Etiology and pathogenesis LATE POSTPARTUM HEMORRHAGE
The etiology. The small delay of the placenta, in some cases as late manifestation of infection (strepto-staphylococcal) of varying intensity.
The pathogenesis. The delay of part of the placenta, the uterus is badly reduced. In bacterial inflammation of the blood clots easily disintegrate and tear; their connection with the walls of the vessels very loose; the walls of blood vessels and surrounding tissues gialinovo reborn.
Symptoms and course LATE POSTPARTUM HEMORRHAGE
Symptoms. After 10 - 15 - 20 days after birth under the influence of low physical stress comes heavy bleeding with fever, chills, slight pain in pahah; sometimes immediately comes overall condition.
The course and treatment. One should distinguish between three types of late postpartum hemorrhage:
Late postpartum hemorrhage due to the delayed particles of child seats. Such particles in the early days of the postpartum period do not disrupt the normal flow reverse the development of postpartum uterus; we can only note a few longer discharge bloody lochia. The entire postpartum period proceeds at normal temperature. Later, after discharge, homework or early sexual intercourse lead to the strengthening or the appearance of vaginal bleeding, fever (up to 38 and 38.5 º), sometimes accompanied by a slight chilling. Vaginal examination outer mouth opened slightly,the body of the uterus is uniformly reduced, uterus, creamy, its shape is approaching rounded. The uterus in the study is reduced by the hands, often blood clots the presence of placental polyp (see). To the elimination of the inflammatory process, if not vital indications for surgical removal of the polyp, the treatment is strictly conservative, as in metroendometrity (see), blood transfusion 75 to 100 ml of 1 - 2 times. After the elimination of inflammation scraping of the uterus. If life-threatening bleeding surgery (curettage, removal of a polyp) with subsequent preventive purpose of penicillin or sulfonamides), a blood transfusion.
Late postpartum hemorrhage in the soil available mild infection of the inner surface of the uterus. The allocation of long retain bloody-serous in nature, sometimes amplifying (under the influence of minor reasons). At the same time the temperature rises to 39 - 40C, often accompanied by chills; after 1 - 2 days drops to a low grade. The General condition is deteriorating slightly, Recalling the initial stage of influenza infection, from which the disease is necessary to distinguish. Vaginal examination the uterus appears to be soft, poorly condensed; its shape is close to normal; the uterus in all its departments are the same; the uterus in the study at hand is not shortened. Internal OS is slightly open, the finger can rarely get through without known violence. Often pronounced swelling of the pelvic tissue. If bleeding profusely, anemia increases, it is necessary to proceed immediately to the scraping of the uterus or if the internal Zev wide open, to enter the uterus finger and examined it. After curettage of the uterus is usually reduced, and the bleeding stops. Immediately after surgery the patient is injected with 50 000 - 100 000 units of penicillin, 1 ml of pituitrin, after 5 to 6 hours 1 more ml. On the lower abdomen ice. When the further blood loss transfusion of 500 to 800 ml of blood and 500 - 600 ml of 5% glucose solution under the skin. In the absence of significant bleeding, the treatment is conservative, as in metroendometrity (see).
Late postpartum hemorrhage motivated septicemia (syndrome Coolers). Usually 10 to 15 days after low-grade postpartum period with considerable serous bloody discharge occurs lucid interval, during which the mother and discharged. House continues quite significant bleeding. Under the influence of the slightest factors (raising a child) comes excessive bleeding. Vaginal examination - the phenomenon of MetroEthernet.Temperature with large remissions from 37.5 to 41º, pulse speeded up to 130 - 140 beats per minute. Frequent repeated chills, ongoing bleeding, progressive anemia. The currettage of a cavity of the uterus; if bleeding continues - tamponade of the uterus, if the bleeding still does not stop the hysterectomy. Blood transfusion, penicillin and all means and methods of dealing with acute blood loss (see), and acute septicemia (see). On Menominee formidable phenomena systematic treatment of anemia (see Diseases of the blood system).
Prevention LATE POSTPARTUM HEMORRHAGE
Careful management of the postpartum period. Extract from maternity hospitals postpartum women with delayed uterine contraction (see) is made only after persistent reduction.