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fatal infections have been known to follow e pis iotomy even in
d e v e l op ed countries [ 126- 128 1.
No reports o n the i nf e ctive comp l ications of ep i s i otomies
in the po or commun i t i e s of t h e developing world ha ve bee n
locat e d s o fa r by t h i s author. From my Own experienc e , they do
occur frequently but have not been r eported i n t h e literature.
Wound infection s with d elayed healing, a r e c o ndi t i o ns
usually associated with mal n ut rition and po o r h ygiene. These
pred isposing fa ctors a r e very preva lent in t he majority o f
women who rec e i ve episiotomy i n poor co unt r i es. I f we remember
too , t h at h igh preval en ces o f i n fect ious pa thog e n s which could
c a u s e epi siot omy wou nd s epsis , have been i d e ntif i ed i n the
gen ital tract of many ....omen r ep orting i n l abou r in t hese
countri es, one i s lef t wondering ho .... s a f e episiotomy ha s be en
in the de veloping wo r l d .
Thr ombophl eb i tis :
48
The physiolog ic c hang e s , whi ch occur with pr eg nancy are
associa t ed with i nc r eas es in bl ood c oagulati on fa ctors s uc h as
fibrinog en , pl a t e l ets, fact ors VII , VIII a nd X, and a deer ea se
i n fibrinolyti c fa ct o r s [ 43] . Af ter de livery , the s e p r eg na nc y
c ha nge s eke.... l y revert to no rmal, althoug h the y pe rsis t i nto
t he early puerperium and together with the post pa rtum ha e mo­
c onc e ntrating blood changes, lead to an i ncrea s ed r i sk of
intravascular thrombosis i n the puerperi um.