Clinical manifestations of puerperal infection

Postpartum infection is a common symptom. This symptom is mainly caused by the decreased body resistance after childbirth. In addition, lying in bed without exercise after childbirth will cause sweating, which can lead to the breeding of bedsores. Therefore, mothers should pay attention to their body hygiene and move appropriately to avoid the formation of bedsores. Bed sore infection usually causes redness and itching of the skin, and may also cause symptoms such as cervicitis or vaginitis. You can learn more about it.

Fever, abdominal pain and abnormal lochia are the main clinical manifestations. The clinical manifestations vary due to different body resistance, degree, scope and location of inflammatory response. According to the location of infection, puerperal infection is divided into the following types:

1. Acute vulvar, vaginal, and cervicitis

It is often caused by perineal injury during delivery or surgical delivery, or vulvovaginitis before pregnancy, and is manifested by local burning, pain, and swelling. Inflammatory secretions stimulate the urethra and may cause urinary pain, frequent urination, and urgency. The sutures of the perineal incision or laceration are embedded in the swollen tissue, and pus is oozing from the pinholes. Vaginal and cervical infections can cause congestion, edema, ulcers, and suppuration of the mucosa, which can lead to vaginal adhesion or even occlusion over time. If the anterior vaginal mucosa is under severe pressure for too long and is accompanied by infection, large areas of tissue may necrotize and fall off, forming a vesicovaginal fistula or a urethral vaginal fistula. In patients with localized lesions, the body temperature generally does not exceed 38°C. The disease may progress upward or to the parauterine tissues, leading to pelvic connective tissue inflammation.

2. Infection of abdominal incision and uterine incision during cesarean section

Infection of the abdominal incision after cesarean section often occurs 3 to 5 days after the operation, with local redness, swelling, tenderness, tissue invasion with obvious nodules, and turbid fluid exudation. If accompanied by fat liquefaction, the exudate may be yellow and oily. In severe cases, tissue necrosis, partial or full-thickness rupture of the incision, and a significant increase in body temperature exceeding 38°C.

3. Acute endometritis and myometritis

It is the most common type of puerperal infection. Endometritis is caused by pathogens invading the decidua through the placental detachment surface, and myometritis is caused by invasion of the uterine muscle layer. The two often accompany each other. The clinical manifestations are low fever, lower abdominal pain and tenderness, increased lochia with odor, etc., starting 3 to 4 days after delivery. If it cannot be controlled in the early stage, the condition will worsen and symptoms will appear such as chills, high fever, headache, accelerated heart rate, increased white blood cell and neutrophil counts. Sometimes it is easy to misdiagnose because the tenderness in the lower abdomen is not obvious and the lochia may not be excessive. When the inflammation spreads to the uterine muscle wall, the lochia will decrease and the odor will be significantly reduced, which can easily be mistaken for improvement. As the infection progresses, multiple small abscesses may form between the muscle walls. B-ultrasound shows that the uterus is poorly enlarged and involuted, the muscle layer has uneven echoes, and small fluid dark areas with unclear boundaries can be seen. If the disease continues to develop, it can lead to sepsis and even death.

4. Acute pelvic connective tissue inflammation, acute salpingitis

It is often secondary to endometritis or deep cervical laceration. The pathogens invade the parauterine tissue through the lymphatic or bloodstream and extend to the fallopian tube and its mesentery. The main clinical manifestations are persistent severe pain in one or both sides of the lower abdomen. Gynecological or rectal examinations may reveal thickening of the parauterine tissue or a solid mass with unclear boundaries. There is obvious tenderness, often accompanied by chills and high fever. Inflammation may accumulate in the rectouterine pouch to form a pelvic abscess, which may spread upward into the abdominal cavity if the abscess ruptures. If the disease invades the entire pelvic cavity, it will thicken and form a huge mass, and the organs inside cannot be identified. The entire pelvic cavity seems to be frozen, which is called "frozen pelvis".

5. Acute pelvic peritonitis, diffuse peritonitis

The inflammation spreads to the uterine serosa, forming pelvic peritonitis, which continues to develop into diffuse peritonitis, with symptoms of systemic poisoning: high fever, chills, nausea, vomiting, abdominal distension, severe pain in the lower abdomen, and obvious tenderness and rebound pain in the lower abdomen during physical examination. The abdominal wall of the parturient is relaxed after delivery, so the tension of the abdominal muscles is often not obvious. Peritoneal inflammatory exudate and fibrin deposition can cause intestinal adhesions, often forming localized abscesses in the rectouterine pouch, irritating the intestine and bladder, leading to diarrhea, tenesmus, and abnormal urination. If the condition cannot be completely controlled, it may develop into chronic pelvic inflammatory disease.

6. Thrombophlebitis

Bacteria secrete heparinase to break down heparin, causing a hypercoagulable state. In addition, inflammation causes blood stasis and damage to the venous wall, especially infections caused by anaerobic bacteria and Bacteroides, which can easily lead to two types of thrombophlebitis. Studies have shown that anticoagulant protein deficiency during pregnancy is closely related to the formation of venous thromboembolism, and congenital anticoagulant protein deficiency such as protein C, protein S, and antithrombin III is one of the factors. Common sites of occurrence include the pelvis, lower limbs, and intracranial cavity.

(1) Pelvic thrombophlebitis often involves the ovarian veins, uterine veins, internal iliac veins, common iliac veins and inferior vena cava. It is usually unilateral and often occurs 1 to 2 weeks after delivery. It is related to the hypercoagulable state of the mother's blood and prolonged bed rest after delivery. The clinical manifestations are chills and high fever following endometritis, which recur repeatedly and may last for several weeks, making diagnosis difficult.

(2) Thrombophlebitis of the lower limbs usually occurs in the femoral vein, popliteal vein, and great saphenous vein on one side, and is characterized by fever, persistent pain in the lower limbs, local venous tenderness or palpable hard cord-like masses, obstructed blood circulation, lower limb edema, and pale skin, which is called femoral white swelling. It can be detected by color Doppler ultrasound blood flow imaging.

(3) Intracranial thrombophlebitis: For every 100,000 births, the risk of stroke is estimated to be 13.1 and the risk of intracranial venous thrombosis is 11.6. The closely related factors are: cesarean section, water, electrolyte, acid-base imbalance, and pregnancy-induced hypertension. MRI and transcranial color Doppler can aid in the diagnosis.

7. Sepsis and septicemia

As the condition worsens, bacteria enter the blood circulation and cause sepsis and septicemia. Especially when the infected blood clots break off, it can cause lung, brain, or kidney abscesses or embolism and death.