Common iliac vein Figure 37-7, the diagnosis can be con firmed by pelvic CT or MR imaging (Klima, 2008). Using either, Brown and colleagues (1r999) found that 20 percent of 69 women with metritis who had fever despite >5 days of appropriate antimicrobial therapy Internal iliac vein had septic pelvic thrombophlebitis.
It has been disproven that intravenous heparin causes fever to dissipate with septic phlebitis (Brown, 1986; Witlin, 1995). And although Garcia and coworkers (2006) and Klima and Snyder (2008) advocate heparin therapy, we do not recommend anticoagulation. In a randomized study of (1999), the addition of heparin to to any pelvic vessel as well as the inferior vena cava. The clot in the right common iliac vein extends from the uterine and internal iliac veins and into the inferior vena cava. The ovarian antimicrobial therapy for septic pelvein septic thrombosis extends halfway to the vena cava. vic thrombophlebitis did not hasten FIGURE 37-7 Septic ovarian vein thrombosis-contrast-enhanced computed tomography scan. A.Enlarged right ovarian vein filled with low-density thrombus (black arrow). Contrast is seen in ureter (white arrow). R = lower pole, right kidney. B. Coronal image demonstrates enlarged right ovarian vein filled with low-density thrombus (arrows). (Reproduced with permission from Worley KC: Postoperative complications. In Yeomans ER, Hoffman BL, Gilstrap LC III, et al (eds):
Cunningham and Gilstrap's Operative Obstetrics, 3rd ed. New York, McGraw Hill Education, 201o7.) recovery or improve outcome. Certainly, no evidence supports long-term anticoagulation.
Episiotomy infections are not common because the operation is performed much less frequently now than in the past (American College of Obstetricians and Gynecologists, 20 16a). Reasons for this are discussed further in Chapter 27 (p. 530). In an older study, Owen and Hauth (1990) described only 10 episiotomy infections in 20,000 women delivered vaginally.
With infection, however, dehiscence is a concern. Ramin and colleagues (1992) reported an episiotomy dehiscence rate of 0.5 percent at Parkland Hospital-80 percent of these were infected. Uygur and associates (2004) reported a I-percent dehiscence rate and attributed two thirds to infection. No data suggest that dehiscence is related to faulty repair.
When the anal sphincter is disrupted at delivery, the subsequent infection rate is higher and is likely influenced by intrapartum antimicrobial treatment (Buppasiri, 2014; Stock, 2013). Lewicky-Gaupp and colleagues (2015) reported a 20-percent infection rate. Infection of a fourth-degree laceration can be even more serious. Goldaber and coworkers (1993) described fourth-degree lacerations in 390 parturients, of whom 5.4 percent had morbidity. In these women, 2.8 percent had infection and dehiscence, 1.8 percent had only dehiscence, and 0.8 percent only infection. Although life-threatening septic shock is rare, it may still occur as a result of an infected episiotomy. Occasionally also, necrotizing fasciitis develops as discussed on page 671.