It was perfect, during the birth of the baby and up to 28 days after the mother complications may occur. Sometimes they are so unpredictable and dangerous that one can only rely on the providence and professionalism of doctors.
1. Damage to the soft tissues of the birth canal and perineum
The circumference of the head of the smallest full-term baby is more than 30 cm. To this diameter, in just a few minutes, the mother's crotch tissues should stretch in the busy period so that the baby is born. How high the risk of surface cracks or deeper ruptures at this point depends on many circumstances. This is not only the “dimensions” of the peanut, but also the elasticity of the woman’s skin, her behavior, swiftness of attempts, the presence of varicose veins of the submucosal veins, and the experience of a midwife taking part in labor.
Cracks in the mucous membrane quickly tighten on their own. Deep ruptures of the vulva, labia, cervix and vagina often become inflamed, heal for a long time with the formation of gross, painful or deforming scars. Their failure is one of the main reasons for the development of genital prolapse in the future, up to uterine prolapse. A torn cervix during subsequent pregnancy can cause a threat of interruption or premature birth, due to dense scars, it may be delayed opening or repeated ruptures. Rectal sphincter of the rectum is a crippling complication requiring long-term treatment and even reconstructive surgery.
During the eruption of the fetal head, when there is a threat of rupture of the mother's perineum, a neat incision is made - an episiotomy. Immediately after birth, its edges are sutured, and the “fresh” suture is regularly treated with antiseptics to avoid suppuration. Such healed postpartum scars do not violate sexual life, do not interfere with conceiving and taking out more children. But the risk is very high that the mother in the subsequent birth will again have breaks, which means an episiotomy.
2. Abnormal labor
Such a situation can occur at any time: from the very first to the attempts. Doctors know which of the expectant mothers is at risk. But to predict for sure who and when will become pathological is impossible.
From "weak" in strength or short contractions, the cervix is \u200b\u200bsmoothed and opens slowly. The fetus "stands" for a long time at the exit from the pelvis, squeezing the soft tissues of the birth canal of a woman with bones. This increases the risk of ruptures, atonic in the mother, and in the child - the appearance of a large birth tumor or cephalohematoma on the top of the head. Both often have postpartum infectious complications, for the prevention and treatment of which antibacterial therapy is required.
If medication weakness cannot be controlled medically, you have to perform an operation or apply traumatic obstetric benefits (forceps or vacuum extraction).
Discoordination
The muscle fibers of the uterus come in tone not simultaneously, but scattered. As a result, there are no normal contractions that smooth the neck and gradually push the fetus out. Chaotic convulsive sharp contractions of the muscles of the uterine body are a huge danger of its rupture or detachment of the placenta - conditions that threaten the life of the fetus and woman in childbirth. If the medication does not manage to cope very quickly with the first symptoms of discoordination that have arisen, an emergency is carried out.
Violent labor>
Excessive contractions in strength, frequency or duration of labor are a debilitating pain for a woman in labor, a risk of rupture of the uterus and perineum. The crumb also gets: birth injuries, the consequences of oxygen starvation from mild neurological disorders up to prenatal death.
3. Premature discharge of amniotic fluid
The longer the waterless period, the higher the risk of developing infectious complications in the child and in the puerpera. And giving birth “on dry” is much more painful than with a whole fetal bladder.
4. Infections
A woman's immunity always decreases during pregnancy, childbirth is difficult for her body. Mucosal cracks, cervical ruptures, perineal skin incision, a huge bleeding surface in the uterus in the area of \u200b\u200bdischarge of the placenta - a place where pathogenic microbes tend. With their rapid reproduction, complications are possible: inflammation of the wounds, endometritis, uterine, up to sepsis. Sometimes the only chance to save a mother’s life is through amputation. The fungus is also activated, causing exacerbation of thrush, which prevents the healing of sutures. For the prevention of infectious complications and their treatment, strong, regular examination of gynecological smears and rehabilitation of the birth canal before and after childbirth are used.
5. Detachment of the placenta
Infections, abnormal labor, a short umbilical cord increase the risk of premature, even before the birth of the baby, separation of the placenta from its attachment to the uterine wall. There is severe uterine bleeding, and oxygen suddenly stops flowing to the fetus. Detachment is a life-threatening complication requiring urgent delivery or an emergency caesarean section.
6. Narrow basin
A large fetus in a miniature woman — an anatomical discrepancy between the size of the birth canal and the fetus — is an indication for planned operative delivery.
The risk of clinical mismatch of the circumference of the pelvis in the mother to the size of the crumbs occurs with facial presentation (so the head is larger), with overload (there is no configuration of the skull bones). Outgrowths on the sacrum from the inside, tumors and cysts on the head and neck of the baby, not detected before childbirth, can become an insurmountable barrier to the baby's advancement through the birth canal.
Both anatomically and clinically narrow pelvis lengthens childbirth, takes all the forces in painful attempts. To extract the baby, doctors often have to use obstetric forceps, vacuum extraction or all kinds of old traumatic methods of "squeezing" out of the uterus. There is a high risk of not only deep ruptures of the neck and perineum, but also a bruise of the spine, stretching of the cartilaginous pubic joint. The result is long-lasting, symphysitis and the need for long-term special treatment.
7. Bleeding
Any birth is necessarily accompanied by a small (up to 0.5% of the mother’s body weight). Myomatous nodes in the uterus, infections, large fetus, multiple pregnancy, labor weakness, tight attachment of the placenta - these are just a few situations in which incomplete after removing the child (hypotonic bleeding) is possible. Then the huge wound surface at the attachment site of the placenta continues to bleed. Atonic bleeding is much more dangerous when the uterus not only does not contract, but relaxes even more. A woman loses liters of blood in a few minutes and cannot survive without the active help of doctors.
Rare complications
8. Chorionocarcinoma
In one case out of a hundred thousand, tiny placental residues after childbirth (including cesarean section) do not tear away, but continue to grow, acquiring the features of a malignant tumor. The resulting nodes in the uterus provoke repeated bleeding of varying intensity. Penetrating into the lymphatic vessels, the villi of the chorionocarcinoma can spread to all organs, taking root there and forming metastases. The disease can begin during pregnancy, and it can already manifest complications only a few months after childbirth.
9. Amniotic fluid embolism
Normally, from the amniotic fluid do not penetrate the mother's circulatory system. But with uterine vein rupture during childbirth, with premature partial detachment of the placenta, water can be absorbed into the vessels. The situation is developing catastrophically quickly: as soon as the liquid reaches the woman’s lungs, gas exchange stops in them. The head ceases to receive oxygen, water provokes a drop (shock) and a severe violation of blood coagulation (DIC) with bleeding literally from everywhere. The death rate from a massive embolism exceeds 80% even in the best medical centers in the world.
10. Uterine rupture
The postoperative scar after the previous cesarean section or after removal of the tumor node on the pregnant uterus can be very stretched and excessively thin. A “fresh” suture will become wealthy, that is, it will be able to withstand all loads, not earlier than 4-8 months after surgery. Any physical effort from a pregnant or recently given birth woman, a blow to her stomach or a fall, not to mention labor contractions, and the uterus will burst in a scar. Only emergency surgeons can save a mother from pain shock and massive bleeding.
Childbirth is a difficult test for the female body, rewarded by the appearance of a child. And when, it would seem, everything is painful behind, another problem may arise. Inflammation of the uterus after childbirth can push family joy into the background, because it requires immediate attention and treatment.
Read this article
Causes of postpartum organ inflammation
The main female organ has three layers. One of them can be exposed to inflammation or all at once. From scratch, the process does not arise; several circumstances are necessary for its launch. Childbirth is one of the provoking factors, but not all women have a uterus inflamed after them.
A complication occurs when:
- In the process of obstetric aid, doctors violated the rules of antiseptics and asepsis. Microorganisms enter the sterile uterus, for which blood and mucus are a favorable environment.
- Internal genital organs were injured. This happens with natural childbirth, it becomes inevitable when a cesarean section is performed.
- Delivery was difficult, with a long waterless period. In this case, more than 6 hours pass between the opening of the membranes and the appearance of the baby. During this time, bacteria manage to capture the uterine cavity.
- Childbirth was accompanied by bleeding, as is the case, for example, with placenta previa. In this case, there is immediately a set of factors favorable for inflammation.
- After the delivery process was completed, placental tissue remained on the inner walls of the uterus. If they are not found in time and removed, they can begin to decompose.
- In the initial postpartum period, the woman began to live sexually too early. Even with the absolute health of the partner, inflammation in the uterus is inevitable.
Symptoms and signs of a problem in a young mother
If the birth took place with violations of the rules of conduct, or there were unforeseen provocative circumstances, inflammation can develop immediately. Already on the second or fourth day, 40% of women show deterioration in well-being.
In general, uterine inflammation after childbirth symptoms are as follows:
- body temperature rises to 38 degrees;
- heart rate increases;
- abdominal pain does not decrease, as is normal;
- the body does not tend to decrease in size, remaining spherical;
- the amount of blood in the discharge remains at the same level, although it should normally decrease;
- there may be a decrease in the volume of output lochia, the appearance of a pungent odor from them.
To the above, some add other manifestations. The signs of uterine inflammation after childbirth are more pronounced, the sharper the process and the greater the number of layers of the organ affected by it:
- pains from periodically disturbing turn into constant, give to the lower back;
- intoxication begins, depriving of appetite, but causing a breakdown, nausea, headaches, chills;
- the uterus contracts poorly, which is obvious by the location of its bottom (the level is higher than it should be at this stage);
- the level of leukocytes in the blood and ESR increase, and the concentration of hemoglobin decreases.
In some women, the signs of inflammation that have begun are so mild that they are mistaken for manifestations of normal recovery after childbirth, fatigue, and a cold.
The supposedly unreasonable jumps in temperature, which should be measured daily in this period, can be said to be unsuccessful. If you do not attach importance to them for a long time, do not seek help, it is easy to get chronic inflammation with the development of adhesions in the pelvis.
Diagnostic methods for uterine inflammation
The inflammatory process is detected by its characteristic signs. But for therapy, it is necessary to identify the cause of its occurrence, as well as the type of pathogen. Therefore, in addition to examining and interviewing a newly mummy, they use the following methods:
- General blood test, detecting the level of white blood cells. The amount of hemoglobin is also important, since its sharp decrease also indicates an inflammatory process.
- Ultrasound of the pelvic organs in order to have an idea of \u200b\u200bthe particles of the placenta delayed in the uterine cavity, as well as the condition of the ovaries and fallopian tubes. Sometimes inflammation can capture them. The organ with this pathology remains enlarged, dense and tense.
- Examination of vaginal smears for infections, bacterial seeding and cytology.
- In rare cases, with ambiguities in determining the diagnosis, when the inflammation does not develop in the maternity hospital, it has erased signs, it is possible to prescribe hysteroscopy of the uterus. With the help of equipment, they not only examine the internal cavity of the organ, but also take tissue particles for histology.
Therapy for postpartum complications
Uterine inflammation after childbirth treatment should have in different directions:
- destruction of the infectious agent;
- elimination of the process of inflammation;
- suppression of the manifestations of the disease to normalize well-being;
- fight against intoxication;
- building up general immunity.
All this can be done only in a hospital, using a complex of drugs and methods:
- Antibiotic therapy. Medicines from this series are selected based on an appropriate analysis. To overcome the infection, use a combination of antibiotics, for example, Amoxicillin, Gentamicin, Ceftriaxone, Ceftazidime along with Metronidazole. They are administered intravenously and intramuscularly.
- Anti-inflammatory treatment. It is provided by taking Aspirin, Ibuprofen, Diclofenac, which also give an analgesic effect.
- Dilation of the cervical canal to facilitate discharge of secretions. Manipulation is done with a lochiometer. In any case, local elimination of the infection by abundant irrigation of the uterine cavity with chilled antiseptic and antibacterial solutions is also necessary.
- Treatment of organ walls with enzymesdissolving particles of a placenta which were late on them. If this is not possible, traditional curettage is performed.
- Stimulate blood circulation and rid the body of toxins. For this, a woman is injected with a dropper a glucose solution or physiological.
- Saturation of tissues with oxygen. The process is carried out using hyperbaric oxygenation (if the clinic has such capabilities), that is, a woman breathes in a special chamber with a composition with an increased content of this component. The procedure helps tissue healing, elimination of toxins, if you do several sessions. In the absence of these capabilities, a similar effect is obtained with the use of Actovegin and Tivortin preparations.
- Stimulation of immunity. You can push the body’s defenses to activity with the help of Viferon, Immunal, and Interal drugs. Vitamins A, E, C, folic acid, and rutin are also needed.
Inflammation of the uterus in the period after childbirth often occurs through no fault of the woman. But in her power to detect pathology, if, despite worries about the newborn, to pay a little attention to herself.
It is necessary to get rid of inflammation not only with medicines, but also with diet and observance of sexual rest. And remember that it is important to bring the treatment to completion, otherwise gynecological problems will pester for a long time later.
Nine months, a woman carries a child in the stomach. And finally, the contractions and childbirth are behind, the newborn baby is sleeping sweetly, and it seems that the worst is over. But the body is weakened, he had to endure serious stress, hormonal changes, and now it is time to recover. What barriers can arise along this path and what complications can a woman face?
Postpartum Complications
The most common complications after natural birth are inflammatory diseases of the pelvic organs. They can appear during pregnancy or long before her, but the woman did not have time to cure them, and also immediately after childbirth, if the young mother did not follow the doctor’s recommendations and did not pay enough attention to personal hygiene.
The most common ones are:
- Postpartum endometritis(inflammation of the uterine mucosa) occurs in 7%. To one degree or another, the uterus is in a damaged state in all women after childbirth, but in most women healing is quick. In the rest, endometritis proceeds in a severe form, symptoms appear on days 2-4 in the form of fever, dark discharge, chills and pain in the lower abdomen. A mild form of endometritis begins a bit later. The disease occurs in natural childbirth and in cesarean section.
- Postpartum hemorrhage. Blood discharge after childbirth is normal if they are profuse only during the week. After this period, the amount of blood decreases, the blood turns from bright red to pale. Pathology can be suspected if two weeks after birth, blood stains continuously appear on sanitary pads or underwear and continue to have a saturated color. Even more dangerous if the bleeding is accompanied by an unpleasant odor or purulent discharge. In this case, you need to urgently consult a doctor. The absence of bleeding after childbirth is also an unkind symptom: it can be a sign of a bend of the uterus or its slow reduction.
- Chorioamnionitis is an inflammation of the membranes of the fetus and uterus. If the fetal membranes ruptured ahead of time, the water spills out earlier, therefore, the anhydrous period lasts longer than it should be. In this condition, the uterus and the fetus are more susceptible to infections, so the probability of developing endometritis in the mother increases, and there is also a risk of infectious diseases in the baby.
- Postpartum mastitis and lactostasis.Both of these complications are associated with lactation. The first is characterized by inflammation of the mammary glands, and the second by stagnation of milk. Their significant difference is that with mastitis, feeding and expressing milk cause severe pain, and with lactostasis, on the contrary, it causes relief.
- Urethra inflammation. Burning and pain during urination are allowed in the first days after birth. If after 7-10 days the symptoms persist, the body temperature rises, there are false desires and pain in the lower abdomen, radiating to the lower back, we can talk about the inflammatory process. A doctor's consultation is required.
Complications after Caesarean section
All of the above ailments may appear after cesarean section. Special complications after surgery are:
- Commissures. Spikes are called intergrowths of the internal structures of the body with ropes or loops of connective tissue. They prevent the spread of inflammation, but if there are too many, dissonance occurs in the abdominal cavity. Adhesions can occur both before childbirth and after them. The most effective methods of control and prevention are physiotherapy and hirudotherapy.
- Bleeding and hematomas in the suture. Pathologies arise if the suture is not applied correctly and during rough mechanical handling during dressing changes and processing.
- Purulent-inflammatory phenomena. If an infection penetrates through the suture or insufficient treatment is performed, the nearest area is characterized by redness, swelling, fever, and a blood-purulent substance is released from the suture.
- Seam discrepancy.In rare cases, around 7-10 days after surgery, the suture may begin to creep. Possible causes are infection or weight bearing.
- Ligature fistulas. Sometimes around the suture threads the skin becomes thickened and fistulas form. The skin turns red, the seals can be hot and painful, pus is released. If measures are not taken in time, an abscess may develop. In the case of fistula formation, repeated suturing is required.
- Hernia. It is rare, more often with a longitudinal section or several pregnancies in a row, ending in surgery.
- Keloid scar. An aesthetic complication that is characterized by a too large, uneven scar.
The consequences of epidural anesthesia during childbirth
Epidural anesthesia is the injection of anesthetic into the spinal cord. It is done in a number of special cases (a too young woman in labor, a multiple pregnancy, anomalies), but the doctor must warn about possible complications and consequences.
- A sharp drop in blood pressure;
- The occurrence of an allergic reaction to the drug;
- Injury of nerve roots (with insufficient qualifications of an anesthesiologist);
- Labored breathing;
- Paralysis of the legs;
- Heart failure;
- If sterility is not observed during a puncture, an inflammatory process can occur, up to septic meningitis;
- Intravascular intoxication occurs if the anesthetic accidentally enters a vein;
- General malaise: headaches and backaches, weakness, nausea, dizziness, "flies" in the eyes, tinnitus;
- Jam of the end of the catheter in the spinal canal.
Another sad consequence is the lack of effect. With certain characteristics of the body, anesthesia may not fully affect or may not work at all.
When carrying out the anesthesia procedure, there is a risk of the drug getting into the vessels, spinal cord tissue, because of which the reaction of the body can be unpredictable. The consequence may be a general malaise for several days, as well as convulsions and hypoxia. Also, one should not forget about the possible negative impact on the child (intoxication, inhibition of mental and physical development, decreased activity).
The consequences of preterm birth
Normally, the baby is preparing to exit the womb by the 40th week of pregnancy. If the contractions begin earlier and childbirth occurs before the due date, then something has gone wrong. Preterm birth is dangerous for both the mother and the baby. The most dangerous consequences:
- The prolonged deep postpartum depression occurs due to the fact that the mother begins to blame herself for what happened;
- Poorly developed respiratory system in a baby requires connection to special breathing apparatus;
- A premature baby often still cannot eat on its own, so connection to an artificial feeding device is required;
- Chronic lung diseases in children;
- Slow mental development, up to dementia;
- Decreased immunity, a tendency to frequent infectious, inflammatory, chronic diseases;
- Character features: tearfulness, moodiness, emotionality;
- Delays in physical development. Premature babies, as a rule, later begin to crawl, sit, walk.
Some complications after childbirth cannot be predicted, while others, such as inflammatory diseases, can be prevented even at the stage of pregnancy planning. The birth of a child is the most pleasant and long-awaited moment in the life of every woman, therefore it is better not to allow it to be overshadowed by unpleasant consequences and take care of your health.
Specially for - Elena Kichak
After childbirth, a woman has not only the joy of motherhood, but also a lot of postpartum problems that may arise as a result of labor. There are many of them and a woman just needs to cope with them with medical care, support and proper self-care.
Postpartum Complications
The uterus after childbirth always begins intensive contractions, taking the previous form, for further normal functioning. Ultrasound will show you how this process goes, but the functions of the uterus do not always work as planned. Pathologies and complications very often occur.Subinvolution. This is the process when the uterus contracts too slowly.
Causes:
- remnants of the placenta that did not exit at birth
- hematomas and tears that were not properly processed, hemmed or not at all.
- blood clots
- the remains of the ovum.
- special drugs are introduced to reduce the uterus
- prescribe antibiotics (be sure to consult a doctor about breastfeeding during this period)
- do vacuum cleaning
Endometritis. On our site there is a separate detailed article about this serious complication (even the disease), but in brief
Causes:
- inflamed endometrium (uterine mucosa)
- violation of the outflow of blood in the uterus
- sTD infections
- abortions
- negligent examination by a gynecologist (carelessness, non-sterilized instruments)
- non-observance of personal hygiene.
- in severe stages of the disease - hospital
- suction vacuum (cleaning)
- antibiotics
- uterine lavage
- candles
Postpartum hemorrhage. This is usually a normal occurrence. It is due to the fact that the placenta exfoliates and exits. It stops on day 7-10, reducing the amount and becoming increasingly dull brownish color.
With the exception of:
- heavy dark scarlet discharge constantly
- gaskets are changed 10-12 times a day
- large blood clots in the discharge
- drawing abdominal pains
- sharp decrease in pressure
- weakness and dizziness
- Treatment and prevention:
- if bleeding has opened after discharge at home, call an ambulance immediately
- you can not live sexually (especially if there was cervical insufficiency or episiotomy)
- exclude any load (up to cleaning the house or raising a three-liter can for at least two weeks)
doctor checkup
Stitches. If you have an episiotomy, cesarean section or hemmed before birth (isthmic-cervical insufficiency), there may be problems with their healing
Causes:
- lack of seam hygiene
- stool breaks
- seam divergence during physical labor
- proper seam care
- no physical activity
- go swimming strictly on the recommendation of a doctor
- wear loose clothing
- taking a laxative to facilitate bowel movements (so as not to strain the body)
- try to move a lot, but slowly (the stitches heal faster with good blood circulation, the main thing is not to overdo it)
Causes:
- rare breastfeeding with a good amount of milk
- improper breast care
- lack of massage
- not feeding the baby at all in the presence of milk
- incorrect attachment of the baby to the chest
- antibiotics
- lactation suppression
- Prevention:
- correctly put the baby to the chest
- hygiene
- treat nipple cracks
Treatment and prevention:
- see a doctor as early as possible before delivery (6-7 month)
- candles
- the main thing is to move more
- laxative
- with complications, they can do surgery
Infectious diseases identified in the postpartum period, but not related to pregnancy and childbirth, are not included in the group of postpartum diseases.
There is a monument in Budapest: the figure of a man, at whose feet a woman shakes a child. The inscription on the pedestal reads: “Retter der Mutter”, which is translated from German as “mother’s savior”. You can’t say anything, pathetic. But the one to whom the monument is erected deserves this.
This is a monument to Semmelweis, the Hungarian obstetrician. While working as an assistant in a maternity hospital, he studied this postpartum complicationlike fever or postpartum sepsis - and came to the conclusion that the source of infection is cadaveric material that enters the mother’s body through the hands of medical students who come to the maternity ward after working in the anatomical theater. To understand the essence of the problem, we must remember that then the death rate from "maternal fever" sometimes reached 30-40%! 10% was considered the norm, i.e. every 10th mother was doomed!
Semmelweiss demanded that all students and doctors before visiting the maternity ward not only wash their hands thoroughly, but then disinfect them with chlorine water, then many diseases simply will not appear. At his insistence, all tools and accessories were also subjected to antiseptic processing. In clinics, mortality due to "maternal fever" has sharply decreased. These innovations laid the foundation for asepsis - a set of measures aimed at preventing the entry of infection into the puerpera.
Types of complications after childbirth
Currently, the classification of postpartum infectious diseases is widespread, according to which various forms of postpartum infection are considered as separate stages of a single dynamically occurring infectious process.
First step - the infection is limited to the area of \u200b\u200bthe birth wound: postpartum endometritis (inflammation of the endometrium - the uterine mucosa), postpartum ulcer (on the perineum, vaginal wall, cervix).
Second phase- the infection spread beyond the birth wound, but remained limited within the pelvis: metritis (inflammation of the muscular membrane of the uterine wall, deeper than with endometritis), parametritis (inflammation of the peritoneal tissue), salpingoophoritis (inflammation of the uterus), pelvic peritonitis (purulent inflammation) peritoneum with lesions of the pelvic cavity, however, not beyond), limited thrombophlebitis of the pelvic veins (blockage of the veins with an infected blood clot with the development of local inflammation of the walls of the vein).
Third stage - the infection has gone beyond the pelvic area and has a tendency to further spread: diffuse peritonitis, in which inflammation occurs not only of the peritoneum of the pelvis, but of the entire abdominal cavity, infectious shock (reaction of the body to massive poisoning by bacterial toxins, expressed in disruption of the internal organs) progressive thrombophlebitis.
Fourth stage- generalized infection - sepsis (blood poisoning).
Where does the infection come from?
In 9 out of 10 cases of postpartum infection, both postpartum complications there is an activation of its own conditionally pathogenic flora (auto-infection), that is, microbes that under normal conditions do not cause disease, but are activated under various adverse conditions. In other cases, infection from the outside with stable hospital types of microorganisms occurs in violation of the rules of asepsis and antiseptics. However, infection with hospital strains can occur without violating aseptic rules.
Briefly it is worth saying where the hospital infection comes from. During the use of antibiotics, disinfectants, some microorganisms necessarily survive. This is the part that has developed resistance to this antibiotic or disinfectant. The person is discharged, and the infection remains inside the institution. And gradually there is a selection of microorganisms that are resistant to almost all antibiotics and disinfectants used! Moreover, these resistant strains “help” others survive, take them under their protection - for example, they secrete substances that inactivate (neutralize) antiseptics, or even include antiseptics and antibiotics in their metabolism! Can you imagine the bacteria that quietly “kill” bleach? For them, daily processing three times with disinfectants is something like mayonnaise to the table.
The fight against this phenomenon is difficult, but necessary. To date, Staphylococcus aureus and banal Escherichia coli demonstrate the greatest adaptability. Having acquired resistance to many substances, they become a real disaster for hospitals, negating the tricks of pharmaceutical companies.
Microflora of an organism
Conditionally pathogenic (not causing diseases in the norm, but capable of becoming infectious agents when the appropriate conditions are created) microorganisms populate the human body, being, paradoxically, a factor in non-specific anti-infection protection.
These microorganisms most often serve the macroorganism (a large organism - a person) faithfully. For example, they produce vitamins in the intestines, decompose certain substances, constantly train the immune system, supporting it in a state of readiness to repulse enemies, protect it from intruders from outsiders. For example, the same Staphylococcus aureus in the genital tract of a woman prevents infection with a widespread genital infection. In return, they receive macroorganism waste, which they use for food, a place for housing, protection. And they do not pretend to anything else, being under the strict control of the immune system, which has already developed antibodies personally for each tenant and is ready to immediately use them at the slightest deviation in his "behavior".
However, under certain conditions, these tenants may become the causative agents of postpartum infectious diseases. This happens if microorganisms are not in their usual niche, but in another place. Or if the body loses control over them due to general weakening or immune disorders.
Bacterial flora of various parts of the body prevents the penetration of pathogens. Any their penetration into healthy tissues is almost always preceded by a change in microflora. The genital tract can be represented as a set of micro-sites of various types, each of which represents a habitat or ecological niche inhabited by several types of microorganisms. Each ecological niche has its own, somewhat different from others, species feature of microorganisms.
But the body not only inhibits the growth of microorganisms, it also carefully selects those that maximize its needs - they protect against the invasion of other microorganisms, stimulate the immune system. For example, during pregnancy, in the female genital tract, microorganisms are selected with reduced ability to become infected and increased immunogenicity, that is, provoking the body to an immune response. When passing through these pathways during childbirth, the child “becomes infected” with these bacteria, but under normal conditions they only stimulate the baby’s immunity and compete for the host’s organism with “impudent” people who came from outside, thereby preventing the possible entry of pathogenic bacteria. In addition, the mother already has a ready-made set of antibodies against them, which allows the child’s body to keep them under control until their own immune defense factors are activated.
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How does the disease develop?
Over the past decade, there has been a worldwide increase complications after childbirth in the form of postpartum infections. Their frequency, due to the lack of unified criteria, ranges from 2 to 10%. More often, infectious complications develop after cesarean section surgery.
The mechanism of the development of diseases consists in the imbalance of the organism – microbe balance, which leads to the suppression of bacteria useful for the macroorganism, such as lactobacilli, and in some cases to their disappearance and, accordingly, to the activation of opportunistic microflora. Actively developing, conditionally pathogenic microflora can reach a sufficiently high concentration and serve as a focus for the development of the postpartum infection process. The decisive role in the occurrence of the infectious process in the postpartum period is played by the state of the macroorganism, virulence (the ability of the microbe to initiate the disease) and massive infection. Imbalance can be caused by various reasons.
Recently, more and more attention has been paid to such sexually transmitted infections as chlamydia, mycoplasma, ureaplasma. Without causing an acute immune response, these infections can “nap” in the body for years, but at the time of its weakening they can manifest themselves, especially in a combination of microbial associations.
Outside of pregnancy, predisposing factors for the occurrence of postpartum infectious diseases are: non-genital foci of infection in the nasopharynx, oral cavity, renal pelvis, various non-infectious diseases leading to a decrease in the immune response (diabetes, impaired fat metabolism).
During pregnancy, this disorder is facilitated by physiological disturbances in the woman’s immune system. The normal vaginal microflora is rather vulnerable, as a result of which there is a violation of the normal species composition of the vaginal microflora in pregnant women, caused by the increased growth of mainly conditionally pathogenic bacteria. The reasons for changing the composition of the vaginal flora in pregnant women can be unreasonable and / or inconsistent antibacterial treatment, as well as the use of various means for local treatment (suppositories, ointments) in practically healthy pregnant women.
Additional factors contributing to development occur in labor complications after childbirthin the form of postpartum infectious diseases. First of all, with the discharge of amniotic fluid, one of the physiological anti-infectious barriers is lost. Against this background, the risk of developing postpartum infectious complications increases sharply. Prolonged childbirth, invasive methods for examining the condition of the fetus during childbirth, obstetric surgery, birth injury, and bleeding also predispose to the development of such diseases.
In the postpartum period, no anti-infection barrier remains in the genital tract of the puerperium. The inner surface of the postpartum uterus is a wound surface, and the contents of the uterus (blood clots) is a favorable environment for the development of microorganisms. Further development of the infectious process is associated with the balance of the organism-microbe system and directly depends on the virulence of the microflora and the massiveness of infection of the uterine cavity, on the one hand, and the state of the defenses of the puerperal organism, on the other.
Manifestations of complications after childbirth
Many complications of pregnancy predispose to the development of the infectious process: anemia, preeclampsia, placenta previa (the placenta blocks the exit from the uterus), pyelonephritis (inflammation of the urinary tract of the kidneys), as well as invasive (surgical) methods for studying the condition of the fetus (amniocentesis - puncture of the fetal bladder with the aim amniotic fluid intake to study the condition of the fetus - etc.).
Symptoms of the disease can appear immediately - on the first or second day - or after a safe discharge from the hospital.
Of particular concern is the fact that against the background of a general decrease in immunity and a general weakening of the body by the pregnancy and the birth process, the diseases are erased, that is, their manifestations may be invisible. Symptoms are not expressed, do not correspond to the severity of the disease, the pains are not intense, the temperature is slightly higher than normal. All this often leads to an underestimation of the woman herself and those around her of the severity of her condition.
Postpartum infectious diseases are manifested by pains in the lower abdomen, discharge of pus-like lochia (postpartum discharge from the genital tract) with an unpleasant odor, symptoms of general intoxication (weakness, fever, headaches, worsening of well-being).
Naturally, almost any woman after childbirth can feel weakness and poor health, weakness, drowsiness: this is a serious shake-up even for an absolutely healthy body. But if at the same time the temperature rises significantly (with “candles” in the morning and in the evening), or it remains slightly above normal, but at the same time health is progressively worsening, an urgent consultation of a specialist is needed, which can prescribe additional examinations to assess the state of the puerpera.
Gastrointestinal disturbances are also noteworthy: decreased or lack of appetite, loose stools, impaired gas discharge, bloating. From the side of the nervous system, disturbances can manifest themselves in the form of sleep disturbances, anxiety, or, conversely, euphoria, when the patient, already almost exhausted, assures her that she is well and do not need to worry about her.
Treatment of complications after childbirth
Treatment should be etiotropic, i.e. aimed at eliminating the cause of the disease, integrated, systematic and active. It should be started as soon as possible, when identifying the initial manifestations of postpartum infection, which greatly helps to prevent the development of its severe forms.
If the above symptoms are suspected, the woman must be hospitalized in a hospital - either in the gynecological department of the hospital, or (more often) in the gynecological department of the maternity hospital where the birth took place. A woman can go there herself either after consulting a doctor of the antenatal clinic - in the direction, or by "ambulance". Antibiotic therapy is the main component in the complex treatment of purulent-inflammatory postpartum diseases.
The patient needs bed rest. Food should be easily digestible, varied, sufficient in calories. Taking into account the increased need of the puerperal organism for fluid, it should receive 2-2.5 liters of fluid per day in the absence of contraindications.
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In case of inefficiency, within a few days of complex therapy, they resort to removing the main focus of infection. With the initial manifestations of uterine inflammation, the so-called uterine lavage is performed, with a pronounced inflammatory process, involvement of the peritoneum in the inflammation (with peritonitis), the uterus is extirpated (removed), the pus is outflowing normally - drainages and catheters are placed.
With a decrease in the body's immune defense, agents are used that increase the specific immunological reactivity and nonspecific protection of the puerperas - immunoglobulins, immunity stimulants.
With a mild postpartum infection and the use of antibiotics that do not penetrate into breast milk, breastfeeding is allowed. In the serious condition of the mother, massive antibiotic therapy of the child is transferred to artificial mixtures, since many drugs pass into breast milk and can cause unwanted reactions in the baby. In each case, the issue of breastfeeding is decided individually.
Prevention of purulent-inflammatory postpartum diseases begins from the first weeks of pregnancy. In the antenatal clinic, pregnant women are identified, who are at high risk of developing a bacterial infection or with its manifestations, conduct preventive and therapeutic measures: treating carious teeth, pyelonephritis, identifying and treating sexually transmitted infections, treating the genital tract with colpitis, etc.<
The obstetric hospital respects the rules of asepsis and antiseptics, widely introduces technologies of obstetrics, such as early application of the newborn to the breast (which helps to reduce the uterus, better outflow of postpartum discharge), a system of isolated joint stay of the mother and baby with subsequent early discharge from the maternity hospital, which leads to reduce the risk of disease in both puerperas and newborns.
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