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Obstetric peritonitis
Last reviewed: 07.07.2025
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Peritonitis in obstetric practice most often develops after a cesarean section. Depending on the route of infection of the peritoneum, several forms of the disease are distinguished. Early obstetric peritonitis occurs on the 1st-3rd day after surgery. It is usually caused by infection during surgery, which was performed against the background of chorioamnionitis.
Peritonitis associated with intestinal paresis develops on the 3rd to 5th day after surgery. It is caused by a disruption of the intestinal barrier function due to its dynamic obstruction, overstretching of the small intestine due to liquid contents and gases.
Obstetric peritonitis due to the inadequacy of the uterine wound often develops on the 4th-9th day after surgery, and its distribution into clinical forms is rather arbitrary, but significantly affects the choice of treatment tactics.
[ Symptoms of obstetric peritonitis
Clinical symptoms of obstetric peritonitis include hyperthermia, abdominal distension and intestinal paresis (absence of peristalsis), concentration of liquid contents in the stomach, dyspnea, tachycardia, vomiting, intoxication that increases, signs of peritoneal irritation. Therapeutic measures give a temporary effect, after 3-4 hours intestinal paresis and other signs of peritonitis increase again.
Diagnosis of obstetric peritonitis
Ultrasound signs of obstetric peritonitis: swollen intestinal loops filled with hyperechoic contents, pronounced hyperechogenicity of the intestinal wall, the presence of free fluid in the abdominal cavity between the intestinal loops, in the lateral canals and the space behind the uterus. The insolvency of the sutures on the uterus is indicated by the uneven thickness of the uterine wall in the projection of the suture, the presence of a "niche" and "fluid structures" in this area.
Signs of peritonitis on abdominal X-ray include hyperpneumatosis, a large number of Kloiber cups that have no shape, and possibly free gas under the dome of the diaphragm.
What do need to examine?
Treatment of obstetric peritonitis
At the early stage of treatment of obstetric peritonitis that developed after cesarean section, intensive conservative therapy is justified for 2-3.5 hours. It is necessary to ensure outflow from the uterus, stimulate bowel function. If there is no effect from conservative therapy during the specified time, laparotomy with revision of abdominal organs, extirpation of the uterus with fallopian tubes are indicated.
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