PuerperalInfection专题知识专家讲座

PuerperalInfection

UNIONHOSPITALMinJiePuerperalInfection专题知识专家讲座第1页DefinitionPuerperalInfection:PuerperalInfectionisdefinedasallinfectionsoriginatinginthefemalegenitaltractsubsequenttoparturitionPuerperalInfection专题知识专家讲座第2页

PuerperalMorbidity:Puerperalmorbidityisdefinedastemperatureof38℃orhigheronany2ofthefirst10dayspostpartumexclusiveoftheinitial24hoursandtobetakenbymouthwithastandardtechniqueatleastfourtimesdailyPuerperalInfection专题知识专家讲座第3页

PuerperalInfectionisaconspicuousdeterminantofpuerperaldisabilityNowadaysitstillrankedastheprimecauseofmaternalmortalityinthecountryPuerperalInfection专题知识专家讲座第4页Etiology

1.PredisposingFactors:(1)Delivery,specialinobstatricmanipulation,prolngedlabor(2)Prematureruptureofmembrane(3)MultiplepelvicexaminationPuerperalInfection专题知识专家讲座第5页(4)Chorioamnionitis(5)Postpartumhemorrage(6)TraumasofgenitaltractduringlaborPuerperalInfection专题知识专家讲座第6页

2.Organismsinvolvedpuerperalinfection:(1)

Aerobicβ-hemolytictreptococciitisthemajorinfectiveagentintroducetedfromoutsideresultinginpuerperalinfection.itcanproduceextratoxin,resultinginsevereinfectionandsepticemia.PuerperalInfection专题知识专家讲座第7页

Clinicfeature:Pyrexiaofasmuchas38℃inearlyphaseChillsRapidpulserateAbdominaldistensionDelayedinvolutionofuterusTendernessinthepositionofuterusanduterineadnexiaPuerperalInfection专题知识专家讲座第8页

(2)AnaerobicStreptococci:Peptococciandpeptostreptococciareusuallyinvolved.Theyaretheorganismsthatnormallyresideinthevagina.PuerperalInfection专题知识专家讲座第9页Whengenitaltraumaandplacentaretainedoccur,orinthepresenceofdamagedanddevitalizedtissues,theymayreproducepromptlyandbecomepathogenicbacteria.PuerperalInfection专题知识专家讲座第10页

(3)Escherichiacoli:Itisthemajorpathogenicagentresultinsepticemiaandsepticshock,whichresideinthevagina,perineumandurethralorifice.Ithasdifferentsensitivitytoantibioticsatthedifferentenvironment.PuerperalInfection专题知识专家讲座第11页

(4)Staphylococcus:MajorpathogenicagentincludeStaphylococcusaureusStaphylococcusepidermidisStaphylococcusaureusmaysesultinsevereinfection.Staphylococcusepidermidisresideinvaginanornally,whichmaysesultinlightinfection.PuerperalInfection专题知识专家讲座第12页

(5)Anaerobicbacteroide:Majorincludingbacteroidefragilisandbacteroidemelaninogenicus.Theyhavethecharacteristicofbloodcoagulationandmayresultinvenousthrombosisofinfetiveposition.PuerperalInfection专题知识专家讲座第13页

PathologyAndClinialPresentation:

(1)Acuteexternalgenitaliainflammation,vaginitis,cervicovaginitisCause:

perineumtraumaduringlaborandmanipulativedelivery.PuerperalInfection专题知识专家讲座第14页

ClinicalPresentation:Reddish,tenderness,ruptureandpusdischargeintheinfectivepositionoftrauma.Vaginaltissueslacerationandcontusionareusheredincongestion,ulcerandpusdischarge.PuerperalInfection专题知识专家讲座第15页Whencervicallacerationccurs,infectionmayspreadresultinginparametritisandpelviccellulites.PuerperalInfection专题知识专家讲座第16页

(2)Acuteendometritisandmyometritis:

Cause:

Invadingpathogenicagentspreadtotheendometriumandmyometriumbythesiteofplacentaseparation.PuerperalInfection专题知识专家讲座第17页

ClinicalPresentation:FeverIncreasingandoffensivelochialdischargePainandtendernessinthelowerabdomenDelayeduterineinvolutionLeukocytosis.PuerperalInfection专题知识专家讲座第18页

(3)Acutepelviccellulitis,acuteinflammationoffallopiantube:

Cause:

pathogenicagenttransmittotheparametriumbylymphandbloodcirculation.PuerperalInfection专题知识专家讲座第19页.ClinicalPresentation:GeneralinflammatoryreactionLocalabscessPuerperalInfection专题知识专家讲座第20页Theclinicfeatureofparturientlnclude:feverrigorpaininthelowerabdomenevenicingpelvic.PuerperalInfection专题知识专家讲座第21页

(4)Acutepelvicperitonitisanddisseminateperitonitis:

Cause:

Spreadoftheinfectiontotheserosalsurfaceoftheuterus,signsofpelvicperitonitisanddisseminateperitonitismaybeelicited.PuerperalInfection专题知识专家讲座第22页

ClinicalPresentation:

Generaltoxicmanifestationoccur:pyrexiaofasmuchas39℃nauseavomitingabdominaldistentionseverepainandtendernessinthelowerabdomenPuerperalInfection专题知识专家讲座第23页

Whenpelvicabscessoccursintherectouterinecul-de-sac,parturientpresentasthesignsof:DiarrheaTenesmusDifficultyinemptyingurineChronicpelvicperitonitismayresultininfertinity.PuerperalInfection专题知识专家讲座第24页

(5)VenousThrombosis:Cause:Whenbacteriaarepropagatedfromtheuterinewallintothevines,pelvicveinthrombophlebitisoccur.PuerperalInfection专题知识专家讲座第25页Pelvicveinsinvolvedareusuallyinclude:VaginalveinUterineveinOvarianveinInternaliliacveinCommoniliacveinPuerperalInfection专题知识专家讲座第26页Anaerobicbacteriaarethemostcommonpathogenicagent.Theycanreleaseenzymeofheparintopromotebloodcoagulation.PuerperalInfection专题知识专家讲座第27页

ClinicalPresentation:

Venousthrombophlebitisoccurs1-2weekslaterinthepostpartum.Patientpresentasthesignsof:chillsrecalcitrantpyresiapersistingseveralweeksPuerperalInfection专题知识专家讲座第28页

Signsofvenousthrombophlebitisinthelegare:PersistentpainandtendernessinthelocalveinsRemittentpyrexia,EdematizationinthelegPuerperalInfection专题知识专家讲座第29页

(6)Septicopyemiaandsepticemia:

Cause:Infectivethrombustransmittothebloodcirculationresultinsepticopyemia.Alargeamountofpathogenicbateriainvadetothebloodcirculationandreproduceresultinsepticemia.PuerperalInfection专题知识专家讲座第30页

ClinicalPresentation:PersistentfeverChillsSignsofgeneraltoxicmanifestationEvensepticshockPuerperalInfection专题知识专家讲座第31页

DiagnosisandDifferentialDiagnosis:

1.presentillnessshouldbedescribedindetail

generalandobstetricexaminationareveryimportant.LaboratoryexaminationincludeBloodroutineUrineroutineCRPinserumatacutephaseofinfectionPuerperalInfection专题知识专家讲座第32页

2.Ascertainpathogenicagent:Measuresinclude:

BloodcultureVaginaldischargesmearDetectionofpathogenicantigenandspecificantibodyPuerperalInfection专题知识专家讲座第33页

3.Ascertainpositionofinfection:Measuresinclude:GeneralphysicalexaminationConventionalbimanualexaminationBultrasoundCTmaybeutilizedtoascertainthepositionofabscessPuerperalInfection专题知识专家讲座第34页

Treatment:

1.

Supportivetherapy:Supportivetherapymayimprovetheabilityofpatienttoresistpathogenicagent.BloodinfusionwhenanemiaoccursPuerperalInfection专题知识专家讲座第35页

2.Surgicalinterventioninclude:CurettagetoevacuateinfectiveretainedproductsofconceptionAbscessincisiontoevacuatepusPuerperalInfection专题知识专家讲座第36页

3.Antibiotics:ThecorrectchoiceofantibioticsisofparamountimportanceinthetreatmentofpuerperalinfectionTheprinciplesare:PuerperalInfection专题知识专家讲座第37页(1)Accordingtothespeciesofpathogenicbacteria:Gram-negativebacteria:AminocyclitolsGentamycinPuerperalInfection专题知识专家讲座第38页Gram-positivebacteria:PenicillineCephalothinAnaerobicbacteria:ChloramphenicolsuccinateClindamycinPuerperalInfection专题知识专家讲座第39页

(2)Accordingtomedicine-sensitivetest(3)Highlyeffective