Peritonitis (10.1) may follow any obstructed labour, or an infected Caesarean section, and is common after rupture of the uterus. If a patient dies she will probably do so because you did not anticipate infection, or because you opened her abdomen much too late. She is likely to be infected: (1) If her labour is abnormally long, and the longer it lasts, the greater the risk. (2) If her baby is dead. (3) If her membranes rupture early and her liquor becomes infected. (4) If she is HIV positive. (5) If your sterile procedures are poor. In any of these conditions, anticipate infection and try to prevent it.
For vaginal bleeding due to infection (secondary PPH) see (22.12) and (23.12).
INFECTION may take the following forms:
Wound infection (12.14) may discharge through the scar into the cavity of her uterus. Infection may resolve, or you may need to drain pus suprapubically. If fever recurs with signs of more pus collecting, do another drainage operation.
Pelvic abscess (10.11), which will need draining suprapubically or via a grid–iron incision.
Peritonitis (10.1): You will probably find that her uterus is totally disrupted, so it is hopeless to try to repair it. A subtotal hysterectomy (24.15) will usually be enough—commonly with the removal of both adnexa, but retain one if you can.
Subphrenic abscess (10.10), which is a common late complication, and is likely to kill her if you don’t drain it; as may multiple abscesses between loops of her bowel (10.3).
Secondary postpartum haemorrhage (22.12) may occur with a retained segment of placenta, needing evacuation, or an infected uterine scar which will mean a hysterectomy (24.15).
Burst abdomen (11.14) occurs especially after several Caesarean sections, and needs repair.
Infertility (19.3) is a late complication of infection.
Bowel obstruction and low-grade peritonitis will occur if packs or swabs have been left behind in the abdomen.