Postpartum purulent-septic diseases: symptoms

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

• weakness, lack of appetite;
• long subfebrile condition with a periodic rise in temperature (in the evenings);
• pain;
• rezi or burning sensation when urinating;
• infringements of a defecation with periodic occurrence of a liquid chair;
• presence of purulent or bloody discharge from the genital tract;
• presence of infiltrates and abscesses in the region of the anterior abdominal wall.

The main complaints of such patients can be scarce, do not reflect the severity of the condition of patients, therefore, a careful collection of anamnesis is of great importance for the diagnosis, with the following main points to be paid to:

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

When vaginal examination of a part of the patients, the cervix of the uterus is formed, in the majority - freely as a "sail" hangs into the vagina. This symptom, especially revealed more than 12-15 days after delivery, is an unfavorable sign, reflecting the severity 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 more often soft. Clearly define the contours of the uterus is often not possible, which is due to the presence of infiltrates on the front abdominal wall, in the behind-a-bubble tissue or parameter. Infiltration in the posterolubular tissue is the earliest and most characteristic sign of secondary inconsistency of the sutures on the uterus.

It should be noted that even in those cases when the infiltrate is not determined, the uterus is usually fixed to the tissues of the anterior abdominal wall in the region of its lower segment. In a number of patients, the uterus is in a single conglomerate with appendages and infiltrate of parametric fiber reaching the pelvic bones.

The leading clinical sign of the disease is non-occlusive endometritis with adequately conducted therapy, which manifests itself in the growth of symptoms of intoxication (hectic temperature, tachycardia).

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 the abolition of antibacterial therapy;
• absence of a tendency to the formation of the cervix;
• presence of a hematoma or infiltrate in the back-bubble space;
• persistent subinvolution of the uterus;
• presence of transient paresis of the intestine.

The presence of such a symptom complex indicates different variants of generalization of the infection and, consequently, the vital necessity of surgical treatment.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]