Obstetrics and gynecology. Postpartum endometritis (most important)

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Obstetrics and gynecology. Postpartum endometritis (most important)

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48. Postpartum endometritis

Postpartum endometritis - inflammation of the mucous membrane of the uterus that occurs after childbirth. With the spread of the inflammatory process to the muscular layer of the uterus, endomyometritis develops. Postpartum endometritis is a type of wound infection, since the inner surface of the uterus after separation of the placenta is an extensive wound surface. Epithelialization and regeneration of the endometrium ends 5-6 weeks after birth.

Postpartum endometritis clinic. Clinical manifestations of a mild form of postpartum endometritis appear on the 5-10th day after birth. Body temperature rises to 38-39 °C, mild chills are observed, tachycardia is detected up to 80-100 beats/min. In the blood there is neutrophilic leukocytosis with a shift to the left, an increase in ESR. The general health of the postpartum mother is relatively satisfactory. On palpation, tenderness of the uterus is noted, which persists for several days. The uterus is slightly enlarged, and the discharge of bloody contents continues for a long time. Manifestations of a severe form of postpartum endometritis begin on the 2-4th day after birth. Very often, this complication develops against the background of chorioamnionitis, after a complicated birth or intrauterine intervention. Body temperature rises to 39 °C or higher, accompanied by severe chills. The postpartum woman complains of headache, weakness, pain in the lower abdomen. There are sleep disturbances, loss of appetite, and tachycardia up to 90-120 beats/min. Upon examination, subinvolution of the uterus is revealed, and it is painful on palpation. From the 3-4th day, discharge from the uterus becomes cloudy, bloody-purulent, and sometimes becomes foul-smelling. There may be a delay in discharge (lochiometer) as a result of insufficient contraction of the uterus.

Treatment of postpartum endometritis. A comprehensive anti-inflammatory treatment is carried out, aimed at localizing the inflammatory process, detoxification, activating the body's defenses and normalizing homeostasis. Before starting treatment, a culture of discharge from the uterine cavity and vagina is performed to determine pathogens and their sensitivity to antibiotics.

In severe forms of postpartum endometritis, a plasma cut is sometimes used, in addition, its positive effect on the hemostasis system, the rheological properties of blood is noted, and reparative processes in the uterus are accelerated.

Sometimes, in the process of treating postpartum endometritis, surgical treatment of the uterine cavity is performed, including hysteroscopy, vacuum aspiration of the contents of the uterus, washing its cavity with cooled solutions of antiseptics. The effectiveness of complex intensive care for postpartum endometritis is evaluated 7 days after the start of treatment. In the absence of the effect of the therapy, even against the background of a satisfactory condition of the puerperal, but with persistent clinical and laboratory signs of inflammation, the issue of removing the uterus is decided.

Author: Ivanov A.I.

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