Biomedical subjects
Publications and source records attributed to H M Listwa.
The pathogenic role of the enterococcus in pelvic infections is controversial. This case report of a pure enterococcal abscess developing after cesarean section supports the view that this organism can be a primary pathogen in obstetric and gynecologic infections. Because of its unusual sensitivity pattern, the enterococcus requires specific antibiotic therapy.
Amniotic fluid from 35 patients delivered by cesarean section was examined by Wright's stain. Of the patients in labor and with rupture of the membranes, 32% had more than 1 polymorphonuclear neutrophil per oil field (PMN/OF) while 68% had less than 1 PMN/OF. In both groups, endometritis occurred frequently, and fever indexes were similar. With ruptured membranes prior to cesarean section, observing greater than 1 PMN/OF of amniotic fluid did not discriminate groups at high and low risk for intrauterine infection.
Amniotic fluid samples from 95 internally monitored patients were examined to determine whether the appearance of polymorphonuclear leukocytes or bacteria could predict intrauterine infection. All patients delivered vaginally. More than one polymorphonuclear leukocyte per oil field were seen in specimens of 32% of patients; bacteria were seen in specimens of 52% of patients, and organisms were grown in 93% of specimens, yet, the overall maternal infection rate was only 6.3%. Moreover, infection developed in only 10% of patients with polymorphonuclear leukocytes in the fluid and 6% of patients with positive gram stain or cultures. For patients who deliver vaginally, the appearance of polymorphonuclear leukocytes or bacteria does not predict infection.
A retrospective review of 300 cesarean sections was performed. Patients with internal fetal monitoring were at no greater risk for infection than were those patients with labor and rupture of membranes but without internal monitoring. However, the combination of rupture of membranes and labor was a major risk factor for both the frequency and severity of maternal infection after cesarean section. Once membranes are ruptured, we find no contraindication to the use of internal monitoring.