COMPLICATIONS

OF PELVIC
INFECTION

Fakhri Mubarok 1510211033

Abdominal Incisional Infections

 FR :
 Obesity
 Diabetes
 Corticosteroid therapy
 Immunosuppression
 Anemia
 Hypertension
 Inadequate hemostasis with hematoma formation
 If prophylactic antimicrobials are given as described above, the incidence
of abdominal wound infection following cesarean delivery ranges from 2 to
10% depending on risk factors
 Although organisms that cause wound infections are generally the same as
those isolated from amnionic fluid at cesarean delivery, hospital-acquired
pathogens may also be causative
 Treatment includes antimicrobials, surgical drainage, and debridement of
devitalized tissue. The fascia is carefully inspected to document integrity.
Wound Dehiscence
 Wound disruption or dehiscence refers to separation of the
fascial layer
 McNeeley and associates (1998) reported a fascial
dehiscence rate of approximately 1 per 300 operations in
almost 9000 women undergoing cesarean delivery.
 Most disruptions manifested on about the fifth postoperative
day and were accompanied by a serosanguineous discharge.
 Necrotizing Fasciitis
 may involve abdominal incisions, or it
may complicate episiotomy or other
perineal lacerations
 diabetes, obesity, and hypertension
 In some cases, however, infection is
caused by a single virulent bacterial
species such as group A b-hemolytic
streptococcus.
 Occasionally, necrotizing infections
are caused by rarely encountered
pathogens (Swartz, 2004).
 Nine cases complicated more than
5000 cesarean deliveries—
frequency of 1.8 per 1000
 Infection may involve skin,
superficial and deep
subcutaneous tissues, and
any of the
abdominopelvic fascial
layers
 In some cases, muscle is
also involved—
myofasciitis.
 Most of these necrotizing
infections do not cause
symptoms until 3 to 5
days after delivery.
Adnexal Abscesses & Peritonitis
 ovarian abscess; caused by bacterial invasion through a rent
in the ovarian capsule; The abscess is usually unilateral, and
women typically present 1 to 2 weeks after delivery

 Peritonitis is infrequent following cesarean delivery. It is

almost invariably preceded by metritis. It most often is
caused by uterine incisional necrosis and dehiscence, but it
may be due to a ruptured adnexal abscess or an
inadvertent bowel injury at cesarean delivery.
 Peritonitis is rarely encountered after vaginal delivery, and
many such cases are due to virulent strains of group A β-
hemocyte streptococci or similar organisms.
 Importantly in postpartum
women, abdominal
rigidity may not be
prominent with puerperal
peritonitis because of
abdominal wall laxity
from pregnancy.
 Pain may be severe, but
frequently, the first
symptoms of peritonitis
are those of adynamic
ileus.
Parametrial Phlegmon
 These
infections
should be
considered
when fever
persists longer
than 72 hours
despite
intravenous
antimicrobial
therapy
 usually unilateral, and they
frequently are limited to
the parametrium at the
base of the broad
ligament.
 If the inflammatory reaction
is more intense, cellulitis
extends along natural lines
of cleavage.
 Occasionally, a parametrial
phlegmon suppurates,
forming a fluctuant broad
ligament mass that may
point above the inguinal
ligament.
Septic Pelvic Thrombophlebitis
 Septic phlebitis arises as an extension along venous
routes and may cause thrombosis
 Lymphangitis often coexists. The ovarian veins may
then become involved because they drain the upper
uterus and therefore the placental implantation site.
 In a 5-year survey of 45,000 women who were
delivered at Parkland Hospital  an incidence of
1 per 9000 following vaginal delivery
 1 per 800 with cesarean delivery.
PROFILAKSIS ANTIBIOTIK