Childbirth without infections. The endometritis at young mothers of
the Endometritis is an inflammation of an internal cover of a uterus. This disease can develop after carrying out abortion, intrauterine researches, but most often it meets after the delivery. How distinguish an endometritis and what treatment is appointed to young mother?
of Manifestation and the reason of an endometritisthe Endometritis begins
most often with temperature increase of a body to 38 º With, a fever, deterioration in health, a headache. Then there are pains in the bottom of a stomach. Such picture is more often observed in cases of development of a disease in the first 5 days after the delivery. If the illness begins later, then such bright manifestations can not be - temperature increases slightly, and belly-ache is defined only at survey. Anyway postnatal allocations change - pus impurity in lokhiya appears. Postnatal allocations can get an unpleasant smell. The doctor at inspection will find subinvolution of a uterus (i.e. postnatal reduction of a uterus will take place much more slowly, than it has to be).with
After the delivery two factors contribute to development of an inflammation of a uterus. The uterus represents an extensive wound surface which, as well as any wound, can inflame under the influence of pathogenic microorganisms. Besides, at all women oppression of immune reactions is after the delivery observed that, certainly, only promotes an inflammation.Recently a significant role as causative agents of an infection own microflora (conditionally - the pathogenic bacteria living in a vagina and intestines which become more active against oppressed immunity of the woman in childbirth), but not brought from the outside began to play
the Postnatal endometritis by and large develops at adverse combination of circumstances.
Risk factors of development of a postnatal endometritis:the Operational rodorazresheniye (carrying out operation of Cesarean section) - to them is caused by
- to 80% of the total amount of cases. In some degree it is natural, at operation not only the internal wall of a uterus, and all its layers and all fabrics since skin is damaged.
- the So-called “total risk factor“ connected with a big duration of delivery, a large number of vaginal researches, big duration of the waterless period etc. It is connected with the fact that during the complicated childbirth it is simpler to causative agents of an infection to get into a uterus cavity, and after such childbirth immunity of the woman appears much more oppressed. Besides, difficult childbirth gives a high probability of the fact that in a cavity of a uterus there can be a congestion separated, blood, small fragments of an afterbirth which are the beautiful soil for development of an inflammation. the Risk aggravates
- also low socially - an economic level of life of patients. Here the hygiene level, quality of food, a lack of medical supervision, a large number of the infections, sexually transmitted (I,ST) etc. plays a role that as a result affects both at the level of a microbic obsemenennost, and a condition of immunity. Besides, some part of women from this group prefers childbirth in house conditions that only increases risk as environment is far from sterility, and also in such conditions a high probability of the complicated childbirth.
Statement of the diagnosis
Diagnosis of a postnatal endometritis most often does not cause difficulty at regular surveys of the doctor in maternity hospital.after the delivery the diagnosis cannot be made to
In the first day. The endometritis usually develops not earlier than on 2 - 3 - e days after the delivery. At the same time the symptoms which forced the doctor to suspect a disease will be numerous temperature increase higher than 37,5 º With, morbidity of a uterus. Pain - from pain, moderately expressed to considerable on intensity, in the bottom of a stomach - can be sharp, but is more often it pressing, in more mild cases morbidity can be noted only during survey, and it is necessary to pay attention of the doctor to it. Also putreform lokhiya - postnatal allocations from a genital tract belong to symptoms of an endometritis.for
At suspicion on an endometritis it will be obligatory the general blood test (in it all-infectious signs - increase of quantity of leukocytes and neutrophils and their young forms, anemia are found) is carried out. At ultrasonography decrease in a tone of a uterus and discrepancy to its due sizes, expansion of a cavity of a uterus, other specific signs of an inflammation come to light, availability of placentary fabric is possible. In certain cases on ultrasonography of changes it is not found. In not clear situations carry out hysteroscopy - research which is conducted under the general anesthesia. Enter the optical apparatus allowing to examine uterus walls, to take a fabric piece for the subsequent histologic research during which thin cuts of a preparation study under a microscope into a uterus.
At the easy or hidden current the disease begins to progress after the woman`s extract from maternity hospital, on 10 - 14 - e days after the delivery. Symptoms in this case happen usual, but most of women do not attach it significance and ask for medical care too late. At the similar course of a disease morbidity can be not expressed or is accepted to a natural postnatal state, and in that case the greatest value accepts numerous temperature increase of a body in the absence of the reason, probable on that (ORZ, a SARS, some other infectious processes). It is necessary to remember that temperature increase within 2 - 3 days without the visible external reason in the first 3 weeks after the delivery - the direct instruction on a possibility of development as mastitis (an inflammation in mammary glands owing to stagnation of milk and accession of an infection most often through cracks or microinjuries of nipples or an areola), and an endometritis. And both of these diseases demand the address to the doctor. So it is the best of all to follow strictly in these time frames the rule: to take body temperature at least once in days. Very important at similar development of the situation as soon as possible to see a doctor for receiving adequate medical care. The doctor in gynecologic consultation who, having suspected mastitis, will send the woman to a surgical hospital will help to understand a situation, and at suspicion on an endometritis - in gynecologic. It should be noted that it is better to see a doctor who conducted pregnancy or childbirth and supervision during the postnatal period as, it is much simpler to it to understand a situation and to appoint more effective treatment. Keep in mind that within 40 days after the delivery the woman can address for consultation in maternity hospital where childbirth was carried out.
the Main components of treatment of an endometritis are the following types of therapy:
- antibacterial (an antimicrobe - Nye - most often antibiotics);
- infusional - introduction of special solutions intravenously for faster removal of toxins from an organism;
- desensibilizing (antiallergic as any infection starts allergic reaction which should be minimized in an organism);
- uterotonichesky (increase of a tone of a uterus, its sokratitelny opportunity - for faster release of a cavity of a uterus from lokhiya);
- local (processing of seams, washing of a vagina and if necessary - and uterus cavities special antimicrobic means);
- if necessary - antikoagulyantny (the special means reducing coagulability of blood), hormonal (at serious conditions), immunostimulating (at considerable decrease in immunity);
- non-drug methods (for example, physiotreatment).
taking into account specifics of each separate case.If purpose of uterotonichesky means and unleavened wheat cake (washing) of a cavity of a uterus have not enough
for the conclusion separated from a uterus cavity, then the vacuum - aspiration (removal of contents by means of special vacuum - the pump) or a uterus cavity scraping can be appointed (it is desirable under visual control - hysteroscopy).
At timely and adequate treatment improvement of a condition of the woman can come in 1 - 2 day, however also longer process of recovery is possible. You should not think that at the first improvement of a state treatment has to be stopped - the minimum term of treatment makes 6 - 7 days.Ideally application of antibacterial means has to be confirmed to
with microbiological researches (crops separated from a uterus on special environments for clarification of the infectious agent who became the causative agent of an infection are made, and then carry out special tests for clarification of its sensitivity to different antibiotics to find the most effective remedy against this concrete microorganism). However in a real situation such research will require not less than 3 days, and treatment needs to be begun immediately. At the same time it can turn out so that results of research will contradict the chosen scheme of treatment and the preparation should be replaced, that is after receiving result of the analysis to the woman another will be appointed, more effective in this case medicine.If the condition of the woman allows
, then the doctor will discuss the possible choice of preparations (which do not get into breast milk), compliance of the mode of treatment and the mode of feeding of the kid.
However in hard cases (at the heavy course of an endometritis, development of its complications: the pelvioperitonita - inflammations of a peritoneum of a small pelvis - the thin cover covering bodies and walls of a small pelvis) can be required intensive treatment or continuous stay of the woman in a distance for the child. Most often this measure compelled and short, and therefore it is worth reflecting keeping breastfeeding - regularly decanting milk. And, of course, as soon as possible (as soon as permission of the attending physician is got) the child will need to be transferred back to breastfeeding.contacts of the child and mother will not be limited to
At treatment of the house (it is possible only in not hard cases and at constant personal control of the doctor) at all, the mode will correspond to their requirements, and if the picked-up treatment allows, breastfeeding will be carried out without special restrictions.If treatment is begun with
in time and consequences do not remain adequate means, most often. However at adverse combination of circumstances (rapid development of a disease, late diagnostics, inadequate remedies) of a consequence can have an effect in the form of development of adhesive process on a cavity of a small pelvis, a pelvioperitonit, generalization of an infection in the form of sepsis (infectious blood poisoning with distribution of an infection to the majority of bodies and fabrics) with all its consequences (the multiple centers of an infection in the majority of bodies and fabrics, considerable intoxication). The requirement at a distance of a uterus can even become result if it is not possible by other methods to stop an inflammation in it - however all this is not the rule, but an exception.
Before childbirth. Prevention of an endometritis during pregnancy is not specific and includes the early address to a maternity welfare unit (and respectively, and early treatment of infections, sexually transmitted, at their diagnostics) and regular supervision at the doctor (that promotes early identification of deviations during pregnancy and their prevention). Complications during pregnancy is a bigger risk of emergence of complication in labor, and respectively, and bigger risk of development of a postnatal endometritis (proceeding from total risk factor) and consequently, their treatment has to be adequate and timely. In particular, gestoz which manifestations can be diagnosed, since the second half of pregnancy (as various arterial pressure on the right and left hands, violations in a koagulogramma (the analysis allowing to judge work of the curtailing system of blood), then the latent and obvious hypostases, increase of arterial pressure and only then - deterioration in health) it has to be treated, since the earliest terms of its development.
the Work-rest schedule excludes night and overtime work from the moment of pregnancy diagnostics, work on harmful production, contacts with toxic agents is not recommended. The maternity leave granted by the state surely has to be used for designated purpose.
the Diet, the regular use vitaminno - mineral complexes and walk in the fresh air promote immunity strengthening and consequently, promote prevention of infectious process that is actual also concerning a postnatal endometritis.
needs to watch more carefully personal hygiene, without giving the chance to develop to inflammatory process both in a vagina, and in any other system of an organism. Especially it is actual at the end of pregnancy. Regular visit of the stomatologist will allow to solve a problem of sanitation of a mouth. It is important as carious teeth are a source of an infection which can make negative impact on the woman`s organism after the delivery and lead, among other, and to a uterus inflammation. Independent survey of skin and care of its purity helps to avoid development on it infectious process. Daily hygienic procedures of genitals are not less important.
After the delivery. Personal hygiene after the delivery - it is very actual. Lokhiya (postnatal separated from a genital tract) - a fine substratum for development of an infection and consequently, as often as possible - after each visit of a toilet - it is necessary to carry out hygienic procedures, at least once in day to take a warm shower (not a bathtub!) laying has to be disposable and began to change at least in 4 - 5 hours later uses, before the termination of allocations to 6 - y to week tampons as they can promote distribution of an infection are after the delivery excluded.to Women from risk groups on development of a postnatal endometritis without fail in maternity hospital carry out by
an antibiotikoprofilaktika, entering one of preparations of antibiotics directly after the delivery. The antibiotic is entered once or is triple. The injected drug can exert impact on a possibility of breastfeeding therefore it is worth taking an interest in advance in this aspect especially as in most cases it is possible to choose not less effective similar preparations, safe for the newborn.
Despite possible fine health, home the woman in childbirth is written out not earlier, than on 4 - 5 - e days after the delivery (and after operation of Cesarean section - not earlier than on 6 - 7 - e days). And matter is not that it is necessary to remove seams, to vaccinate the child, and that these first postnatal days are most dangerous on development of infectious complications including an endometritis.carry out by
in a number of maternity hospitals at an extract ultrasonography of a uterus. This rather effective action for early diagnostics of development of a postnatal endometritis though which is not giving an absolute guarantee.to track
the woman who is in clinic much more simply, than for staying at home. Daily measurements of temperature, rounds and surveys of the doctor set as the purpose early diagnostics of any complications, treatment will be more effective if it is begun in due time.If pregnancy took place
under supervision of the qualified doctor, any deviations and complications in time were diagnosed and effectively treated, the woman was psychologically ready to childbirth, childbirth (even quick) passed well, then and probability of complications (including postnatal endometritis) is minimum.