Postpartum Infection

Август 8, 2022

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Postpartum Infection

Содержание

2. Postpartum infection – is a septic wound infection distinguished by anatomic features of female reproductive organs
3. Classification principles - By prevalence: local, generalized forms. - By infection localization: vagina, uterus, ovaries, parametric
4. Factors making patients susceptible to infection    Changes in vaginal biocenose in final stages
5. Sponsored Medical Lecture Notes – All Subjects USMLE Exam (America) – Practice
6. Important!!!  In the postpartum period the intra- uterine wall is a traumatic surface easily infected
7. Etiology Iron-deficiency anemia. Gestosis. Placental presentation. Pyelonephritis.         
8. Postpartum ulcer – is caused by contamination of abrasions, fissures, ruptures of vulval and vaginal mucous
9. Diagnostics    Hyperemia. Edema. Necrotic or purulent wound incrustation.
10. Treatment    The wounds are cleansed with antiseptics locally (hydrogen peroxide, furacilin, chlorhexidine, dioxidine,
11. Postpartum endomyometritis. The most common infection in the postpartum period!
12. CLINICAL SYMPTOMS. ACUTE FORM. Temperature elevation › 38° on 2-5th day following delivery. Chills. Abdominal pain.
13. DIAGNOSTICS          Bimanual examination (the uterus is enlarged,
14. TREATMENT         Bed rest. Antibiotic therapy (semisynthetic penicillin, combination
15. Important!!! If the examination reveals placental tissues or membranes in the uterine cavity, it is necessary
16.  Postpartum salpingo- oophoritis is rarely observed. The ovaries are normally affected on one side. The
17.  Postnatal parametritis – the process normally begins when lacerations or infections of the cervix are
18. Clinical symptoms     Chills on the 10-12th day following delivery. Temperature elevation to
19.  On bimanual examination a painful infiltrate is found in the fornices, the fornices are shortened.
20. Postnatal trombophlebitis (affecting pelvis minor veins, superficial and deep veins of lower limbs). Causes Hypercoagulation. Vessel
21. Clinical symptoms    Temperature elevation. Hyperemia and tenderness along of varix dilatated shin veins.
22. 22 Treatment      Bed rest, lower limb should be maintained uplifted. Antibacterial
23. Obstetric peritonitis. Causes.      Consequence of endomyometritis. Perforation of inflammatory tubo-ovarian mass.
24. Pathogenesis Endogenous intoxication Generalized vascular disorders General tissue hypoxia Metabolic disorders Dysfunction of essential organs and
25.  Enteroparesis. Motor, secretion, and absorption functions are affected. Significant amounts of protein and electrolyte containing
26. Obstetric peritonitis phases    Reactive phase (compensatory mechanisms preserved). Toxic phase. Terminal phase.
27. Clinical symptoms psychomotor agitation thirst dryness of mucous membranes general weakness tachycardia (does not correspond to
28. unsatisfactory sleep absence of appetite pallor of the skin nausea eructation flatulence vomiting (not always) 
29.  On palpation: the abdomen is distended, the uterus is enlarged, softened, the contours are indistinct,
30. Treatment.  Preoperative preparation (2 hours): stomach  decompression, infusion therapy intended for liquidation of hypovolemia
31. Postoperative period:      liquidation of hypovolemia and improvement of rheological properties of
32. - antibiotic therapy; - cardio-vascular collapse prevention and treatment; - vitamin therapy; - motor and evacuation
33.  Postpartum sepsis – severe non-specific infective process developing and progressing when normal reactivity of the
34. Clinical symptoms Septicemia occurs on the 3-4th day following delivery, progresses violently. Septicopyemia progresses unevenly: periods
35. IMPORTANT!!! The diagnosis is based on the following prerequisites: - presence of an infection nidus; -
36.  Impaired CNS function: euphoria, depression, sleep disturbance. Dyspnea. Cyanosis.      
37. Diagnostics            Clinical blood analysis. Clinical
38. Treatment   Preoperative preparation during 6-8 hours, hypervolemic hemodilution mode. Operative treatment – hysterectomy and
39. Postoperative period:      liquidation of hypovolemia and improvement of rheological properties of
40. - antibiotic therapy; - cardio-vascular collapse prevention and treatment; - vitamin therapy; - motor and evacuation
41.  Postpartum lactational mastitis is an inflammation of breast tissue. The most common organism reported in
42. Classification    Serous mastitis. Infiltrative mastitis (diffuse, nodular). Suppurative mastitis (intramammary, phlegmonous or necrotic
43. Clinical symptoms        Rapid elevation in temperature to 39˚C. Chills.
44. Examination shows that the breast is engorged, the skin above the breast is hyperemic. With the
45. Treatment       Antibacterial therapy. Procedures against lactostasis. Spasmolytics (no-spa) in combination
46. 46  With suppurative mastitis surgical treatment is indicated (incision of the abscess, bathing with antiseptics
48. Скачать презентацию

Слайд 2

Postpartum infection – is a septic wound infection distinguished by anatomic features of female

reproductive organs and their functional status during pregnancy.

Слайд 3

Classification principles
- By prevalence: local, generalized forms.
- By infection localization: vagina, uterus, ovaries, parametric tissue, pelvis minor veins, mammary

gland.
- By infection type: aerobic (enterococci, Escherichia coli, Klebsiella, group B streptococci, staphylococci); anaerobic (Bacteroids, fusobacteria, peptococci, peptostreptococcus); gram-positive, gram- negative, mycoplasma, Chlamydia, fungi.

Слайд 4

Factors making patients susceptible to infection



Changes in vaginal biocenose in final stages of pregnancy.
Pregnancy-related immunodeficiency

development. Delivery type.

Слайд 5

Important!!!
 In the postpartum period the intra- uterine wall is a

traumatic surface easily infected by the spread of pathogenic and opportunistic pathogenic flora.

Слайд 7

Etiology
Iron-deficiency anemia. Gestosis.
Placental presentation. Pyelonephritis.









Prolonged labour. Prolonged anhydrous term. Serious loss

of blood.
Genital tract wounds. Surgical procedures.

Слайд 8

Postpartum ulcer – is caused by contamination of abrasions, fissures, ruptures of vulval and

vaginal mucous membranes.
The patient’s general condition is satisfactory.

Слайд 9

Diagnostics



Hyperemia. Edema.
Necrotic or purulent wound incrustation.

Слайд 10

Treatment



The wounds are cleansed with antiseptics locally (hydrogen peroxide, furacilin, chlorhexidine,

dioxidine, hypertonic solution).
Wound debridement with proteolytic ferments is performed (tripsin, chemotripsin).
After the wound has been cleansed from pus, ointment bandages are applied (levomicole, dioxicole).

Слайд 11

Postpartum
endomyometritis.
The most common infection in the postpartum period!

Слайд 12

CLINICAL SYMPTOMS.
ACUTE FORM.
Temperature elevation › 38° on 2-5th day following delivery.
Chills.
Abdominal pain.
Foul-smelling,

pus-containing lochia.
Headache.
Facial hyperemia.
Postpartum psychosis (the degree depends on the level of intoxication).

Слайд 13

DIAGNOSTICS









Bimanual examination (the uterus is enlarged, painful, softened, contractive movements are

restricted).
Clinical blood count. Ultrasonography.
Thermometry.
Bacterioscopic and bacteriological analysis of vaginal discharge.
Biochemical blood test (c-reactive protein increase, hypoproteinemia, hypoalbuminemia).
Coagulogram. Hysteroscopy.
Clinical urine analysis.

Слайд 14

TREATMENT








Bed rest.
Antibiotic therapy (semisynthetic penicillin, combination of cephalosporin and metronidazole).
Infusion therapy

(combination of colloids and crystalloids).
10% calcium gluconate, 10 ml i.v. Vitamin therapy.
Spasmolytics (no-spa, papaverine hydrochloride).
Immunomodulators.
Intrauterine lavage with antiseptic

Слайд 15

Important!!!
If the examination reveals placental tissues or membranes in the uterine

cavity, it is necessary to perform curettage or vacuum aspiration of the uterus.
LOW-GRADE ENDOMYOMETRITIS progresses without pronounced clinical symptoms. The onset of the disease is normally on the 7-9th day following delivery. The most common causes of the disease are Chlamydia or mycoplasma infections.

Слайд 16

 Postpartum salpingo-
oophoritis is rarely observed. The ovaries are normally affected on one

side. The clinical history of the disease is similar to manifestations of endomyometritis, which is followed by salpingo-oophoritis

Слайд 17

 Postnatal parametritis – the process normally begins when lacerations or infections of

the cervix are present.
Lateral parts of parametrium are commonly affected.

Слайд 18

Clinical symptoms




Chills on the 10-12th day following delivery.
Temperature elevation to 39 -

40°. Tensive lower abdominal pain.
Acruturesis or dyschezia in cases when the process has spread to front or back parametrium.

Слайд 19

 On bimanual examination a painful infiltrate is found in the

fornices, the fornices are shortened.

 For diagnostics and treatment see endomyometritis.

Слайд 20

Postnatal trombophlebitis (affecting pelvis minor veins, superficial and deep veins of lower

limbs).
Causes
Hypercoagulation.
Vessel wall lesions.

Слайд 21

Clinical symptoms



Temperature elevation.
Hyperemia and tenderness along of varix dilatated shin veins.
Edema (if

deep veins of lower limbs are involved).

Слайд 22

22
Treatment





Bed rest, lower limb should be maintained uplifted.
Antibacterial therapy.
Anticoagulants: direct effect

(heparin), indirect effect (kleksan, fraxiparin, troxevasin, aspirin).
Medicines improving rheological properties of the blood: rheopolyglukin, trental, kurantil.
Hirudotherapy.

Слайд 23

Obstetric peritonitis.
Causes.





Consequence of endomyometritis.
Perforation of inflammatory tubo-ovarian mass.
Torsion of ovarian tumor pedicle.
Necrosis

of the subserous node of hysteromyoma.
Infected rupture of uterine sutures after caesarean section.

Слайд 24

Pathogenesis
Endogenous intoxication
Generalized vascular disorders General tissue hypoxia
Metabolic disorders
Dysfunction of essential organs

and systems Destructive changes in kidneys, pancreas, liver, small intestine
Enteroparesis

Слайд 25

 Enteroparesis. Motor, secretion, and absorption functions are affected.
Significant amounts of

protein and electrolyte containing liquid accumulate in the intestinal lumen. Overdistension and ischemia of the intestinal wall cause impairment of the intestinal barrier function which leads to increased intoxication

Слайд 26

Obstetric peritonitis
phases



Reactive phase (compensatory mechanisms preserved).
Toxic phase. Terminal phase.

Слайд 27

Clinical symptoms
psychomotor agitation
thirst
dryness of mucous membranes
general weakness
tachycardia (does not correspond to the

body temperature)
fever
pulse rate exceeds 100bpm
shallow breathing

Слайд 28

unsatisfactory sleep
absence of appetite
pallor of the skin
nausea
eructation
flatulence
vomiting (not always)

the pain syndrome

is not evident (due to

overdistension of the front abdominal wall after delivery).

Слайд 29

 On palpation: the abdomen is distended, the uterus is enlarged,

softened, the contours are indistinct, peritoneum irritation symptoms are not pronounced, sluggish peristalsis, slow flatus discharge.

Слайд 30

Treatment.

Preoperative preparation (2 hours): stomach

decompression, infusion therapy intended for liquidation of

hypovolemia and metabolic acidosis, fluid, protein and electrolytic balance correction, detoxication of the body, antibacterial therapy.
Operative treatment: hysterectomy, abdominal cavity drainage.

Слайд 31

Postoperative period:





liquidation of hypovolemia and
improvement of rheological properties of the blood;
acidosis

correction;
provision for the body’s energy demands;
antiferment and anticoagulant therapy (combination of contrical and heparin);
maintenance of artificial dieresis;

Слайд 32

- antibiotic therapy;
- cardio-vascular collapse prevention and treatment;
- vitamin therapy;
- motor

and evacuation intestinal function recovery (proserin, ganglio-blockers);
- ultraviolet irradiation of autoblood, hyperbaric oxygenation.

Слайд 33

 Postpartum sepsis – severe non-specific infective process developing and progressing when normal

reactivity of the organism is changed.

Слайд 34

Clinical symptoms
Septicemia occurs on the 3-4th day following delivery, progresses violently.
Septicopyemia progresses

unevenly: periods of recrudescence caused by metastatic infection and formation of new niduses are followed by periods of amelioration.

Слайд 35

IMPORTANT!!!
The diagnosis is based on the following prerequisites:
- presence of an

infection nidus;
- fever and chills;
- etiological factor was detected in blood.

Слайд 36


Impaired CNS function: euphoria, depression, sleep disturbance.
Dyspnea. Cyanosis.






Pale, grey or yellow

skin. Tachycardia, pulse lability. Hypotension.
Enlarged liver and spleen.

Слайд 37

Diagnostics











Clinical blood analysis. Clinical urine analysis. Coagulogram (platelets). Blood electrolytes.
Bacteriological analysis.

Lungs radiography.
ECG.
Blood sugar.
Acid-base condition. Central venous pressure.
Monitoring: arterial pressure, pulse rate, heart rate, body temperature.

Слайд 38

Treatment


Preoperative preparation during 6-8 hours, hypervolemic hemodilution mode.
Operative treatment – hysterectomy

and salpingectomy, abdominal cavity drainage.

Слайд 39

Postoperative period:





liquidation of hypovolemia and
improvement of rheological properties of the blood;
acidosis

correction;
provision for the body’s energy demands;
antiferment and anticoagulant therapy (combination of contrical and heparin);
maintenance of artificial dieresis;

Слайд 40

- antibiotic therapy;
- cardio-vascular collapse prevention and treatment;
- vitamin therapy;
- motor

and evacuation intestinal function recovery (proserin, ganglio-blockers);
- ultraviolet irradiation of autoblood, hyperbaric oxygenation, plasmapheresis, hemosorption, hemodialysis.

Слайд 41

 Postpartum lactational mastitis is an inflammation of breast tissue.
The most common organism reported in

mastitis is Staphylococcus aureus, Streptococcus is less common.
The organisms invade the breast tissue via cracking or fissures in the nipple or lactiferous ducts. Lactostasis is conducive to progressing of the inflammatory process.

Слайд 42

Classification



Serous mastitis.
Infiltrative mastitis (diffuse, nodular).
Suppurative mastitis (intramammary, phlegmonous or necrotic suppurative,

gangrenous).

Слайд 43

Clinical symptoms







Rapid elevation in temperature to 39˚C. Chills.
Painful breast. Headache.
General malaise, weakness.

Sleep disturbance.
Loss of appetite.

Слайд 44

Examination shows that the breast is engorged, the skin above the

breast is hyperemic.
With the right treatment the disease is cured within 1-2 days; if inadequate therapy is chosen, the disease advances to the next (infiltrate) stage.
The diagnosis is made on the basis of clinical symptoms.

Слайд 45

Treatment






Antibacterial therapy. Procedures against lactostasis.
Spasmolytics (no-spa) in combination with uterotonics (oxytocin).
Parlodel

(to decrease milk production). Vitamin therapy.
Anti-staphylococcus gamma globulin, hyperimmune anti-staphylococcus plasma.

Слайд 46

46
 With suppurative mastitis surgical treatment is indicated (incision of the

abscess, bathing with
antiseptics and drainage of the pus).

 IMPORTANT!!! During the course of treatment for postpartum septic diseases breastfeeding should be discontinued as the baby might
receive high doses of medicines with mother’s milk.


Postpartum Infection

Содержание

Postpartum infection – is a septic wound infection distinguished by anatomic features of female

Classification principles- By prevalence: local, generalized forms.- By infection localization: vagina, uterus, ovaries, parametric tissue, pelvis minor veins, mammary

Factors making patients susceptible to infectionChanges in vaginal biocenose in final stages of pregnancy.Pregnancy-related immunodeficiency

SponsoredMedical Lecture Notes – All SubjectsUSMLE Exam (America) – Practice

Important!!! In the postpartum period the intra- uterine wall is a

EtiologyIron-deficiency anemia. Gestosis.Placental presentation. Pyelonephritis.Prolonged labour. Prolonged anhydrous term. Serious loss

Postpartum ulcer – is caused by contamination of abrasions, fissures, ruptures of vulval and

DiagnosticsHyperemia. Edema.Necrotic or purulent wound incrustation.

TreatmentThe wounds are cleansed with antiseptics locally (hydrogen peroxide, furacilin, chlorhexidine,

Postpartumendomyometritis.The most common infection in the postpartum period!

CLINICAL SYMPTOMS.ACUTE FORM.Temperature elevation › 38° on 2-5th day following delivery.Chills.Abdominal pain.Foul-smelling,

DIAGNOSTICSBimanual examination (the uterus is enlarged, painful, softened, contractive movements are

TREATMENTBed rest.Antibiotic therapy (semisynthetic penicillin, combination of cephalosporin and metronidazole).Infusion therapy

Important!!!If the examination reveals placental tissues or membranes in the uterine

 Postpartum salpingo-oophoritis is rarely observed. The ovaries are normally affected on one

 Postnatal parametritis – the process normally begins when lacerations or infections of

Clinical symptomsChills on the 10-12th day following delivery.Temperature elevation to 39 -

 On bimanual examination a painful infiltrate is found in the

Postnatal trombophlebitis (affecting pelvis minor veins, superficial and deep veins of lower

Clinical symptomsTemperature elevation.Hyperemia and tenderness along of varix dilatated shin veins.Edema (if

22TreatmentBed rest, lower limb should be maintained uplifted.Antibacterial therapy.Anticoagulants: direct effect

Obstetric peritonitis.Causes.Consequence of endomyometritis.Perforation of inflammatory tubo-ovarian mass.Torsion of ovarian tumor pedicle.Necrosis

PathogenesisEndogenous intoxicationGeneralized vascular disorders General tissue hypoxiaMetabolic disordersDysfunction of essential organs

 Enteroparesis. Motor, secretion, and absorption functions are affected.Significant amounts of

Obstetric peritonitisphasesReactive phase (compensatory mechanisms preserved).Toxic phase. Terminal phase.

Clinical symptomspsychomotor agitationthirstdryness of mucous membranesgeneral weaknesstachycardia (does not correspond to the

unsatisfactory sleepabsence of appetitepallor of the skinnauseaeructationflatulencevomiting (not always)the pain syndrome

 On palpation: the abdomen is distended, the uterus is enlarged,

Treatment.Preoperative preparation (2 hours): stomachdecompression, infusion therapy intended for liquidation of

Postoperative period:liquidation of hypovolemia andimprovement of rheological properties of the blood;acidosis

- antibiotic therapy;- cardio-vascular collapse prevention and treatment;- vitamin therapy;- motor

 Postpartum sepsis – severe non-specific infective process developing and progressing when normal

Clinical symptomsSepticemia occurs on the 3-4th day following delivery, progresses violently.Septicopyemia progresses

IMPORTANT!!!The diagnosis is based on the following prerequisites:- presence of an

Impaired CNS function: euphoria, depression, sleep disturbance.Dyspnea. Cyanosis.Pale, grey or yellow

DiagnosticsClinical blood analysis. Clinical urine analysis. Coagulogram (platelets). Blood electrolytes.Bacteriological analysis.

TreatmentPreoperative preparation during 6-8 hours, hypervolemic hemodilution mode.Operative treatment – hysterectomy

Postoperative period:liquidation of hypovolemia andimprovement of rheological properties of the blood;acidosis

- antibiotic therapy;- cardio-vascular collapse prevention and treatment;- vitamin therapy;- motor

 Postpartum lactational mastitis is an inflammation of breast tissue.The most common organism reported in

ClassificationSerous mastitis.Infiltrative mastitis (diffuse, nodular).Suppurative mastitis (intramammary, phlegmonous or necrotic suppurative,

Clinical symptomsRapid elevation in temperature to 39˚C. Chills.Painful breast. Headache.General malaise, weakness.

Examination shows that the breast is engorged, the skin above the

TreatmentAntibacterial therapy. Procedures against lactostasis.Spasmolytics (no-spa) in combination with uterotonics (oxytocin).Parlodel

46 With suppurative mastitis surgical treatment is indicated (incision of the

Похожие презентации

Classification principles
- By prevalence: local, generalized forms.
- By infection localization: vagina, uterus, ovaries, parametric tissue, pelvis minor veins, mammary

Factors making patients susceptible to infection



Changes in vaginal biocenose in final stages of pregnancy.
Pregnancy-related immunodeficiency

Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

Important!!!
 In the postpartum period the intra- uterine wall is a

Etiology
Iron-deficiency anemia. Gestosis.
Placental presentation. Pyelonephritis.









Prolonged labour. Prolonged anhydrous term. Serious loss

Diagnostics



Hyperemia. Edema.
Necrotic or purulent wound incrustation.

Treatment



The wounds are cleansed with antiseptics locally (hydrogen peroxide, furacilin, chlorhexidine,

Postpartum
endomyometritis.
The most common infection in the postpartum period!

CLINICAL SYMPTOMS.
ACUTE FORM.
Temperature elevation › 38° on 2-5th day following delivery.
Chills.
Abdominal pain.
Foul-smelling,

DIAGNOSTICS









Bimanual examination (the uterus is enlarged, painful, softened, contractive movements are

TREATMENT








Bed rest.
Antibiotic therapy (semisynthetic penicillin, combination of cephalosporin and metronidazole).
Infusion therapy

Important!!!
If the examination reveals placental tissues or membranes in the uterine

 Postpartum salpingo-
oophoritis is rarely observed. The ovaries are normally affected on one

Clinical symptoms




Chills on the 10-12th day following delivery.
Temperature elevation to 39 -

Clinical symptoms



Temperature elevation.
Hyperemia and tenderness along of varix dilatated shin veins.
Edema (if

22
Treatment





Bed rest, lower limb should be maintained uplifted.
Antibacterial therapy.
Anticoagulants: direct effect

Obstetric peritonitis.
Causes.





Consequence of endomyometritis.
Perforation of inflammatory tubo-ovarian mass.
Torsion of ovarian tumor pedicle.
Necrosis

Pathogenesis
Endogenous intoxication
Generalized vascular disorders General tissue hypoxia
Metabolic disorders
Dysfunction of essential organs

 Enteroparesis. Motor, secretion, and absorption functions are affected.
Significant amounts of

Obstetric peritonitis
phases



Reactive phase (compensatory mechanisms preserved).
Toxic phase. Terminal phase.

Clinical symptoms
psychomotor agitation
thirst
dryness of mucous membranes
general weakness
tachycardia (does not correspond to the

unsatisfactory sleep
absence of appetite
pallor of the skin
nausea
eructation
flatulence
vomiting (not always)

the pain syndrome

Treatment.

Preoperative preparation (2 hours): stomach

decompression, infusion therapy intended for liquidation of

Postoperative period:





liquidation of hypovolemia and
improvement of rheological properties of the blood;
acidosis

- antibiotic therapy;
- cardio-vascular collapse prevention and treatment;
- vitamin therapy;
- motor

Clinical symptoms
Septicemia occurs on the 3-4th day following delivery, progresses violently.
Septicopyemia progresses

IMPORTANT!!!
The diagnosis is based on the following prerequisites:
- presence of an


Impaired CNS function: euphoria, depression, sleep disturbance.
Dyspnea. Cyanosis.






Pale, grey or yellow

Diagnostics











Clinical blood analysis. Clinical urine analysis. Coagulogram (platelets). Blood electrolytes.
Bacteriological analysis.

Treatment


Preoperative preparation during 6-8 hours, hypervolemic hemodilution mode.
Operative treatment – hysterectomy

Postoperative period:





liquidation of hypovolemia and
improvement of rheological properties of the blood;
acidosis

- antibiotic therapy;
- cardio-vascular collapse prevention and treatment;
- vitamin therapy;
- motor

 Postpartum lactational mastitis is an inflammation of breast tissue.
The most common organism reported in

Classification



Serous mastitis.
Infiltrative mastitis (diffuse, nodular).
Suppurative mastitis (intramammary, phlegmonous or necrotic suppurative,

Clinical symptoms
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Rapid elevation in temperature to 39˚C. Chills.
Painful breast. Headache.
General malaise, weakness.

Treatment
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Antibacterial therapy. Procedures against lactostasis.
Spasmolytics (no-spa) in combination with uterotonics (oxytocin).
Parlodel

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 With suppurative mastitis surgical treatment is indicated (incision of the