POSTPARTUM (POST-ABORTION) INFECTIOUS DISEASES : ADNEXITIS (ADNEXITIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
The etiology. Infection streptostafilokokkovoe.
The pathogenesis. The infection gets into the epididymis or by hematogenous or through pipes from the uterus (usually) reg continuitatem or lymphogenous way.
Symptoms. After 8 - 10 days after birth, a sharp increase of the temperature up to 39 - 40°, increased heart rate, poor overall health, expressed peritoneal phenomena - nausea, vomiting, bloating, symptom Shchetkina (Blumberg) in the field of appendages. Mild spotting. Mild chills. Pain that radiates to the lower back and legs. Vaginal examination is determined enlarged, pasty, irregularly shortened uterus, diffusely infiltrated appendages, sharp pelvic swelling of the tissue around them.
For. The symptoms described in a few days remain the same intensity, the temperature is increased, with remissions 0.75 1° when the corresponding pulse rate, then they gradually subside, particularly peritoneal phenomena disappear. In the field of appendages in the future find infiltrate with limited mobility, a few bumpy, painful on palpation and on their own (especially when moving). Sometimes it is possible to separately test the thickness of convoluted pipe.
Complications. The festering sore of tubes and ovaries (piosalpinks, pivarium), pelvic peritonitis. When revealed in the free abdominal cavity abscess, peritonitis.
Recognition based on the above it is not difficult. It is necessary to distinguish from appendicitis, parametritis and pelvic thrombophlebitis of the veins. Mandatory re-bacteriological studies on gonococcus.
The prediction is relatively favorable, with the formation of ulcers serious.
Strict bed rest, ice on the lower abdomen, powerful pain - candles with belladonna. Sulfa drugs and penicillin (3 hours 50 000 units) until the acute symptoms subside (to its normal temperature), after which light baths (carefully!), at the same time autohemotherapy 10 ml in 2 days or a blood transfusion by 50 - 70 ml again after 3 to 4 days in order to total body stimulation; intravenous 10% solution of calcium chloride in 10 ml once every 5 - 6 days. When proven gonococcal disease etiology - specific treatment (seediseases of the female genital organs, gonorrhea). Only after the disappearance of acute persistent phenomena may be allowed to stay at home. After 7 to 9 months, depending on climatic conditions and in the absence at this time of exacerbations, mud,-paraffin or torfolechenie in a resort or in non-resort atmosphere. At the break of abscess in the abdominal cavity - immediate operation.