Postpartum disorders - postnatal bacterial infections. The problem is very serious postpartum illness, a pathology that occurs in women during the postpartum period (from the moment of separation of placenta and the end of 6 weeks), is directly related to pregnancy and childbirth and is caused by infection (mostly bacterial).
Do not apply to post-natal illness all other diseases, including infections (influenza, dysentery, etc.) are identified in the postpartum period, but directly to pregnancy and childbirth are not related.
In the obstetric hospital, where significant numbers of pregnant women are concentrated, childbirth and newborns, because of their physiological characteristics very prone to infection, hospital infection is especially dangerous. The frequency of postpartum diseases varies significantly due to the lack of standardized criteria, and preferably ranges from 2 to 6%. More precisely, it reflects the individual clinical forms. Significantly more likely to develop postpartum illness after cesarean section, so endometriosis is seen in 10-15% of operated women.
In connection with the prevention, early detection and rational treatment of the initial manifestations of postpartum infection including endometritis, generalized septic processes in childbirth, as well as deaths with them in modern conditions are observed less frequently.
Classification of postoperative disease presents considerable difficulties due to a variety of pathogens, polymorphism, and dynamics of their clinical manifestations and the lack of standardized criteria and terminology. At the present time in our literature the most accepted classification of postpartum infectious diseases Sazopova - Bartels. According to this classification, the various forms of post-natal infection of the birth canal are treated as separate stages of a single dynamically flowing infectious (septic) process. The first stage - defined by the following local signs of infection in the wound area of labor (inflammation in the area of family wounds) endomyometritis postpartum postpartum plague pyo-inflammatory process in the perineum, vulva, vagina, cervix)
The second stage - determined by the local manifestations of an infectious inflammatory process, extending beyond the wound, but remains localized: metritis parametritis salpingo pelvioperitonit metrotromboflebit thrombophlebitis pelvic vein thrombophlebitis of femoral vein (for the second phase are only limited, indecomposable thrombophlebitis). With the spread of infection from puerperal ulcers occur vulvitis. colpitis, parakolpity, etc. (These same diseases can occur as a result of descending infection)
In the third stage of the severity of the infection is close to the Generalized: diffuse peritonitis septic endotoxic shock anaerobic gas infection is a progressive thrombophlebitis
The fourth stage - a generalized infection: sepsis, sepsis without apparent metastases with metastases
The authors propose to consider the following variants of generalized infection, characterize and determine the severity of the disease:
endocardial, characterized by the presence of septic lesions of the heart (endocarditis, pancarditis)
peritoneal, poliserozny flowing with purulent inflammation of the large serous cavities tromboflebichesky, the anatomical substrate of which is thrombophlebitis limfangichesky option, which is the generalization of infection by lymphogenous
Unlike some other infectious diseases caused by certain agent for postpartum illness is characterized by poly etiology. various clinical forms of puerperal infection may be caused by various microorganisms. At the same time, post-natal illness often associated with polymicrobial infection. For any infectious disease is determined by the interaction between the pathogen and the organism as a consequence of the dual evolution of parasite and host. However, each type of microorganism having a specific set of biological properties, has a decisive influence on the clinical picture of puerperal diseases in essence, defining their character.
The etiology of postpartum illness has undergone significant changes due to mainly the use of antibacterial drugs (especially antibiotics) in medical practice. In 50-60s the main causative agent of postpartum diseases was Staphylococcus aureus. Today in the etiology of postpartum diseases increasingly important role played by Gram-negative opportunistic bacteria (Escherichia, Proteus, Klebsiella), they also complicate the puerperal diseases of other etiologies. Postpartum disorders can develop when writing the microorganisms from the environment (mainly hospital strains) or by activating its own conditionally pathogenic microorganism. Perhaps perineal infection, vagina, cervix. In connection with the more widespread use in the last decade in obstetric practice cesarean section infection can develop in the uterus (the place of dissection and the surgical wound in the abdominal wall). The main pathway from the primary site of infection - lymph and blood vessels (often a combination of both).
Several factors contribute to the development of post-natal illness during pregnancy. They are:
non-genital bacterial infection
bleeding from the genital
invasive methods for studying the functional state of the fetus
Surgical correction of isthmic-cervical insufficiency, etc.
At the time of delivery:
delayed rupture of membranes (premature, early) or reasonable amniotomy with a long interval of anhydrous
long-term (prolonged) labor
unfounded multiple vaginal study
bleeding from the genital organs (at the time of delivery and the postpartum period)
invasive methods for studying the functional state of the fetus and uterine activity chorioamnionitis, etc.
In the postpartum period:
delay parts of placenta
previously deferred inflammatory diseases of the genital organs
the presence of non-genital lesions of bacterial infection
endocrine diseases, etc.
In the presence of these factors, women must be included in a group at high risk for postpartum conditions to conduct appropriate preventive and therapeutic measures.
The clinical picture of puerperal diseases is very variable, due to the polietiolognchnostyu postpartum infection, stages, and different ways of distribution, unequal response of the female organism. With a significant diversity of the clinical course of both localized and generalized disease there are a number of postpartum symptoms characteristic of post-natal illness.
Common symptoms are:
increase in body temperature
lack or loss of appetite
dizuricheskie and dyspeptic symptoms
decrease in blood pressure (septic shock, sepsis)
Local symptoms are:
pain in the abdomen
delay of lochia
profuse lochia pussy with an unpleasant odor
festering wounds of the perineum, vagina, abdominal wall after cesarean section
swelling of the perineum
There are erased, subclinical form of postpartum diseases which are characterized by a mismatch between the patient well-being, clinical manifestations of the disease and the severity of it. Thus, prevention and adequate treatment of postpartum disorders to reduce their effects.