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Obstetric peritonitis
Last reviewed: 23.04.2024
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Peritonitis in obstetrical practice most often develops after cesarean section. Depending on the pathway of infection, the peritoneum secrete several forms of the disease. Early obstetric peritonitis occurs on the 1st-3rd day after the operation. It is usually due to infection during surgery, which was carried out against the background of chorioamnionitis.
Peritonitis associated with intestinal paresis develops on the 3rd-5th day after the operation. It is caused by a violation of the barrier function of the intestine due to its dynamic obstruction, overgrowth of the small intestine due to liquid contents and gases.
Obstetrical peritonitis due to the inferiority of the wound on the uterus more often develops on the 4th-9th day after the operation, and some distribution on clinical forms is relatively arbitrary, but it has a significant effect on the choice of therapeutic tactics.
[Symptoms of obstetric peritonitis
Clinical symptoms of obstetric peritonitis include hyperthermia, abdominal distention and intestinal paresis (absence of peristalsis), concentration of liquid contents in the stomach, dyspnea, tachycardia, vomiting, intoxication, which increases, signs of irritation of the peritoneum. Therapeutic measures give a temporary effect, after 3-4 h, intestinal paresis and other signs of peritonitis are reinforced.
Diagnosis of obstetric peritonitis
US-signs of obstetric peritonitis: bloated, filled with hyperechoic content of the intestinal loop, pronounced hyperechoinality of the intestinal wall, presence of free fluid in the abdominal cavity between the intestinal loops, in the lateral canals and space behind the uterus. The inconsistency of the sutures on the uterus is indicated by the uneven thickness of the uterine wall in the projection of the suture, the presence in this area of the "niche" and "liquid structures".
Signs of peritonitis with a survey radiograph of the abdominal cavity include hyperpneumatosis, a large number of Kloyber bowls that do not have a shape, possibly free gas under the dome of the diaphragm.
What do need to examine?
Treatment of obstetric peritonitis
At an early stage of treatment of obstetric peritonitis, which developed after cesarean section, intensive conservative therapy for 2-3.5 hours is justified. It is necessary to provide an outflow from the uterus, stimulate the function of the intestine. In the absence of the effect of conservative therapy, laparotomy with revision of abdominal organs, extirpation of the uterus with fallopian tubes are shown during this time.
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