Urogenital disorders

IV./4.4.: Diagnostics beside imaging

In the early diagnosis of puerperal infection and constant monitoring of the process traditional diagnostic procedures still play a crucial role. Besides the regular monitoring of temperature, respiration, heart rate and the blood pressure , the external and internal examination (bimanual examination), as well as checking the lochia should be highlighted. Ultrasonography - possibly transabdominal ultrasound - is also very important, primarily in indicating or excluding a possible retention.

Infections of the birth canal are easily recognizable by inspection and exploration. In case of endometritis the fundus of the uterus is higher than expected on external examination, and it is pressure sensitive and softer than normally during pelvic examination. In adnexoparametritis and/or abscess the surrounding tissue of the uterus or the region of the adnexum is sensitive to palpation or a painful mass is palpable, moving the cervix elicits pain.

The laboratory blood work show leukocytosis (13-15000 G/L), accelerated sedimentation, left shift in the blood cell counts. Eosinophilia detected in peripheral blood work may indicate drug-induced fever. Except for the less severe cases that respond well and quickly to treatment it is recommended to perform microbiological tests (lochia and wound culture). Efforts should be made to change the antibiotics in possession of the results of the bacterial culture and antibiogramm findings. Urine culture is only recommended if pyelonephritis is suspected based on clinical symptoms. Haemoculture is necessary in case of immunosuppressed patients and patients with bacterial endocarditis, and if the initial antibacterial treatment has not been effective.

IV./4.5.: Differential diagnosis

The following diseases could be considered in the differential diagnosis of puerperal fever: pneumonia/atelectasia, pyelonephritis, appendicitis and the postpartum vena ovarica thrombosis (POVT), mastitis and pseudomembranous colitis. Beyond the bimanual examination and the laboratory tests, imaging studies (vaginal and abdominal ultrasonography, CT, MRI) may help in finding the right diagnosis.