Puerperal infection

Introduction Puerperal infection refers to the infection of pathogens during childbirth and puerperium, causing local and systemic inflammatory response. The incidence rate is 1% to 7.2%, which is one of the four major causes of maternal death. The puerperal morbidity refers to the daily measurement of the mouth table 4 times within 10 days after the delivery of 24 hours, and the body temperature reaches or exceeds 38 ° C twice. It can be seen that the meaning of puerperal infection and puerperal morbidity is different. Although the cause of puerperal morbidity is mainly puerperal infection, it also includes other infections and fevers other than postpartum genital tract, such as urinary tract infection, mastitis, and upper respiratory tract infection.

Cause

Infection incentive

The body's response to invading pathogens depends on the type, quantity, virulence of the pathogen and the body's defense capabilities. Any factors that impair the maternal reproductive tract and systemic defense capacity are beneficial to pathogen invasion and reproduction. Such as anemia, malnutrition, chronic diseases, near-prenatal period effect, premature rupture of membranes (bacterial effect of lysozyme in amniotic fluid, bactericidal effect after amniotic fluid loss), amniocentesis, various obstetric surgical operations, birth canal injury, production Pre-natal blood, uterine cavity filling, birth canal foreign body, prolonged labor, placental residue, etc., can all be the cause of puerperal infection.

(1) Pathogens that infect the genital tract or other parts of normal pregnant women can cause disease when there is a cause of infection.

(2) Infected infections are caused by contact with patients with contaminated clothing, utensils, various surgical instruments, and articles.

an examination

1. Detailed medical history, systemic and local physical examination, attention to the exclusion of other diseases and wound infections that cause puerperal morbidity, and routine blood tests. Detection of C-reactive protein in serum acute phase reactive substances helps early diagnosis of infection.

2. Identify the pathogen. The identification of pathogens is very important for the diagnosis and treatment of puerperal infections.

1 pathogen culture: routine disinfection of the vagina and the cervix, with a cotton swab through the cervical canal, taking the secretions of the uterine cavity, due to the frequent use of secretions or pus by the cervix intestinal uterus to carry out aerobic and anaerobic bacteria to cultivate.

2 secretion smear examination: If the oxygen culture results are negative, and a large number of bacteria appear in the smear, suspected anaerobic infection.

3. Determine the lesion. Through systemic examination, triple or double diagnosis, sometimes thickened fallopian tube or pelvic abscess mass can be touched, auxiliary examination such as B-mode ultrasound, color Doppler, CT, magnetic resonance and other means can be used for calving The location and qualitative diagnosis of inflammatory masses, abscesses and venous thrombosis caused by infection.

Differential diagnosis

1, acute endometritis, uterine myositis

The pathogen invades through the placenta exfoliation surface and spreads to the decidua and is called endometritis. Infection invades the myometrium, called uterine myositis endometritis with uterine myositis. In severe cases, there are chills, high fever headaches, rapid heart rate, increased white blood cell density, and different abdominal tenderness. The lochia is not necessarily too many and is easily misdiagnosed.

2, acute pelvic connective tissue inflammation, acute salpingitis

Pathogens along the parauterine lymph or blood to the para-uterine tissue, an acute inflammatory reaction and the formation of inflammatory masses affect the fallopian tube mesangial, wall. A "freezing pelvis" can also form if it invades the entire pelvic cavity. Gonorrhea gondii infection along the genital tract mucosa, reaching the fallopian tube and the pelvic and abdominal cavity to form an abscess, can be high fever.

3, acute pelvic peritonitis and diffuse peritonitis

Inflammation continues to develop, spread to the uterine serosa, form pelvic peritonitis and then develop into diffuse peritonitis, symptoms of systemic poisoning, such as high fever, nausea, vomiting, abdominal distension, obvious tenderness in the lower abdomen, rebound tenderness. Because the abdominal muscles of the maternal abdominal muscles are not more obvious. Inflammatory exudation of the peritoneal surface, intestinal adhesion caused by intestinal adhesion can also form a localized abscess in the rectum uterus. If the abscess spreads into the intestine and bladder, diarrhea, urgency and urinary dysfunction can be developed into a chronic pelvic cavity. Inflammation leads to infertility.

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