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Postpartum endometritis
Last reviewed: 23.04.2024
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Postpartum endometritis (endometritis) is an inflammation of the surface layer of the endometrium. Endomiometritis (endomiometritis, metroendometritis) is the spread of inflammation from the basal layer of the endometrium to the myometrium. Panmetritis (panmitritis) is the spread of inflammation from the endometrium and myometrium to the serous layer of the uterus.
[Symptoms of postpartum endometritis
The initial stage of postpartum endometritis can be of different severity and have a polymorphic picture. It is necessary to distinguish between classic, erased and abortive forms of endometritis, as well as endometritis after cesarean section. The classical form of endometritis usually develops on the 3rd-5th day after birth. This form is characterized by fever, intoxication, a change in the psyche, pronounced leukocytosis with a shift of the leukocyte formula to the left, pathological discharge from the uterus. With the erased form of endometritis, the disease usually develops on the 8th-9th day after birth, body temperature is subfebrile, local manifestations are little pronounced. The abortive form of endometritis proceeds, as well as classical, but at a high level of immunological defense quickly stops. Endometriometry after caesarean section may be complicated by pelvic peritonitis, peritonitis, which develops 1-2 days after the operation.
Diagnosis of postpartum endometritis
Diagnosis of postpartum endometritis is based on:
- clinical data: complaints, anamnesis, clinical examination. With vaginal examination: the uterus is moderately sensitive; subinvolution of the uterus; purulent discharge;
- laboratory data: general blood test (leukogram), general urine analysis, bacteriological and bacterioscopic examination of cervical and / or uterine discharge, blood and urine tests, if necessary, immunogram, gram coagulation, blood biochemistry;
- instrumental data: ultrasound.
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Treatment of postpartum endometritis
In most cases, the treatment of postpartum endometritis is pharmacological, but also surgical.
Complex treatment of postpartum endometritis includes not only systemic antibacterial, infusion, detoxicapion therapy, but also local treatment. Antibiotic therapy can be empirical and purposeful. The advantage is given to targeted antibiotic therapy, which is possible with the use of accelerated methods of identification of the pathogen using a multimicrotest system. If the fever continues for 48-72 hours after the start of treatment, the resistance of the causative agent to the antibiotics used should be suspected. Treatment with intravenous antibiotics should last 48 hours after the disappearance of hyperthermia and other symptoms. Tableted antibiotics should be prescribed for the next 5 days.
It should be borne in mind that antibiotics enter the mother's milk. The immature enzyme system of the infant can not cope with the complete elimination of antibiotics, which can lead to a cumulative effect. The degree of diffusion of the antibiotic into breast milk depends on the nature of the antibiotic.
Women who are breastfeeding can be prescribed the following antibiotics: penicillins, cephalosporins, individually addressed by the question of macrolides (in the literature lead to conflicting data on erythromycin), aminoglycosides. Categorically contraindicated in breastfeeding antibiotics: tetracyclines, fluoroquinolones, sulfonamides, metronidazole, tinidazole, clindamycin, imipenems.
Local therapy for endometritis is aspiration-flushing drainage of the uterine cavity using a double-lumen catheter, through which the walls of the uterus are irrigated with solutions of antiseptics, antibiotics. Chilled to 4 ° C 0.02% chlorhexidine solution, isotonic sodium chloride solution at a rate of 10 ml / min. Contraindications to aspiration-washing drainage of the uterus are: inconsistency of the sutures on the uterus after a cesarean section, the spread of infection outside the uterus, as well as the first days (up to 3-4 days) of the postpartum period. If pathological inclusions (blood clots, fetal remains) in the uterine cavity by washing drainage can not be washed, they must be removed by vacuum-aspiration or careful curettage on the background of antibacterial therapy and normal body temperature. In the absence of such conditions, curettage is carried out only for vital indications (bleeding in the presence of placenta remnants).
Operative treatment is used in case of ineffectiveness of conservative therapy and in the presence of negative dynamics in the first 24-48 hours of treatment, with the development of SIRS. Surgical treatment of postpartum endometritis consists of laparotomy and extirpation of the uterus with fallopian tubes.
Proper treatment of postpartum endometriometritis is the basis of the prevention of common forms of infectious diseases in the puerperas.