Postpartum diseases

Postpartum diseases (synonym puerperal diseases - diseases that develop in the postpartum period, associated with pregnancy and childbirth. There are infectious (septic) and noncommunicable postpartum diseases.
Classification postpartum infectious diseases (proposed by Bublichenko): 1) disease, localized in the vagina and into the uterus,- postpartum ulcers, metroendometrit (see), lohiometra; 2) disease, localized outside the uterus,- adnexitis (see), pelvioperitonit (see), parametritis (see), thrombophlebitis (see), mastitis (see); (3) General and septic diseases - various forms of sepsis (see).
The postpartum infectious diseases, staphylococci and streptococci, rarely E. coli, Bacillus gas gangrene, gonorrhea, and other microbes. Postpartum diseases occur when the penetration of bacteria in the body through a wound surface (inlet gate): the inner surface of the uterus after the separation of the placenta, tears, cracks, abrasions, formed on the cervix, vagina and perineum. Pathogens are put on the wound surface external (exogenous infection) or on the wound get germs that existed in the woman's body (endogenous infection). Activation of endogenous infection may contribute to premature and early discharge of water, prolonged delivery, hemorrhage with subsequent anemia, trauma generic ways, the delay in the uterus parts of the fetal membranes and blood clots (see the Postpartum period). When exogenous infection microbes are brought unclean hands, tools, contact with patrimonial ways, in the process of care and treatment of postpartum women and adolescent girls, as well as airborne.
Beginning postpartum diseases characterized by the formation of inflammatory process in the field of wound surface.
With good resistance and proper treatment is the healing of the infected wound surface and the disease is terminated. With the weakening of protective forces of the organism and high virulence of microbes recent spread beyond the primary tumor. The spread of germs can occur through the lymphatic vessels (lymphogenous way), the blood vessels (hematogenous route) or the fallopian tubes (canalicular path). Perhaps the spread of germs simultaneously on blood and lymphatic vessels.
In postpartum women and adolescent girls with postpartum infectious disease temperature increases. In the mild course of the disease it may be low and declining rapidly, and in severe (sepsis, septicaemia) the temperature is kept at a high figures. There is increased heart rate, which in the mild course corresponds to temperature, and in severe it is very frequent and exceeds the figures, characteristic for the given temperature. Often there is a chill. The midwife must remember that these symptoms are typical of postnatal septic diseases. So with increasing temperature, increased heart rate and chill postpartum women and adolescent girls in the first place, there may be a septic infection. In the presence of lohiometra (delayed discharge from the cervix), metroendometritis is possible to note the uterus subinvolution (not good enough its reduction). Under favorable course of the disease subinwalucia completed by the end of the 3rd week.
Prevention of postpartum diseases consists first of all in the preparation of a pregnant for childbirth, keeping it personal hygiene; required daily washing of external genitals; sexual intercourse in the last two months of pregnancy is contraindicated. Pregnant should avoid contact with infectious patients.
During childbirth, the midwife must thoroughly clean your hands before each manipulation. Fetal bladder can not be opened up to full disclosure of the cervix without special to that testimony. After birth, the placenta it must be carefully examined, as captured in the uterus part of the placenta can be a fertile soil for the development of infection. The midwife must protect their hands from bruises and injuries and have no contact with infectious patients. Chamber maternity Department should regularly to air, to irradiate mercury-quartz lamps.
With postpartum diseases travaileth in need of medical help. Doctor prescribes antibacterial drugs (antibiotics, sulfonamides), reduce the uterus funds, restorative treatment. The patient required bed rest.
To noncommunicable postpartum diseases are: postpartum eclampsia (see), generic shock, postpartum psychosis (see the Postpartum period). Generic shock occurs after heavy painful birth and after the birth of a fetus or placenta. The woman suddenly appears blanching of the skin and visible mucous, dizziness, nausea, vomiting, cold sweat; the pulse thread, your blood pressure falls. Often there comes the unconscious.
Treatment generic shock: subcutaneously to 1 ml of 2% solution of omnopon, warm sick, intravenous drip of 5% glucose solution (up to 1 l), heart funds (camphor 2 ml of the 20% oil solution subcutaneously, caffeine 1 ml of 10% solution subcutaneously); transfusion of blood under the supervision of a physician.

Postpartum diseases. To the postpartum diseases include diseases (predominantly infectious origin), directly related to pregnancy and childbirth. Less common diseases noncommunicable nature (postnatal eclampsia, postpartum hemorrhage). However, not any complication in the postpartum period, is a "postpartum illness", for example flu, sore throat, malaria and other
Postpartum infection is wound infection resulting from infection during childbirth wound surfaces soft generic ways, placental site. To postpartum infection also include lohiometra, insufficient reverse involution of the uterus, accompanied by fever, postnatal mastitis, single and multiple temperature rise without precise localization process.
Individual cases and outbreaks of postpartum infection was observed at all times and described by Hippocrates. Currently postpartum diseases (including all kinds of diseases, connected with infection, and is not related) represents approximately 2 to 3%to 5%. Outbreaks of epidemics postpartum infections currently are not observed. Cases of generalized sepsis occur only rarely, and the related mortality is in obstetric institutions of the USSR the last place in the overall maternal mortality.
Classification. Infectious postpartum diseases are divided into localized, i.e. limited to a specific organ, and generalized (puerperal sepsis). For localized disease include postpartum ulcers (infected breaks crotch, vagina, and cervix), postpartum endometritis (decidua), metroendometrit (see) and metachromatic (see:), adnexitis (see), pelvic peritonitis, parametritis (see). To generalized - sepsis (see) without metastases (septicaemia) and metastasis (pyosepticemia and thrombophlebitises form of sepsis). Postpartum diffuse peritonitis considered as peritoneal form septicemia.
Infectious postpartum disease is shared also by severity as mild, moderate and severe. In mild cases, the infection is usually quickly cured (puerperal endometritis and metroendometrit, puerperal ulcers). In cases of moderate infection spreads outside of the genitals, but does not go into generalized. This includes: parametrial infiltrates and abscesses, inflammation of the uterus with the involvement of the pelvic peritoneum - pelvioperitonit (see). The disease often continues for a long time, however, the vast majority of women recovering. Severe systemic infection in the form of puerperal sepsis is the most dangerous postpartum disease in which the primary focus of infection (input its gates) has a time value.
The etiology and pathogenesis. Postpartum infection occurs as a result of either making pathogenic microbes from the outside, or the activation of microbial flora inhabiting a sexual way, postpartum women and adolescent girls (infection). Pathogens puerperal infection is mainly strepto-staphylococci, rarely E. coli, gonorrhea, rarely tetanus infection, diphtheria Bacillus, agents of scarlet fever and other generally prevails mixed infection (Association of germs).
Making the infection from the outside possible failure to comply with the medical staff of aseptic and antiseptic rules in preparing women for childbirth and delivery. Activation own infection contribute generic injuries, violation inherent in sexual ways women protective mechanisms, as well as various obstetric manipulation.
There are the following methods of infection: 1) direct infection of the wound surfaces (cracks, breaks, placental site), 2) Scandinavia infection through the birth canal (intracanalicular path), 3) spread through the lymphatic and blood vessels, and 4) the metastasis of uregently foci of infection (sore throat, influenza, purulent otitis media and other).
The development of postpartum infection depends not only on the type of pathogen, its virulence, location, character And status of the gate of the infection, how it is spread, but largely from the reactivity and body resistance postpartum women and adolescent girls. To the occurrence of postpartum infection diseases predispose transferred during pregnancy and childbirth, particularly bleeding. Special danger is represented by hemolytic streptococci. Primary infection of the placental site prognostically more serious than the infection of wounds perineum and vagina.


Symptoms and course. Symptoms of postpartum infection numerous febrile temperature, single or repeated vomiting, the phenomenon of intoxication, delay lohii or, on the contrary, the rich, dirty, smelling discharge, pain of varying intensity and character, decrease or loss of appetite, sleep disturbance, blurred dysuric and diarrhoeal phenomenon (in sepsis often rich, liquid, foul-smelling stools), reducing the percentage of hemoglobin and the number of erythrocytes in peripheral blood increased leukocytosis (in some cases up to 25 000-35 000 and more), accelerated ROHE, neutrophilia, aneosinophilia, limfopenia. In the urine in severe and prolonged postpartum infection is noted albuminuria. If septicopyemia with metastatic renal disease in the urine detect significant changes: albuminuria, mikrogematuria, pyuria, cylindruria, bacteriuria and other
The disease depends on the type and virulence of pathogens of infection, the condition of entrance gate infection, the intensity of the inflammatory reaction, the initial state postpartum women and adolescent girls, its reactivity and resilience. On the background of preliminary anemizatsii in patients with weakened transferred or available extragenital diseases, postpartum infection occurs more frequently and severe. In severe cases, instead of giperlakotsitos and accelerated ROHE are there leukopenia and slowing ROHE. There may be various kinds of local inflammation.
From postpartum diseases most often see postpartum endometritis, mild or severe. The latter is accompanied by high and long-term temperature, more pronounced symptoms of intoxication. With the endometrium (the remnants of the decidual shell) the process can move a muscle of the uterus (endomiometritis), Vienna uterus (microthrombosis) and to serve as a further source of infection spread beyond the uterus (pelvic phlebitis, parametritis, pelvioperitonit, adnexitis).
The time of onset of clinical symptoms and severity of their depend largely on the localization of postpartum infection. For example, evidence of endometritis may appear on the 3-4th day after the delivery, parametritis in the middle or at the end of the second week, sepsis, already in the first hours or the first day after birth. Rising gonorrhea proceeds initially sluggish amid subfebrile temperature, and when moving it into the uterus and pelvic peritoneum - acute (usually in the second week). When localized postpartum infection duration and severity of the disease depend on the nature of the inflammation. When purulent inflammation disease is more long and hard. It is especially postpartum sepsis.
Diagnostics is carried out on the basis of the evaluation of complaints of the patient, the onset of the disease, General condition, the temperature curve, data of the external examination, inspection of the external genitalia, perineum and vagina and cervix, if necessary, two-handed research (vaginal and pryamokishechnye), the nature and quantity of the discharge - lohii, smear microscopy and bacteriological their studies, blood cultures, analysis of blood and urine, and some special functional tests. With postpartum sepsis, bacteriemia can be absent. Differentiation is necessary between the true postpartum diseases and diseases of different origin, as well as between postpartum infectious and non-infectious diseases.
The prognosis depends on the character and localization of postpartum illness, type of infection, clinical manifestations, relatively favorable in all kinds of localized infection and doubtful with postpartum sepsis, where maternal mortality is still high.
Treatment. Etiotropic therapy with high doses of broad-spectrum antibiotics and sulfonamides (after a preliminary determination of sensitivity to him pathogenic flora). Tonic and antitoxic funds (glucose, calcium chloride intravenous, vitamins). If necessary, repeat the transfusion of small doses of donor blood or erythromyci, plasma, poliglyukina, heart funds. Strict bed rest. Care of the patient. High-calorie, easily digestible, vitaminized food in small portions in 2-3-hour intervals. Regulation of the intestine. The impact on infected wounds (puerperal ulcers), antiseptics and antibiotics (powders, emulsions), ultraviolet irradiation of infected tearing of the perineum (to dissolve the seams). Special surveillance require a septic patients, for whom it is desirable to organize individual care. Purulent accumulation void surgically. Postpartum peritonitis subject surgical treatment possible with extensive drainage of the abdominal cavity. With postpartum thrombophlebitis shows the use of anticoagulants and hirudotherapy (intravenous drugs contraindicated), long-strict bed rest, elevation of extremities, dry heat, small doses of iodine preparations.
Prevention. Rehabilitation of pregnant women. Warning common infections during pregnancy. Hardening, therapeutic exercises. Strict antiseptic and asepsis in childbirth. Vaginal examination only on the testimony. Rational management of deliveries. Warning generic injuries. Timely fighting bleeding. The correct maintenance of the postnatal period. The isolation of patients from healthy puerperas.