104 Obstetrics and Gynecology Board Review •••
❍ True or False: Postpartum uterine infection is usually caused by a single organism.
False.
❍ What organism most commonly causes late onset postpartum metritis?
Chlamydia.
❍ What are the clinical signs of postpartum uterine infection?
Fever, fundal tenderness, tachycardia, foul-smelling lochia, and elevated white blood count of 15,000 to 30,000.
❍ What is the incidence of bacteremia associated with post cesarean uterine infection?
10% to 20%.
❍ List the organisms most commonly causing postpartum uterine infection.
Aerobes:
Enterococcus.
Staphylococcus aureus.
Group A, B, D streptococci.
Gram-negative bacteria—Escherichia coli, Klebsiella, Proteus.
Anaerobes:
Peptococcus species.
Peptostreptococcus species.
Bacteroides species.
Clostridium species.
Fusobacterium species.
Other:
Mycoplasma.
Gonorrhea.
Chlamydia trachomatis.
❍ What are the risk factors for post cesarean section wound infection?
Obesity, diabetes, corticosteroid therapy, immunosuppression, anemia, wound hematoma, and uterine infection.
❍ What is the treatment of wound infection?
Antibiotics and surgical drainage.
❍ What is necrotizing fasciitis?
A rare complication of wound infection involving the deep soft tissues, including muscle and fascia.
❍ What are the risk factors for necrotizing fasciitis?
Diabetes, obesity, intravenous drug use, age >50, hypertension, malnutrition, malignancy, cirrhosis, and peripheral
vascular disease.