Infected postpartum wounds

Infected postnatal wounds can manifest themselves in different ways. Clinical signs of infection in wounds that heal with primary tension:

1. Complaints:

• on intense, often throbbing pain in the wound site;
• to increase the body temperature - subfebrile or to 38-39 ° C;

2. local changes:

• hyperemia around the wound without positive dynamics;
• the appearance of swelling of the tissue, which gradually increases;
• when palpation is determined by the infiltration of tissue, which often increases; may occur deep infiltrates (necrotizing fasciitis, which can spread to the buttocks, anterior abdominal wall, often with a fatal outcome);
• Serous exudate quickly passes into purulent.

Clinical signs of infection in wounds that heal with secondary tension:

• Progressive edema and tissue infiltration around the wound;
• the appearance of dense painful infiltrates without clear contours;
• signs of lymphangitis and lymphadenitis;
• the wound surface is covered with a continuous fibrin-purulent coating;
• deceleration or cessation of epithelialization;
• granulations become pale or cyanotic, their bleeding sharply decreases;
• the amount of exudate increases, its character depends on the pathogen.

The type of pathogen also determines the clinical course of wound infection:

• Staphylococcal infection is characterized by the rapid development of the local process with pronounced manifestations of purulent-resorptive fever;
• Streptococcal infection tends to diffuse spread in the form of phlegmon with mildly expressed local symptoms;
• for Pseudomonas aeruginosa characterized by a languid, prolonged course of local process after acute onset, with severe manifestations of general intoxication.

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How to recognize infected postnatal wounds?

Bacteriological study of exudate is carried out in order to determine the pathogen and its sensitivity to antibiotics. The sampling of the material should be performed at the beginning of antibiotic therapy. The material for research can be exudate, pieces of tissue, washings from a wound. Material is collected with sterile tools and put! In sterile test tubes or vials with a standard medium. The sowing of the material must be carried out for 2 hours after the sampling. Simultaneously with taking the material for bacteriological examination, it is necessary to make at least two smears stained according to Gram, for the purpose of an indicative rapid diagnosis.

Accelerated methods of identification of the causative agent of wound infection using multimicrotest systems can be used. The duration of the procedure is 4-6 hours,

In the absence of microbial growth in the clinical material, the following reasons should be excluded:

• presence in the posted material of high concentrations of local or systemic antibacterial drugs;
• violation of the regime of storage and transportation of samples;
• Methodological errors in the baklaboratory;
• effective control of the infectious wound process with antibacterial drugs;
• presence of anaerobic infection.

Treatment of infected postpartum wounds

In most cases, local treatment is sufficient. Treatment includes surgical, pharmacological and physiotherapy methods.

Surgical treatment of the wound

Primary treatment of brine is performed according to the primary indications. Repeated primary surgical treatment of the wound is performed if the first surgical intervention for some reason was non-radical and there was a need for repeated intervention even before the development of infectious complications in the wound.

Surgical treatment of the wound consists of the following stages:

• removal of non-viable tissues from the wound, which are the substrate for primary necrosis;
• removal of hematomas (especially deep located);
• final stop of bleeding;
• restoration of damaged tissues.

Secondary treatment of the wound is performed on secondary indications, usually in connection with purulent-inflammatory complications of the wound. Repeated secondary treatment of the wound with severe forms of wound infection can be repeated many times. In most cases, secondary surgical treatment of the wound includes:

• removal of the focus of infection-inflammatory alteration;
• wide opening of pockets, swim;
• full drainage with ensuring the outflow of exudate;
• use of local antiseptics.

Pharmacological methods are antibiotic prophylaxis and antibiotic therapy.

Antibiotic prophylaxis is a systemic appointment of an antibacterial drug by the time of microbial contamination of the wound or development of postoperative wound infection, and also in the presence of signs of contamination, provided that the primary treatment is surgical. Antibiotic prophylaxis is prescribed at risk of infection of massive wounds of the perineal, vagina and laparotomic wound at caesarean section.

Principles of antibacterial prophylaxis:

• at a caesarean section without complications is spent after extraction of the child by disposable intravenous introduction of an antibiotic in an average daily dose in view of results of antibiotic resistance of the revealed hospital strains;
• In case of complications during the operation or detection of signs of the inflammatory process, the same drug can also be used for antibiotic therapy;
• continuation of the introduction of an antibiotic within 24 hours from the end of the operation does not lead to an increase in the effectiveness of prevention of wound infection;
• preventive premature antibiotic prescribing prior to surgery is inexpedient, as this leads to disruption of the digestive tract biocenosis and colonization of its upper divisions. Antibiotic therapy is the use of antibiotics for prolonged treatment in the event of an inflammatory process. Antibiotic therapy can be:
• empirical - based on the use of wide-spectrum drugs, active against potential pathogens;
• purposeful - drugs are used according to the results of microbiological diagnosis.

Of great importance is the local use of antiseptics. To clean the wound, 10% sodium chloride solution, 3% hydrogen peroxide solution, 0.02% chlorhexidine solution, etc. Can be used. For more rapid healing, you can use gaskets with left-handed or levosin, or sintomycin, or solcoseryl ointment, etc.

Physiotherapeutic procedures in the period of convalescence include UHF-inductotherapy, ultraviolet irradiation, electrophoresis with medicinal preparations.

Prevention of wound infection is the rational management of childbirth and the postpartum period, the observance of rules of asepsis and antiseptics.