Postpartum endometritis refers to those gynecological diseases that are a consequence of past births. With it, the inflammation affects the mucous membrane of the uterus, which can also cross the muscle layer. Let us consider the violation in more detail, let's name its causes, signs and methods of therapy.
Postpartum endometritis - causes
Endometritis after childbirth is formed in the area where the placenta previously located. At the time of separation of the afterburn, the blood vessels are traumatized. A wound surface is formed, which is susceptible to the action of pathogenic microorganisms. However, it does not always get infected. The development of pathology is facilitated by provoking factors, among which:
- reduction of local immunity (the presence of chronic inflammatory and infectious processes in the reproductive system);
- protracted labor;
- non-observance of the rules of intimate hygiene in the postpartum period.
Often the prerequisite for the development of postpartum endometritis is the slowing down of the process of involution (recovery) of the uterus, delay of lop-hews. In this case, opportunistic microorganisms act as pathogens that cause disturbance, which are present in a small amount in the urogenital system. Among them:
- staphylococcus aureus;
- streptococcus ;
- viruses.
Endometritis after caesarean section
Developing endometritis after cesarean is often due to emergency surgery. So, with a planned cesarean, the frequency of endometritis does not exceed 5%, and in case of an emergency cesarean, 22-80%. Postpartum endometritis, as a consequence of caesarean, often occurs in severe form. This is due to the infection of the incision on the uterus and the rapid spread of inflammation beyond the mucous membrane. As a result, other diseases develop:
- myometrium - muscular layer damage;
- metrotromboflebit.
Because of the inflammatory process, there is a violation of regenerative processes in the dissected wall of the uterus. This can be caused by suture material. Reduced contractile activity of the uterus, because of which the outflow of lochia is difficult and aggravates the situation. The disease occurs on the 4-5th day and is accompanied by:
- body temperature 38-39 degrees;
- chills;
- an increase in the number of cardiac contractions - tachycardia.
Endometritis after abortion
Postpartum endometritis in women can be triggered by abortion in the past. Instrumental interventions affecting the uterine cavity increase the likelihood of this disorder developing. This is due to the severe trauma of the endometrial layer. As a result, the entire mucosa becomes a wound surface that is susceptible to the action of pathogenic microorganisms. Non-compliance with hygiene and medical recommendations leads to the development of endometritis.
Endometritis after childbirth - symptoms
In order to detect postpartum endometritis in time, every mother should know the symptoms of this disease. Depending on the clinical picture, three forms of disturbance are distinguished, each of which has its own characteristics:
- Light form. It develops for 5-12 days. At the same time, against the background of general well-being, the body temperature rises to 38-39 degrees. The state of health does not suffer much. Patients report soreness in the uterus, which lasts 3-7 days. When palpation, doctors note a slight increase in the size of the uterus. Lochias are bloody in nature, even a week after the start.
- Heavy form. The disease is formed on 2-4 days after the birth of the baby. In 25% of cases, endometritis is formed on the background of chorioamnionitis after complicated delivery, surgical intervention. With prolonged, dynamic observation, a proper improvement is not observed and after a few days, negative dynamics can be noted. Women are concerned about:
- headache;
- weakness;
- pain in the lower abdomen;
- sleep disturbance;
- the temperature is 39 degrees.
- Shabby form. Begins on 3-4 days. The temperature of the body does not exceed 38 degrees. In most patients, the lochia is first brown, but then goes to the saccharum. Soreness of the uterus persists for 3-5 days. Against the background of the therapy, the temperature is normalized after 5-10 days.
Extractions in the endometrium
Calling the main signs of postpartum endometritis, it must be said that erased and light forms can occur almost imperceptibly for the woman herself. However, postpartum endometritis is always manifested by changing the vaginal discharge. After the birth of the baby, the uterine cavity is cleared, and the mother fixes the lochia . Normally they have a red hue, they are uniform, without clots and unpleasant odor. With the development of the inflammatory process, the picture changes completely.
When the postpartum early endometritis develops, the lochia often acquires a brownish hue. When they are examined, impurities of pus can be detected. Appear clots of blood, which are formed due to a complicated outflow. Gradually, the discharge begins to take on an unpleasant odor. The situation requires medical intervention. When examining a woman in a gynecological chair, the doctor diagnoses slowing the recovery of the uterus.
Diagnosis of postpartum endometritis
To diagnose acute postpartum endometritis, an experienced gynecologist needs to be examined only with mirrors. In most cases, changes affect the cervix. In addition, it is possible to suspect a violation in bimanual examination of the genital organ through the anterior abdominal wall. The diagnosis of "postpartum endometritis" is made on the basis of the results of laboratory tests:
- blood test;
- Analysis of urine;
- bacterial culture of the discharge from the uterus (establishes the type of pathogen);
- Ultrasound of the small pelvis;
- hysteroscopy.
Endometritis - consequences
In the absence of proper therapy, non-compliance with medical prescriptions, there is a risk of complications. In such cases, the inflammatory process becomes widespread and passes to neighboring organs. In this case, doctors record the following complications of postpartum endometritis:
- pelvioperitonitis - inflammation of the peritoneal serous membrane of the pelvic cavity;
- peritonitis - inflammation of the peritoneum;
- thrombophlebitis - an inflammatory process affecting the blood vessels in the small pelvis;
- pelvic abscess - purulent focus, having its own walls;
- sepsis.
Postpartum endometritis - treatment
Treatment of postpartum endometritis begins with the establishment of the type of pathogen and the cause that triggered the disease. The basis of therapy is antibacterial and anti-inflammatory drugs. In parallel, prescribe drugs to increase the body's defenses. To improve the outflow of lochia, use antispasmodics. The course is selected individually, taking into account the degree of violation and severity of its symptoms.
Endometritis - treatment, drugs
Antibiotics for endometrium are prescribed taking into account the ongoing breastfeeding. Semisynthetic penicillins and cephalosporins are used . Among such medicines it is necessary to allocate:
- Cefuroxime;
- Ceftriaxone;
- Ofloxacin;
- Cefotaxime .
Often appoint a combined regimen, with the simultaneous administration of metronidazole and antibiotics of the lincomycin group. The latter are not used in breastfeeding, as they penetrate into the milk. If necessary, the woman stops for the duration of breastfeeding. Treatment with antibacterial drugs is stopped 24-48 hours after the clinic's improvement.
When endometritis is caused by the presence of tissues in the uterine cavity after the scraping, surgical treatment is performed. It includes:
- vacuum aspiration;
- hysteroscopy;
- washing of the uterine cavity with cooled antiseptics (furacilin, dioxin 1%).
Washing is recommended to reduce the absorption of decomposition products and toxic compounds. In addition, this procedure significantly reduces the amount of purulent discharge, improves the process of lochia. Manipulation is carried out after 4-5 days, with natural delivery and after 6-7 days with cesarean section. A woman at this time is in the hospital.
Physiotherapy with endometrium
When the disease is endometritis, procedures of a physiotherapeutic nature help to alleviate the course. Among the most common:
- Interference current therapy for Nemuk - involves the use of currents of low and medium frequencies conducted through 4 electrodes;
- pulsed currents of low frequency - used for early rehabilitation;
- acupuncture - has a favorable immunostimulating effect.
Prophylaxis of postpartum endometritis
To exclude the disease, endometritis, prevention should begin at the planning stage of pregnancy. Physicians are advised to prepare in advance for this responsible process. Prevention of endometritis involves compliance with such measures as:
- detection and therapy of chronic diseases of the reproductive system before conception;
- timely registration for pregnancy;
- regular visit to the doctor;
- rational management of labor - taking contraindications to childbirth through natural birthmarks, examining the separated afterbirth, administering antibiotics after cesarean surgery to prevent infection.