Postpartum endometritis: Symptoms and Treatment after cesarean as manifested disease

One of the possible birth complications is infection of the uterus, resulting in a postpartum endometritis. Bacterial infection spreads from the lower reaches of the vagina and the body cavity.

Acute endometritis usually develops immediately after delivery or during recovery. Infection mostly polymicrobial, occurs predominantly streptococci growth peptostreptokokkov or gram negative organisms.

pathology Causes

Endometritis postpartum women can develop for different reasons:

1. Inflammation after penetration of microbes during delivery of existing chronic foci. The main pathogens are considered gardnerelly and Enterobacteriaceae. Intensive growth is observed in the fall of immunity, post-operative and post-natal care, with intensive blood loss.
2. Surgery. With higher frequency endometritis development is observed after cesarean delivery. As a result, the manipulation maybe primary infection incision, thereby decreasing the contractile the possibility of the uterus, its self-cleaning is difficult, so that optimal conditions for the development of pathogenic microflora.
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3. The sharp decline in immune strength. It can be observed in the last weeks of the third trimester and immediately after delivery. This increases the risks of possible inflammation. The immune system returns to normal not earlier than 7 days after birth and up to 10 days after a cesarean section.
4. Nesanirovannye chronic infectious foci. As well as inflammatory diseases, diseases of the endocrine system, metabolic disorders, existing inflammation of the endometrium during prolonged wearing Navy, after frequent and curettage abortion, could be the trigger for endometritis.
5. Pregnancy complications, worsening of chronic pathologies, miscarriage threat, polyhydramnios, suturing the cervix, previous infection, the use of invasive diagnostic techniques.
6. Complications during childbirth - protracted process, trauma, manual removal of placenta and placenta, blood loss, anhydrous period.
7. Postpartum complications - unexpressed uterine involution, trauma, development of inflammatory processes, prolonged bed rest, lack of hygiene.
8. Early onset of sexual activity.

Symptoms of endometritis may occur within 1-2 days after birth, but most develop after 4-10 days. Also, it does not exclude the occurrence at any time for a few more months.

symptoms

After delivery, the following symptoms may occur endometritis:

1. Manifestation of mild - slight rise in body temperature, being lightly pulling pain in the abdomen. Usually these symptoms are observed in the 6-10 th day, the woman feels chills, tachycardia is diagnosed. Discharge from the uterus usually standard for post-partum period.
2. In severe pathology develops almost immediately and at 2-3 hours, raising the temperature reaches 40 degrees, the pulse quickens to 100-120 beats are present sharp pain, fatigue, disturbed sleep and appetite, uterus increases and becomes painful. On the fourth day allocation acquire brown tint, then purulent.

Less common pathology were obliterated. In this case the temperatures do not exceed 38 degrees, decreasing uterine contractions intensity discharge becomes sukrovichnymi with bad smell rotten.

Endometritis after cesarean section

Endometritis after cesarean section is more common, because during invasive manipulation made by cutting soft tissues, there is direct contact with the instruments endometrium. This increases the risk of penetration and further development of pathogenic microflora.

Furthermore, during surgery often glucocorticosteroid failure, depressing effect on the immune system. It is a condition for the spread of infection, which is included in the vagina.

Development postpartum endometritis can promote inappropriate suture. Rejection can occur within hours after birth.

The seam on the uterine wall reduces its contractility and provokes opportunity lochia delay in the cavity. It becomes a breeding ground for pathogenic microorganisms.

Since COP Dysmenorrhea can manifest the same symptoms - of pain, fever, change of the character selections. It is also possible discomfort in the abdomen, swelling of tissues, bloating, difficulty urinating.

During the examination there is tenderness to palpation of the uterus, according to analyzes of the blood increases the number of leukocytes and ESR.

diagnosis of endometritis

Diagnosis is made as soon begins to show symptoms of the disease. Diagnosis after the examination, comprising:

• collecting data on the pregnancy, the birth process;
• bimanual examination;
• urinalysis, blood;
• bakposev vaginal discharge;
• Ultrasound of the pelvic organs with the use of Doppler;
• in some cases, carried out and hysteroscopy Endometrial tissue biopsy.

In the process of US postpartum endometritis determined to increase uterine volume expansion cavity, the presence of gas inclusions and after COP - inconsistency suture tissue infiltration.

Also inspect the endometrium can be observed cyanosis, edema, foci of hemorrhage. Complete blood analysis usually shows leukocytosis, leukocyte shift to the left, increasing ESR. With seeding determined microflora sensitivity to antibacterial agents series.

Additionally identified diseases of the female reproductive organs, sites of infection. Determined by the acidity of vaginal secretions in the development of endometritis pH <7. Bakposev blood performed in cases of suspected development of sepsis.

treatment of the disease

Treatment is carried out postpartum endometritis complex using antibacterial drugs. Particular importance is given to the sensitivity of microflora to one or another antibacterial agent. Funds are also used for the restoration of the endometrium.

Treatment of acute endometritis

Treatment acute phase of endometritis It includes both pharmacological and non-pharmacological treatment. In any case shown hospitalization, bed rest, attachment cold, diet.

The emphasis is on the use of antibiotics in the treatment. Most often, this third-generation cephalosporins. If the detected sensitivity to certain substances, the choice of medication is carried out individually.

Antimicrobial drugs are added to the contractions based on oxytocin, antispasmodics, anticoagulants, antihistamines, vitamins, immunostimulants. To eliminate the infection of the mucous used means of local impact - suppositories.

After the relief of acute state held physiotherapy - phonophoresis, electrophoresis, laser and magnetic therapy, darsonvalization, acupuncture and other treatments.

In the presence of the uterine wall placenta residue was purified by necrotic particles membranes using vacuum aspiration, or scraping. Also carried flushing drainage.

Radical treatment is hysterectomy - complete removal of the uterus. The operation is performed only when there is no response to treatment for more than 1 week and maintaining clinical signs of inflammation.

Treatment of chronic endometritis

In the absence of therapy in an acute stage of disease and pathology assignment nonconforming products may acquire chronic. As a result - increase the risk of miscarriage, a failed IVF complications in the postpartum period and during pregnancy.

Chronic Phase endometritis always has a tendency to rise using means of intrauterine contraception, abortion, and with frequent Diagnostic curettage.

In this phase of the disease to diagnose immunocytochemical study employed. During the inspection of the shell thickness can be seen, serous plaque, adhesions, hemorrhage.

In the chronic phase of the treatment of endometritis therapy carried out in phases. The basis of the same antibacterial agents are generally broad-spectrum action. Combined hormonal and metabolic therapy - reception utrozhestan, Actovegin, vitamins, riboksin, Wobenzym.

Directly into the vagina entered medical suppositories, which prevent uterine bleeding, cropped inflammation.

Second place in the chronic phase of disease treatment takes physiotherapy: electrophoresis using iodine, zinc, copper, lidazy, ultrasound and magnetic. Such methods can reduce the inflammatory swelling of the mucous, enhance immunity, stimulate circulation. Balneology is also used.

Ancillary therapies

Comprehensive treatment of postnatal pathology also comprises:

• personal hygiene;
• temporary abstinence from sexual intercourse;
• with the exception of diet-products causing stagnation of fluid in the body;
• girudoterapii application.

Vitamin complexes therapy can improve the immune system. With the same purpose may be assigned immunostimulants in the form of tablets, suppositories, solutions for intravenous administration.

As a symptomatic treatment applied anti-inflammatory drugs, and drugs whose action is directed at the removal of toxins from the body, sedative drugs.

High ozone results shows that strengthens the immune defense metabolic processes and structures. It is also used, especially in the acute phase, the funds on the basis of oxytocin, which increases the contractile ability of the uterus. Upon detection of residues of the placenta in the cavity is often carried out sanation with antiseptics uterus.

possible complications

Manifestations of endometritis not only cause discomfort a woman, but can cause serious complications:

1. Sepsis, that is blood poisoning. Is the most dangerous obstetric complications. Infection during the movement of lymph and blood covers the entire body and can even lead to death.
2. The risk of septic pathology (increased after COP). The frequency of such cases, reaches to 10% of naturally parous and to 50% after COP.
3. Daylight pathologies in chronic phase flow. This threatens the future challenges in child-bearing, resulting in childbirth and pregnancy pathologies.
4. The risk of developing pelvioperitonita - accumulation of pus in the pelvic cavity.
5. Inflammation of the tubes, ovaries.
6. failure regulation, Copious until bleeding, reproductive system disorders.

symptoms can not be underestimated, even erased to prevent disease and further complications. Any change in the nature of post-partum vaginal discharge, the emergence them ichor, pus, increased on higher temperature and the appearance of pain in the uterus should be a cause for tests and further treatment appointments doctor.

In the past, endometritis, occurring after birth, he was called puerperal fever. According to various sources, this pathology takes the lives of up to half of all births. Today, during the widespread use of antibiotics, the disease is successfully cured in most cases (with the timely initiation of therapy) and does not cause serious consequences.