are associated with each clinical picture?
Endomyometritis: Prevotella (was Bacteroides) biviens and/or Gardnerella (60%), aerobic gram-negative bacilli
(Escherichia coli, Klebsiella pneumoniae, Proteus), and Group B Streptococcus.
Late onset endomyometritis: Chlamydia and Mycoplasma.
Pelvic abscess: Prevotella and Bacteroides.
Necrotizing fasciitis.
Group A Streptococcus + Staphylococcus.
Mixed aerobe + anaerobes including Clostridia.
Group B Streptococcus + anaerobes.
❍ Postpartum patient presenting with mild fever, hip tenderness, and paravaginal tenderness. Delivery record
shows an uncomplicated vaginal delivery with a pudendal block for anesthesia. What’s going on?
Retroperitoneal mixed aerobe and anaerobic abscess following needle track along trochanter and/or psoas muscle.
Start antibiotics and confirm with CT.
❍ What is the average gestational age for delivery/multiple gestations beyond 24 weeks?
Twins: 36 to 37 weeks.
Triplets: 33 to 34 weeks.
Quadruplets: 30 to 31 weeks.
Three or more fetuses reduced to twins: 35 to 36 weeks.
❍ At what gestational age, it is generally not recommended to use a vacuum to assist delivery?
34 weeks or less.
❍ What is the risk of using a vacuum below this age limit?
Intraventricular hemorrhage.
❍ What is the incidence of placenta previa?
03 to 0.5%.
❍ What is the risk of placenta accreta in women who have a placenta previa?
After first C/S: 3%.
After second C/S: 11%.
After third C/S: 40%.
After fourth C/S: 61%.
❍ What is the maternal mortality rate associated with placenta accreta?
7%.