Find information on medical topics, symptoms, drugs, procedures, news and more, written for the health care professional. Puerperal endometritis is uterine infection, typically caused by bacteria ascending from the lower genital or GI Thrombophlebitis puerperalis. Symptoms are uterine tenderness, abdominal or pelvic pain, fever, malaise, and sometimes discharge.
Diagnosis is clinical, rarely aided by culture, Thrombophlebitis puerperalis. Treatment is with broad-spectrum Thrombophlebitis puerperalis eg, clindamycin plus gentamicin. Endometritis may develop after chorioamnionitis during labor or postpartum. Gram-positive cocci predominantly group B streptococci, Staphylococcus epidermidisand Enterococcus sp. Gram-negative bacteria predominantly Gardnerella vaginalis, Thrombophlebitis puerperalis, Escherichia coli, Klebsiella pneumoniae, Thrombophlebitis puerperalis, and Proteus mirabilis.
Uncommonly, peritonitis, pelvic abscess, pelvic thrombophlebitis with risk of pulmonary embolismor a combination develops. Rarely, septic shock and its sequelae, Thrombophlebitis puerperalis, including death, occur. Typically, the first symptoms are lower abdominal pain and uterine tenderness, followed by fever—most commonly within the first 24 to 72 h postpartum. Chills, headache, Warum ist trophischen Geschwüren, and anorexia are common.
Sometimes the only symptom is a low-grade fever. Pallor, tachycardia, and leukocytosis usually occur, and the uterus is soft, large, and tender. Discharge may be decreased or profuse and malodorous, with or without blood. When parametria are affected, pain and fever are severe; the large, tender uterus is indurated at the base of the broad ligaments, extending to the pelvic walls or posterior cul-de-sac.
Other causes of fever and lower abdominal symptoms include UTI, wound infection, septic pelvic thrombophlebitis, and perineal infection. Uterine tenderness is often difficult to distinguish from incisional tenderness in patients who have had a cesarean delivery. Patients with low-grade fever and no abdominal pain are evaluated for other occult causes, such as atelectasis, breast engorgement or infection, UTI, and leg thrombophlebitis. If temperature abruptly rises after 2 or 3 days of low-grade fever, the cause is probably an infection rather than breast engorgement.
Endometrial cultures are rarely indicated because specimens collected through the cervix are almost always contaminated by vaginal and cervical flora. Endometrial Krampfadern tief Foto should be done only when endometritis is refractory to routine Thrombophlebitis puerperalis regimens and no other cause of infection is obvious; sterile Thrombophlebitis puerperalis with a speculum is used to avoid vaginal contamination, and the sample is sent for aerobic and anaerobic cultures.
Blood cultures are rarely indicated and should be done only when endometritis is refractory to routine antibiotic regimens or clinical findings suggest Thrombophlebitis puerperalis. Abdominal and pelvic imaging, usually by CT, is Thrombophlebitis puerperalis for abscess but detects pelvic thrombophlebitis only if the clots are large. If imaging shows neither abnormality, a trial of heparin is typically begun to treat presumed pelvic thrombophlebitis, usually a diagnosis of exclusion.
A therapeutic response confirms the diagnosis. If adequate treatment of puerperal endometritis does not result in a downward trend in peak temperature after 48 to 72 h, consider pelvic abscess and, Thrombophlebitis puerperalis, particularly if no abscess is evident on scans, septic pelvic thrombophlebitis. Clindamycin plus gentamicinwith or without ampicillin.
Treatment is a broad-spectrum antibiotic regimen given IV until women are afebrile for 48 h, Thrombophlebitis puerperalis. The first-line choice is clindamycin mg q 8 h plus gentamicin 1. Continuing treatment with oral antibiotics is not necessary. Preventing or minimizing predisposing factors is essential.
Appropriate hand washing should be encouraged. Vaginal delivery cannot be sterile, but aseptic techniques are used. Treat based on clinical findings eg, postpartum pain, fundal tenderness, or unexplained feverusing broad-spectrum antibiotics. In occult umbilical cord prolapse contained within the uterusthe umbilical cord is often compressed by a shoulder or the head.
A fetal heart rate pattern that suggests cord compression and progression to hypoxemia may be the only clue. Tap to switch to the Consumer Version.
Puerperal Endometritis By Julie S. This is the Professional Version. Click here for the Consumer Version. Incidence of postpartum endometritis is affected mainly by the mode of delivery: Scheduled caesarean deliveries done before labor starts: Unscheduled caesarean deliveries done after labor starts: Prolonged rupture of the membranes, Thrombophlebitis puerperalis.
Infection tends to be polymicrobial; the most common pathogens include. Anaerobes predominantly peptostreptococci, Thrombophlebitis puerperalis sp, and Prevotella sp. Pelvic abscess may manifest as a palpable mass separate from and adjacent to the Thrombophlebitis puerperalis. Usually tests to exclude other causes eg, urinalysis and urine culture, Thrombophlebitis puerperalis. Puerperal endometritis is more common after cesarean delivery, particularly if Salbe Krampfadern auf der Grundlage einer kastanie. For cesarean delivery, give prophylactic antibiotics within 60 min before surgery.
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Puerperal Infection definition of Puerperal Infection by Medical dictionary https: The infection may also be referred to as puerperal or postpartum fever. The genital tract, particularly the uterus, is the most commonly infected site. In some cases infection can spread to other points in the body. Widespread infection, or sepsisis a rare, Thrombophlebitis puerperalis, but potentially fatal complication.
Given modern medical treatment and antibioticsit very rarely advances to the point of threatening a woman's life. Deaths related to puerperal infection are very rare in the industrialized world. It is estimated three inbirths result in maternal death due to infection. However, the death rate in developing nations may be times higher. Postpartum fever may arise from several causes, Thrombophlebitis puerperalis, not necessarily infection.
If the fever is related to infection, it often results from endometritis, an inflammation of the uterus. Urinary tract, breast, Thrombophlebitis puerperalis, and wound infections are also possible, as well as septic thrombophlebitisa blood clot-associated inflammation of veins. A woman's susceptibility to developing an infection is related to such factors as cesarean Thrombophlebitis puerperalis, extended labor, obesityThrombophlebitis puerperalis, and poor prenatal nutrition.
The primary symptom of puerperal infection is a fever at any point between birth and 10 days postpartum. A temperature of An assortment of bacterial species may cause puerperal infection. Many of these bacteria are normally found in the mother's genital tract, but other bacteria may be introduced from the woman's intestine and skin or from a healthcare provider. The associated symptoms depend on the site and nature of the infection. The most typical site of infection is the genital tract.
Endometritis, which affects the uterus, Thrombophlebitis puerperalis, is the most prominent of these infections. Endometritis is much more common if a small part of the placenta has been retained in the uterus. Typically, several species of bacteria are involved and may act synergistically—that is, the bacteria's negative effects are multiplied rather than simply added together.
Synergistic action by the bacteria can result in a stubborn infection such as an abscess, Thrombophlebitis puerperalis. The major symptoms of a genital tract infection include fever, Thrombophlebitis puerperalis, abdominal painuterine tenderness, and abnormal vaginal discharge. If these symptoms do not respond to antibiotic therapy, Thrombophlebitis puerperalis, an abscess or blood clot may be suspected, Thrombophlebitis puerperalis.
Other causes of postpartum fever include urinary tract infections, wound infections, Thrombophlebitis puerperalis thrombophlebitis, and mastitis, Thrombophlebitis puerperalis. Mastitis, or breast infection, is indicated by fever, malaise, achy muscles, and reddened skin on the affected breast. It is usually caused by a clogged milk duct that becomes infected. Infections of the urinary tract are indicated by fever, frequent and painful urination, and back pain. An episiotomy and a cesarean section carry the risk of a wound infection, Thrombophlebitis puerperalis.
Such infections are suggested by a fever and pus-like discharge, inflammation, and swelling at wound sites. Fever is not an automatic indicator of puerperal infection. A new mother may have a fever owing to prior illness or an illness unconnected to childbirth. However, Thrombophlebitis puerperalis fever within 10 days postpartum is aggressively investigated.
Physical symptoms such as pain, malaise, loss of appetite, Thrombophlebitis puerperalis, and others point to infection. Many doctors initiate antibiotic therapy early in the fever period to stop an infection before it advances, Thrombophlebitis puerperalis.
A pelvic examination is done and samples are taken from the genital tract to identify the bacteria involved in the infection. The pelvic examination can reveal the extent of infection and possibly the cause, Thrombophlebitis puerperalis.
Blood samples may also be taken for blood counts and to test for the presence of infectious bacteria. A urinalysis may also be ordered, especially if the symptoms are indicative of a urinary tract infection. If the fever and other symptoms resist antibiotic therapy, an ultrasound examination or computed tomography scan CT scan is done to locate potential abscesses or blood clots in the pelvic region.
Magnetic resonance imaging MRI may be useful as Thrombophlebitis puerperalis, in addition to a heparin challenge Thrombophlebitis puerperalis if blood clots are suspected. If a lung infection is suspected, a chest x ray may also be ordered, Thrombophlebitis puerperalis. Antibiotic therapy is the backbone of puerperal infection treatment.
Initial antibiotic therapy may consist of clindamycin and gentamicin, which Thrombophlebitis puerperalis a broad array of bacteria types. If the fever and other symptoms Thrombophlebitis puerperalis not respond to these antibiotics, a third, such as ampicillin, is added.
Other antibiotics may be used depending on the identity of the infective bacteria and the possibility of an allergic reaction to certain antibiotics. Abscess Thrombophlebitis puerperalis A pus-filled area with definite borders. Blood clot — A dense mat formed by certain components of the blood stream to prevent blood loss.
Cesarean section — Incision through the abdomen and uterus to facilitate delivery. Computed tomography scan CT scan — Cross-sectional x rays of Thrombophlebitis puerperalis body are compiled to create a three-dimensional image of the body's internal structures.
Episiotomy — Incision of the vulva external female genitalia during vaginal delivery to prevent tissue tearing. Heparin — A blood component that Thrombophlebitis puerperalis the amount of clotting. It can be used as a drug to reduce blood clot formation.
Heparin challenge test — A medical test to evaluate how readily the blood clots. Magnetic resonance imaging MRI — An imaging technique that uses Übungen mit Krampfadern im Wasser large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
Postpartum — Referring to the time period following childbirth, Thrombophlebitis puerperalis. Prophylactic — Measures taken to prevent disease. Sepsis — The presence of viable bacteria in the blood or body tissues, Thrombophlebitis puerperalis. Septic — Referring to the presence of infection. Thrombophlebitis — An inflammation of veins accompanied by the formation of blood clots. Ultrasound examination — A medical test in which high frequency sound waves are directed at a particular internal area of the body.
As the sound waves are reflected by internal structures, a computer uses the data to construct an image of the structures. Warfarin — A drug that reduces the ability of the blood to clot.
Antibiotics taken together are effective against a wide range of bacteria, but may not be capable of clearing up the infection alone, especially if an abscess or blood clot is present. Heparin is combined with the antibiotic therapy in order to break apart blood clots.
Heparin is used for five-seven days, Thrombophlebitis puerperalis, and may be followed by warfarin for the following month. If the infection is complicated, it may be necessary to surgically drain the infected site. Infected episiotomies can be opened and allowed to drain, Thrombophlebitis puerperalis abscesses and blood clots may require surgery. Antibiotic therapy and other treatment measures are virtually always successful in curing puerperal infections.
References Weißer Tee Varizen periodicals archive? Student's t-test and Fisher's exact test were used to compare differences of means in normal distributions and differences in frequencies of categorical variables, respectively, for factors possibly associated with puerperal infections.
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