In the famous book by Jerome K. Jerome, “Three in a boat, not counting the dog,” the hero found everything except for maternal fever. What is it? We will understand in this article.
A group of diseases caused by infectious infection of women in labor during childbirth is called postpartum sepsis, or, as they used to say in old times, maternal fever (fever).
general information
There was a maternal fever in the Middle Ages. One of the first to describe the case of this ailment is Hippocrates. Before the opening of the first maternity hospital in the 17th century, cases of postpartum fever infection were epidemiological in nature.
In the middle of the 19th century, the Hungarian obstetrician Ignaz Semmelweiss made a number of assumptions about the causes of postpartum fever. He first pointed out 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 19th 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 women in labor.
Maternal fever, mentioned in the classics, was most often described as a dangerous and incurable disease. The use of aseptics, antiseptics in modern medicine, the use of antibiotic therapy leads to the fact that postpartum sepsis is successfully treated.
Types of postpartum infection include:
- Endometritis is an inflammation of the uterus.
- Divergence of the seam on the perineum after the incision.
- Seam discrepancy after cesarean section.
- Mastitis.
Maternal fever: reasons
What are the causes of postpartum fever?
- As a rule, infection of pathogens of a woman’s body occurs when an antiseptic is not observed during childbirth.
- Most often, infection occurs with "hospital" strains of bacteria, characterized by increased resistance to drugs.
- Due to the weakening of immunity caused by stress during childbirth, a woman's own conditionally pathogenic flora can become activated in the body of a woman and cause an infectious process.
About pathogens
The causative agents of postpartum sepsis are:
- bacteroids;
- Proteus;
- Staphylococcus aureus;
- gonococcus;
- E. coli;
- Klebsiella;
- hemolytic streptococcus;
- peptostreptococcus and so on.
But, of course, not a flea in maternal fever. This is not a pathogen, but simply the name of one of the shades of color, and has nothing to do with the disease.
Most often, postpartum sepsis is a polymicrobial infection caused by several types of pathogens.
Places of penetration of microorganisms are:
- Ruptures of the vagina, cervix and perineum.
- The area 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, such as endometritis, colpitis and vulvitis;
- the use of invasive methods of perinatal studies;
- direct electrocardiography of the fetus;
- the use of surgical correction for cervical insufficiency and isthmus;
- the use of frequent vaginal examinations in the process of obstetric care;
- uterine bleeding.
- early discharge of waters;
- conducting obstetric operations, for example, turning the fetus, expanding the neck by using forceps.
In primiparas, maternal fever develops more often than with repeated births.
Symptoms
1-2 days after birth, symptoms of postpartum sepsis may appear:
- fever and chills;
- tachycardia;
- general malaise, other symptoms of general intoxication;
- thirst, loss of appetite;
- pain over the entire surface of the abdomen, and not just below;
- fetid, with admixtures of pus discharge (lochia) from the birth canal, sometimes any discharge is absent;
- with mastitis complete cessation or reduction of lactation.
In addition to maternal fever, other ailments arise.
At first, the inflammatory process does not extend beyond the birth wound. Then, depending on the lesion, specific manifestations of labor fever appear:
- puerperal ulcers - wounds with a grayish bottom, with swollen and hyperemic edges, located on the cervix, walls of the vagina, perineum;
- puerperal colpitis is an inflammation of the vaginal mucosa.
Secondary signs of the disease join the spread of the inflammatory process:
- endometritis affecting the mucous membranes of the uterus;
- parametritis, affecting the peritoneal tissue;
- adnexitis, otherwise inflammation of the uterus;
- pelvioperitonitis - damage to the peritoneum of the pelvis;
- metrothrombophlebitis - inflammation of the veins of the uterus;
- thrombophlebitis - inflammation of the veins of the pelvis and lower extremities.
The third stage of the disease is characterized by symptoms of generalized sepsis and symptoms of general peritonitis. How is maternal fever detected?
Diagnostics
The diagnosis of postpartum sepsis is made on the basis of existing clinical symptoms after a gynecological examination and blood test.
Treatment
Treatment of postpartum sepsis is prescribed taking into account the severity of the disease. Main directions:
- Given the sensitivity to antibiotics, antibiotic therapy is performed. Drugs are prescribed compatible with breastfeeding, in severe cases, feeding is stopped.
- Immunostimulating drugs (antistaphylococcal immunoglobulin, T-activin, plasma transfusion, administration of toxoid are indicated).
- Mandatory infusion therapy to relieve intoxication and restore the water-salt balance (alkaline solutions, hemodes, proteins and reopoliglyukin).
- Antihistamines are prescribed (Suprastin, Tavegil).
- The administration of proteolytic enzymes (trypsin) has been shown.
With a generalized form of sepsis, glucocorticoids and anabolic hormones are prescribed.
It is possible to carry out physiotherapeutic procedures:
- electrical stimulation 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 - trimming the edges with suturing;
- with endometritis, when blood is retained in the uterus, removal of the remaining placenta and instrumental revision of the uterine cavity are indicated.
With peritonitis, that is, in severe cases, they carry out extirpation - removal of the uterus along with appendages.
Forecast
The outcome of a disease with a birth infection depends on many factors:
- the time when 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 the wound, recovery is usually complete and without consequences. With a generalized form of sepsis, mortality reaches 65%.
Prevention
In order to prevent maternal fever, the following measures must be observed:
- rehabilitation of acute and chronic inflammatory extragenital and gynecological diseases;
- during childbirth, the prevention of rupture of the tissue of the birth canal;
- strict observance of the rules of asepsis and antiseptics.
The hero of the book, apparently, knew the symptoms of this ailment, since he had found all the diseases in himself, except for maternal fever. Be healthy!