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1、Puerperal Infection,UNION HOSPITALMin Jie,Definition,Puerperal Infection: Puerperal Infection is defined as all infections originating in the female genital tract subsequent to parturition,Puerperal Morbidity:Puerperal morbidity is defined as temperature of 38 or higher on any 2 of the first 10 days
2、 postpartum exclusive of the initial 24 hours and to be taken by mouth with a standard technique at least four times daily,Puerperal Infection is a conspicuous determinant of puerperal disabilityNowadays it still ranked as the prime cause of maternal mortality in the country,Etiology,1.Predisposing
3、Factors:(1)Delivery,special in obstatric manipulation,prolnged labor(2)Premature rupture of membrane(3)Multiple pelvic examination,(4)Chorioamnionitis (5)Postpartum hemorrage (6)Traumas of genital tract during labor,2.Organisms involved puerperal infection: (1) Aerobic-hemolytic treptococciit is the
4、 major infective agent introduceted from outside resulting in puerperal infection.it can produce extratoxin, resulting in severe infection and septicemia.,Clinic feature: Pyrexia of as much as 38 in early phase Chills Rapid pulse rate Abdominal distension Delayed involution of uterus Tenderness in t
5、he position of uterus and uterine adnexia,(2)Anaerobic Streptococci:Peptococci and peptostreptococci are usually involved . They are the organisms that normally reside in the vagina.,When genital trauma and placenta retained occur,or in the presence of damaged and devitalized tissues,they may reprod
6、uce promptly and become pathogenic bacteria.,(3)Escherichia coli:It is the major pathogenic agent result in septicemia and septic shock,which reside in the vagina,perineum and urethral orifice.It has different sensitivity to antibiotics at the different environment.,(4)Staphylococcus :Major pathogen
7、ic agent include Staphylococcus aureus Staphylococcus epidermidisStaphylococcus aureus may sesult in severe infection. Staphylococcus epidermidis reside in vagina nornally,which may sesult in light infection.,(5)Anaerobic bacteroide:Major including bacteroide fragilis and bacteroide melaninogenicus.
8、They have the characteristic of blood coagulation and may result in venous thrombosis of infetive position.,Pathology And Clinial Presentation:,(1)Acute external genitalia inflammation,vaginitis,cervicovaginitisCause:perineum trauma during labor and manipulative delivery.,Clinical Presentation: Redd
9、ish,tenderness,rupture and pus discharge in the infective position of trauma. Vaginal tissues laceration and contusion are ushered in congestion,ulcer and pus discharge.,When cervical laceration ccurs,infection may spread resulting in parametritis and pelvic cellulites.,(2)Acute endometritis and myo
10、metritis:Cause: Invading pathogenic agent spread to the endometrium and myometrium by the site of placenta separation.,Clinical Presentation: Fever Increasing and offensive lochial discharge Pain and tenderness in the lower abdomen Delayed uterine involution Leukocytosis.,(3)Acute pelvic cellulitis,
11、 acute inflammation of fallopian tube:Cause:pathogenic agent transmit to the parametrium by lymph and blood circulation.,.,Clinical Presentation: General inflammatory reaction Local abscess,The clinic feature of parturient lnclude:feverrigorpain in the lower abdomeneven icing pelvic.,(4)Acute pelvic
12、 peritonitis and disseminate peritonitis:Cause: Spread of the infection to the serosal surface of the uterus,signs of pelvic peritonitis and disseminate peritonitis may be elicited.,Clinical Presentation:General toxic manifestation occur: pyrexia of as much as 39 nausea vomiting abdominal distention
13、 severe pain and tenderness in the lower abdomen,When pelvic abscess occurs in the rectouterine cul-de-sac, parturient present as the signs of: Diarrhea Tenesmus Difficulty in emptying urine Chronic pelvic peritonitis may result in infertinity.,(5)Venous Thrombosis:Cause:When bacteria are propagated
14、 from the uterine wall into the vines,pelvic vein thrombophlebitis occur.,Pelvic veins involved are usually include: Vaginal vein Uterine vein Ovarian vein Internal iliac vein Common iliac vein,Anaerobic bacteria are the most common pathogenic agent.They can release enzyme of heparin to promote bloo
15、d coagulation.,Clinical Presentation:Venous thrombophlebitis occurs 1-2 weeks later in the postpartum. Patient present as the signs of: chills recalcitrant pyresia persisting several weeks,Signs of venous thrombophlebitis in the leg are: Persistent pain and tenderness in the local veins Remittent py
16、rexia, Edematization in the leg,(6)Septicopyemia and septicemia:Cause: Infective thrombus transmit to the blood circulation result in septicopyemia. A large amount of pathogenic bateria invade to the blood circulation and reproduce result in septicemia.,Clinical Presentation: Persistent fever Chills Signs of general toxic manifestation Even septic shock,Diagnosis and Differential Diagnosis:,1.present illness should be described in detailgeneral and obstetric examination are very important.Laboratory examination include Blood routine Urine routine CRP in serum at acute phase of infection,
