Postpartum infection (puerperal fever) with high fever is one of the pathologies observed in the postpartum period, the etiology of which is closely correlated with the presence of pathogenic microbes colonizing postpartum wounds. What are the causes and symptoms of maternal fever? How is the puerperal infection treated?
Postpartum infection( puerperal fever ) may be limited only to the primary site, but it happens that bacteria or they spread throughout the body, contributing to systemic infection. It should be emphasized that the gate of infection is almost the entire birth canal through which the baby passes during delivery. Primary damage may concern the uterine body, cervix, vagina or vulva, and the incision wound itself may create excellent conditions for the development of pathogens.
Postpartum infection is initially a local infection, usually confined to the postpartum wound. Inflammation can spread to adjacent structures in the reproductive system. A common complication is inflammation of the appendages, which results from the transmission of bacteria to the fallopian tubes through the mucosa. In severe conditions, apart from the usual inflammation involving the fallopian tube, an empyema of the fallopian tube may appear, and even peritonitis limited to the pelvis. The clinical picture of the patient is most disturbing when it comes to diffuse peritonitis, which is a threat to the patient's life and he alth.
Puerperal parametritis is another complication of puerperal infection. In this case, the infection spreads through the lymphatic vessels. The most pathognomonic ailments reported by patients are: very severe pain radiating to the lower limb, of course as in the case of a simple puerperal infection with accompanying fever. In addition, a painful inflammatory infiltrate is observed in the physical examination, the enlargement of which is associated with discomfort during voiding or defecation. There is excessive pressure on the bladder or rectum.
Causes of puerperal infection
Postpartum infection is very often referred to as puerperal fever, which results from the fact that the infection is accompanied by a high fever, even exceeding 39st. C. The most common pathogenic microorganisms are aerobic bacteria, eg Eschericha coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Streptococcus or the popular Staphylococcus aureus. Rarely, these are anaerobic bacteria: Bacteroides or Clostridium. However, for most infections, the single strain responsible for the infection cannot be isolated. As a rule, it is several species of bacteria. In addition to bacteria escaping from the wound after childbirth, some strains may come from the hands of the staff.
Symptoms of maternal fever
The clinical course is closely correlated with the infectious factor. Depends on its virulence. Undoubtedly, the patient's general condition is of great importance, namely the state of the immune system. Properly functioning immune mechanisms are able to fight off most bacteria. Factors increasing the risk of puerperal infection include: weakening of the patient's immune system, significant blood loss after childbirth, past obstetric procedures.
The most pathognomonic symptoms include:
- low-grade fever followed by high fever, even above 39 degrees C, which are the most characteristic of puerperal infection, not without reason the term puerperal fever is used interchangeably
- discharge from the uterine cavity - changing consistency during infection - may become foul-smelling and change its consistency
- uterine contraction disorder after childbirth, which definitely increases the risk of hemorrhage, and this may lead to hypovolemic shock, i.e. resulting from improper filling of the vascular bed
- severe pain during palpation. The abdominal wall is very tender, the pain is stabbing, initially one-sided, as the infection develops, new ailments appear, i.e. nausea, vomiting, general malaise, distressed facial expression, fast and weak pulse, dry and chapped tongue, fast and shallow breath, which is an expression of a shock that begins; in some cases there is local irritation of the intestines
- retention of puerperal excrements, although it is a symptom accompanying a mild form of puerperal infection
Treatment of puerperal infection
Puerperal infection requires hospitalization of the patient, and outpatient treatment is a mistake. Due to the spread of the infection, it is extremely important to undertake diagnostic and therapeutic measures relatively quickly in order to avoid he alth and life-threatening complications. The primary form of treatment is antibiotic therapy, preferably in line withantibiogram. The drugs with a broad spectrum of action are the most frequently chosen, which allows the elimination of most strains of bacteria. Apart from antibiotic therapy, symptomatic treatment can be used, various types of compresses and diastolic medications are allowed. In some situations, surgical intervention is necessary. It is important that treatment is started as soon as possible by choosing a broad-spectrum antibiotic. After receiving the result of the antibiogram, the treatment should be intensified.