Postpregnancy Genital Tract and Wound Infections

Nell Tharpe, CNM, CRNFA, MS

Disclosures

J Midwifery Womens Health. 2008;53(3):236-246. 

In This Article

Necrotizing Fasciitis

Numerous case reports have identified women with necrotizing fasciitis following obstetric or gynecologic surgery.[30,33,48,49] Necrotizing fasciitis is a rare but exceedingly serious infection of soft tissues. It is an aggressive infectious process producing exotoxins that cause rapidly spreading tissue necrosis, as illustrated in Figure 1. Necrotizing fasciitis is associated with a high incidence of maternal mortality, ranging from 13% to 48% in affected women. In a retrospective analysis of necrotizing fasciitis infections of the pelvis or lower abdomen that included 6 postpartum women, 3 infections were associated with a third- or fourth-degree perineal injury, and 3 with cesarean birth. Five of the six women had pain severe enough to require narcotic analgesia, one woman required a temporary colostomy, and one woman died as a result of overwhelming sepsis.[30]

Necrotizing fasciitis. Reprinted with the permission of Internet Scientific Publications. Original image published at: www.ispub.com/ostia/index.php?xmlFilePath=journals/ijps/vol2n2/abdominal.xml.

The presence of severe, often unilateral, pain and erythema disproportionate to the woman's expected condition should prompt immediate referral for evaluation.[30]

Progressive signs of necrotizing fasciitis include high fever that does not respond to antibiotics, signs of systemic illness, and a hard or "wooden" consistency to the affected area.[16] In addition to aggressive antibiotic therapy, radical surgical debridement of infected tissue is required. Necrotizing fasciitis should be included in the differential diagnosis of postpartum women who present with signs or symptoms of wound infection.[48,49]

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