In the famous book by Jerome K. Jerome "Three in a boat, not counting the dog" the hero found everything except childbed fever. What is it? Let's figure it out in this article.
A group of diseases caused by infectious infection of women in labor during childbirth is called postpartum sepsis, or, as they used to say, puerperal fever (fever).
General information
Maternity fever arose in the Middle Ages. Hippocrates was one of the first to describe the case of this disease. Until the opening of the first maternity hospital in the 17th century, cases of infection with puerperal fever were epidemiological in nature.
In the middle of the 19th century, the Hungarian obstetrician Ignaz Semmelweis made a number of assumptions about the causes of puerperal fever. He was the first to point out the need to use antiseptic solutions during childbirth. However, their widespread use in obstetrics began to be applied only at the end of the 19th century.
According to statistics, today only 0.2-0.3% of cases among all obstetric complications are sepsis, which occurs against the background of endometritis in 90% of women in labor.
The puerperal fever mentioned in the classic books was most often described asdangerous and incurable disease. The use of aseptics, antiseptics in modern medicine, the use of antibiotic therapy lead to the fact that postpartum sepsis is successfully treated.
Types of postpartum infection include:
- Endometritis - inflammation of the uterus.
- Seam split at the crotch after incision.
- Suture divergence after caesarean section.
- Mastitis.
Paternity Fever: Causes
What are the causes of postpartum fever?
- As a rule, infection with pathogens of a woman's body occurs when antiseptics are not observed during childbirth.
- The most common infection occurs with "hospital" strains of bacteria, characterized by increased resistance to drugs.
- Due to the weakening of the immune system caused by stress during childbirth, a woman's own opportunistic flora can activate in the body and cause an infectious process.
About pathogens
The causative agents of postpartum sepsis are:
- bacteroids;
- proteus;
- Staphylococcus aureus;
- gonococcus;
- E. coli;
- Klebsiella;
- hemolytic streptococcus;
- Peptostreptococci and so on.
But certainly not a flea in childbed fever. This is not a pathogen, but simply the name of one of the shades of color, and has nothing to do with the disease.
Most often, postpartum sepsis is a polymicrobial infection caused byseveral types of pathogens.
Microorganism entry points are:
- Tears of the vagina, cervix and perineum.
- Area of attachment of the placenta in the uterine cavity.
Infection, as a rule, occurs by contact, in contact with the wound surface of dirty hands and non-sterile instruments. Then the spread of pathogens passes through the lymphatic and blood vessels.
Risk factors
Risk factors for postpartum sepsis:
- acute and chronic inflammatory diseases of women - extragenital, such as cystitis and pyelonephritis, and gynecological, such as endometritis, colpitis and vulvitis;
- use of invasive perinatal research methods;
- direct fetal electrocardiography;
- application of surgical correction for insufficiency of the cervix and isthmus;
- use of frequent vaginal examinations during childbirth;
- uterine bleeding.
- early water break;
- Performing obstetric operations such as fetal rotation, cervical dilatation using forceps.
Puupital fever develops more frequently in primiparas than in second births.
Symptoms
1-2 days after birth, symptoms of postpartum sepsis may appear:
- high fever and chills;
- tachycardia;
- general malaise, other symptoms of general intoxication;
- thirst, decreaseappetite;
- pain all over the abdomen, not just below;
- fetid, with impurities of pus discharge (lochia) from the birth canal, sometimes there is no discharge;
- with mastitis, complete cessation or reduction of lactation.
Besides puerperal fever, other ailments occur.
First, the inflammatory process does not spread beyond the birth wound. Then, depending on the lesion, specific manifestations of labor fever appear:
- puerperal ulcers - wounds with a grayish bottom, with edematous and hyperemic edges, located on the cervix, vaginal walls, perineum;
- puerperal colpitis is an inflammation of the vaginal mucosa.
Secondary signs of the disease join the spread of the inflammatory process:
- endometritis affecting the mucous membranes of the uterus;
- parametritis affecting periuterine tissue;
- adnexitis, otherwise inflammation of the uterine appendages;
- pelvioperitonitis - defeat of the pelvic peritoneum;
- metrothrombophlebitis - inflammation of the veins of the uterus;
- thrombophlebitis - inflammation of the veins of the pelvis and lower extremities.
The third stage of the disease is characterized by symptoms of generalized sepsis and symptoms of general peritonitis. How is puerperal fever diagnosed?
Diagnosis
The diagnosis of "puerperal sepsis" is made on the basis of the present clinical symptoms, after a gynecological examination and blood test.
Treatment
Treatment for puerperal sepsis is based on the severity of the disease. Main destinations:
- Taking into account the sensitivity to antibiotics, antibiotic therapy is carried out. Drugs are prescribed compatible with breastfeeding, in severe cases, feeding is stopped.
- Immunostimulating drugs (anti-staphylococcal immunoglobulin, T-activin, plasma transfusion indicated, toxoid administration).
- Infusion therapy is required to relieve intoxication and restore the water-s alt balance (alkaline solutions, hemodez, proteins and reopoliglyukin).
- Antihistamines are prescribed ("Suprastin", "Tavegil").
- Introduction of proteolytic enzymes (trypsin) is indicated.
In the generalized form of sepsis, glucocorticoids and anabolic hormones are prescribed.
It is possible to carry out physiotherapy procedures:
- electrical stimulation of the uterus;
- UHF;
- UV irradiation;
- microwaves;
- ultrasound.
Topical treatment of infection:
- washing ulcers with a solution of sodium chloride and hydrogen peroxide, for large wounds - truncation of the edges with suturing;
- with endometritis, when blood is retained in the uterus, removal of the remaining placenta and instrumental revision of the uterine cavity is indicated.
With peritonitis, that is, in severe cases, extirpation is performed - removal of the uterus along with appendages.
Forecast
Outcome of the disease with a birth infectiondepends on many factors:
the time when treatment was started, and the immunity of the woman in labor;
degrees of pathogenicity of bacteria
If the inflammation process is limited to the wound, recovery is usually complete and without consequences. With a generalized form of sepsis, mortality reaches 65%.
Prevention
In order to prevent puerperal fever, the following measures must be observed:
- sanation of acute and chronic inflammatory extragenital and gynecological diseases;
- during childbirth, prevention of tearing of the tissue of the birth canal;
- strict adherence to the rules of asepsis and antisepsis.
The hero of the book, apparently, knew the symptoms of this disease, because he found all the diseases in him, except for puerperal fever. Stay he althy!
