Postpartum infection

1. 11
Postpartum infectionPostpartum infection

2. 22
Postpartum infectionPostpartum infection –– is ais a
septic wound infectionseptic wound infection
distinguished by anatomicdistinguished by anatomic
features of female reproductivefeatures of female reproductive
organs and their functional statusorgans and their functional status
during pregnancy.during pregnancy.

3. 33
Classification principlesClassification principles
 - By prevalence:- By prevalence: local, generalized forms.local, generalized forms.
 - By infection localization:- By infection localization: vagina, uterus,vagina, uterus,
ovaries, parametric tissue, pelvis minor veins,ovaries, parametric tissue, pelvis minor veins,
mammary gland.mammary gland.
 -- By infection type:By infection type: aerobic (enterococci,aerobic (enterococci,
Escherichia coli, Klebsiella, group BEscherichia coli, Klebsiella, group B
streptococci, staphylococci); anaerobicstreptococci, staphylococci); anaerobic
(Bacteroids, fusobacteria, peptococci,(Bacteroids, fusobacteria, peptococci,
peptostreptococcus); gram-positive, gram-peptostreptococcus); gram-positive, gram-
negative, mycoplasma, Chlamydia, fungi.negative, mycoplasma, Chlamydia, fungi.

4. 44
Factors making patientsFactors making patients
susceptible to infectionsusceptible to infection
 Changes in vaginal biocenose inChanges in vaginal biocenose in
final stages of pregnancy.final stages of pregnancy.
 Pregnancy-relatedPregnancy-related
immunodeficiency development.immunodeficiency development.
 Delivery typeDelivery type..

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6. 66
Important!!!Important!!!
 In the postpartum period the intra-In the postpartum period the intra-
uterine wall is a traumatic surfaceuterine wall is a traumatic surface
easily infected by the spread ofeasily infected by the spread of
pathogenic and opportunisticpathogenic and opportunistic
pathogenic flora.pathogenic flora.

7. 77
EtiologyEtiology
 Iron-deficiency anemia.Iron-deficiency anemia.
 Gestosis.Gestosis.
 Placental presentation.Placental presentation.
 Pyelonephritis.Pyelonephritis.
 Prolonged labour.Prolonged labour.
 Prolonged anhydrous term.Prolonged anhydrous term.
 Serious loss of blood.Serious loss of blood.
 Genital tract wounds.Genital tract wounds.
 Surgical procedures.Surgical procedures.

8. 88
 Postpartum ulcerPostpartum ulcer –– is caused byis caused by
contamination of abrasions, fissures,contamination of abrasions, fissures,
ruptures of vulval and vaginal mucousruptures of vulval and vaginal mucous
membranes.membranes.
 The patient’s general condition isThe patient’s general condition is
satisfactory.satisfactory.

9. 99
DiagnosticsDiagnostics
 Hyperemia.Hyperemia.
 Edema.Edema.
 Necrotic or purulent woundNecrotic or purulent wound
incrustation.incrustation.

10. 1010
TreatmentTreatment
 The wounds are cleansed with antisepticsThe wounds are cleansed with antiseptics
locally (hydrogen peroxide, furacilin,locally (hydrogen peroxide, furacilin,
chlorhexidine, dioxidine, hypertonic solution).chlorhexidine, dioxidine, hypertonic solution).
 Wound debridement with proteolytic fermentsWound debridement with proteolytic ferments
is performed (tripsin, chemotripsin).is performed (tripsin, chemotripsin).
 After the wound has been cleansed from pus,After the wound has been cleansed from pus,
ointment bandages are applied (levomicole,ointment bandages are applied (levomicole,
dioxicole).dioxicole).

11. 1111
PostpartumPostpartum
endomyometritisendomyometritis ..
The most commonThe most common
infection in theinfection in the
postpartum period!postpartum period!

12. 1212
CLINICAL SYMPTOMS.CLINICAL SYMPTOMS.
 ACUTE FORM.ACUTE FORM.
 Temperature elevation › 38° on 2-5th dayTemperature elevation › 38° on 2-5th day
following delivery.following delivery.
 Chills.Chills.
 Abdominal pain.Abdominal pain.
 Foul-smelling, pus-containing lochia.Foul-smelling, pus-containing lochia.
 Headache.Headache.
 Facial hyperemia.Facial hyperemia.
 Postpartum psychosis (the degreePostpartum psychosis (the degree
depends on the level of intoxication).depends on the level of intoxication).

13. 1313
DIAGNOSTICSDIAGNOSTICS
 Bimanual examination (the uterus is enlarged, painful,Bimanual examination (the uterus is enlarged, painful,
softened, contractive movements are restricted).softened, contractive movements are restricted).
 Clinical blood count.Clinical blood count.
 Ultrasonography.Ultrasonography.
 Thermometry.Thermometry.
 Bacterioscopic and bacteriological analysis of vaginalBacterioscopic and bacteriological analysis of vaginal
discharge.discharge.
 Biochemical blood test (c-reactive protein increase,Biochemical blood test (c-reactive protein increase,
hypoproteinemia, hypoalbuminemia).hypoproteinemia, hypoalbuminemia).
 Coagulogram.Coagulogram.
 Hysteroscopy.Hysteroscopy.
 Clinical urine analysis.Clinical urine analysis.

14. 1414
TREATMENTTREATMENT
 Bed rest.Bed rest.
 Antibiotic therapy (semisynthetic penicillin,Antibiotic therapy (semisynthetic penicillin,
combination of cephalosporin andcombination of cephalosporin and
metronidazole).metronidazole).
 Infusion therapy (combination of colloids andInfusion therapy (combination of colloids and
crystalloids).crystalloids).
 10% calcium gluconate, 10 ml i.v.10% calcium gluconate, 10 ml i.v.
 Vitamin therapy.Vitamin therapy.
 Spasmolytics (no-spa, papaverineSpasmolytics (no-spa, papaverine
hydrochloride).hydrochloride).
 Immunomodulators.Immunomodulators.
 Intrauterine lavage with antisepticIntrauterine lavage with antiseptic

15. 1515
Important!!!Important!!!
 If the examination reveals placental tissues orIf the examination reveals placental tissues or
membranes in the uterine cavity, it is necessarymembranes in the uterine cavity, it is necessary
to perform curettage or vacuum aspiration of theto perform curettage or vacuum aspiration of the
uterus.uterus.
 LOW-GRADE ENDOMYOMETRITISLOW-GRADE ENDOMYOMETRITIS progressesprogresses
without pronounced clinical symptoms. Thewithout pronounced clinical symptoms. The
onset of the disease is normally on the 7-9th dayonset of the disease is normally on the 7-9th day
following delivery. The most common causes offollowing delivery. The most common causes of
the disease are Chlamydia or mycoplasmathe disease are Chlamydia or mycoplasma
infections.infections.

16. 1616
 Postpartum salpingo-Postpartum salpingo-
oophoritisoophoritis is rarely observed.is rarely observed.
The ovaries are normally affectedThe ovaries are normally affected
on one side. The clinical history ofon one side. The clinical history of
the disease is similar tothe disease is similar to
manifestations ofmanifestations of
endomyometritis, which isendomyometritis, which is
followed by salpingo-oophoritisfollowed by salpingo-oophoritis

17. 1717
 Postnatal parametritisPostnatal parametritis ––
the process normally beginsthe process normally begins
when lacerations or infectionswhen lacerations or infections
of the cervix are present.of the cervix are present.
Lateral parts of parametriumLateral parts of parametrium
are commonly affected.are commonly affected.

18. 1818
Clinical symptomsClinical symptoms
 Chills on the 10-12th day followingChills on the 10-12th day following
delivery.delivery.
 Temperature elevation to 39 - 40°.Temperature elevation to 39 - 40°.
 Tensive lower abdominal pain.Tensive lower abdominal pain.
 Acruturesis or dyschezia in cases whenAcruturesis or dyschezia in cases when
the process has spread to front or backthe process has spread to front or back
parametrium.parametrium.

19. 1919
 On bimanual examination aOn bimanual examination a
painful infiltrate is found in thepainful infiltrate is found in the
fornices, the fornices arefornices, the fornices are
shortened.shortened.
 For diagnostics and treatmentFor diagnostics and treatment
see endomyometritis.see endomyometritis.

20. 2020
Postnatal trombophlebitisPostnatal trombophlebitis
(affecting pelvis minor veins,(affecting pelvis minor veins,
superficial and deep veins ofsuperficial and deep veins of
lower limbs)lower limbs)..
CausesCauses
 Hypercoagulation.Hypercoagulation.
 Vessel wall lesions.Vessel wall lesions.

21. 2121
Clinical symptomsClinical symptoms
 Temperature elevation.Temperature elevation.
 Hyperemia and tenderness along ofHyperemia and tenderness along of
varix dilatated shin veins.varix dilatated shin veins.
 Edema (if deep veins of lower limbsEdema (if deep veins of lower limbs
are involved).are involved).

22. 2222
TreatmentTreatment
 Bed rest, lower limb should beBed rest, lower limb should be
maintained uplifted.maintained uplifted.
 Antibacterial therapy.Antibacterial therapy.
 Anticoagulants: direct effect (heparin),Anticoagulants: direct effect (heparin),
indirect effect (kleksan, fraxiparin,indirect effect (kleksan, fraxiparin,
troxevasin, aspirin).troxevasin, aspirin).
 Medicines improving rheologicalMedicines improving rheological
properties of the blood: rheopolyglukin,properties of the blood: rheopolyglukin,
trental, kurantil.trental, kurantil.
 Hirudotherapy.Hirudotherapy.

23. 2323
Obstetric peritonitis.Obstetric peritonitis.
Causes.Causes.
 Consequence of endomyometritis.Consequence of endomyometritis.
 Perforation of inflammatory tubo-ovarianPerforation of inflammatory tubo-ovarian
mass.mass.
 Torsion of ovarian tumor pedicle.Torsion of ovarian tumor pedicle.
 Necrosis of the subserous node ofNecrosis of the subserous node of
hysteromyoma.hysteromyoma.
 Infected rupture of uterine sutures afterInfected rupture of uterine sutures after
caesarean section.caesarean section.

24. 2424
PathogenesisPathogenesis
Endogenous intoxication
Generalized vascular disorders
General tissue hypoxia
Metabolic disorders
Dysfunction of essential organs and systems
Destructive changes in kidneys, pancreas, liver, small intestine
Enteroparesis

25. 2525
 Enteroparesis. Motor, secretion, andEnteroparesis. Motor, secretion, and
absorption functions are affected.absorption functions are affected.
Significant amounts of protein andSignificant amounts of protein and
electrolyte containing liquidelectrolyte containing liquid
accumulate in the intestinal lumen.accumulate in the intestinal lumen.
Overdistension and ischemia of theOverdistension and ischemia of the
intestinal wall cause impairment ofintestinal wall cause impairment of
the intestinal barrier function whichthe intestinal barrier function which
leads to increased intoxicationleads to increased intoxication

26. 2626
Obstetric peritonitisObstetric peritonitis
phasesphases
 Reactive phase (compensatoryReactive phase (compensatory
mechanisms preserved).mechanisms preserved).
 Toxic phase.Toxic phase.
 Terminal phase.Terminal phase.

27. 2727
Clinical symptomsClinical symptoms
 psychomotor agitationpsychomotor agitation
 thirstthirst
 dryness of mucous membranesdryness of mucous membranes
 general weaknessgeneral weakness
 tachycardia (does not correspond to thetachycardia (does not correspond to the
body temperature)body temperature)
 feverfever
 pulse rate exceeds 100bpmpulse rate exceeds 100bpm
 shallow breathingshallow breathing

28. 2828
 unsatisfactory sleepunsatisfactory sleep
 absence of appetiteabsence of appetite
 pallor of the skinpallor of the skin
 nauseanausea
 eructationeructation
 flatulenceflatulence
 vomiting (not always)vomiting (not always)
 the pain syndrome is not evident (due tothe pain syndrome is not evident (due to
overdistension of the front abdominal wall afteroverdistension of the front abdominal wall after
delivery).delivery).

29. 2929
 On palpation: the abdomen isOn palpation: the abdomen is
distended, the uterus is enlarged,distended, the uterus is enlarged,
softened, the contours are indistinct,softened, the contours are indistinct,
peritoneum irritation symptoms areperitoneum irritation symptoms are
not pronounced, sluggish peristalsis,not pronounced, sluggish peristalsis,
slow flatus dischargeslow flatus discharge..

30. 3030
Treatment.Treatment.
 Preoperative preparation (2 hours):Preoperative preparation (2 hours): stomachstomach
decompression, infusion therapy intended fordecompression, infusion therapy intended for
liquidation of hypovolemia and metabolicliquidation of hypovolemia and metabolic
acidosis, fluid, protein and electrolytic balanceacidosis, fluid, protein and electrolytic balance
correction, detoxication of the body,correction, detoxication of the body,
antibacterial therapy.antibacterial therapy.
 Operative treatmentOperative treatment: hysterectomy, abdominal: hysterectomy, abdominal
cavity drainage.cavity drainage.

31. 3131
Postoperative period:Postoperative period:
 - liquidation of hypovolemia and- liquidation of hypovolemia and
improvement of rheological properties ofimprovement of rheological properties of
the blood;the blood;
 - acidosis correction;- acidosis correction;
 - provision for the body’s energy- provision for the body’s energy
demands;demands;
 - antiferment and anticoagulant therapy- antiferment and anticoagulant therapy
(combination of contrical and heparin);(combination of contrical and heparin);
 - maintenance of artificial dieresis;- maintenance of artificial dieresis;

32. 3232
 - antibiotic therapy;- antibiotic therapy;
 - cardio-vascular collapse prevention and- cardio-vascular collapse prevention and
treatment;treatment;
 - vitamin therapy;- vitamin therapy;
 - motor and evacuation intestinal function- motor and evacuation intestinal function
recovery (proserin, ganglio-blockers);recovery (proserin, ganglio-blockers);
 - ultraviolet irradiation of autoblood,- ultraviolet irradiation of autoblood,
hyperbaric oxygenation.hyperbaric oxygenation.

33. 3333
 Postpartum sepsisPostpartum sepsis ––
severe non-specific infectivesevere non-specific infective
process developing andprocess developing and
progressing when normalprogressing when normal
reactivity of the organism isreactivity of the organism is
changed.changed.

34. 3434
Clinical symptomsClinical symptoms
 Septicemia occurs on the 3-4th daySepticemia occurs on the 3-4th day
following delivery, progresses violently.following delivery, progresses violently.
 Septicopyemia progresses unevenly:Septicopyemia progresses unevenly:
periods of recrudescence caused byperiods of recrudescence caused by
metastatic infection and formation of newmetastatic infection and formation of new
niduses are followed by periods ofniduses are followed by periods of
amelioration.amelioration.

35. 3535
IMPORTANT!!!IMPORTANT!!!
 The diagnosis is based on theThe diagnosis is based on the
following prerequisites:following prerequisites:
 - presence of an infection nidus;- presence of an infection nidus;
 - fever and chills;- fever and chills;
 - etiological factor was detected in- etiological factor was detected in
blood.blood.

36. 3636
 Impaired CNS function: euphoria,Impaired CNS function: euphoria,
depression, sleep disturbance.depression, sleep disturbance.
 Dyspnea.Dyspnea.
 Cyanosis.Cyanosis.
 Pale, grey or yellow skin.Pale, grey or yellow skin.
 Tachycardia, pulse lability.Tachycardia, pulse lability.
 Hypotension.Hypotension.
 Enlarged liver and spleen.Enlarged liver and spleen.

37. 3737
DiagnosticsDiagnostics
 Clinical blood analysis.Clinical blood analysis.
 Clinical urine analysis.Clinical urine analysis.
 Coagulogram (platelets).Coagulogram (platelets).
 Blood electrolytes.Blood electrolytes.
 Bacteriological analysis.Bacteriological analysis.
 Lungs radiography.Lungs radiography.
 ECG.ECG.
 Blood sugar.Blood sugar.
 Acid-base condition.Acid-base condition.
 Central venous pressure.Central venous pressure.
 Monitoring: arterial pressure, pulse rate, heartMonitoring: arterial pressure, pulse rate, heart
rate, body temperaturerate, body temperature..

38. 3838
TreatmentTreatment
 Preoperative preparation during 6-8Preoperative preparation during 6-8
hours, hypervolemic hemodilutionhours, hypervolemic hemodilution
mode.mode.
 Operative treatment – hysterectomyOperative treatment – hysterectomy
and salpingectomy, abdominaland salpingectomy, abdominal
cavity drainage.cavity drainage.

39. 3939
Postoperative period:Postoperative period:
 - liquidation of hypovolemia and- liquidation of hypovolemia and
improvement of rheological properties ofimprovement of rheological properties of
the blood;the blood;
 - acidosis correction;- acidosis correction;
 - provision for the body’s energy- provision for the body’s energy
demands;demands;
 - antiferment and anticoagulant therapy- antiferment and anticoagulant therapy
(combination of contrical and heparin);(combination of contrical and heparin);
 - maintenance of artificial dieresis;- maintenance of artificial dieresis;

40. 4040
 - antibiotic therapy;- antibiotic therapy;
 - cardio-vascular collapse prevention and- cardio-vascular collapse prevention and
treatment;treatment;
 - vitamin therapy;- vitamin therapy;
 - motor and evacuation intestinal function- motor and evacuation intestinal function
recovery (proserin, ganglio-blockers);recovery (proserin, ganglio-blockers);
 - ultraviolet irradiation of autoblood,- ultraviolet irradiation of autoblood,
hyperbaric oxygenation, plasmapheresis,hyperbaric oxygenation, plasmapheresis,
hemosorption, hemodialysis.hemosorption, hemodialysis.

41. 4141
 Postpartum lactational mastitisPostpartum lactational mastitis is anis an
inflammation of breast tissue.inflammation of breast tissue.
 The most common organism reported inThe most common organism reported in
mastitis is mastitis is Staphylococcus aureusStaphylococcus aureus,,
StreptococcusStreptococcus is less common.is less common.
 The organisms invade the breast tissueThe organisms invade the breast tissue
via cracking or fissures in the nipple orvia cracking or fissures in the nipple or
lactiferous ducts. Lactostasis is conducivelactiferous ducts. Lactostasis is conducive
to progressing of the inflammatoryto progressing of the inflammatory
process.process.

42. 4242
ClassificationClassification
 Serous mastitis.Serous mastitis.
 Infiltrative mastitis (diffuse, nodular).Infiltrative mastitis (diffuse, nodular).
 Suppurative mastitisSuppurative mastitis
(intramammary, phlegmonous or(intramammary, phlegmonous or
necrotic suppurative, gangrenous).necrotic suppurative, gangrenous).

43. 4343
Clinical symptomsClinical symptoms
 Rapid elevation in temperature to 39˚C.Rapid elevation in temperature to 39˚C.
 Chills.Chills.
 Painful breast.Painful breast.
 Headache.Headache.
 General malaise, weakness.General malaise, weakness.
 Sleep disturbance.Sleep disturbance.
 Loss of appetite.Loss of appetite.

44. 4444
 Examination shows that the breast isExamination shows that the breast is
engorged, the skin above the breast isengorged, the skin above the breast is
hyperemic.hyperemic.
 With the right treatment the disease isWith the right treatment the disease is
cured within 1-2 days; if inadequatecured within 1-2 days; if inadequate
therapy is chosen, the disease advancestherapy is chosen, the disease advances
to the next (infiltrate) stage.to the next (infiltrate) stage.
 The diagnosisThe diagnosis is made on the basis ofis made on the basis of
clinical symptoms.clinical symptoms.

45. 4545
TreatmentTreatment
 Antibacterial therapy.Antibacterial therapy.
 Procedures against lactostasis.Procedures against lactostasis.
 Spasmolytics (no-spa) in combinationSpasmolytics (no-spa) in combination
with uterotonics (oxytocin).with uterotonics (oxytocin).
 Parlodel (to decrease milk production).Parlodel (to decrease milk production).
 Vitamin therapy.Vitamin therapy.
 Anti-staphylococcus gamma globulin,Anti-staphylococcus gamma globulin,
hyperimmune anti-staphylococcushyperimmune anti-staphylococcus
plasma.plasma.

46. 4646
 With suppurative mastitis surgicalWith suppurative mastitis surgical
treatment is indicated (incision oftreatment is indicated (incision of
the abscess, bathing withthe abscess, bathing with
antiseptics and drainage of theantiseptics and drainage of the
pus).pus).
 IMPORTANT!!!IMPORTANT!!! During the courseDuring the course
of treatment for postpartum septicof treatment for postpartum septic
diseases breastfeeding should bediseases breastfeeding should be
discontinued as the baby mightdiscontinued as the baby might
receive high doses of medicinesreceive high doses of medicines
with mother’s milk.with mother’s milk.


47. 4747