1. postoperativeinfections
Dr.Bakhtiyari

2. Febrile morbidity:
A temperature of 38c or greater recorded on 2 occasions,at least 6h apart,more than24h after the surgical procedure.
Some have used a definition of a single elevation of 39c.
This excludes a fever during the first 24h.
It is important to recognizing that all febrile morbidity is not infectious morbidity.
It is important to treat infection not fever.

3. VAGINALFLORA
NO data have supported the concept that timing of gynecologic surgery in relation to menses alters infection rates.
Surgery itself alters the numbers and types of bacteria in the vagina and cx.

5. Risk factors; Premenopausal age Bacterial vaginosis Blood loss
Radical surgery
Lower socioeconomic status
D.M.
Prolonged op.time
Others(Hb,….)

6. Cuff cellulitis Symptoms and signs of infection usually begin late .
There is always an element of Induration,erythema,edema in the V,C immediately after hysterectomy.
Infected:lower abdominal pain,pelvic pain,back pain,fever,abnormal vaginal discharge.
The parametrial and adenexal are nontender.
WBC is mildly to moderately elevated.

7. INFECTED VAGINAL CUFF HEMATOMA OR CUFF ABSCESS
ABSCESS:fever that is usually early in the postop.chills,pelvic pain,rectal pressure,lower abdominal pain,vaginal cuff tenderness,mass,purulent drainage.
An infected cuff hematoma can present later ,drop in the Hb.

8. Post.op.Ovarian obscess
Late
sonography

9. Septic pelvic thrombophlebitis
Fever doesnot respond to antibiotic therapy in the absence of abscess or infected hematoma.
CTS-MRI
Anticoagulation :7-10 days

10. Osteomyelitis pubis Late:6-8w
Pain,tenderness,low grade fever,elevated ESR,mod leukocytosis,cultures.

11. Wound infections
SURGICAL TECHNIQE(cautery,skin closure,..)

12. Evaluation of the patient with suspected infection

13. TREATMENT Pelvic infections are polymicrobial
Timing of onset may be an indicator of pathogen

14. prevention
Hand washing
UTI
Antibiotic prophylaxis

15. ANTIMICROBIAL PROPHYLACTICREGIMENS;