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puerperal sepsis[pyü′ər·prəl ′sep·səs]
an infectious disease that afflicts women in the postnatal period. Infectious agents enter the birth canal of the woman during complicated childbirth. Inflammation of the vagina and of the uterus or the cervix occurs first, and then the infection may become generalized (sepsis). The several stages of puerperal sepsis are determined by the extensiveness and gravity of the infection. In the first stage, infection is limited to an inflammation in the region of the vulvar orifice (postpartum endometriosis, postpartum abscess). In the next stage, the infection extends beyond the vulvar orifice but remains localized (inflammation of periuterine tissue and uterine appendages; thrombophlebitis of the femoral veins and the veins of the uterus and the pelvis). In the third stage, the infection is almost as severe as a generalized one (generalized peritonitis, septic shock, progressive thrombophlebitis). In the last stage of puerperal sepsis, the infection is generalized (sepsis).
Infections of the uterus (endometrioses) are most common. The illness begins three or four days after delivery. Symptoms include exhaustion, weakness, elevation of temperature to 37.5°-38°C, abdominal pains, and increased postnatal discharges. Involution of the uterus is retarded. The illness may last ten to 12 days. If the infection spreads beyond the uterus, the uterine appendages become diseased (salpingoophoritis). Mastitis often develops after the delivery. A special form of puerperal sepsis is septic endotoxin shock, which develops when coliform microbes enter the bloodstream. When the microbes are destroyed, a powerful endotoxin is released, which produces a state of shock. The shock soon gives way to circulatory insufficiency, and the disease often ends with the development of acute renal insufficiency.
Treatment requires hospital care and rest. Antibiotics, sulfanilamides, and anticoagulants may be prescribed. Desensitization therapy may be recommended, along with injection of agents that increase the body’s resistance (fractional transfusions of blood, plasma). With diffuse peritonitis, surgical intervention is required. Prevention includes strict observance of sanitary measures in delivery rooms, detection and treatment of bacillus carriers among medical personnel, and early diagnosis and treatment of incipient forms of the disease.
REFERENCEBartel’s, A. V. Poslerodovye infektsionnye zabolevaniia. Moscow, 1973.
A. P. KIRIUSHCHENKOV