Signs of inflammation after childbirth. Complication after childbirth: mastitis. Inflammation in the area of ​​postpartum sutures

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There is probably no woman who is not afraid of childbirth. After the birth of a child, all the fears that have tormented us for 9 months are left behind. It seems that a new life stage has begun in life - joyful and serene, because the long-awaited baby has finally been born.

However, no woman is immune from postpartum complications. Any representative of the fair sex can encounter them. Why complications arise after childbirth, what abnormalities and health problems can be detected in a woman are questions to which we have to find answers.

Causes of postpartum complications

Why women may experience complications after childbirth - actual question. Every representative of the fair sex should know the reasons, because most problems can be prevented. Postpartum complications may occur:

• due to the activation of microflora inhabiting the human body;
• due to the ingress of pathogenic microorganisms from the outside;
• due to exacerbation of existing diseases;
• due to the nature of pregnancy;
• due to abnormal birth;
• due to careless or incorrect actions of medical staff.

One of the reasons for complications that arise after childbirth is the activation of opportunistic microorganisms that live in the body of any person (on the skin, in internal organs, on mucous membranes). The mother's immune system is weakened.

The body's defenses are further reduced in cases where childbirth is accompanied by the loss of a large volume of blood. In case of weakened immunity, conditionally pathogenic microorganisms become more active and begin to multiply faster, leading to inflammatory processes. If hygiene rules are not followed, a woman exposes herself to even more complications. Pathogenic microorganisms can come from external environment into internal organs.

In some cases, the cause inflammatory processes are diseases that were diagnosed in a woman before childbirth. Complications develop 3-5 days after the birth of the child. fever, abdominal pain, bloody issues from the vagina with an admixture of pus - typical symptoms inflammatory processes affecting the internal organs of the small pelvis.

The causes of postpartum complications may lie in the peculiarities of the course of pregnancy. As a rule, problems arise with polyhydramnios, oligohydramnios, multiple pregnancy. The size of the child is of great importance. If the fetus is large, then the likelihood of complications in postpartum period very high. In such cases, a decrease in uterine contractility is observed. Because of this, heavy bleeding begins after childbirth. Also, women with large fetuses most often experience deep vaginal ruptures and perineal ruptures.

Complications after childbirth in women can occur in cases where the process of giving birth to a child was difficult and with abnormalities. For example, with excessively violent labor activity, characterized by frequent and strong contractions, women in labor experience ruptures of the cervix and perineum, and severe bleeding begins. With weak labor, the uterus contracts with insufficient force, and the intervals between contractions increase. Childbirth is delayed, leading to fatigue of the woman in labor. With weak labor, there is a high probability of infection of the birth canal, the development of inflammatory processes, and the occurrence of severe bleeding during and after childbirth.

Actions that lead to postpartum complications medical workers, their negligence. For example, if medical instruments are used carelessly, a woman may suffer serious injury. In addition, the occurrence of inflammatory processes is provoked by the use of non-sterile objects by obstetricians and gynecologists. Complications caused by these reasons are quite rare. Qualified specialists They don’t make mistakes and always try to help their patients.

Common Postpartum Complications

Every woman who has given birth to a child and is in the postpartum ward is closely monitored by doctors. Specialists monitor body temperature, uterine contractions, and discharge from the genital tract. Monitoring the condition of a woman in labor allows for timely detection of complications, of which the most common are postpartum hemorrhage, endometritis, inflammation urethra(urethritis), pyelonephritis, mastitis. Let's consider in more detail all the listed complications.

Bleeding

The most common postpartum complications in women are uterine bleeding. The reasons for their occurrence are:

• benign tumors in the uterus (fibroids, fibroids);
• violation of the contractile function of the myometrium (muscular lining of the uterus);
• excessive stretching of the uterus, which is observed during multiple pregnancies, polyhydramnios;
• long and difficult delivery;
• application medicines, helping to reduce the tone of the uterus;
• mechanical damage to the uterus during childbirth;
• poor blood clotting.

Blood loss of up to 0.5% of a woman's body weight is considered normal. If a woman in labor loses more blood, then experts regard this as pathological postpartum bleeding. Symptoms such as pallor skin, tachycardia, arterial hypotension.

Previously, postpartum hemorrhage was the cause deaths. Now this complication is not so dangerous. Thanks to modern medical devices, techniques can very quickly find out and eliminate the cause of postpartum hemorrhage.

Endometritis

After the birth of a child, a woman’s endometrium, the mucous membrane lining the uterine cavity, may become inflamed. Experts call this complication postpartum endometritis. main reason the occurrence of the disease - microorganisms entering the uterine cavity. The inflammatory process can begin either after natural childbirth, and after cesarean section.

With postpartum endometritis, the following main symptoms occur:

• incessant pain aching character in the lower abdomen;
• mucopurulent vaginal discharge from scanty to abundant;
• uterine bleeding.

General state getting worse. Body temperature stays between 37.2–37.5 degrees. There is rapid fatigue and weakness. When diagnosing a disease, doctors prescribe antibiotics wide range actions.

Postpartum endometritis is a very serious complication. If left untreated, the inflammation will spread to the deeper layers of the uterus, penetrate into the fallopian tubes and will lead to infertility or sepsis.

Inflammation of the urethra (urethritis)

Another complication that can occur after the birth of a child is inflammation of the urethra. The cause of the disease may be microorganisms that have entered the urinary system, or injuries due to the use of obstetric forceps. Sometimes irritation occurs due to the catheter that is placed after childbirth.

Symptoms of postpartum inflammation are:

• redness and sticking of the edges of the opening of the urethra;
• pain that occurs during urination;
• discharge of pus from the urethra.

To relieve inflammation, doctors prescribe antibiotics that kill the microorganisms that provoked the inflammatory process. If treatment is not carried out, then a progressive complication will lead to the defeat of the entire genitourinary system.

Pyelonephritis

In the first days after childbirth, a woman who has given birth to a baby may experience postpartum pyelonephritis, which refers to inflammation of the kidneys, which began due to the ingestion of microorganisms (for example, coli, staphylococci, enterococci, Pseudomonas aeruginosa). This complication affects pelvis, parenchyma and calyces of the kidneys. If a woman was diagnosed before giving birth chronic form diseases, then after the birth of a child, pyelonephritis will certainly make itself felt. To prevent complications during childbirth and after them, it is necessary to treat all diseases in a timely manner.

With this complication the following symptoms are observed:

• severe increase in body temperature (up to 38–40 degrees);
• pain felt in the lumbar region;
• malaise, weakness;
• loss of appetite;
• sometimes nausea and vomiting.

When diagnosing postpartum pyelonephritis, doctors prescribe antibacterial and anti-inflammatory drugs. Also, a woman suffering from this disease is sent for physiotherapy, undergoes infusion-detoxification therapy. At strong changes kidneys require surgery.

Mastitis

Approximately 2–11% of women are diagnosed with mastitis after childbirth. Underneath this medical term experts understand the inflammation of the mammary gland that began during the period of feeding the child. Most often, the disease is diagnosed in primiparous women 2-3 weeks after the birth of the baby.

The causative agents of postpartum mastitis are staphylococci, streptococci and other microorganisms. They penetrate through cracks in the nipples into the mammary gland from the baby’s mouth and from soiled underwear. The likelihood of mastitis increases if a woman does not follow the rules of caring for the mammary glands, stagnation of milk, poor emptying glands while feeding the baby.

Signs of postpartum mastitis include:

• bursting pain in the chest;
• high body temperature;
• hardening of the mammary glands;
• redness of the skin;
• formation of an abscess under the skin.

On initial stage For diseases, experts recommend applying cold to the sore spot, completely emptying the mammary glands, and putting the baby to the breast as often as possible. Sometimes antibiotics are required. If suppuration is detected, the abscess is opened. Feeding from the affected mammary gland is stopped for a while.

If left untreated, the disease progresses. Very advanced cases Gangrene of the mammary glands begins. If treatment is started in a timely manner, irreversible consequences can be avoided.

When you need to see a doctor urgently

Complications do not always occur immediately after childbirth, when medical staff monitors the woman's condition. Suspicious symptoms may also occur after discharge from the hospital. Some signs serve as a signal of serious complications that threaten the health and life of a woman. If you notice them, you should immediately consult a doctor.

So, if you have the following symptoms, you should visit a specialist as soon as possible:

• very heavy bleeding began;
• there was severe, undying pain in the lower abdomen;
• the cesarean section suture turned red and began to fester;
• body temperature has risen;
• vaginal discharge has an unpleasant odor.

Severe bleeding can lead to death if a woman does not seek help in time. The rest of the symptoms will also not pass without a trace. They may indicate an infection in the body. Inflammatory processes localized in the uterus are fraught with the appearance of adhesions. Because of them, the conception of the next child can be difficult.

In conclusion, it is worth noting that complications during and after childbirth are an exciting topic for women, because it concerns their condition and health. The first days and weeks after the baby is born may not be as happy and cloudless as it would seem. There is a possibility that the postpartum period will be overshadowed by various complications. Their occurrence depends on many factors:

• woman's health,
• woman's personality,
• lifestyle,
• course of pregnancy,
• actions of the medical staff.

Do not worry or despair if any complication arises after childbirth. A positive attitude will help you overcome temporary difficulties and overcome any illness.

Useful video about what complications in childbirth can be

After giving birth, a woman experiences not only the joy of motherhood, but also a host of postpartum problems that can arise as a result of labor. There are a lot of them and a woman just needs to cope with them when medical care, support and proper care behind you.

Complications after childbirth

The uterus after childbirth always begins intense contractions, taking the same form, for further normal functioning. An ultrasound will show you how this process goes, but the functions of the uterus do not always work according to plan. There are very often pathologies and complications.

Subinvolution. This is when the uterus contracts too slowly.
Causes:

• remnants of the placenta that did not come out during childbirth
• hematomas and ruptures that were not properly treated, stitched, or did not happen at all.
• blood clots
• remnants of the fertilized egg.

Treatment:

• are introduced special drugs to contract the uterus
• antibiotics are prescribed (be sure to consult your doctor about breastfeeding during this period)
• do vacuum cleaning

Endometritis. There is a separate detailed article on our website about this. serious complication(even disease), but in short
Causes:

• inflammation of the endometrium (the lining of the uterus)
• violation of the outflow of blood in the uterus
• STD infections
• abortions
• negligent examination by a gynecologist (carelessness, unsterilized instruments)
• non-compliance with personal hygiene.

Treatment:

• at a severe stage of the disease - a hospital
• suction vacuum (cleaning)
• antibiotics
• lavage of the uterine cavity
• candles

Bleeding after childbirth. This is usually normal phenomenon. It is due to the fact that the placenta detaches and comes out. It stops on days 7-10, decreasing in quantity and acquiring an increasingly dull brownish color.
With the exception of:

• profuse dark scarlet discharge constantly
• pads are changed 10-12 times a day
• large blood clots in the discharge
• nagging pain in a stomach
• sharp drop in pressure
• weakness and dizziness
• Treatment and prevention:
• if bleeding begins after being discharged from home, call an ambulance immediately
• you can’t be sexually active (especially if you’ve been cervical insufficiency or episiotomy)
• exclude any stress (up to and including cleaning the house or lifting a three-liter jar for at least two weeks)

prescribing hemostatic drugs
check with a doctor

Seams. If you have had an episiotomy, C-section or stitched before birth (isthmic-cervical insufficiency), problems with their healing may occur
Causes:

• lack of seam hygiene
• ruptures during defecation
• dehiscence of seams during physical labor

Treatment and prevention:

• proper care of seams
• no physical activity
• swim strictly on doctor's advice
• wear loose clothes
• taking a laxative to ease bowel movements (so as not to strain the body)
• try to move a lot, but slowly (sutures heal faster with good blood circulation, the main thing is not to overdo it)

Mastitis. This is an inflammation of the mammary glands, which is caused by getting into them specific infection- Staphylococcus aureus. The breast becomes red, hardens, and swelling appears. The temperature also rises (sometimes up to 39 degrees).
Causes:

• infrequent breastfeeding if available good quantity milk
• improper care behind the chest
• no massage
• not feeding the baby at all if milk is available
• improper attachment of the baby to the breast

Treatment:

• antibiotics
• suppression of lactation
• Prevention:
• attach the baby to the breast correctly
• maintaining hygiene
• treat cracked nipples

Haemorrhoids. This disease appears even before childbirth, but after it can worsen to serious proportions. Hemorrhoidal cones can grow and transfer the disease to a chronic stage. Bleeding and pain in anus become unbearable.
Treatment and prevention:

• Consult your doctor as soon as possible before giving birth (at 6-7 months)
• candles
• the main thing is to move more
• laxative
• in case of complications, surgery may be performed

It is impossible to keep everything under control, but basic prevention and timely consultation with a doctor can help you avoid many problems that, if left unchecked, will lead to irreversible consequences.

The birth of a baby is a rather serious period in the life of every woman. After all, the new mother is faced with dramatic changes in her existence, she has to completely adapt to a new rhythm, to new responsibilities and rules of existence. The female body itself is faced with a huge number of changes, and in order to understand whether everything is happening correctly, you need to have information about the peculiarities of the course of the postpartum period. It is especially difficult for a woman to perceive everything that happens after her first birth. This has never happened to her before... So let’s talk about what a woman normally experiences after childbirth, how the body’s recovery is going and what possible complications await her.

Many experts talk about the first month after birth as the tenth month of pregnancy. On average, the postpartum period lasts approximately two months. It begins immediately after the birth of the placenta and lasts until full recovery all organs and tissues female body that changed during pregnancy. In addition, at this stage, women begin to lactation and develop a sense of motherhood.

Restoring a woman’s body after childbirth

A woman changes in the first month after giving birth. In the first month after childbirth, the normal tone of the cerebral cortex, as well as subcortical centers, is restored. At the same time, the body is cleared of pregnancy hormones, and activity is restored endocrine system. The heart returns to its own to the usual position, its activity gradually becomes easier due to a decrease in blood volume. The kidneys function especially actively.

Significant changes occur in the reproductive system. In the first month after childbirth, the uterus contracts every day and its size decreases. Over the entire postpartum period, the mass of this organ decreases from a kilogram to fifty grams. This process is called involution of the uterus; it can be traced by changes in the height of its fundus. Already a day after birth, the fundus of the uterus is located at the level of the navel, and every day the standing height decreases by one centimeter. Around the sixth to eighth week after birth, the size of the uterus corresponds to its non-pregnant volume.

At the same time, the formation of the uterine cervix occurs. Immediately after birth, the diameter of the internal pharynx is ten to twelve centimeters, and after a week and a half it is completely closed. After another ten days (three weeks after birth), the external os of the uterus closes and takes on a slit-like shape.

Inner walls The uterus after separation of the placenta is an extensive wound surface, its healing is accompanied by the release of lochia - wound secretion. In the first days after birth, they look bloody, after four days they become reddish-brown, and by the tenth day they take on a light liquid appearance. Such discharge is initially characterized by a characteristic musty odor, its severity decreases over time. If the involution of the uterus is slowed down, the release of lochia may be delayed, as a result of which the admixture of blood in them is observed longer.

Muscle tone is gradually restored pelvic floor. The tone of the vaginal walls is also normalized, the volume of the vagina is reduced and swelling disappears. Cracks, abrasions or tears that appeared during childbirth gradually heal. The muscle wall area is also slowly strengthened by muscle contraction.

The mammary glands are actively developing. Two or three days after childbirth, they become rude and respond with soreness. Active production of milk begins.

What are the feelings during this period after childbirth in women?

In the first time after childbirth, new mothers notice drowsiness and extreme fatigue, but their condition quickly normalizes. In the first days, women complain about painful sensations in the perineal area, as well as in the area of ​​the external genitalia, even in the absence of tears. When a caesarean section occurs, pain in the sutures is recorded.

Uterine contractions usually occur during breastfeeding and may resemble mild contractions. The pain is more pronounced when repeated births.

In the first days after childbirth, women do not feel the urge to urinate, and they may also experience constipation. They are often bothered by breast tenderness (during milk let-in) and discomfort in the nipples. To eliminate such symptoms, you need to monitor the correct attachment of the baby to the breast and carry out feedings on demand. Need to .

Possible complications after childbirth in women

TO possible violations postpartum period include complications from the uterus. These may be postpartum hemorrhages, they require immediate surgical intervention and infusion donated blood.

A complication in the form of subinvolution of the uterus is also possible - in this case, the rate of its contraction slows down. In some cases, women who have recently given birth develop endometritis - an inflammatory lesion of the mucous membranes of the uterus, due to infection of its contents. This pathological condition accompanied by increased body temperature, pain in the lower abdomen and unpleasant smell lochia. For endometritis, surgery can be performed, and the patient is also prescribed antibiotics.

Problems after childbirth in women may arise due to the development breastfeeding. It can be complicated by stagnation of milk in the mammary glands. In this case, the breasts become swollen and painful, pockets of inflammation appear, and body temperature may rise. With proper and systematic feeding of the child, lactostasis goes away successfully. But if the application is performed incorrectly, then it can turn into, requiring medication, and sometimes surgical treatment. Therefore, it is the key to mother’s health.

A huge number of new mothers are faced with such a problem as. This is not a fatal, but very painful complication. To treat it, nipples are treated with special wound-healing agents.

TO possible complications The postpartum period also includes postpartum ulcers - inflammation of the tissues of the uterus, vagina or skin.

A doctor observing a new mother in the maternity hospital can identify postpartum complications.

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The birth of a baby is the most important process, during which a woman must be under the strict supervision of doctors. However, after giving birth, the mother should not be left alone either. Indeed, in the first time after this, the most various complications which are easier to prevent than to deal with later. For what reasons does a fever occur after childbirth and what this may indicate - this is exactly what I want to talk about now.

What happens after childbirth

Initially, it should be noted that even if the birth process itself went well and without complications, this is not a reason to relax. After all, the most important are also the first 24 hours after the birth of a baby. At this time, many of the most various problems. And one of them is temperature after childbirth. So, in the first couple of days, doctors closely monitor the health of not only the baby, but also the woman in labor. Periodically, doctors check the degree of uterine contraction, the condition of the breasts, examine and clarify the nature of the discharge. If there were seams, they must be periodically processed. And, of course, the mother’s body temperature is measured at least three times a day. After all, this is the most important indicator that can signal a problem in time. Even by the speed and nature of the temperature increase, a preliminary diagnosis can already be made.

About norm and deviations

What is she like after giving birth? Same as healthy person, - 36.6-37°C. However, it is also necessary to take into account the characteristics of each individual organism. After all, there are people who have a stable normal temperature- 37 °C, but for some this is already a serious indicator of problems.

True, situations when it can increase do not always indicate the appearance of complications:

In other cases, temperature after childbirth may indicate various complications. It is worth remembering that recovery during the postpartum period lasts approximately 5-8 weeks. Also, throughout this time, the young mother needs to closely monitor changes in health and body temperature.

Reasons for a slight increase in temperature

It happens that a woman has a temperature of 37 ° C for some time after childbirth. If the lady is completely tormented by nothing, and this condition itself does not bring any discomfort, do not worry. Indeed, such a slight increase in performance may be due to the following natural causes:

• which the body experiences immediately after childbirth.
• A stressful condition that often occurs after an experience.
• Arrival breast milk. This process is almost always accompanied by an increase in temperature, which gradually subsides.
• An increase in body temperature can also respond to the large loss of fluid that a woman experiences in the period after childbirth.

Mastitis

If a lady has a fever a certain time after giving birth, this may indicate a disease such as mastitis. By the way, it is very common among young mothers. So, it is worth noting that mastitis is a pathology of breast tissue. It is caused by various microbes and bacteria, as well as other pathogenic microorganisms that enter the breast through cracks in the nipple and are carried with the blood stream. The main symptoms in this case:

You also need to remember that the chest in this case will be a little swollen, the skin may turn red. The normal flow of milk is also disrupted. You can cope with the problem with antibiotics, but in some of the most severe cases, surgery may be needed.

Metroendometritis

Complications after childbirth in women can also cause inflammation of the uterine cavity. It occurs in the case of accumulation of secretions in the body of the woman in labor, blockage of the cervix with a blood clot, retention of a placental particle, with an exacerbation of an old disease. In this case, the temperature occurs approximately 2-4 days after childbirth, it stays around 39 ° C. At the same time, the woman also feels chills, there is a loss of appetite, and sleep disturbances are observed. On palpation, pain is felt in the lower abdomen. The nature of the secretions changes: they become cloudy, smell bad, their number can significantly increase or decrease. The problem can be treated with antibiotics. Sometimes it is necessary to rinse the uterine cavity.

Lactostasis

If a woman has a fever after giving birth, this may be evidence of a pathology such as lactostasis (affects the woman’s mammary glands). During it, illness occurs in the chest. The reasons for the problem are quite banal: skipping one or a couple of feedings. But at the same time, lactostasis can also occur due to uneven pumping, as well as overheating or hypothermia of the breast. Temperatures do not exceed 39 °C. Symptoms disappear almost immediately after emptying the breast. If this problem is not dealt with, it can develop into mastitis.

Other problems

If a woman has a temperature of 38 °C after childbirth, this may indicate one of the following diseases:

1. Thrombophlebitis. In this case, the woman’s veins become inflamed, which leads to their blockage with blood clots. It is worth noting that this disease provokes metroendometritis, described above. Body temperature may increase two weeks to a month after the baby is born. This phenomenon is accompanied by chills, as well as swelling of the legs.
2. Pelveoperitonitis. This is inflammation in the pelvis abdominal wall. The temperature can even rise to 41-42 °C. Other symptoms: nausea, vomiting, strong pain in the uterine area, chills. The woman's condition is rapidly deteriorating.
3. Parametritis. This is an inflammation of the fatty tissue around the uterus. Temperatures can also rise to around 40 °C. There are chills, nausea, vomiting, painful sensations during defecation and urination.

In any case, we must remember that with the slightest doubt, it is best to immediately seek medical help. After all, if the problem is detected earlier, it can be dealt with in a shorter time.

After giving birth, a woman often feels like all her worries are behind her. But, alas, sometimes the first, the most happy Days or weeks life together mothers and infants are overshadowed by a variety of complications, not least among which are postpartum purulent-septic diseases of the mother.

Causes

Postpartum inflammatory diseases are often caused by opportunistic microbes that inhabit the body of any person. They constantly live on the skin, mucous membranes, in the intestines, without disturbing their "owner", but under certain conditions they can cause a disease. And childbirth, especially if they are accompanied by large blood loss, leading to anemia and, accordingly, to a decrease in the body's defenses, can become this favorable condition to activate microbes. The cause of inflammatory processes in the postpartum period can also be sexually transmitted infections (gonococci, chlamydia, mycoplasma, etc.). There are also associations of 2-3 microbes that enhance the pathogenic properties of each other.

Blood loss during childbirth, anemia, beriberi, disorders in the blood coagulation system, remnants placental tissue or membranes in the uterine cavity, surgical interventions in childbirth, cracked nipples, severe pregnancy and childbirth, a long anhydrous period in childbirth - these are the main conditions that support the infection.

Currently, the most common are postpartum endometritis (inflammation of the uterus), chorioamnionitis (inflammation of the membranes and uterus during childbirth), mastitis (inflammation of the breast), pyelonephritis (inflammation of the kidneys) and, much less often, pelvic vein thrombophlebitis (inflammation of the pelvic veins, often complicated by thrombosis), peritonitis (inflammation of the peritoneum) and sepsis ( general infection blood).

To avoid development severe complications very important early diagnosis of these diseases at the first symptoms; it's even better to warn them with preventive measures in a group of high-risk women.

Let's look at the most common ones postpartum complications inflammatory nature.

Postpartum endometritis (inflammation of the uterine cavity)

Most common after cesarean section, manual examination postpartum uterus, manual separation placenta and discharge of the placenta (if the independent separation of the placenta is difficult due to a violation of the contractile function of the uterus), with a long anhydrous interval (more than 12 hours), in women admitted to childbirth with inflammatory diseases genital tract (for example, against the background of sexually transmitted infections), in patients with big amount abortions in the past.

A pure form of endometritis is distinguished, which is much less common (in 15% of cases) and develops without remnants of placental tissue, and endometritis against the background of remnants of placental tissue, retention of the fetal membrane, blood clots, sutures applied with catgut (one of the types suture material, produced from animal tendons, and therefore often causes inflammatory reactions. Now rarely used) after cesarean section.

Endometritis is classified into mild, moderate and severe. As a rule, these forms differ from each other in the degree of severity, the degree of general intoxication (from the Greek. toxikon - poison) - painful condition caused by the action of bacteria, viruses, harmful substances) of the body and the required duration of treatment.

Symptoms

• Increased body temperature, usually from 1 to 7 days after birth, depending on the severity of the disease. With a mild form of endometritis, body temperature usually rises only on the 5-7th day after birth, usually up to 38°C; in severe forms, the first symptoms appear already on the 2-4th day, body temperature can reach 40°C.
• Pain in the lower abdomen. They may be minor and intermittent in the lower abdomen with endometritis mild degree and intense, constant, radiating throughout the abdomen and lower back in severe forms of the disease.
• Lochia ( postpartum discharge from the genital tract) long time(more than 14 days after birth) remain bright, then acquire brown-brown color, with an unpleasant odor.
• The uterus contracts poorly, the height of the uterine fundus does not correspond to the day of the postpartum period.
• Phenomena of general intoxication: chills, weakness, loss of appetite, headaches.

Diagnostics

IN general analysis blood is detected increased amount leukocytes, i.e. leukocytosis, sometimes - a decrease in hemoglobin levels. At ultrasound examination in the uterine cavity, remains of placental tissue, membranes, blood clots, and subinvolution of the uterus are found (the uterus contracts poorly, its size does not correspond to the day of the postpartum period).

Treatment

• If subinvolution of the uterus is detected, a careful expansion of the cervical canal is carried out in order to create conditions for the outflow of the contents of the uterine cavity; if the contents of the uterine cavity, vacuum aspiration or curettage is performed (Vacuum aspiration is the suction of the contents of the uterine cavity using a special device. Curettage is the removal of the contents of the uterine cavity and the surface layer of the endometrium using a special instrument - a curette).
• Currently, in many clinics and maternity hospitals, the uterine cavity is washed with chilled antiseptic solutions.
• Antibacterial therapy main method of treatment. Broad-spectrum antibiotics are used, since many infections are caused by the association of several microbes. When choosing an antibiotic, it is based on which microbe most often causes a particular inflammation, whether the antibiotic is excreted in milk, and whether it affects the child. If the antibiotic does not provide sufficient effect within 2-3 days, it is changed to another. The method of taking antibacterial drugs depends on the severity of endometritis: for the disease light form you can limit yourself to tablets antibacterial drugs; in severe cases of endometritis, antibiotics are administered intramuscularly or intravenously.
• Infusion (detoxification) therapy ( intravenous administration drugs) is carried out to eliminate the effects of intoxication and improve blood circulation. Infusion therapy It is necessary to carry out both mild and severe endometritis. To carry it out, glucose solutions (5, 10, 20%), physiological solution (0.9% sodium chloride solution), etc. are used.
• For all forms of endometritis, immunocorrective therapy is carried out, which helps strengthen the body's defenses and increases immunity (drugs such as Viferon, Kipferon, etc. are used).
• HBO ( hyperbaric oxygen therapy) is a type of therapy that helps saturate the body's cells with oxygen. At infectious diseases Cells of any nature suffer from hypoxia - lack of oxygen. The therapy process consists of allowing the woman to breathe a mixture of increased content oxygen through a mask. This therapy is very effective in initial manifestations endometritis, strengthens the body's defenses.

Prevention

The incidence of postpartum endometritis can be significantly reduced by prophylactic antibiotics when the risk of its development is relatively high (after cesarean section, manual entry into the uterine cavity, with an anhydrous interval of more than 12 hours). Also, before giving birth (ideally before pregnancy), it is necessary to conduct an examination and eliminate the infection of the birth canal.

Chorioamnionitis (inflammation of the membranes)

Most often occurs with premature rupture of membranes. As the anhydrous interval during labor increases, the risk of intrauterine infection of the fetus increases.

Symptoms

• During a relatively long anhydrous period (6-12 hours), a pregnant woman or woman in labor experiences an increase in body temperature, chills, purulent discharge from the genital tract, and an increase in heart rate. In every fifth woman, chorioamnionitis turns into postpartum endometritis.

Treatment

When signs of chorioamnionitis appear, intensive delivery is carried out (labor stimulation, and in case of persistent weakness of labor forces - cesarean section) against the background of antibacterial and infusion therapy.

Prevention

During childbirth or surgery, it is imperative to monitor the state of vital function. important organs women, especially for the condition of the blood coagulation system, since due to bad contraction uterus and/or decreased blood clotting ability may develop heavy bleeding, which sometimes leads to the need to remove the uterus.

Postpartum mastitis (inflammation of the mammary gland) and lactostasis (milk stagnation)

Postpartum mastitis occurs in 2-5% of cases, more often in primigravidas. 9 out of 10 women with purulent mastitis are admitted to surgical hospital from home, since this disease most often begins at the end of the 2nd and during the 3rd week, and sometimes a month after birth.

This is a disease of nursing mothers: if there is no lactation, there is no postpartum. In 80-90% of cases it is caused Staphylococcus aureus. Infection occurs when a microorganism penetrates through a crack in the nipple in the lactating gland. This is the main difference between mastitis and lactostasis (accumulation and “stagnation” of milk in the mammary gland), since lactostasis develops without the presence of cracked nipples. Mastitis is usually one-sided, but can occur on both sides.

Symptoms

• Increase in body temperature to 38.5-39°C and above.
  • Pain in the mammary gland that is local in nature.
  • Redness of the mammary gland in the affected area (most often in the area of ​​the upper outer quadrant of the mammary gland. The mammary gland is conventionally divided into 4 quadrants: upper and lower outer and upper and lower posterior), swelling.
• Upon palpation (manual examination) of this area of ​​the mammary gland, painful, dense areas are identified. Expressing milk is extremely painful and, unlike lactostasis, does not bring relief.
  • Phenomena of general intoxication: chills, headaches, weakness, etc.

Diagnostics

• Examination, palpation of the mammary glands.
• Ultrasound of the mammary glands.
• Bacteriological examination of milk.

The initial stage of mastitis should be distinguished from lactostasis. With lactostasis, there is a feeling of heaviness and tension in the mammary gland, there is no redness or swelling of the skin, milk is released freely, and pumping, unlike mastitis, brings relief. The general condition of women with lactostasis suffers little; after pumping, the body temperature normalizes and the pain stops.

Treatment of lactostasis

If you have lactostasis, you can massage your breasts under the shower jet. warm water, after which pumping becomes much easier. Physiotherapy procedures are also used (for example, warming up, exposure to high-frequency current - Ultraton, Vityaz devices, etc.), without inhibiting lactation, milk is expressed (20-30 minutes before this, 2 ml of No-shpa is injected intramuscularly, immediately before pumping - intramuscularly). If there is no effect from physiotherapeutic procedures in combination with expressing milk, lactation is inhibited with parlodel or similar drugs.

Treatment of mastitis

Treatment should begin at the first symptoms of the disease, which significantly reduces the possibility of developing purulent inflammation of the mammary gland and surrounding tissues. Previously, when treating mastitis, they limited the amount of liquid they drank, which is now considered a gross mistake: to combat intoxication, a woman should drink up to 2 liters of liquid per day. Nutrition should be complete, aimed at increasing the body's resistance.

• Antibacterial therapy is quite effective in stages 1 and 2 of mastitis
• At purulent mastitis(when an abscess develops - limited inflammation of the mammary gland - or phlegmon - diffuse purulent inflammation mammary gland) is carried out surgery(opening the abscess, removing dead tissue within healthy tissue) against the background of antibacterial therapy.
• Suppressing lactation with drugs increases the effectiveness of treatment several times. No type of mastitis can be treated without suppressing or inhibiting lactation. IN modern conditions Complete suppression of lactation is rarely used, only for purulent mastitis, but more often they resort to inhibition of lactation. If lactation is inhibited or suppressed by drugs, pumping should not be used, since this stimulates the production of prolactin by the pituitary gland and, accordingly, stimulates lactation. Even at the initial stage of mastitis, you cannot breastfeed the child, due to the high risk of infection, as well as the entry of antibiotics and other drugs into the child’s body. medicines, inferior milk. The issue of resuming breastfeeding is decided individually and only after control milk culture after treatment.

Prevention

Begins during pregnancy and includes balanced diet, familiarizing women with the rules and techniques of breastfeeding, timely treatment cracked nipples, lactostasis, wearing a bra that does not compress the mammary glands, washing hands before feeding, air baths for 10-15 minutes after feeding.

High risk factors for the development of postpartum mastitis:

• hereditary predisposition;
• outbreaks purulent infection in organism;
• mastopathy (presence of compactions and small nodules in the mammary gland);
• anatomical features nipples (inverted or flat nipples);
• available chronic diseases internal organs, especially in the acute stage.