Читать книгу Managing Medical and Obstetric Emergencies and Trauma - Группа авторов - Страница 142

On examination look for sources of infection that may require surgical drainage or surgical excision of infected tissue, and tailor the investigations to the history and examination findings. Mortality reports emphasize that the recognition of the genital tract as the source of infection is often delayed with over‐reliance on antibiotics to control the infection. Imaging is often delayed in those cases of women who die from sepsis and there is a reluctance to undertake surgical measures.

 Identify source of infection as rapidly as possible; imaging and repeat imaging may be required

 Closed‐space infections need surgical drainage, including evacuation of retained products of conception

 In women with endometritis not responding to antibiotics, a septic pelvic thrombosis should be considered; these patients will require anticoagulation together with antibiotics

 Women not responding may have myometrial necrosis and/or abscess formation, which continues to seed into the blood stream; in these cases, early surgical intervention, with possible recourse to hysterectomy, could save lives

 Necrotising fasciitis is another condition that requires early surgical intervention with fasciotomy and aggressive antibiotic therapy