HAMDANUL HAQUE

7637m2
TOPIC-8

Questions for theoretical study:

1. What is the definition of "postpartum infection"?

Ans:- Postpartum infections comprise a wide range of entities that can occur
after vaginal and cesarean delivery or during breastfeeding. In addition to
trauma sustained during the birth process or cesarean procedure, physiologic
changes during pregnancy contribute to the development of postpartum
infections.

2. What is the definition of "intra-hospital (hospital) infection"?

Ans:- Nosocomial infections, otherwise known as hospital-acquired
infections, are those infections acquired in hospital or healthcare service unit
that first appear 48 h or more after hospital admission or within 30 days after
discharge following in patient care.

3. What is the classification of postpartum infectious diseases?

Ans:- Endometritis is the most common infection in the postpartum period.
Other postpartum infections include (1) postsurgical wound infections, (2)
perineal cellulitis, (3) mastitis, (4) respiratory complications from anesthesia,
(5) retained products of conception, (6) urinary tract infections (UTIs), and (7)
septic pelvic phlebitis.

4. What is the etiology of postpartum infectious diseases?

Ans:- Local spread of colonized bacteria is the most common etiology for
postpartum infection following vaginal delivery.

5. What is the pathogenesis of postpartum infectious diseases?

Ans:- The majority of postpartum infections result from physiologic and
iatrogenic trauma to the abdominal wall and reproductive, genital, and
urinary tracts that occur during childbirth or abortion, which allows for the
introduction of bacteria into these normally sterile environments.

6. What are the risk factors for postpartum infectious diseases?

Ans:- The following increase the risk for postpartum infections:
  History of cesarean delivery
 Premature rupture of membranes
 Frequent cervical examination (Sterile gloves should be used in examinations.
Other than a history of cesarean delivery, this risk factor is most important in
postpartum infection.)
 Internal fetal monitoring
 Preexisting pelvic infection including bacterial vaginosis
 Diabetes
 Nutritional status
 Obesity

7. What clinics and diagnostics of postpartum infected wounds?

Ans:-
Clinic:-
Patients with wound infections, or episiotomy infections, have erythema, edema,
tenderness out of proportion to expected postpartum pain, and discharge from the
wound or episiotomy site.
Drainage from wound site should be differentiated from normal postpartum lochia
and foul-smelling lochia, which may be suggestive of endometritis.
Diagnostics:-
Laboratory studies should include the following:
 Complete blood count
 Electrolytes
 Blood cultures, if sepsis is suspected
 Urinalysis, with cultures and sensitivity tests
 Cervical or uterine cultures
 Wound cultures, if appropriate
 Lactate, if sepsis suspected
 Coagulation studies, if pelvic thrombosis, deep vein thrombosis, pulmonary
embolism, or invasive treatment (eg, surgical procedure) is being considered
Pelvic ultrasonography may be helpful in detecting retained products of
conception, pelvic abscess, or infected hematoma.
Contrast-enhanced CT or MRI are useful in establishing the diagnosis of
septic pelvic thrombosis.

8. What are the methods of treating postpartum infected wounds?

Ans:- Drainage, debridement, and irrigation may be required. Broad-
spectrum antibiotics should be administered.

9. What are the clinics and diagnostics of postpartum endometritis?

Ans:- Endometritis may be characterized by lower abdominal tenderness on one or
both sides of the abdomen, adnexal and parametrial tenderness elicited with
bimanual examination, and temperature elevation (most commonly >38.3°C).
Some women have foul-smelling lochia without other evidence of infection.

10. What are the methods of treating postpartum endometritis?

Ans:- In most cases, initial antimicrobial treatment is a combination of an
aminoglycoside and clindamycin. Alternatively, an aminoglycoside plus
metronidazole with or without ampicillin may also be used. [13]
Mild cases of endometritis after vaginal delivery may be treated with oral
antimicrobial agents (eg, doxycycline, clindamycin).
Moderate-to-severe cases, including those involving cesarean deliveries, should be
treated with parenteral broad-spectrum antimicrobials.

11. What clinics and diagnostics and treatment of lactation mastitis?

Ans:- Patients with mastitis have very tender, engorged, erythematous
breasts. Infection frequently is unilateral.

12. What are the methods of lactation mastitis treatment?

Ans:- Supportive measures include rest, adequate fluids, and nutrition. Also
use local measures, such as ice packs, analgesics, and breast support.
Administer a penicillinase-resistant antibiotic such as cephalexin,
dicloxacillin or cloxacillin, or clindamycin in penicillin-allergic patients.

13. What is the current classification of septic states?

Ans:- Sepsis can be divided into three stages: sepsis, severe sepsis and septic
shock.

14. What are the basic principles of treatment for obstetric sepsis?
Ans:- The accepted principles of treatment include prompt administration of
antibiotics (target to administer within one hour of suspecting sepsis), source
control, intravenous fluid therapy and organ system support with vasopressor
drugs, mechanical ventilation, and renal replacement therapy as required.

15. What are the clinics and diagnostics of obstetric peritonitis?

Ans:-
Clinic:-
Peritonitis is an infection of the lining of the abdominal wall (peritoneum)
caused by bacteria or irritating substances. Peritonitis causes pain and
swelling in the abdomen and can be very serious if it is not treated.
Symptoms of peritonitis include: Swelling of the belly, which may feel hard
(rigid).
 Diagnostics:-
The diagnosis of PD-associated peritonitis requires any two of the following
features: (1) clinical features consistent with peritonitis, i.e., abdominal pain
or cloudy dialysis effluent; (2) dialysis effluent white cell count >100/µl
(after a dwell time of at least 2 hours), with >50% neutrophils.

16. What are the basic principles of treatment for obstetric peritonitis?
Ans:- Active resuscitation Use broad-spectrum antibiotics, and in
combination with multiple antibiotics Emergency surgery to remove
infection, wash abdomen and drain.

17. What are the clinical forms of infectious thrombotic complications in

obstetrics?
Ans:- Pain, swelling and tenderness in 1 leg, usually at the back of your
lower leg (calf) – the pain may be worse when you walk. a heavy ache or
warm skin in the affected area. red skin, particularly at the back of your leg
below the knee.

18. What are the basic principles of treating obstetric thrombotic complications?
Ans:- Treatment with an injection of a drug called heparin to thin the blood.
There are various types of heparin. The most commonly used in pregnancy is
low-molecular-weight heparin (LMWH).

19. What is the prevention of postpartum infectious diseases?

Ans:- The most important aspect of prehospital care in a postpartum patient
with a suspected infection is to ensure adequate fluid volume and to prevent
sepsis and shock. Provide aggressive fluid management, begin cardiac
monitoring, and administer oxygen.
Empiric combination of clindamycin (900 mg q8 h IV or 600 mg q6 h IV) and
an aminoglycoside (most commonly gentamicin 5 mg/kg q24 h or 1.5 mg/kg
q8 h) remains the most effective regimen to treat postpartum endometritis.

20. General information about obstetric operations. Indications, conditions,

contraindications. Training. Examination. Instruments.
21. The operation of interruption of pregnancy in early and late terms.
22. Operations preparing the birth canal (perineo and episiotomy, amniotomy).
23. Forceps. Vacuum extraction of the fetus. Indications, conditions,
contraindications.
24. Surgical intervention in labor and the postpartum period.
25. Manual separation of the placenta, separation of the placenta: technique of.
26. Cesarean section in modern obstetrics. Indications and contraindications for
cesarean section. Options for caesarean section.
27. Surgical methods of stopping uterine bleeding in obstetrics. Ligation of
uterine and ovarian vessels. Supravaginal amputation of the uterus.
Extirpation of the uterus. Ligation of internal iliac arteries: indications.
28. Traumatic injuries of the vulva, vagina and perineum.
29. Raptures of the cervix during labor.
30. The tearing of the uterus during pregnancy and childbirth: classification,
mechanisms of occurrence.
31. The clinical picture of uterine rupture: threatened, which began and has
already taken place.
32. Especially tearing of the uterus along the scar: diagnosis, treatment,
prevention.
33. Inversion of the uterus. Causes. Tactics of the doctor.
34. Discrepancy and gaps of the joints of the pelvis in childbirth
35. Organization of assistance for pregnant women with extragenital diseases.
36. Features of carrying out three scheduled hospitalizations of pregnant women
with extragenital diseases.
37. When and for what purpose the first planned hospitalization of pregnant
women with extragenital illnesses is carried out.
38. The second planned hospitalization to the department of extragenital
pathology of pregnant women with extragenital diseases in critical periods
for each disease.
39. The third planned hospitalization to the department of extragenital pathology
of pregnant women with extragenital diseases. Purpose and term of
pregnancy depending on the pathology.
40. How often is a review of pregnant women with extragenital pathology by a
therapist (and, if necessary, an endocrinologist, a cardiologist and other
adjacent specialists)?
41. What diseases of the cardiovascular system are most common in pregnant
women?
42. What to consider when deciding on the admissibility of pregnancy in
patients with acquired (rheumatic) heart disease?
43. Name the contraindication for preservation of pregnancy in case of acquired
heart defects.
44. Features of the course of pregnancy and childbirth in patients with
congenital heart disease.
45. What are the contraindications for the continuation of pregnancy in the case
of heart congenital disease.
46. Pregnancy and childbirth in women undergoing heart surgery (mitral
commissurotomy, prosthetics of valves, correction of congenital heart
defects).
47. Give a description of primary hypertension in pregnant women. Tell the
classification of hypertonic disease, depending on the lesion organs. Specify
the complications of pregnancy.
48. What three types of hemodynamics are excreted in patients with arterial
hypertension?
49. Name the contraindication for carrying pregnancy in patients with
hypertension.
50. Name the features of the course of pregnancy in the case of arterial
hypotension.
51. Features of the examination and preparation of pregnant women with
extragenital diseases in the department of extragenital pathology to
childbirth.
52. Tell us about the choice of the method of delivery in women with diseases of
the cardiovascular system: a) self-degeneration by natural childbirth; b)
reduction of a powerful period by the operation of overlaying obstetric
forceps; c) delivery by cesarean section.
53. Name the contraindication for carrying pregnancy in case of respiratory
diseases.
54. Features of the course of pregnancy, childbirth and postpartum period in
women with kidney disease. Influence on the fetus.
55. Name contraindications to preservation of pregnancy in women with kidney
pathology.
56. Features of the course of pregnancy, childbirth and postpartum period in
women with diabetes mellitus. Influence on the fetus.
57. Name contraindications to preservation of pregnancy in women suffering
from diabetes mellitus.
58. The third planned hospitalization of pregnant women with diabetes.
Inspection, prenatal preparation, prevention of distress syndrome.
59. The choice of time and method of delivery in pregnant women with diabetes.
60. Indications for delivery by scheduled cesarean section in pregnant women
with diabetes mellitus.
61. Contraindications to pregnancy in case of thyroid gland diseases.
62. Name contraindications to preservation of pregnancy in women with blood
diseases.
63. Diseases of the liver and gall bladder, in the presence of which the
pregnancy is contraindicated.
64. Name contraindications to preservation of pregnancy in women with
diseases of the digestive system.
65. Features of the course of pregnancy, childbirth in women with diseases of
the organs of vision.
66. Rehabilitation of women with extragenital pathology in the postpartum
period.
67. The role of women’s counseling in the prevention of complications during
pregnancy and childbirth in women with extragenital pathology.
68. Groups of pathogens of intrauterine infectious diseases?
69. Methods of diagnosis, clinic, treatment and prevention of viral infections?
70. Tactics of pregnant women with feverish typhus?
71. How are bacterial infections diagnosed and treated?
72. Causes of fetal death in various types of infectious diseases?
73. What diseases are parasitic?
 74. What is intrauterine fetal infections?
75. What are the medical indications before abortion?

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