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Classification of endometritis
Postpartum endometritis #1
Postpartum endometritis #2
SPT #1
SPT #2
100
The definition of postpartum febrile morbidity by US Joint Commission on Maternal Welfare.
What is an oral temperature of greater or equal to 38.0 degrees Celsius on any two of first 10 days postpartum, exclusive of the first 24 hours?
100

Polymicrobial.

What is the microbiology of postpartum endometritis?

100
Most studied broad spectrum antibiotics with coverage of beta-lactamase producing anaerobes to treat postpartum endometritis.
What is clindamycin (900 mg every eight hours) plus gentamicin (1.5 mg/kg every eight hours or 5 mg/kg every 24 hours in patients with normal renal function)?
100
The physiologic conditions in the setting of SPT that fulfill Virchow's triad for the pathogenesis of thrombosis.
What is pelvic vein endothelial damage, venous stasis and hypercoagulability?
100
A complication of SPT occur in about 2 percent of cases.
What is pulmonary emboli?
200
An acute, non-obstetric cause of endometritis.
What is PID related to STIs or what is PID related to gynecologic procedures?
200
The most important risk factor for development of postpartum endometritis.
What is Cesarean delivery?
200
The duration of antibitoic treatment for postpartum endometritis.
What is parenteral antibiotics until the patient is clinically improved and afebrile for 24 to 48 hours? In the absence of bacteremia, we recommend not prescribing oral antibiotic therapy after successful parenteral treatment.
200
The two types of SPT.
What are ovarian vein thrombophlebitis (OVT) and deep septic pelvic thrombophlebitis (DSPT).
200
Early and current methods of treatment of SPT.
What are surgical excision or ligation of the thrombosed vein and now antibiotic therapy in conjunction with systemic anticoagulation?
300
An acute and chronic obstetric cause of endometritis.
What is retained products of conception?
300
The clinical criteria for the diagnosis of postpartum endometritis.
What is fever and uterine tenderness occurring in a postpartum woman? Other signs and symptoms which support the diagnosis include foul lochia, chills, and lower abdominal pain. The uterus may be soft and subinvoluted, which can lead to excessive uterine bleeding. Sepsis is an unusual presentation.
300
Addition of ampicillin or vancomycin (in penicilin-allergic) patients.
What if the patient doesn't improve in symptoms within 48 to 72 hours of initiating adequate antibiotic therapy?
300
The usual clinical manifestations in patients with OVT.
What are presentation within one week after delivery and appearing clinically ill with symptoms that may include fever and abdominal pain localized to the side of the affected vein, the flank, or the back. Pelvic tenderness may reflect OVT or an alternative diagnosis such as endometritis. Nausea, ileus, and other gastrointestinal symptoms may occur but are usually mild, which may be helpful in distinguishing right-sided OVT from appendicitis, pyelonephritis or other processes.
300
The dosing of unfractionated and low molecular weight heparin for management of SPT.
What is an initial bolus of unfractionated heparin of 5000 units followed by continuous infusion of 16 to 18 U/kg for a goal PTT of 1.5 to 2.0 times the patient's baseline? What is enoxaparin 1 mg/kg subcutaneously every 12 hours)?
400
Organisms that lead to chronic, non-obstetric causes of endometritis.
What are infections with chlamydia, TB, or other organisms causing cervicitis and PID?
400
Laboratory studies that are of limited value in diagnosis of postpartum endometritis.
What are WBC count, endometrial cultures, and blood cultures? A rising neutrophil count associated with elevated numbers of bands is suggestive. Endometrial cultures are not useful. Blood cultures can be useful in guiding antimicrobial treatment if the patient fails to respond to empiric therapy.
400

Prevents risk of postpartum endometritis in patients about to undergo cesarean delivery.

What is antibiotic prophylaxis administered prior to procedure?

400
The usual clinical manifestations in patients with DSPT.
What is presentation with fever in the early postpartum or postoperative period (usually within three to five days of delivery); not appearing clinically ill; having fever or chills as the only symptoms, and appearing clinically well between fever spikes; and not having abdominal or pelvic tenderness?
400
The duration of anticogulation in the absence of documented thromboses or underlying hypercoagulable state.
What is discontinuing anticoagulation following resolution of fever for at least 48 hours?
500

Non-infectious etiologies of chronic, non-obstetric causes of endometritis.

What are intrauterine foreign bodies or growths (IUD and submucous leiomyoma), radiation related, and unknown?

500
The differential diagnosis of postpartum endometritis.
What are surgical site infection, mastitis/breast abscess, urinary tract infection, pneumonia, and deep vein thrombosis.
500
Another way to prevent risk of postpartum endometritis in patients undergoing cesarean delivery.
What is spontaneous placental extraction instead of manual extraction?
500
The imaging of choice to assist with disagnosis of SPT.
What is CT? CT or MRI can be useful for diagnosis of OVT but not for DSPT. A negative imaging study cannot exclude SPT. CT is favored over MRI; ultrasonography should not be used for the diagnosis of SPT if CT or MRI is available.
500
The duration of anticoagulation if septic emboli or extensive pelvic thromboses (eg, thrombosis involving the ovarian vein, iliac veins or vena cava) are documented radiographically.
What is six weeks? Subsequently, follow-up imaging to evaluate for persistence or resolution of thromboses should be obtained to guide subsequent management.