Hysterectomy Case Studies

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We review the most important clinical factors an obstetrician gynecologist should consider when encountering a critically ill patient with a life-threatening infection. Most obstetrician gynecologists are reluctant to perform aggressive surgery, particularly a hysterectomy, in young nulliparous patients; however, these surgical interventions can be necessary to save patient lives. This article specifically focuses on clostridial species, Staphylococcus aureus and Group A streptococcal bacteria, given that these particular microbes have been associated with necrotizing soft tissue infections, toxic shock syndrome, sepsis and death in cases pertaining to obstetrics and gynecology. We also review the obstetric and gynecological procedures that…show more content…
Although there are multiple types of C. perfringens, Type A is responsible for gas gangrene, food poisoning and necrotizing enterocolitis, which represent the most common infectious manifestations of the bacterium in humans. In all conditions except food poisoning, an exotoxin underlies the diseases’ pathogeneses. For gas gangrene, the condition most commonly implicated in gynecologic C. perfringens infections, a phospholipase C and a thiol-activated hemolysin cause the condition. Phospholipase C, or α-toxin, also displays both sphingomyelinase activity and platelet aggregation that contribute to the local tissue necrosis and cytotoxicity observed in C. perfringens infection [52, 53]. Additional animal studies have demonstrated that α-toxin also decreases myocardial function, perhaps through inhibition of the calcium-magnesium ATPase in the cardiac sarcoplasmic reticulum [54]. These findings may suggest an additional mechanism for the shock symptoms observed in patients with C. perfringens septicemia. The hemolysin, or θ-toxin, targets cholesterol receptors in the cell membrane to form pores and subsequently hemolysis [52]. This toxin also plays a role in advancing tissue necrosis by downregulating polymorphonuclear leukocyte adhesion to endothelial cells…show more content…
perfringens infections are rare, especially after the legalization of therapeutic abortion, there are numerous accounts in the literature describing episodes occurring after cesarean section, amniocentesis, cordocentesis, endometrial ablation, abortion, molar pregnancy or vaginal delivery [56-67]. There is a particularly prominent role of C. perfringens in hospital-acquired gynecologic infection [67]. Furthermore, as with C. septicum, there are reported cases of C. perfringens infection in the setting of choriocarcinoma as well as endometrial or ovarian cancer [68-70]. Several reports have documented C. perfringens isolates from vaginal and cervical cultures, with some finding a 0.8-8% prevalence in normal vaginal flora, a 1-9% prevalence postnatally, and up to a 29% prevalence after abortion [60, 67, 71, 72]. These prevalence rates may even underestimate prevalence: culture-independent methods including high-throughput sequencing techniques of 16S rRNA genes suggest that the vaginal microbiome is even more diverse than originally appreciated [73]. Regardless of the accurate prevalence rates, colonization with exotoxin-producing C. perfringens strains occur in a minority of

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