产褥感染（英文）（学习资料）课件

Puerperal Infection UNION HOSPITAL Min 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 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 disability Nowadays it still ranked as the prime cause of maternal mortality in the country Etiology 1.Predisposing 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 treptococci it is the 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 the 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 reproduce 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 pathogenic agent include Staphylococcus aureus Staphylococcus epidermidis Staphylococcus 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. 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,cervicovaginitis Cause: perineum trauma during labor and manipulative delivery. Clinical Presentation: Reddish,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 myometritis: 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, 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: fever rigor pain in the lower abdomen even icing pelvic. (4)Acute pelvic 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 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 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 blood 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 pyrexia, 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 detail general and obstetric examination are very important. Laboratory examination include Blood routine Urine routine CRP in serum at acute phase of infection 2.Ascertain pathogenic agent: Measures include: Blood culture Vaginal discharge smear Detection of pathogenic antigen and specific antibody 3.Ascertain position of infection: Measures include: General physical examination Conventional bimanual examination B ultrasound CT may be utilized to ascertain the position of abscess Treatment: 1. Supportive therapy : Supportive therapy may improve the ability of patient to resist pathogenic agent. Blood infusion when anemia occurs 2.Surgical intervention include: Curettage to evacuate infective retained products of conception Abscess incision to evacuate pus 3.Antibiotics: The correct choice of antibiotics is of paramount importance in the treatment of puerperal infection The principles are: (1)According to the species of pathogenic bacteria: Gram-negative bacteria: Aminocyclitols Gentamycin Gram-positive bacteria: Penicilline Cephalothin Anaerobic bacteria: Chloramphenicol succinate Clindamycin (2)According to medicine-sensitive test (3)Highly effective and broad-spectrum antibiotics (4)Combination antimicrobial therapy 4.Treatment of venous thrombosis: In these cases treatment with Intravenous heparin shoud be given for A minimum of 7 days with a dosage of 50mg CASE