Lecture of postpartum infection

2021-03-22 12:00 AM

Inflammation is not localized in the uterine lining, but develops into the subframe and forms pseudomembranes in the organs in the subframe and interacts.

Postpartum infections are infections that occur in pregnant women after giving birth that start from the genital tract (vagina, cervix, uterus).

Some common pathogenic bacteria

There are many types of bacteria that cause postpartum infections: Staphylococcus, streptococci, E. Coli, bacteria such as Clostridium, Bacteroides.

Way of transmission: From the vagina through the cervix, through the uterine tube to the peritoneum.

Through the area of ​​vegetable cling to cause blood infection.

Favorable factors: Poor nutrition, anemia, fetal toxicity, premature rupture of amniotic fluid, premature rupture of amniotic fluid, prolonged labor, removal procedure, uterine control, epidemic termination ...

Postpartum infections

Bacterial infections of the anogenital layer, vulva, and vagina

Reason

The perineal suture is not sterile, the perineal recovery stitch is not technically correct or is not stitched, and there is a gauze left over in the vagina.

Symptom

Fever is not high.

Wound site: Swelling, redness, pain, pus.

Production is not foul.

Treatment

Local care: Wash with antiseptic; Cut only when there is pus, sanitary lozenges, sterile gauze.

Inflammation of the lining of the uterus

Cause: Sour vegetables, missed membranes, bacterial amniotic fluid, uterine control procedures, peeling non-sterile artificial vegetables.

Symptom

Fever 38 - 38 0 5 (a few days after giving birth)), fatigue, irritability.

Exudate a lot, foul, mixed with blood, pus ...

The cervix is ​​opened, the uterus contracts slowly, the uterus is painful.

Cultivate the solution to find bacteria and make an antibiotic.

A more severe form of inflammation of the endometrium is generalized metritis. The inflammatory process spreads to the layer of the uterine muscle, with small apical cells. The clinical symptoms are more severe than inflammation of the lining of the uterus, easily cause peritonitis or septicemia.

Treatment

Systemic antibiotics: Ampixilin, Gentamixin.

Medicines to increase uterine contractions: Oxytocin, Ergotin.

If the vegetables are missing, wait for the temperature to drop or the fever stops before curettage of the uterus.

If total uterine inflammation must be partially hysterectomy and blood culture to detect blood infection early.

Inflammation of the peritoneum and ligaments

Symptom

Postpartum fever 8 - 10 days.

Subframe manipulation shows a soft, painful mass, unclear margin, limited mobility.

Excessive discharge, foul, slow cervix closing; the uterus contracts slowly.

Progression: May resolve with aggressive treatment or become subfromic peritonitis.

Treatment

Resting.

Apply ice and antibiotics.

If a pus is formed, the puncture is drained through the sac along the vagina.

Subframe peritonitis

The inflammatory process is not localized in the uterine lining, but develops into the subframe and forms pseudomembranes in the organs in the subframe and causes adhesion. The reaction of the peritoneum will produce sacs of fluid filled with blood and pus.

Symptom

More explosive than uterine mucositis. Average from 7 - 15 days.

The temperature gradually increased from 39 to 40 0 C, coldness, fatigue, and dirty tongue.

There is abdominal wall reaction in the subframe, slightly distended abdomen, upper part of the subframe, and the abdomen soft.

Vaginal visit: Baby cervix, uterus enlargement, painful mobility.

Sacs with the vagina: edema, pain.

Vaginal examination combined with manipulation of the abdomen: the subframe with solid mass, not moving, pain.

Leukocytosis test increases, culture of fluid to find pathogenic bacteria.

Progression: Can be resolved with aggressive treatment, may develop into total peritonitis.

Treatment

Vacation, ice pack, high dose antibiotics.

If Apxe Douglas, then quote and save through the pocket with the vagina.

Whole peritonitis

Reason

After cesarean section is not sterile.

After inflammation of the endometrium, total metritis is not well treated.

After the procedure to peel vegetables, control the uterus.

It is possible that bacteria that spread from the oviduct accumulation cause peritonitis.

Symptom

7-10 days after delivery, or 3-4 days after cesarean section.

Body symptoms: Dry lips, dirty tongue, sunken eyes, signs of poisoning, infection.

Defecation sometimes loose, stools.

Abdominal side wall reaction or peritoneal induction (sometimes unknown)

X-ray of the abdomen unprepared: The abdomen has dilated loops, the water level, the vapor level.

Electrolytes: Components Ca ++, Cl- decreased.

Differential diagnosis with sub-frame peritonitis, functional inter-enteritis.

Treatment

Systemic antibiotics.

Rehydration water, electrolytes.

Partial hysterectomy.

Wash and drain the abdomen.

Sepsis

The most severe form of postpartum infection.

Symptom

Body: Constant high fever, fluctuating temperature, accompanied by a high fever with chills, fatigue, signs of infection, toxicity: dry lips, dirty tongue, shortness of breath, yellow skin, dark urine .

Obstetrics: The cervix is ​​ajar, the uterus is enlarged, slowly shrinks; painful uterine pressure; producing foul, dirty fluid mixed with blood and pus.

Listening to lungs: There may be rashes.

If infected ... (+) can see the manifestations of secondary infection foci: muscle apxe, liver apxe, brain apxe.

Blood culture, culture of fluid: If positive is certain, negative is not excluded, mainly based on clinical practice.

Other tests: Red blood cells decreased, leukocytes increased, mainly neutrophils increased, Hematocrit decreased.

Complications: May be functional renal failure, interstitial nephritis, lung apxe, endocarditis. Brain apxe, meningitis ...

Prognosis: Depends on secondary site of infection and whether or not treatment is correct and timely.

Treatment

Use antibiotics according to the antibiotic map. In the absence of an antibiotic, a broad-spectrum antibiotic should be used: Cephalosporin; flagyl, quinoline group ...

Combine blood transfusion, heart support ...

When the temperature returns to normal or drops: partial hysterectomy to eliminate the primary infection.

Thrombophlebitis

Reason

Common in people, prolonged labor, blocked circulation of blood vessels (venous system), increased fibrinolysis.

Symptom

Appear late 12-15 days after delivery.

Mild fever, chills, rapid pulse.

If thrombophlebitis is slow, the leg is swollen, white, painful, and the heel cannot lift off the bed.

If treatment is not timely, it can cause obstructive inflammation of the pulmonary artery, kidney and possibly death.

Treatment

Do tests for bleeding, blood clotting, platelets, Quick time and Prothrombin rate.

The limb has had thrombophlebitis for at least 3 weeks after the fever has gone.

Systemic antibiotic combined with corticosteroids after a few days of antibiotic use

Anticoagulants: Heparin 25,000 UI / kg body weight / 24 hours intravenously or drip intravenously or Dicoumarol 2-10 mg / 24 hours (anti-vitamin K, slow acting). Tracking results of treatment with Howell, Quick time test.

Prevention of postpartum infections

Treatment of inflammatory foci during pregnancy: Urinary tract inflammation, genital ...

Prevent infection of amniotic fluid and prolonged labor.

Giving birth: Do not leave vegetables, the instructions for uterine control must be correct, follow the good hygiene and disinfection regime.

Postpartum: Avoid holding epidemic services, cleaning and taking care of the episiotomy properly.