Microthrombosis

Microthrombosis is an inflammation and thrombosis of the veins of the uterus. Usually microthrombosis is postpartum complication of metroendometritis (see).
Over and symptoms. Clinical manifestations of microthrombolic manoharachary. In puerperas should pay attention to the increased heart rate, increased body temperature, delay, reverse development of the uterus, prolonged bleeding from the genital tract. When vaginal examination on the surface of the uterus can palpable typical twisted strands representing dilated veins. In the blood are moderate leukocytosis, and accelerated ROHE. In case of exacerbation, suppuration of blood clots in veins of the uterus appear shivering with fever to 40-41 degrees and the subsequent reduction of its almost to normal.
Treatment. Patients with microthrombolic to be treated in hospital, where they designate an appropriate therapy: bed rest, diet therapy (exception savoury dishes), cold on the bottom of the stomach (in the first days of the disease), analgesics, antibiotics and antisense funds (Dimedrol, pipolfen and others). With the increase in blood clotting shows the use of combined (neodikumarin 0.3 g 2 times a day, in the next days to 0.15 g 3 times a day, then on the 0.2 - 0.1 g per day; or fenilin 0.03 g 1-2 times a day). Anticoagulants are prescribed by a doctor under the control blood coagulability. Anticoagulants cannot be applied previously 3-4-th day of the postnatal period due to the risk of uterine bleeding. Care, prevention of - see Postpartum diseases.

Microthrombosis (from the Greek. metra - uterus; thrombos - a clot of blood, a blood clot; phleps, phlebos - Vienna) - vein inflammation of the uterus (printing. Fig. 5). Microthrombosis is usually a complication of postpartum metroendometritis (see). Vienna placental site is always partially closed by thrombosis. If contractility of the uterus is insufficient, thrombosis can capture of Vienna on the broader plot, spreading beyond the placental site.
Bimanual examination is determined badly diminished painful uterus, the increase in volume, softish consistency. Under the serous cover it possible to identify typical twisted strands (the affected veins). The cervical canal and on the 2nd week remains open, letting a finger, as with a delay parts of the placenta. The krovanistye allocation, generous, sometimes long, but bleeding with the formation of large blood clots or selection of red blood is not observed (opposed to the delay in the uterus parts of the placenta). Reverse development of the uterus detained. The temperature is subfebrile. For microthrombolic characteristic frequency and lability of the pulse, which should be considered, as in the absence of a softening and suppuration of blood clots microthrombosis on the clinical picture resembles metroendometrit. In the inclinations of blood clots to soften and suppuration appear chills, sharp fluctuations of temperature: up to 40 - 41 degrees, reduced almost to normal.
Under favorable for microthrombolic after a few chills temperature becomes normal. With the progression of the process after the 12th day of the postnatal period is developing clinical picture thrombophlebitis pelvic veins.
Throm pelvic veins clinical picture is basically the same as when microtrombidiidae that difficult diagnosis. In addition to increased bad reduced the uterus, in the beginning of the disease along the veins of the pelvis are determined painful tight and twisted strands, In the future, become involved in the inflammatory process of cellulose, environmental Vienna and laying in the basis of the broad ligament of the uterus, revealed a small flat infiltrates, located inland from the throat to the big sciatic clippings, sometimes reaching the side wall of the pelvis. If the inflammatory process affects of Vienna, walking on the edge of the uterus, higher domestic Zev on the lateral surface of the uterus by a small painful infiltrate.
Internal investigation with microtrombidiidae and thrombosis of the veins of the pelvis should be done with great caution so as not to violate the integrity of the blood clot not call this embolism or distribution septic infection.
A peculiar form M is the so-called Stripping metritis (metritis dissecans). When Stripping the metritis due to thrombosis blood and lymph vessels on a particular area is the paralysis of the muscles of the uterus. By 3-4 weeks post-partum period reject and erupt dead pieces of muscular tissue that is the main feature of the Stripping of metritis. The disease is the General condition with temperature 39-40 degrees and headache. Reverse development of the uterus slowed sharply; her bottom when this is on the same level as in the first days postpartum period - uterine subinvolution, inflammatory edema and its high standing. The latter is easily installed during vaginal examination; in some cases the cervix barely achieved exploring finger. Vaginal discharge initially very rich, bloody, brown, with sudden putrid smell, in the future become purulent. Sharp decrease of allocations usually occurs within 1 to 2 days after discharge from the uterus dead tissue. If, despite the passage of sequestration, highlight continue to be plentiful, purulent and smell,- in the uterus are still davidlevine chunks of dead tissue.
Possible complications: pyosepticemia, peritonitis, profuse bleeding that occurs when the rejection of the deep layers of dead tissue.
Treatment with microtrombidiidae, as with metroendometrit. In the acute stage of the disease - in bed, cold on the bottom of the stomach, reducing the uterus means, antibiotics (streptomycin, biomitsin and others), sulfa drugs. In chronic M - physiotherapeutic treatment: paraffin - ozokeritotherapy, diathermy, mud, sulfur pools and irrigation. When bleeding - drugs LPV, Katarina chloride (staticin), calcium chloride, ascorbic acid, menadione. With increased content of prothrombin in the blood - an anticoagulant (heparin, neodikumarin, and others).
Prevention. Careful observance of conditions of asepsis and antisepsis in the conduct of birth, as well as for operational interventions that must be done carefully to avoid excessive strain and injury tissue of the uterine wall. There should be no prolonged strong compression of the uterus head of the fetus and the bones of the pelvis.