Geburtshilfe Frauenheilkd 2015; 75 - P029
DOI: 10.1055/s-0035-1555052

Severe Pelvic Abscess Formation following Caesarean Section

D Muin 1, N Ghaem Maghami 2, M Thanh-Long Takes 3, I Hösli 2, O Lapaire 2
  • 1Medizinische Universität Wien; Geburtshilfe, Wien, Österreich
  • 2Universitätsspital Basel; Geburtshilfe, Basel, Schweiz
  • 3Universitätsspital Basel; Radiologie, Basel, Schweiz

Introduction:

The most common obstetric infection is postpartum endometritis mainly due to three risk factors namely caesarean section, lack of prophylactic antibiotics and presence of pathogens during labor. The most common risk factors for post-caesarean endometritis are young age, low socioeconomic status, long labor and duration of ruptured membranes, multiple vaginal examinations and delivery for cephalopelvic disproportion.

Case Report:

A 24-year old Caucasian Gravida I with uneventful past medical and obstetric history was induced at 41+4/40. A pathological CTG in second stage led to 2ndcaesarean section. Preoperative single-shot Augmentin® was given, standard operation procedure performed and a healthy male newborn delivered (APGAR 2/9/10; 4135 g, body 51 cm, head 37 cm; pH.u.a. 7.22, pH.u.v. 7.32). No intraoperative complication was reported. The patient was discharged in stable condition on day 4. Ten days after delivery, the patient returned with lower abdominal pain, green vomiting, diarrhea and temperature up to 39 °C. The diagnosis of postoperative endometritis was made and the patient re-admitted for i.v. Augmentin 2.2 g TDS. In view of persisting fever, a computertomography was performed and showed four abscesses, involving the right adnexa (59 × 57 × 68 mm), left bladder site (43 × 17 × 40 mm), between the cervix and iliopsoas muscle (35 × 34 × 32 mm) and posterior cul-de-sac (71 × 44 × 57 mm). The abscess at the right adnexae was drained under CT-guidance, and 100 ml pus was suctioned under ultrasound guidance from the abscess in the pouch of Douglas. In both drainage samples gardnerella vaginalis, mycoplasma hominis, ureaplasma urealyticumand actinobaculum schaalii were cultured. Upon recommendation of microbiologists, the therapy was continued with i.v. Augmentin 2.2 g TDS and oral Dalacin 300 mg TDS for two weeks. Thereupon, the infection parameters showed a rapid decline and temperature settled. The patient was discharged in good health seven days after the abscess drainage.

Conclusion:

By this case report we want to show an unusual development of severe post-caesarean pelvic abscesses despite antibiotic prophylaxis.