THE POPULAR DISEASES

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Postpartum diseases occur in the postpartum period (in the first 6 to 8 weeks after childbirth) and are directly related to pregnancy and childbirth. There are infectious and non-infectious postpartum diseases.

Infectious (septic) postpartum diseases occur most often. These include diseases caused by infection of the birth canal (actually infectious postpartum diseases), as well as extragenital infectious processes - mastitis , pyelonephritis .

The causative agents of these diseases can be golden and hemolytic streptococcus, conditionally pathogenic aerobic gram-negative microorganisms (E. coli, proteus, Klebsiella, etc.), anaerobic microflora (bacteroides, peptococci, peptostreptococcus, etc.). The role of conditionally pathogenic Gram-negative microorganisms is increasing, due to their high resistance to antibiotics, which are widely used in clinical practice; The frequency of postpartum diseases caused by anaerobic microflora is increasing. Infectious agents can get to the wound surface of the uterus (including the placenta pad), damaged areas of the cervix, vagina, perineum (entrance gates of infection) from the outside (for example, recorded during vaginal examination, manual examination of the uterine cavity if the rules of asepsis are not respected). Reducing the body's defenses promotes the development of the infectious process. Infectious postpartum diseases can also arise as a result of the activation of their own opportunistic pathogens.

The risk of developing these diseases increases with the presence of chronic infectious processes in the pregnant woman, the so-called invasive methods of research during pregnancy and childbirth (amniocentesis, amnioscopy), surgical correction of ischemic-cervical insufficiency, a long anhydrous period, frequent vaginal examinations in childbirth, obstetrical operations, Uterine bleeding, etc.

There is a perception that infectious postpartum diseases are stages of an infectious (septic) process. The first ethane includes lesions limited to the area of ​​the birth wound: endometritis, which is the most frequent infectious postpartum disease, and postpartum ulcers - pyoinflammatory process in the area of ​​rupture and cracks in the perineum, vaginal wall and cervix with superficial necrosis of tissues and the formation of a hard-to-separate plaque dirty - gray or gray-yellow color, edema and hyperemia of surrounding tissues.

The second stage of infection development is characterized by its spread beyond the birth wound; In this case, lesions of the myometrium (endomyometritis), periarticular tissue (parametritis), appendages of the uterus (adnexitis), peritoneum of the pelvis (pelvioperitonitis), veins of the uterus (metrotrombophlebitis), pelvic veins and veins of the lower extremities (thrombophlebitis) may occur.

At the third stage, peritonitis can be observed (usually occurs after caesarean section), septic shock , anaerobic gas infection, progressive thrombophlebitis ; On clinical manifestations the disease acquires a similarity with a septic infection. The fourth stage is characterized by the development of sepsis.

Clinical manifestations largely depend on the nature of the lesions, but they also have common features: increased body temperature, increased heart rate, chills, weakness, decreased appetite, sometimes thirst. Possible erased forms in which the patient's well-being for a long time can not be disturbed, the body temperature is subfebrile, the local symptoms with local lesions are poorly expressed, the ESR remains normal. The midwife should promptly presume the presence of a septic infection and immediately hospitalize the puerpera.

Diagnosis is established on the basis of clinical picture, laboratory and instrumental studies. Characteristic haematological signs are leukocytosis , increased ESR, a decrease in hematocrit; With septic shock, thrombocytopenia, hypercoagulability. With erased forms of diseases, blood test data do not correspond to the true severity of the disease. Clinical analysis of urine allows to establish the presence of pyelonephritis, which for the first time can manifest itself in the postpartum period. The etiological role of microorganisms is established by bacteriological examination of the contents of the vagina and canal of the cervix, breast milk, blood, urine. Bacteriological study is carried out before the start of treatment with antibacterial drugs and includes determining the sensitivity of microflora to them. According to the indications, ultrasound and X-ray studies, hysteroscopy are used.

Treatment . Parents should receive at least 2 - 2.5 liters of fluid per day (including liquid administered parenterally). An obligatory component of the treatment is antibiotics, which are prescribed taking into account the sensitivity of microflora to them. Antibiotics are excreted in breast milk, so the mothers breastfeeding, the use of streptomycin, tetracycline, rifampicin, and levomycetin is contraindicated. At the time of treatment, it is advisable to stop breastfeeding, and with mastitis, lactation with bromocriptine (parlodel) should be completely suppressed. To enhance immunological reactivity and nonspecific protection, T-activin, antistaphylococcal immunoglobulin , antistaphylococcal plasma, adsorbed staphylococcal anatoxin are used. With the aim of detoxification, elimination of metabolic and hemodynamic disorders, intravenous infusions of haemodesis, polyglucin, reopolyglucin, protein preparations, salt and alkaline solutions are used. The complex treatment also includes antihistamines (suprastin, tavegil, etc.), proteolytic enzymes (trypsin, chymotrypsin), in generalized forms - anabolic hormones, glucocorticoids. Of the physical methods of treatment use electro-stimulation of the uterus, UHF-therapy, ultraviolet irradiation, microwaves of the decimeter and centimeter range, ultrasound.

According to the indications, surgical methods of treatment are used. For example, with endometrium, which develops against the background of a delay in the uterus of the blood, lousy or parts of the aftereffect, an instrumental audit of the uterine cavity is performed, if necessary, removal of the delayed parts of the placenta; With peritonitis - extirpation of the uterus with fallopian tubes.

With the postpartum ulcer, mainly local treatment is carried out, aimed at removing purulent deposits and activating tissue regeneration. To remove purulent raids in the wound, a sterile gauze turunda impregnated with a 10% solution of sodium chloride or cicerol is administered. Turundu is changed every day until the wound is completely cleansed of pus. After that appoint applications with ointment.

Prevention should begin during pregnancy and include treatment of gynecological (vulvitis, colpitis, etc.) and extragenital diseases (chronic tonsillitis, sinusitis, pyelonephritis, bronchitis, etc.). Of great importance is the rational management of childbirth and the postpartum period (prevention of a long anhydrous interval, the timely appointment of funds that stimulate labor, adequate analgesia of the birth, prevention and proper treatment of gaps in the soft tissues of the birth canal, etc.). It is important that the staff of obstetric institutions adhere to a strict sanitary and hygienic regime, personal hygiene, asepsis and antiseptic when caring for the mother.

Noninfectious postpartum diseases. These include mainly the complications of labor: postpartum preeclampsia and eclampsia, pubic symphysis discrepancy, shock , embolism, uterine bleeding, eversion of the uterus . Uterine bleeding can occur in the first hours after birth or at a later date as a result of the formation of the placental polyp.

In the postpartum period, there may be an accumulation of postpartum secretions (lochia) in the uterine cavity - the lochiometer. It is caused by insufficient contractile activity of the uterus or spasm of internal uterine throat. With a lohiometer, the uterus is enlarged, the number of secretions from the genital tract is less than usual. Palpatory uterus is painless, body temperature is normal, there is no tachycardia. With the help of ultrasound, fluid accumulation in the uterine cavity is determined. Treatment consists in the appointment of funds that reduce the uterus (oxytocin 5 ED or 0.02% solution of metargergometrin 1 ml 2 times a day intramuscularly). 20 minutes before the introduction of these funds for the removal of cervical spasm, it is advisable to intramuscularly inject 2 ml of a 2% solution of no-shp. Sometimes inside appoint stiptitsin (kotarnin chloride) to 0,05 g 3 times a day. If the lychiometer is not eliminated in time, the development of an endometritis is possible. Prevention consists in the correct management of the postpartum period (monitoring the contraction of the uterus, the nature and volume of secretions).

In the postpartum period, sometimes there are so-called postpartum psychoses. Their causes may be severe labor (prolonged course, surgical interventions), exhaustion, anemia, infection, mental trauma. Clinical manifestations are diverse - agitation, delirium , depression (sometimes thoughts of suicide), etc. Such patients require individual supervision (nursing), if necessary they are transferred to a psychiatric hospital.