Endometritis Puerperal

Endometritis puerperal is an infection which is typically caused by bacteria from the lower genital or the gastrointestinal tract of the uterus. Symptoms include uterine discomfort, abdominal or pelvic pain, fever, malaise and sometimes significant discharge. The diagnosis is clinically discovered rarely using a bacterial culture. The treatment is carried out with broad-spectrum antibiotics (eg. B. Clindamycin together with gentamycin).

The incidence of postpartum endometritis is mainly influenced by the mode of delivery:

Endometritis puerperal is an infection which is typically caused by bacteria from the lower genital or the gastrointestinal tract of the uterus. Symptoms include uterine discomfort, abdominal or pelvic pain, fever, malaise and sometimes significant discharge. The diagnosis is clinically discovered rarely using a bacterial culture. The treatment is carried out with broad-spectrum antibiotics (eg. B. Clindamycin together with gentamycin). The incidence of postpartum endometritis is affected mainly by the birth mode: Vaginal Enbindung: 1-3% planned caesarean section (before birth): 5-15% non-planned caesarean section (after the onset of birth): 15-20%, the frequency is also influenced by circumstances of the patient. Etiology A endometritis can develop out of chorioamnionitis at birth or after birth. Predisposing conditions include Longer phase with cracked amniotic sac Internal fetal monitoring protracted course of labor cesarean Repeated digital vaginal examination retention of placenta remains in the uterus postpartum bleeding bacterial colonization of the lower genital tract anemia Bacterial vaginosis Young maternal age Low socioeconomic status The infection is often multibakteriell; the most common pathogens are Gram-positive cocci (mostly Group B Streptococcus, Staphylococcus epidermidis and Enterococcus sp.) anaerobes (mainly Peptostreptococci, Bacteroides sp., and Prevotella sp.) Gram-negative bacteria (predominantly Gardnerella vaginalis, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis ). The development of peritonitis, a pelvic abscess, a pelvic thrombophlebitis (with the risk of pulmonary embolism) or a combination of these complications is unusual. Septic shock and its consequences, including a lethal output, it is rare. Symptoms and complaints first typical symptoms include pelvic pain and pressure painful uterus, followed by fever – usually within the first 24-72 hours after birth. Chills, headache, severe malaise and loss of appetite are common. But sometimes the only symptom is a slightly elevated temperature. Usually occur pallor, tachycardia, and leukocytosis, and the uterus is soft, enlarged and painful on palpation. The weekly flow can be reduced or strong and foul-smelling, bloody or not to be bloody. If the parametria are mitbefallen, pain and fever are threatening; the great, painful pressure uterus is hardened at the base of the broad ligaments, which spread to the pelvic wall or pouch of Douglas. A pelvic abscess may be provided adjacent a palpable tumor next to or directly on the uterus. Diagnosis Clinical Investigation Normally examination to rule out other causes (eg., Urine analysis and urine culture) The diagnosis is made 24 hours after birth based on the clinical findings of pain, tenderness and temperature> 38 ° C after delivery. After the first 24 hours, a endometritis can be puerperal assumed when no other cause for the temperature ? 38 ° C shows on 2 consecutive days. Other causes of fever and abdominal discomfort are urinary tract infection, wound infection, septic pelvic thrombophlebitis and perineal infection. A tenderness of the uterus is required in patients who have had a Caesarean section, often difficult to distinguish from pain through the gash. Patients with slightly elevated fever and without abdominal pain are examined for other occult causes such as atelectasis, engorgement or chest infection, urinary tract infection and thrombophlebitis of the leg. Fever, which is caused by engorgement, usually remains ? 39 ° C. If the fever with slightly elevated temperature suddenly increases after 2 or 3 days, the cause is likely to be a less infection and a engorgement. Usually, a urinalysis and a bacterial culture of urine are carried out. Bacteriological smears of the endometrium are rarely indicated, since samples are taken on the way through the cervix, are almost always contaminated by the normal vaginal and cervical bacterial colonization. Bacteriological swabs of the endometrium should only be accepted if a endometritis proves compared to a routinely used antibiotic therapy plan as refractory and no other cause of infection is obvious; the decrease takes place sterilely with a speculum to prevent a vaginal contamination. The sample for the application of aerobic and anaerobic cultures will be sent. Blood cultures are rarely indicated and should only take place if endometritis remains or refractory to antibiotic therapy routine plans address the clinical findings for septicemia. If despite adequate treatment of endometritis the fever persists over> 48 hours (some doctors use a 72-hour time frame) without the maximum temperature tends to decrease, other causes such as pelvic abscess and pelvic thrombophlebitis (especially if no abscess on the scans is visible) are considered. Imaging of the abdomen and pelvis, usually a CT is sensitive for an abscess, but is facing a pelvic thrombophlebitis only if the clot is large. Shows the imaging no anomaly, a suspected pelvic thrombophlebitis is typically treated experimentally with heparin until the diagnosis was excluded. The diagnosis is confirmed by response to therapy. Tips and risks if adequate treatment of endometritis puerperal does not lead to a tendency of lower maximum temperature within 48-72 hours, a pelvic abscess and, especially when no abscess was seen in the imaging, a septic pelvic thrombophlebitis be considered should. Treatment clindamycin plus gentamicin, with or without ampicillin Treatment consists of i.v. Regimen with broad-spectrum antibiotics, which is given to the patients are free of fever over 48 hours. is the treatment of choice clindamycin 1. 900 g every 8 hours together with gentamycin 1.5 mg / kg every 8 hours or 5 mg / kg, 1 time / day; if a suspected enterococcus infection exists or no improvement within 48 hours, ampicillin is added 1 g every 6 hours additionally. Continuous therapy with oral antibiotics is not necessary. Prevention is essential is to prevent or minimize the vulnerable-making for the disease factors. It should be pointed out washing their hands. Although a vaginal birth can not be sterile, accordingly aseptic precautions is still subdued. The prophylactic administration of an antibiotic in case of cesarean section 60 minutes before the operation can reduce the risk of endometritis by up to 75%. Summary A endometritis puerperalis is more common after cesarean section, especially if unplanned, before. There are usually a polymicrobial infection. The treatment is based on the clinical findings (z. B. postpartum pain, uterine fundus sensitive or unexplained fever) with broad-spectrum antibiotics. Endometrial and blood cultures are not routinely made. In a cesarean section, antibiotics may be given 60 minutes before the operation prophylactically.

Health Life Media Team

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