POSTPARTUM (POST-ABORTION) INFECTIOUS DISEASES : THROMBOPHLEBITIS OF DEEP VEINS OF THE PELVIS - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
The etiology. The damage to blood vessels strepto-staphylococci.
The pathogenesis. As a result of changes (under the influence of infection) blood vessels (veins), blood flow and the blood itself is formed of inflammatory infiltration of the vessel walls and surrounding tissue, in the future, the true thrombosis. The process takes place mainly in the veins of the pelvis and lower extremities.
Symptoms. On 3 - 4th day postpartum period, the temperature rises to 39 - 40C spectacular chills; the pulse quickens dramatically. The tongue is coated and moist. The constipation. The temperature of the small remissions of 1 - 1.5 º, repeated chills. Pulse all the time continues to be quickened. 5 - 8th day of illness a pronounced symptom Shchetkina (Blumberg), mainly in the lower abdomen. Swelling of the skin of the abdomen and pelvic region, the entire foot. Sharp pains in the leg. When thrombophlebitis of veins of the pelvic vaginal examination determined enlarged and creamy uterus. In different parts of the parametrium felt convoluted, painful throbbing bands, one or more, or even the tangle (thrombosis venous plexus), going in different directions of a heavyweight. Tromboflebitichesky process often tends to transition to the femoral vein. In such cases, a vaginal examination in the pelvic tissue and closer to pupartovoy conjunction, are infiltrated the area where the fan-shaped diverge in different directions separate coiled strands, throbbing, painful, with clearly marked infiltration of the surrounding tissue. All these bands represent the venous vessels, the walls of which are affected by the inflammatory process. When thrombophlebitis of veins of the thigh: the smoothness of the inguinal fold on the affected limb, swelling of the hip, raising the skin temperature of the affected hip (dilation of superficial veins), pain on palpation of the area Karpova triangle, probing deep in his thickened vessels, swelling in the popliteal fossa, pain popliteal vein, sore calf muscles, radiating pain in the heel; a feeling of heaviness, numbness, pins and needles in the extremities. In the treatment of penicillin, the disease often occurs in low-grade or even normal temperature; other clinical phenomena occur as described.
For a long period with remissions.
Complications. Suppuration of blood clots (pyemia).
Recognition based on the above it is not difficult. Definitely a vaginal examination. Depending on the location of the lesion put the diagnosis of thrombophlebitis or other veins.
The clot may be subjected to resorption or germinate connective tissue, or be subjected to purulent fusion, which determines the prognosis of the disease.
see Pyosepticemia. To start with penicillin and sulfonamides. Absolute rest. Ice pack on the lower abdomen. High position of both legs. Leeches (5 - 6) in the acute period, respectively the place of destruction. Avoid enemas, compresses, heating pads. Special attention is paid to the care, nutrition. Intravenous administration of drugs requires especial care. When firmly established low-grade fever, easy movements at high position of the feet do not cause any changes in the clinical picture, the overall health of the patient is satisfactory, you should switch to a biodegradable treatment (autohemotherapy, Solux), the total UV irradiation, light gymnastics of the lower extremities.