Most women with puerperal infections respond to treatment with antibiotics. However, about 10 to 15 percent develop complications, including parametrial phlegmon, septic thrombophlebitis, intra-abdominal abscess or peritonitis from uterine incisional necrosis. Brown and colleagues conducted a retrospective study to evaluate the clinical use of computed tomography in women with persistent puerperal infection.
The study included 74 women who underwent abdominopelvic computed tomography because of persistent puerperal infection that was unresponsive to antimicrobial therapy. The clinical courses of these women were retrospectively reviewed. Twenty of the women had delivered vaginally and 54 had delivered by cesarean section. Most of the women had been treated initially with single-agent antibiotic therapy for 48 to 72 hours.
Roentgenographic studies had been ordered for the following indications in these women: uterine infection and persistent fever despite antimicrobial therapy (39 women); palpable pelvic mass and persistent fever despite antimicrobial therapy (28 women); clinically obvious femoral vein thrombophlebitis (four women), and readmission with postpartum fever and no other findings (three women).
In 57 of the women, at least one abnormality was noted on computed tomography, including pelvic mass, thrombophlebitis or uterine incisional dehiscence. These results correlated with clinical and surgical findings. In 16 women, a palpable pelvic mass was seen on tomography. However, masses that were not detected on clinical examination were visualized in another 29 women, and a clinically palpable mass was not visualized by tomography in five women. In 12 women who had normal findings on pelvic examination, septic pelvic thrombophlebitis was diagnosed by tomography. A poor correlation was found with roentgenographic findings and uterine incisional necrosis and dehiscence. The authors believe that in some instances, pelvic computed tomography is useful to evaluate persistent puerperal infection that is not responsive to antimicrobial therapy. These studies must be correlated with clinical findings. (Surgery, Gynecology and Obstetrics, April 1991, vol. 172, p. 285.)
COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
Home
A
Arthritis
