puerperal infection
Introduction
Introduction to calving infection Puerperalinfection refers to the infection of pathogens in the reproductive tract 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. For postpartum fever, first consider the puerperal infection. Childbirth reduces or destroys the defensive function and self-purification of female genital tract. If maternal malnutrition, anemia during pregnancy, premature rupture of membranes, combined chronic disease, prolonged labor, and postpartum hemorrhage are all causes of puerperal infection. Fever, abdominal pain, and lochia are the three main symptoms of puerperal infection. However, the clinical manifestations of patients with different degrees of infection and the degree of individual response to inflammation are different. Severe infections are preferred for comprehensive treatment such as broad-spectrum high-efficiency antibiotics. When necessary, the adrenal glucocorticoid can be added for a short period of time to improve the body's ability to stress. basic knowledge The proportion of illness: 1% Susceptible people: good for postpartum women Mode of infection: non-infectious Complications: sepsis
Cause
Cause of puerperal infection
Pathogen species (34%):
At present, it is considered that the ecology in the vagina during pregnancy and puerperium is extremely complicated, and there are a large number of aerobic bacteria, anaerobic bacteria, fungi, chlamydia, mycoplasma and other parasitic, but anaerobic bacteria predominate, in addition, many non-pathogenic bacteria in specific environments Also cause illness.
1, aerobic streptococcus: -hemolytic streptococcus can be divided into 18 families, group B streptococci GBS, produce exotoxin and lysozyme, making it pathogenic, virulence, strong dissemination ability, and production infection is closely related and can cause serious infection. Its clinical features are early onset of fever at an average of 11 hours after birth, body temperature over 38 ° C, chills, rapid heart rate, abdominal distension, poor uterine involution, tenderness in the uterus or accessory area, and even Bacteremia, aerobic streptococcus is the main pathogen of exogenous infections.
2, Escherichia coli: Escherichia coli and its related Gram-negative bacillus, Proteus, is the main strain of exogenous infection, is also the most common pathogen of bacteremia and septic shock, E. coli parasitic in the vagina, perineum Around the urethral opening, it can rapidly proliferate in the puerperium. The sensitivity of E. coli to different antibiotics in different environments is very different, and drug sensitivity tests are needed.
3. Staphylococcus: The main pathogens are Staphylococcus aureus and Staphylococcus epidermidis. The pathogenicity of the two is significantly different. The Staphylococcus aureus is mostly an exogenous infection, which can easily cause serious wound infection, Staphylococcus epidermidis. It is present in the vaginal flora and causes less infection. Staphylococcus is resistant to penicillin by producing penicillinase.
4. Anaerobic streptococcus: It is more common in digestive streptococci and digestive cocci, and exists in normal vagina. When the birth canal is damaged, residual tissue necrosis, local redox potential is low, the bacteria rapidly multiply, mixed infection with E. coli, release Unusual odor.
5, anaerobic genus: a group of absolutely anaerobic Gram-negative bacilli, including Bacteroides fragilis, pigment-producing bacilli, etc., such bacteria have the characteristics of accelerating blood coagulation, can cause thrombosis in adjacent parts of the infection Phlebitis.
In addition, Clostridium, both gonorrhea can cause puerperal infection, but less common, mycoplasma and chlamydia can also be one of the pathogens of puerperal infection.
Source of infection (20%):
There are two sources of infection: one is self-infection, the pathogen that is parasitic in the reproductive tract or other parts of normal pregnant women, and can cause disease when there is a cause of infection. Second, foreign infections, caused by contaminated clothing, utensils, various surgical instruments, articles, etc., cause infection.
Causes of infection (20%):
The body's response to human pathogens depends on the type, quantity, virulence and defense ability of the pathogen. Any factors that weaken the maternal reproductive tract and systemic defense capacity are beneficial to the invasion and reproduction of the original body, such as anemia, malnutrition, Chronic disease, near the expected date of sexual effect, premature rupture of membranes, lysozyme in sheep water has a bactericidal effect, when the amniotic fluid loss, the bactericidal effect is weakened, amniotic cavity infection, various obstetric surgery operations, birth canal injury, prenatal and postpartum blood, palace Cavity filling, foreign body in the birth canal, prolonged labor, placenta residue, etc., can all be the cause of puerperal infection.
Prevention
Calving infection prevention
Strengthen health promotion during pregnancy, keep the whole body clean, avoid bathing and sexual intercourse in the third trimester of pregnancy, strengthen nutrition, enhance physical fitness, treat acute vulvovaginitis and cervicitis and other complications, avoid premature rupture of membranes, delayed labor, birth canal injury and postpartum hemorrhage, disinfection Maternal use, strict aseptic operation, correct control of surgical indications, strict observation after childbirth, antibiotics prevention for those who may develop sputum infection and puerperal morbidity.
Complication
Complications of calving infection Complications sepsis
Sepsis and sepsis, acute pelvic peritonitis, diffuse peritonitis.
Symptom
Symptoms of puerperal infection Common symptoms Wound infection high fever sputum purulent discharge Abdominal tenderness Postpartum fever puerperium sputum purulent secretion increased postpartum lochia is not odor persistent pain
Fever, abdominal pain, and lochia are the three main symptoms of puerperal infection. However, the clinical manifestations of patients with different degrees of infection and the degree of individual response to inflammation are different.
1, perineum, vagina and cervical infection
When the perineum is cut open, there is pain in the perineum and limited maternal activity. The wound is red and swollen, tender, instinctive, cracked and purulent. Vaginal laceration infection is secondary to vaginal surgery for midwifery, vaginal mucosa congestion and edema, infection can spread to the paravaginal tissue, forming vaginal wall adhesions, scar formation, severe tissue necrosis can occur, forming bladder vaginal fistula or urethra Vaginal fistula. Once the deep cervical laceration is infected, it can be spread by lymphatic spread or directly spread, causing pelvic connective tissue inflammation.
2, abdominal wall wound infection after cesarean section
Often occurring 4 to 7 days after surgery, antibiotic treatment has no significant effect, body temperature continues to retreat, wound pain, local redness or induration, tenderness, wound exudation or purulent discharge, severely infected wound full layer Split open and even lead to the uterus incision.
3, postpartum uterine infection
Often manifested as acute endometritis and uterine myositis. Bacterial invasion from the placenta exfoliation surface, disseminated to the decidual layer of the uterus causes acute endometritis, such as infection spread to the deep muscle layer, the formation of uterine myositis. When the inflammation is confined to the endometrial layer, local congestion and edema, endometrial necrosis, a large amount of purulent secretions, maternal abdominal pain, fever, body temperature is about 38 ° C, the amount of lochia is odorous, the uterus is delayed, the palace Bottom tenderness. If the inflammation is controlled in time, the necrotic tissue can be exfoliated within a few days, the endometrium is repaired, and the symptoms disappear. Conversely, pathogenic bacteria with strong virulence (such as Escherichia coli) can spread to the muscular layer and para-uterine tissue to form uterine myositis and pelvic cellulitis. In severe cases, peritoneal peritonitis may be involved. Its clinical features are often maternal after cesarean section, or have placental residual, or difficult to produce forceps. Maternal chills, high fever, lower abdominal pain, the amount of lochia can be more or less, the smell is dispensable, the total number of white blood cells is significantly increased, the uterus is relapsed, the uterus is tender, and the symptoms of systemic poisoning should be alert to the occurrence of sepsis. .
Examine
Examination of puerperal infection
1. Systemic and local physical examination, pay attention to the exclusion of other diseases and wound infections that cause puerperal morbidity, and conduct routine tests of hematuria to detect C-reactive protein in the serum of acute phase reaction substances, which is helpful for early diagnosis of infection.
2. Identify pathogens. Identification of pathogens is very important for the diagnosis and treatment of puerperal infections. The methods are as follows:
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 pathogen antigen and specific antibody check: There are many commercial kits available, which can be quickly detected.
3, determine the lesion site, through systemic examination, triple or double diagnosis, sometimes can be thickened fallopian tube or pelvic abscess mass, auxiliary examination such as B-mode ultrasound, color ultrasound Doppler, CT, magnetic resonance, etc. The detection method can locate and qualitatively diagnose the inflammatory mass, abscess and venous thrombosis caused by puerperal infection.
Diagnosis
Diagnosis and identification of puerperal infection
Diagnosis can be performed based on clinical performance and laboratory tests. At the same time, other diseases that cause infection should be excluded.
1. Detailed medical history, general and local physical examination
Pay attention to the exclusion of other diseases and wound infections that cause puerperality, and perform routine tests for hematuria. Detection of C-reactive protein in serum acute phase reactive substances helps early diagnosis of infection.
2, determine the pathogen
The identification of pathogens is very important for the diagnosis and treatment of puerperal infection. The methods are as follows: (1) Pathogen culture: After routine disinfection of the vagina and cervix, cotton swabs are used to pass the cervical canal, and the secretions of the uterine cavity are taken. Use secretions or pus for double culture of aerobic and anaerobic bacteria; 2 secretion smear examination: if the aerobic culture results are negative, and a large number of bacteria appear in the smear, suspected anaerobic infection; 3 pathogens Antigen and specific antibody tests: Many commercial kits have been available for rapid detection.
3, determine the lesion
Through systemic examination, sputum 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.
