Maternity fever: the causes, symptoms and characteristics of treatment

In the famous book by Jerome K. Jerome "Three in a boat, not counting a dog" the hero found everything in himself, except for a maternity fever. What is it? Let's look at this article.

A group of diseases caused by infectious infection of women in labor during labor is called postnatal sepsis, or, as they said in old days, a maternity fever (fever).

general information

There was a maternity fever in the Middle Ages. One of the first described the case of this ailment Hippocrates. Before the opening of the first maternity hospital in the XVII century, cases of infection with postpartum fever were epidemiological in nature.

In the middle of the XIX century Hungarian obstetrician Ignaz Semmelweis made a number of assumptions about the causes of postpartum fever. He first pointed to the need to use antiseptic solutions for obstetric care. However, their widespread use in obstetrics began to be applied only at the end of the XIX century.

According to statistics, today only 0.2-0.3% of cases among all obstetric complications occur in sepsis, which occurs against the background of endometritis in 90% of parturient women.

Rodile fever, mentioned in the books of the classics, was most often described as a dangerous and incurable disease. The use of aseptics, antiseptics, antibiotic therapy in modern medicine leads to the fact that postpartum sepsis is successfully treated.

The types of postpartum infection include:

• Endometritis is an inflammation of the uterus.
• Divergence of the seam on the perineum after incision.
• Seam divergence after caesarean section.
• Mastitis.

Rodile fever: the causes

What are the causes of postpartum fever?

• As a rule, infection with pathogens of a woman's organism occurs when non-observance of antiseptics during childbirth.
• The most common infection occurs in "hospital" strains of bacteria, which are characterized by increased resistance to drugs.
• Because of the weakening of immunity caused by stress during childbirth, a conditional pathogenic flora can activate in the body of a woman and cause an infectious process.

About pathogens

The causative agents of postpartum sepsis are:

• Bacteroides;
• Proteus;
• Staphylococcus aureus;
• Gonococcus;
• E. coli;
• Klebsiella;
• Hemolytic streptococcus;
• Peptostreptococcus and so on.

But, of course, not a flea in a maternity fever. It's not a causative agent, it's just the name of one of the shades of color, and has nothing to do with the illness.

Most often postpartum sepsis is a polymicrobial infection caused by several types of pathogens.

The places of penetration of microorganisms are:

• Tears of the vagina, cervix and perineum.
• The zone of attachment of the placenta in the uterine cavity.

Infection, as a rule, occurs by contact, in contact with the wound surface of dirty hands and non-sterile instruments. Then the spread of pathogens passes through the lymphatic and blood vessels.

Risk factors

Risk factors for postpartum sepsis:

• Acute and chronic inflammatory diseases of women - extragenital, such as cystitis and pyelonephritis, and gynecological, for example endometritis, colpitis and vulvitis;
• Invasive methods of perinatal research;
• Direct electrocardiography of the fetus;
• The use of surgical correction for cervical and uterine insufficiency;
• The use of frequent vaginal tests in the process of obstetric care;
• Uterine bleeding.
• Early water drainage;
• Conducting obstetric operations, for example turning the fetus, expanding the cervix by using forceps.

In primiparas, the fetus develops more often than with repeated childbirth.

Symptoms

After 1-2 days after delivery, symptoms of postpartum sepsis may appear:

• High fever and chills;
• tachycardia;
• General malaise, other symptoms of general intoxication;
• Thirst, loss of appetite;
• Pain across the entire abdomen, not just below;
• Fetid, with impurities of pus excretion (lochia) from the birth canal, sometimes there are no discharge;
• With mastitis complete cessation or reduction of lactation.

In addition to maternity fever, there are other ailments.

First, the inflammatory process does not extend beyond the birth wound. Then, depending on the focus of the lesion, there are specific manifestations of ancestral fever:

• Puerperal ulcers - wounds with a grayish bottom, with edematic and hyperemic edges, located on the cervix, vaginal walls, perineum;
• Puerperal colpitis is an inflammation of the vaginal mucosa.

The secondary signs of the disease are attached to the spread of the inflammatory process:

• Endometritis, affecting the mucous membranes of the uterus;
• Parametr, affecting otematocytic cellulose;
• Adnexitis, otherwise inflammation of the appendages of the uterus;
• Pelvioperitonitis - peritoneum of the pelvis;
• Metrotromboflebit - inflammation of the uterine veins;
• Thrombophlebitis - inflammation of the veins of the pelvis and lower limbs.

The third stage of the disease is characterized by symptoms of generalized sepsis and symptoms of general peritonitis. How is it revealed?

Diagnostics

The diagnosis of "postpartum sepsis" is made on the basis of existing clinical symptoms, after a gynecological examination and a blood test.

Treatment

Treatment of postpartum sepsis is prescribed taking into account the severity of the disease. Main directions:

• Taking into account the sensitivity to antibiotics, antibiotic therapy is carried out. Preparations are prescribed compatible with breastfeeding, in severe cases, feeding is stopped.
• Immunostimulating drugs (anti-staphylococcal immunoglobulin, T-activin, plasma transfusion, injection of anatoxin).
• Obligatory infusion therapy for the removal of intoxication and restoration of the water-salt balance (alkaline solutions, haemodes, proteins and rheopolyglucin).
• Antihistamines are prescribed (Suprastin, Tavegil).
• The introduction of proteolytic enzymes (trypsin) is shown.

In the generalized form of sepsis, glucocorticoids and anabolic hormones are prescribed.

It is also possible to carry out physiotherapeutic procedures:

• Electrostimulation of the uterus;
• UHF;
• UV irradiation;
• microwave;
• ultrasound.

Local treatment of the focus of infection:

• Washing ulcers with a solution of sodium chloride and hydrogen peroxide, with large wounds - truncation of the edges with the application of sutures;
• With endometrium, when blood is retained in the uterus, removal of the remaining placenta and instrumental revision of the uterine cavity is indicated.

With peritonitis, that is, in severe cases, extirpation is performed - removal of the uterus along with the appendages.

Forecast

The outcome of the disease during the birth can depend on many factors:

• The time when the treatment was started, and the immunity of the woman in labor;

• The degree of pathogenicity of bacteria.

If the process of inflammation is limited only by wound, recovery is usually complete and without consequences. With the generalized form of sepsis, lethality reaches 65%.

Prevention

In order to prevent maternity fever, the following measures should be observed:

• Sanation of acute and chronic inflammatory extragenital and gynecological diseases;
• In the process of childbirth, prevention of tissue graft ruptures;
• Strict adherence to the rules of asepsis and antiseptics.

The hero of the book, apparently knew the symptoms of this disease, because he found all the diseases, except for the maternity fever. Be healthy!