••• Chapter 11^ The Puerperium^105
❍ True or False: Wound infection resulting in necrotizing fasciitis is usually monobacterial.
False. Usually polymicrobial, caused by the anaerobes and aerobes listed in Question 8. If monobacterial, usually a
result of Group A beta-hemolytic streptococcus.
❍ Name five common extrapelvic causes of puerperal fever.
Atelectasis, pneumonia, pyelonephritis, breast engorgement, and thrombophlebitis.
❍ In a woman with post cesarean wound infection, what is the most common presenting symptom, and how
many days after cesarean section does the symptom usually occur?
Fever on postoperative, day 4.
❍ List complications of postpartum uterine infection that result in persistent fever.
Wound infection, peritonitis, pelvic abscess, parametrial phlegmon, pelvic hematoma, septic pelvic thrombophlebitis,
and antibiotic-resistant bacteria.
❍ How long after delivery does ovarian abscess complicating postpartum uterine infection usually present?
1 to 2 weeks.
❍ True or False: Ovarian abscess complicating postpartum uterine infection is usually bilateral.
False.
❍ What is the parametrial phlegmon?
An area of induration in the broad ligament resulting from parametrial cellulitis and postpartum metritis.
❍ What is the approximate incidence of wound infection following cesarean section?
3% to 15%
❍ True or False: Enigmatic fever is associated with postpartum septic thrombophlebitis.
True.
❍ What is the one constant clinical characteristic of enigmatic fever?
Hectic fever spikes following initial response to antimicrobial treatment of postpartum pelvic infection.
❍ What are the clinical features of ovarian vein thrombosis?
Lower abdominal or flank pain on postpartum day 2 to 3, possible fever, and possible palpable tender
adnexal mass.
❍ What is the incidence of episiotomy infection or breakdown after vaginal delivery?
<1%.
❍ What is the primary cause of episiotomy breakdown?
Infection.