Postpartum purulent-septic diseases - Symptoms

The main complaints of patients with delayed complications of cesarean section are:

• weakness, lack of appetite;
• prolonged subfebrile temperature with periodic increases in temperature (in the evenings);
• pain;
• pain or burning sensation when urinating;
• bowel movements with periodic appearance of loose stools;
• the presence of purulent or bloody discharge from the genital tract;
• the presence of infiltrates and abscesses in the area of the anterior abdominal wall.

The main complaints of such patients may be scanty and do not reflect the severity of the patient's condition, therefore, a thorough collection of anamnesis is of great importance for making a diagnosis, with particular attention to the following points:

• the presence of risk factors for the development of purulent-septic complications listed above;
• a prolonged febrile period, with resumption of hyperthermia after the end of antibacterial therapy;
• the presence of transient intestinal paresis;
• prescribing antibacterial therapy in the postoperative period, especially long-term or repeated courses;
• the use of massive infusion therapy, intensive or repeated courses of treatment for intestinal paresis;
• use of any type of drainage and sanitation of the uterus, abdominal cavity, pelvic cellular spaces, wounds of the anterior abdominal wall;
• the presence of intrauterine infectious diseases in the child (from vesiculosis to sepsis);
• the presence of infiltrates, suppuration of the wound of the anterior abdominal wall, healing of the wound completely or partially by secondary intention.

During vaginal examination, the cervix of some patients is formed, while in most cases it hangs freely in the vagina like a "sail". This symptom, especially detected more than 12-15 days after delivery, is an unfavorable sign, reflecting the degree of expression of inflammatory-necrotic changes in the anterior wall of the uterus, especially its lower segment. The size of the uterus in all patients exceeds the value normally corresponding to certain days of the postpartum period, the consistency of the organ is often soft. It is often impossible to clearly determine the contours of the uterus, which is associated with the presence of infiltrates on the anterior abdominal wall, in the retrovesical tissue or parametrium. Infiltrate in the retrovesical tissue is the earliest and most characteristic sign of secondary failure of the sutures on the uterus.

It should be noted that even in cases where the infiltrate is not detected, the uterus is usually fixed to the tissues of the anterior abdominal wall in the area of its lower segment. In a number of patients, the uterus is in a single conglomerate with appendages and parametrial tissue infiltrate reaching the pelvic bones.

The leading clinical symptom of the disease is intractable endometritis despite adequate therapy, which manifests itself in an increase in symptoms of intoxication (hectic temperature, tachycardia).

An analysis of clinical manifestations of delayed complications of cesarean section revealed a number of prognostically unfavorable clinical symptoms:

• repeated increase in temperature above 38°C after discontinuation of antibacterial therapy;
• absence of tendency to form the cervix;
• the presence of a hematoma or infiltrate in the retrovesical space;
• persistent subinvolution of the uterus;
• the presence of transient intestinal paresis.

The presence of such a symptom complex indicates various variants of infection generalization and, consequently, the vital need for surgical treatment.

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