Description puerperal infection
Puerperium (postpartum) is a period that begins after birth and ending with the forty second day after. In this period there is a return to the changes incurred pregnancy and childbirth. New mum learning to breastfeed and take care of the baby. In addition to physiological changes, however, this period also brings some dangers. One is infection.
Infections in the postpartum period is one of the causes of maternal morbidity and in rare cases can threaten a woman’s life. This risk threatens more at birth by Caesarean section. Before the discovery of the principles of asepsis and antisepsis (ie. A thorough disinfection of the hands of the obstetrician, sterile gloves, sterile instruments …) but these complications were more often and postpartum women died.
Only Ignaz Semmelweis, a physician of Hungarian origin operating in Austria in the early 19th century literally made a revolutionary discovery. Conceived and expertly explained that puerperal fever arises entry of a “toxic substances” in the genitals. However, as the big discoveries is, Semmelweis was in its time met rather ridicule. Ironically, he died unappreciated sepsis from spreading infection of the injured finger. His laws and rules They were adopted after long debates to a whole quarter of a century later.
Puerperal sepsis was in the Middle Ages considered a consequence of residues having bloody discharge or parts of the placenta in utero. After childbirth remains in the uterus after separation of the placenta wound area. This is due to a like childbirth easy entry gate infection. After delivery, the uterus forms called. Lochia (having bloody discharge), which are the remnants of tissue, blood, phlegm after birth, etc. They are a very good breeding ground for bacteria. You can enter the uterus from the vagina rise. Furthermore, they can spread from the uterus to the fallopian tubes, ovaries and into the pan. They can cause sepsis image.
Infection can occur either by transferring outside when breaking adequate sanitation, clogging staff, medical facilities or childbirth, unsterile instruments like. It may also arise penetration of bacteria from the vagina where no bacteria were settled before birth, as well as from other places in the body, for example during coinfection urinary tract infections, tonsillitis, or inflammation of the worm-like appendage (appendix).
Infectious agents (agents) who contribute to the infection are usually part of a mixed bacterial flora.They are used here e.g. Staphylococcus aureus, S. epidermidis, Eschrichia coli, streptococci, gonococci, mycoplasmas, clostridia and others. The course of infection depends on the immune status of women, birth injuries extent, the circumstances under which infection occurred, and the type of hazard agents. The inflammation can occur only locally as an infection of the external genitalia, vagina, uterus, peritoneum or blood vessels. More serious are the general signs, custom puerperal sepsis.
Risk factors for puerperal infection
There are the maternal factors as obesity, anemia, chronic illness, infection of the vagina, low social level. Furthermore, there are factors related to childbirth – premature rupture of membranes, uterine infections, obstructed labor, frequent vaginal gynecological examination.
Prevention of puerperal infection
At-risk births are sometimes administered antibiotics because of the risk of infection. It is mainly preterm rupture of membranes, which are obvious signs of infection. Sometimes it is because of pre-existing infections should be to perform a caesarean both to prevent the development of infecting the baby. Furthermore, the easier the treatment of non-pregnant patients. After delivery of the baby and placenta obstetrician always checks the uterus, if there is no trace of the placenta. If so, remove them. It is also necessary to check the healing of wounds and scars birth after Caesarean section.
Symptoms of puerperal infection
Injury to the vagina and external genitalia are usually heals well, rarely cause infections overall development. Infected wounds are reddened, swollen, painful, on the surface it is purulent.
The most common infection after childbirth is an inflammation of the uterus. It manifests with fever, sometimes more abundant stinking having bloody discharge, can sometimes lead to a weaker bleeding and abdominal pain. In the blood are higher inflammatory parameters (CRP, sedimentation, leukocytes). If the penetration of infection into the uterine musculature may form abscess (bounded purulent inflammation). May lead to excretion of pus or abscess for caving into the abdominal cavity. Nedělka has a high temperature, chills, fever, purulent discharge, uterus on palpation hurts.
In spreading into the cervix around the clinical picture is stormy. Fever is high, lower abdominal pain shoot thighs, the frequent urge to urinate and stool.
Disability ovaries and fallopian tubes are not common. If this happens, it affects as fever, pain in the lower abdomen, nausea, vomiting, alteration of bowel movements.
Inflammation may be the uterus, fallopian tubes, ovaries, or from the wound after Caesarean section to move to the peritoneum. The image is stormy. Usually high fever, chills, chills, nausea, vomiting, rapid heartbeat, abdominal distension. When a diffuse infection can be life-threatening. The patient is seized, has sunken eyes, a pointed nose (ie. Hippocratovská face).
A dangerous complication is also the spread of inflammation in the pelvic veins. This manifests similarly bounded peritonitis, possibly adding the swelling of the lower limbs.
Life-threatening infection is to develop a comprehensive body – sepsis. This is caused by washout of bacteria and their toxins into circulation. It manifests with fever (40 ° C), chills, shivering, rapid heart beat strongly (to 140). Sick is wasted, a coated tongue, bluish lips, sallow skin, and sometimes diarrhea. When failure of antibiotic treatment, the overall condition worsens, and the woman died on the overall intoxication of the organism. Not always sepsis manifested so suddenly.Sometimes it occurs gradually, with intermittent fevers, persistent fever later, adding a rapid, weak pulse, lowers blood pressure and exhaustion occurs.
Treatment of puerperal infection
When infected outer genitals sufficient local rinsing e.g. 3% hydrogen peroxide, powders with antibiotics. When manifestations of cervical inflammation, inflammation of the fallopian tubes, ovaries, peritoneum, or celkvých infections are treated with antibiotics systemically submitted.Further attention is paid to the overall health. When fever is served antipyretics to reduce it. When the pain analgesics, icing the lower abdomen. It is always required absolute bed rest. In the case of vascular infections are necessary “blood thinners” (LMWH). In the case of sepsis require treatment in intensive care unit, sometimes one has to proceed to surgical treatment.
How do you help yourself
It is essential to comply with increased hygiene. The Sunday-worn first days after birth liner, because at that time preclude having bloody discharge from the uterus. They must likewise often as sanitary napkins vary, not only after each breast-feeding, but when they are soaked. Rinsing genitals initially recommended after every urination, stool and lactation. With a total bath should be selected showering, bathing in the postpartum period is not appropriate.
Complications puerperal infection
It is always necessary slightest inflammation in the Sunday-school treat, because even he can jump in the overall infection. Total life-threatening infections. Can damage the organs, especially the liver or kidneys, which can be permanent. For inflammations of the ovaries and fallopian tubes may cause pozánětlivým adhesions. This then leads to blockage of the fallopian tubes and subsequent infertility. Inflammation of the uterus and the peritoneum, which are not adequately treated they can cause complications in pregnancy.
Other names: Sepsis, puerperal fever, puerperal infection