PuerperalInfection专题知识专家讲座

PuerperalInfection

UNIONHOSPITALMinJie第1页DefinitionPuerperalInfection:PuerperalInfectionisdefinedasallinfectionsoriginatinginthefemalegenitaltractsubsequenttoparturition第2页

PuerperalMorbidity:Puerperalmorbidityisdefinedastemperatureof38℃orhigheronany2ofthefirst10dayspostpartumexclusiveoftheinitial24hoursandtobetakenbymouthwithastandardtechniqueatleastfourtimesdaily第3页

PuerperalInfectionisaconspicuousdeterminantofpuerperaldisabilityNowadaysitstillrankedastheprimecauseofmaternalmortalityinthecountry第4页Etiology

1.PredisposingFactors:(1)Delivery,specialinobstatricmanipulation,prolngedlabor(2)Prematureruptureofmembrane(3)Multiplepelvicexamination第5页(4)Chorioamnionitis(5)Postpartumhemorrage(6)Traumasofgenitaltractduringlabor第6页

2.Organismsinvolvedpuerperalinfection:(1)

Aerobicβ-hemolytictreptococciitisthemajorinfectiveagentintroducetedfromoutsideresultinginpuerperalinfection.itcanproduceextratoxin,resultinginsevereinfectionandsepticemia.第7页

Clinicfeature:Pyrexiaofasmuchas38℃inearlyphaseChillsRapidpulserateAbdominaldistensionDelayedinvolutionofuterusTendernessinthepositionofuterusanduterineadnexia第8页

(2)AnaerobicStreptococci:Peptococciandpeptostreptococciareusuallyinvolved.Theyaretheorganismsthatnormallyresideinthevagina.第9页Whengenitaltraumaandplacentaretainedoccur,orinthepresenceofdamagedanddevitalizedtissues,theymayreproducepromptlyandbecomepathogenicbacteria.第10页

(3)Escherichiacoli:Itisthemajorpathogenicagentresultinsepticemiaandsepticshock,whichresideinthevagina,perineumandurethralorifice.Ithasdifferentsensitivitytoantibioticsatthedifferentenvironment.第11页

(4)Staphylococcus:MajorpathogenicagentincludeStaphylococcusaureusStaphylococcusepidermidisStaphylococcusaureusmaysesultinsevereinfection.Staphylococcusepidermidisresideinvaginanornally,whichmaysesultinlightinfection.第12页

(5)Anaerobicbacteroide:Majorincludingbacteroidefragilisandbacteroidemelaninogenicus.Theyhavethecharacteristicofbloodcoagulationandmayresultinvenousthrombosisofinfetiveposition.第13页

PathologyAndClinialPresentation:

(1)Acuteexternalgenitaliainflammation,vaginitis,cervicovaginitisCause:

perineumtraumaduringlaborandmanipulativedelivery.第14页

ClinicalPresentation:Reddish,tenderness,ruptureandpusdischargeintheinfectivepositionoftrauma.Vaginaltissueslacerationandcontusionareusheredincongestion,ulcerandpusdischarge.第15页Whencervicallacerationccurs,infectionmayspreadresultinginparametritisandpelviccellulites.第16页

(2)Acuteendometritisandmyometritis:

Cause:

Invadingpathogenicagentspreadtotheendometriumandmyometriumbythesiteofplacentaseparation.第17页

ClinicalPresentation:FeverIncreasingandoffensivelochialdischargePainandtendernessinthelowerabdomenDelayeduterineinvolutionLeukocytosis.第18页

(3)Acutepelviccellulitis,acuteinflammationoffallopiantube:

Cause:

pathogenicagenttransmittotheparametriumbylymphandbloodcirculation.第19页.ClinicalPresentation:GeneralinflammatoryreactionLocalabscess第20页Theclinicfeatureofparturientlnclude:feverrigorpaininthelowerabdomenevenicingpelvic.第21页

(4)Acutepelvicperitonitisanddisseminateperitonitis:

Cause:

Spreadoftheinfectiontotheserosalsurfaceoftheuterus,signsofpelvicperitonitisanddisseminateperitonitismaybeelicited.第22页

ClinicalPresentation:

Generaltoxicmanifestationoccur:pyrexiaofasmuchas39℃nauseavomitingabdominaldistentionseverepainandtendernessinthelowerabdomen第23页

Whenpelvicabscessoccursintherectouterinecul-de-sac,parturientpresentasthesignsof:DiarrheaTenesmusDifficultyinemptyingurineChronicpelvicperitonitismayresultininfertinity.第24页

(5)VenousThrombosis:Cause:Whenbacteriaarepropagatedfromtheuterinewallintothevines,pelvicveinthrombophlebitisoccur.第25页Pelvicveinsinvolvedareusuallyinclude:VaginalveinUterineveinOvarianveinInternaliliacveinCommoniliacvein第26页Anaerobicbacteriaarethemostcommonpathogenicagent.Theycanreleaseenzymeofheparintopromotebloodcoagulation.第27页

ClinicalPresentation:

Venousthrombophlebitisoccurs1-2weekslaterinthepostpartum.Patientpresentasthesignsof:chillsrecalcitrantpyresiapersistingseveralweeks第28页

Signsofvenousthrombophlebitisinthelegare:PersistentpainandtendernessinthelocalveinsRemittentpyrexia,Edematizationintheleg第29页

(6)Septicopyemiaandsepticemia:

Cause:Infectivethrombustransmittothebloodcirculationresultinsepticopyemia.Alargeamountofpathogenicbateriainvadetothebloodcirculationandreproduceresultinsepticemia.第30页

ClinicalPresentation:PersistentfeverChillsSignsofgeneraltoxicmanifestationEvensepticshock第31页

DiagnosisandDifferentialDiagnosis:

1.presentillnessshouldbedescribedindetail

generalandobstetricexaminationareveryimportant.LaboratoryexaminationincludeBloodroutineUrineroutineCRPinserumatacutephaseofinfection第32页

2.Ascertainpathogenicagent:Measuresinclude:

BloodcultureVaginaldischargesmearDetectionofpathogenicantigenandspecificantibody第33页

3.Ascertainpositionofinfection:Measuresinclude:GeneralphysicalexaminationConventionalbimanualexaminationBultrasoundCTmaybeutilizedtoascertainthepositionofabscess第34页

Treatment:

1.

Supportivetherapy:Supportivetherapymayimprovetheabilityofpatienttoresistpathogenicagent.Bloodinfusionwhenanemiaoccurs第35页

2.Surgicalinterventioninclude:CurettagetoevacuateinfectiveretainedproductsofconceptionAbscessincisiontoevacuatepus第36页

3.Antibiotics:ThecorrectchoiceofantibioticsisofparamountimportanceinthetreatmentofpuerperalinfectionTheprinciplesare:第37页(1)Accordingtothespeciesofpathogenicbacteria:Gram-negativebacteria:AminocyclitolsGentamycin第38页Gram-positivebacteria:PenicillineCephalothinAnaerobicbacteria:ChloramphenicolsuccinateClindamycin第39页

(2)Accordingtomedicine-sensitivetest(3)Highlyeffectiveandbroad-spectrumantibiotics(4)Combinationantimicrobialtherapy第40页

4.Treatmentofvenousthrombosis:InthesecasestreatmentwithIntravenousheparinshoudbegivenforAminimumof