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What to treat the remains of the placenta after childbirth. Remains of placental tissue after childbirth

Bloody discharge from the genital tract to postpartum period in women are the norm. The amount and nature of discharge after childbirth is carefully monitored by doctors in maternity hospital. This is no coincidence, because it is precisely by these indicators that we can early stage diagnose the development of postpartum complications. Many women are frightened by blood clots that come out of the uterus during this period. Is this discharge normal, and what to do if you notice clots on the pad after childbirth.

Causes of bleeding

During labor, a woman's uterus is subjected to severe stress. After the fruit and its shell come out, damage remains on the walls. Over time inner fabrics heal, and residual tissue and clots come out along with the blood.

This discharge during the postpartum period is called lochia. Normally, lochia can be secreted for 6–8 weeks after birth, gradually becoming less abundant and saturated. By the end of the second month after the birth of the baby, the lochia should stop; if this does not happen, you need to consult a doctor.

In order to exclude the presence of postpartum complications, specialists maternity hospital carefully control the intensity of discharge. Before the mother and baby are discharged home, the woman should undergo an ultrasound examination. Nowadays, this analysis has become mandatory and in all maternity hospitals in the country, doctors are required to conduct an examination. If you were not given the opportunity to be examined before discharge, be sure to visit antenatal clinic for the purpose of performing an ultrasound.

Nature of bleeding

In the first days after childbirth, bleeding from the uterus is strong, profuse and saturated in color. Clots are the norm these days. They have dark color and slimy consistency, similar to pieces of liver. The discharge is especially intense in the first days after labor. Further, the intensity of the discharge decreases and the lochia become more and more transparent.

As long as the entire placenta is connected to the uterus and has not detached, bleeding even with very prolonged succession period does not take place. The severity of bleeding depends on the size of the detached part of the placenta and its location: the bleeding is more profuse, the lower the placenta is attached, the larger the exposed part of the placental area, and the smaller contractility uterus. Bleeding is especially severe when the placenta is not fully born and some part of it is retained in the uterine cavity (lobules that have not separated from the uterine wall or only part of the lobule).
Sometimes there is no external bleeding, despite the fact that the uterus contains either the entire placenta, partially or completely detached, or a small part of it. In such cases, paleness usually occurs. skin, increased heart rate and breathing, falling blood pressure and other signs of increasing general anemia. The reservoir for lost blood is the uterus, which, due to overflow with blood, increases in volume, becomes tense and spherical. The causes of this condition are spasm of the internal pharynx, mechanical closure dense fabrics- a blood clot, a lobule of placenta blocking the pharynx, or membranes in the form of a hood covering it from the inside. Therefore, the degree of external bleeding cannot serve as a criterion for assessing the general condition of the woman in labor, which is determined not so much by the amount lost blood, how much reactivity of the patient to blood loss, which largely depends on the course of labor. Thus, long, difficult and painful labor during the first two periods depletes the strength of the woman in labor, reduces the compensatory functions of the body, as a result of which the woman in labor often cannot cope with sudden blood loss, sometimes even minor. This is especially evident in diseases of the cardiovascular system, severe toxicosis of pregnancy and other severe conditions women in labor.
Almost various tests to determine the integrity of the born placenta have not justified themselves: scalding the maternal surface with boiling water, filling the placenta vessels through the umbilical vessels with milk, some coloring, non-diffusing substance, etc. All these tests do not give a convincing answer to the question posed, and at the same time At the same time, they take up a lot of the doctor’s time, which he needs to provide quick and effective care to the woman in labor.

The appearance of signs of anemia in the absence of external bleeding, as well as a gradual enlargement of the uterus, taking on a spherical shape, indicates a spasm of the internal pharynx or blockage of its lumen with parts of the placenta.
Prevention of retained parts of the placenta consists of following the rules of labor management, especially the afterbirth period. These include emptying the bladder after the birth of the fetus, very careful observation for the general condition of the woman in labor; It is necessary to refrain at this time from palpating the abdomen and especially the uterus, from pulling the umbilical cord; the placenta should be rationally removed from the birth canal as soon as the placenta is completely detached; Before this, you cannot prescribe ergotine and other drugs that cause spastic contractions of the uterus, etc.
Of great importance is the fight against miscarriages and inflammatory gynecological diseases, proper management of childbirth during multiple pregnancy and pathological childbirth, especially with placenta previa, polyhydramnios, weakness of labor, toxicosis of pregnancy, and symptoms of a clinically narrow pelvis.

Treatment. Bleeding in the afterbirth period should be stopped as soon as possible. To do this, you must first try to strengthen the afterbirth contractions, which can be achieved by injecting 1 ml of pituitrin. Prescribing in such cases drugs that cause spastic contraction of the uterine muscles (ergot, ergotine, etc.) is an unacceptable medical error.
The separated placenta must be removed from the uterus using one of the well-known methods: Abuladze, Lazarevich-Crede, etc. If these methods do not give quick effect, they should be applied under anesthesia, after which the afterbirth is usually quickly released. If bleeding continues after the birth of the placenta, perform a control examination of the uterine cavity by hand. If a lobe of the placenta is retained in the uterine cavity, which can usually be determined by a defect in the tissue of the born placenta, an operation is performed manual separation retained lobules from the walls of the uterus and releasing them outward. Even in cases where no placenta remains are found in the uterine cavity, entering the uterus with the hand is useful, as this stimulates uterine contractions and often stops bleeding. If small pieces are detected by palpation on the placental site after manual separation of the placenta, they should be removed instrumentally by scraping with a blunt curette, preferably a spoon-shaped one (A.I. Lebedev model). In all cases, after removing the placenta, the uterus is carefully stroked (but not massaged) to increase the tone of its muscles and remove blood clots from the cavity.
It is necessary to remove the entire placenta, because even the smallest pieces remain in the uterine cavity placental tissue may lead to bleeding from the uterus and postpartum infectious disease (up to sepsis) in the postpartum period, and sometimes the development of chorionepithelioma.
After complete emptying of the uterus, in order to enhance its contractions, an injection of 1 ml of ergotine is prescribed and cold bottom part belly.
In each case of hand entry into the uterine cavity, measures must be taken to prevent postpartum infection(sulfonamides, penicillin, etc.). If there is significant blood loss, repeated blood transfusions are used.

Ends birth process, the recovery period begins. The reproductive organ has the amazing ability to grow during pregnancy. Immediately after the baby is born, he weighs 1 kg; by the end of rehabilitation, the weight reaches 50 g. However, successful contraction can be complicated by a number of problems, one of which is the remains of the placenta in the uterus after childbirth. The obstetrician notices a violation during examination.

Stage 3 of labor is marked by the birth of the placenta. If it does not come off completely, you will need medical care, which will be placed directly in maternity ward. According to the norm, the period lasts 15 – 20 minutes. Contractions and pushing help expulsion. When the procedure is delayed, stimulants are introduced. Their use protects the woman in labor from large blood loss.

Why does the placenta not come out after childbirth?

  1. low uterine tone. The organ contracts weakly or completely immobilizes, separation from the walls does not occur;
  2. completely detaches, but the cervix creates obstacles to final expulsion;
  3. part of the organ has grown too close and cannot come off on its own.

Remnants of placental tissue are observed after childbirth when it is removed through the umbilical cord. The obstetrician gives an injection and the placenta is detached. The doctor places one hand on the stomach, the other pulls the umbilical cord. Once the separation has occurred, she comes out easily. Otherwise, part remains inside.

A piece of placenta in the uterus can get stuck due to too hasty action by the obstetrician or weakness of the organ. The doctor pulled thin thread and broke off. For everything to go right away successfully, the obstetrician asks you to push during contractions. The reproductive organ sometimes contracts quickly after the baby is released, preventing the expulsion of the remains.

In some women, retained placenta is explained by a special structure. There is an additional part that is attached to the main one, a separate vessel. It does not come off on its own or, once unstuck, remains inside.

These reasons force the obstetrician to carefully examine the cavity of the reproductive organ. If a vessel break that causes concern is detected, cleaning is carried out. Sometimes a piece of the placenta remains after childbirth, when the afterbirth gets caught in the scar from a previously performed cesarean section and attaches to the fibroma. Progress to the exit is also hampered by complete bladder. The obstetrician places a catheter for emptying.

Symptoms and diagnosis

When the time comes to push, the genital organ pushes the baby out with the help of muscle contractions. On this labor activity doesn't end. There is another 3rd stage ahead - the birth of the placenta. If the organ does not come out completely, and the obstetrician did not notice this, subinvolution begins to develop.

The first warning sign is bleeding. You need to point out the deviation to the doctor. Then, during the examination, the gynecologist will see the looseness of the enlarged reproductive organ. The temperature rises to 37 - 37.5 degrees. It remains like this for the entire time the disease lasts.

What comes out of the uterus after childbirth:

  • umbilical cord;
  • placenta;
  • membranes;
  • blood clots;
  • mucus;
  • different fragments.

They continue to come out for 1.5 months. It's worse if the discharge remains inside. There is a danger of development adverse consequences. A doctor's help is simply necessary in such a situation.

Symptoms of residues:

  1. the temperature rises;
  2. bleeding begins;
  3. inflammation develops;
  4. there is a general deterioration in health.

With such signs you need to urgently contact the clinic. After the examination, the gynecologist will prescribe an ultrasound examination, during which it will be possible to see whether the placenta remains inside or not. To eliminate the consequences, cleaning is carried out under general anesthesia.

5 – 7 days after the end of labor, blood clots fall out. Then they take on a smearing character and completely disappear. If after 2 - 3 weeks no changes are observed, blood continues to flow out, a polyp may have formed. When the placenta does not completely come out after childbirth, an ultrasound shows an enlarged uterus. That's why copious discharge should be wary.

It happens that the blood flows out, then 2-3 days of rest occur and the process resumes. Inflammation develops. It is indicated by an unpleasant “aroma”, painful spasms, high temperature, the indicators of which are recorded on the elbow. Endometritis that goes undetected in time will negatively affect reproductive function body. Infertility will begin to develop.

Indications for cleaning

If the placenta remains after childbirth, surgical intervention is performed in the body. It is prescribed through diagnostics, and then the problem is eliminated. Therapy is carried out according to individual characteristics women in labor, stages of development of consequences.

Why do they clean the uterus after childbirth:

  • free the inside from the remains of the placenta;
  • remove blood clots;
  • remove pathological neoplasms;
  • Histological material is taken for research.

When cleaning:

  • formation of myomatous nodular formations;
  • availability placental polyps inside the reproductive organ;
  • endometritis hyperplasia;
  • unstoppable blood flow;
  • suspicion of a low-quality tumor manifestation;
  • miscarriage;
  • stopped pregnancy;
  • complications after abortions.

During curettage, stagnation of secretions from the upper layer of the mucosa is removed. The gynecologist carefully removes the endometrium from the inner walls, cleans the cervix, and rinses the tubes. If there are infectious diseases that can spread to the unprotected endometrium, cleaning is postponed.

How is the placenta removed after childbirth? The obstetrician does light massage reproductive organ. Then it grabs abdominal wall, asks the woman to push. This Abuladze method is quite simple and painless. If there are signs of blood stagnation in the uterus after childbirth or it leaks profusely, the doctor uses manual separation. The procedure is considered complex and anesthesia is prescribed.

Complications

Is it dangerous when the placenta remains after childbirth? When a baby is put to the breast frequently, oxytocin is produced. It promotes good reduction reproductive organ. If the placenta does not expel completely, small pieces remain, they will come out on their own. Otherwise, inflammation will develop. You'll have to undergo a curettage procedure.

The obstetrician always conducts an examination of the placenta, even if the baby's place was not fully delivered and remains are found a day after birth. Are being checked birth canal, the condition of the cervix is ​​assessed, and the amount of blood loss is determined.

Disruption of the processes of separation of the placenta and discharge of the placenta will require additional actions. When, despite the use of such measures, last stage labor, the organ comes out more than 30 minutes, the danger of opening increases uterine flow blood. When the fragments are not removed in time, the organ may become infected.

Consequences of manual separation:

  1. large blood flow;
  2. the appearance of problems due to inept mechanical intervention;
  3. hemorrhagic shock;
  4. inflammatory process;
  5. sepsis;
  6. fatal outcome.

When the baby's place fails, after childbirth they take it out by hand. Severe bleeding, incorrect actions may lead to complete removal reproductive organ. If all manipulations are performed in good faith, the woman in labor will quickly recover and will be able to give birth again later.

Where does pain occur after manual cleaning:

  • in the area of ​​the uterus. It contracts and returns to its original parameters;
  • in the vagina. During surgery muscle sections stretched out;
  • in my head. Unpleasant manifestations are associated with the consequences of general anesthesia.

By maintaining hygiene, you can avoid complications by monitoring your health and taking medications in a timely manner. When a woman notices dizziness, increased discharge, or fainting, she needs to contact a gynecologist. It is prohibited to douche or use tampons. You cannot visit the bathhouse or take a bath. You should avoid intimate relationships until recovery is complete.

Rehabilitation

For quick recovery It is important to organize time taking into account work and rest. 8 hours should be allocated to sleep, the same amount to work, and the 3rd part should be devoted to relaxation. Return to sports is allowed a month after surgery, provided that this does not harm the recovery process.

If labor took place with complications, the beginning intimate life It is better to agree with your doctor. Rush to join sexual relations not worth it. Reproductive system women should rest. It is necessary to carefully observe hygiene so that infection does not penetrate into the cavity of the reproductive organ.

If the temperature rises after cleaning, the doctor prescribes anti-inflammatory drugs. They are necessary to stop inflammation that can develop inside. Medicines in this series also relieve painful spasms.

Restore the reproductive organ after cleaning with herbs. Vegetation enriched with phytoestrogens has a beneficial effect on the growth of the epidometrium. Women drink a decoction of boron uterus, red brush. They are very indicated during the rehabilitation period.

When the placenta does not move away on its own after birth, antibiotics are prescribed. Women in labor take them for 5–10 days, 1–2 tablets. The course depends on the prescribed remedy. State female body shows when to start taking it: directly on the day of cleaning, the day before. The goal of medications is to prevent bacteria from entering.

During the rehabilitation period, you should balance your diet. You don’t need to eat anything fatty, spicy, or salty. It is recommended to have breakfast with yogurt, cottage cheese, and eggs. During the day, cereals, soups, low-fat varieties fish. In the evening - vegetables, chicken. During the day, snacks include fruit products. It is useful to introduce yams, corn, and soybeans into the diet. They are rich in phytoestrogens.

When the endometrium of the uterus is completely restored, pregnancy is possible. However, you should not rush to conceive. Rest between births should be observed at intervals of 2 years. Before trying to conceive, it is better to consult a gynecologist.

When a piece of the placenta is left in the uterus after childbirth, curettage becomes the only way to salvation. The procedure is considered traumatic, but necessary. If the gynecologist refers to it, it should not be avoided. Any evasion is fraught unpleasant consequences. After a properly completed recovery period, no complications should appear. Any consequences are unlikely.

Childbirth - complex process for the body. The woman experiences a lot of stress, which can lead to complications. Which uterine discharge is normal and which should you be wary of? What symptoms should cause concern and go to the hospital?

Blood clots in the uterus after childbirth

During pregnancy and childbirth, the uterus is subjected to the greatest test and stress. It is with the help of this organ that the child matures, the process of its birth, after which it pushes out the placenta (the membrane of the fetus, the umbilical cord that connected the baby to the mother and the placenta). But despite the fact that most of the remains (lochia) come out immediately after the birth process is completed, some still remain in the uterus. Therefore, if a clot comes out of the uterus after childbirth, then you should not panic. The remainder of the placenta comes out gradually. The process can take up to six to eight weeks.

The discharge of lochia is similar to clots after childbirth in the uterus. The first days they are quite abundant and have a bright scarlet color. Over time they become lighter. As a result, the lochia are released in an almost transparent color.

Several periods of increased discharge can be noted:

  • Breastfeeding. At this moment, an active contraction of the muscles of the reproductive organ occurs, which helps cleanse it of unnecessary elements.
  • When suddenly rising from bed. It is even possible to experience nagging pain.

The release of lochia decreases gradually over several months. The process is most intense in the first week, then gradually becomes less noticeable. As a rule, after two months, the reproductive organ stops secreting clots after birth in the uterus, which indicates that complete cleansing has occurred.

The process of cleansing the uterine cavity may be accompanied by pulling painful sensations, which gradually disappear. The reason for this is contractions of the reproductive organ. The pain will stop when the uterus returns to its original size and shape.

This normal phenomenon for a woman. During the period when lochia is especially abundant, the woman in labor is under the supervision of a doctor and medical personnel.

Woman's behavior

The first few days after the long-awaited process of childbirth, the discharge is especially abundant. At this time, you need to carefully monitor hygiene and use special medical pads. After the discharge becomes moderate, you can switch to using regular pads, and then daily ones. Don't forget to change your hygiene products regularly.

Discharge from the maternity hospital

Before sending the woman in labor home, an ultrasound examination is performed. It examines the uterine cavity for the presence of large lochia. If you have not had an ultrasound examination, please contact the clinic at your place of registration or residence. The procedure can protect you from complications.

If any deviations are detected, the statement is postponed to a later date. late date. There should be no clots left in the uterus at all. Otherwise, the woman may be prescribed a procedure such as cleaning after childbirth. If clots are detected in the first two or three days after the long-awaited moment, when the walls of the uterus have not yet contracted, then the procedure for cleansing the reproductive organ will be less unpleasant, because there will be no need to expand the walls.

Scraping after childbirth

The procedure is an operation that is performed in a hospital. Cleaning after childbirth is sometimes easy necessary procedure. During it, the doctor removes all remnants of the placenta that remain in the uterus. This allows you to avoid pain and inflammation in the future. The process itself is performed under anesthesia, so the woman does not feel pain.

Causes of placenta remnant

If clots remain in the uterus after childbirth, then possible reasons this could be:

  • Low activity of the uterine walls, which leads to ineffective contractions. The cause of the problem is usually a decrease in the level of such female hormone, like prolactin. It is he who contributes uterine contractions and removal of amniotic membranes.
  • The presence of a bend in the isthmus of the uterus. It could be congenital feature body. During the period of active discharge, blockage of the passage may occur, which will lead to an inflammatory reaction. Availability similar feature established by ultrasound examination. In its absence, the woman herself will be able to recognize the danger by the main symptom of the bend - a sudden stop of discharge.

When should you seek help from a doctor?

If blood clots come out, your doctor will be able to tell you exactly what they are. Even after the doctor confirms that everything is fine and goes home, the woman should pay special attention to their secretions. As soon as any strange symptoms appear, you should not delay your visit to the doctor.

The reasons to contact a gynecologist should be:

  • If blood clots in the uterus after childbirth are bright scarlet in color and are accompanied by painful sensations.
  • Very heavy bleeding.
  • If the discharge continues after two months.
  • If lochia has an odor and is accompanied by itching.
  • Increase in body temperature and cessation of lochia secretion.
  • If there are pauses in the discharge for several days.

Precautions

Compliance simple rules will help avoid complications and pathologies.

  • Maintain personal hygiene. Wash your genitals several times a day. This helps reduce the risk of an inflammatory reaction.
  • Refrain from active loads and lifting heavy weights.
  • Pay close attention to your stool. There should be no delays or constipation.
  • Lie on your back once or twice a day. This position stimulates the release of lochia.
  • After childbirth, it is recommended to apply ice to the abdomen. This helps reduce blood loss.

Possible complications

If you find yourself alarming symptoms, then you should not delay your visit to the gynecologist. Otherwise, this can lead to complications such as:

  • The development of endometriosis is the process of inflammation of the inner layer of the uterus.
  • The beginning of subinvolution is the cessation of muscle contractions of the uterus.
  • Blockage of the uterus, which will lead to an inflammatory reaction.
  • Development of the inflammatory process due to increasing infection.

After the examination, the gynecologist sends the woman for an ultrasound examination to determine the exact cause of the pathology, after which, as a rule, he cleanses the uterus. In some situations it is possible to limit drug treatment. In this case, the woman is prescribed antibiotics. When breastfeeding, the doctor selects a drug that can be used during this period. In any case, it is recommended not to neglect precautions. So, it is better to feed the baby before taking the medicine. Give your baby lacto- and bifidobacteria throughout the treatment period. They will help avoid problems with the still unformed intestines.

Conclusion

Thus, clots after childbirth in the uterus and their release are normal physiological process. Knowing the symptoms of complications and inflammation, a woman should not be afraid.

After giving birth, a woman often feels like all her worries are behind her. But, alas, sometimes the first, happiest days or weeks life together mothers and babies are overshadowed by a variety of complications, not the least of which are postpartum purulent-septic diseases of the mother.

Reasons

Postpartum inflammatory diseases are often caused by opportunistic microbes that inhabit the body of any person. They constantly live on the skin, mucous membranes, and in the intestines, without disturbing their “owner,” but under certain conditions they can cause disease. And childbirth, especially if it is accompanied by large blood loss, leading to anemia and, accordingly, a decrease in the body’s defenses, can become this favorable condition to activate microbes. Reason inflammatory processes in the postpartum period there may also be sexually transmitted infections (gonococci, chlamydia, mycoplasma, etc.). There are also associations of 2-3 microbes that enhance each other’s pathogenic properties.

Blood loss during childbirth, anemia, vitamin deficiency, disorders of the blood coagulation system, remnants of placental tissue or membranes in the uterine cavity, surgical interventions during childbirth, cracked nipples, severe pregnancy and childbirth, a long anhydrous interval during childbirth - these are the main conditions that support the infection.

Currently, the most common postpartum endometritis (inflammation of the uterus), chorioamnionitis (inflammation of the membranes and uterus during childbirth), mastitis (inflammation of the mammary gland), pyelonephritis (inflammation of the kidneys) and, much less frequently, thrombophlebitis of the pelvic veins (inflammation of the pelvic veins, often complicated by thrombosis), peritonitis (inflammation of the peritoneum) and sepsis ( general infection blood).

To avoid the development of severe complications, it is very important early diagnosis of these diseases at the first symptoms; it's even better to warn them with preventive measures in a group of high-risk women.

Let's look at the most common ones postpartum complications inflammatory nature.

Postpartum endometritis (inflammation of the uterine cavity)

Most common after cesarean section, manual examination postpartum uterus, manual separation of the placenta and discharge of the placenta (if independent separation of the placenta is difficult due to a violation contractile function uterus), with a long anhydrous interval (more than 12 hours), in women admitted for childbirth with inflammatory diseases genital tract (for example, against the background of sexually transmitted infections), in patients with a large number abortions in the past.

There is a pure form of endometritis, which is much less common (in 15% of cases) and develops without remnants of placental tissue, and endometritis against the background of remnants of placental tissue, retained membranes, blood clots, sutures placed with catgut (one of the types suture material, produced from animal tendons, and therefore often causes inflammatory reactions. Now rarely used) after cesarean section.

Endometritis is classified into mild, moderate and severe. As a rule, these forms differ from each other in the degree of severity, the degree of general intoxication (from the Greek toxikon - poison) - a painful condition caused by the action of bacteria, viruses, harmful substances) of the body and the required duration of treatment.

Symptoms
  • Increased body temperature, usually from 1 to 7 days after birth, depending on the severity of the disease. With a mild form of endometritis, body temperature usually rises only on the 5-7th day after birth, usually up to 38°C; in severe forms, the first symptoms appear already on the 2-4th day, body temperature can reach 40°C.
  • Pain in the lower abdomen. They may be minor and intermittent in the lower abdomen with endometritis mild degree and intense, constant, radiating throughout the abdomen and lower back in severe forms of the disease.
  • Lochia ( postpartum discharge from the genital tract) long time(more than 14 days after birth) remain bright, then acquire a brown-brown color, with an unpleasant odor.
  • The uterus contracts poorly, the height of the uterine fundus does not correspond to the day of the postpartum period.
  • Phenomena of general intoxication: chills, weakness, loss of appetite, headaches.
Diagnostics

IN general analysis blood is detected increased amount leukocytes, i.e. leukocytosis, sometimes - a decrease in hemoglobin levels. At ultrasound examination in the uterine cavity, remains of placental tissue, membranes, blood clots, and subinvolution of the uterus are found (the uterus contracts poorly, its size does not correspond to the day of the postpartum period).

Treatment
  • If subinvolution of the uterus is detected, a careful expansion of the cervical canal is carried out in order to create conditions for the outflow of the contents of the uterine cavity; if the contents of the uterine cavity, vacuum aspiration or curettage is performed (Vacuum aspiration - suction of the contents of the uterine cavity using a special device. Curettage - removal of the contents of the uterine cavity and the surface layer of the endometrium using special tool- curettes).
  • Currently, in many clinics and maternity hospitals, the uterine cavity is washed with chilled antiseptic solutions.
  • Antibacterial therapy main method of treatment. Antibiotics are used wide range, since many infections are caused by the association of several microbes. When choosing an antibiotic, it is based on which microbe most often causes a particular inflammation, whether the antibiotic is excreted in milk, and whether it affects the child. If the antibiotic does not provide sufficient effect within 2-3 days, it is changed to another one. The method of taking antibacterial drugs depends on the severity of endometritis: for the disease light form you can limit yourself to tablets antibacterial drugs; in severe cases of endometritis, antibiotics are administered intramuscularly or intravenously.
  • Infusion (detoxification) therapy ( intravenous administration drugs) is carried out to eliminate the effects of intoxication and improve blood circulation. Infusion therapy must be carried out for both mild and severe course endometritis. To carry it out, glucose solutions (5, 10, 20%), physiological solution (0.9% sodium chloride solution), etc. are used.
  • For all forms of endometritis, immunocorrective therapy is carried out, which helps strengthen the body's defenses and increases immunity (drugs such as Viferon, Kipferon, etc. are used).
  • HBOT (hyperbaric oxygen therapy) is a type of therapy that helps saturate the body's cells with oxygen. At infectious diseases Cells of any nature suffer from hypoxia - lack of oxygen. The therapy process consists of allowing the woman to breathe a mixture of increased content oxygen through a mask. This therapy is very effective in initial manifestations endometritis, strengthens the body's defenses.
Prevention

Frequency postpartum endometritis can be significantly reduced prophylactic use antibiotics at a relatively high risk of its development (after cesarean section, manual entry into the uterine cavity, with an anhydrous interval of more than 12 hours). Also, before giving birth (ideally before pregnancy), it is necessary to conduct an examination and eliminate the infection of the birth canal.

Chorioamnionitis (inflammation of the membranes)

Most often occurs with premature rupture of membranes. As the anhydrous interval during labor increases, the risk of intrauterine infection of the fetus increases.

Symptoms
  • During a relatively long anhydrous period (6-12 hours), a pregnant woman or woman in labor experiences an increase in body temperature, chills, purulent discharge from the genital tract, and an increase in heart rate. In every fifth woman, chorioamnionitis turns into postpartum endometritis.
Treatment

When signs of chorioamnionitis appear, intensive delivery is carried out (labor stimulation, and in case of persistent weakness of labor forces - C-section) against the background of antibacterial and infusion therapy.

Prevention

During childbirth or surgery, it is imperative to monitor the state of vital function. important organs women, especially for the condition of the blood coagulation system, since due to poor contraction of the uterus and/or a decrease in blood clotting ability, severe bleeding may develop, which sometimes leads to the need to remove the uterus.

Postpartum mastitis (inflammation of the mammary gland) and lactostasis (milk stagnation)

Postpartum mastitis occurs in 2-5% of cases, more often in primigravidas. 9 out of 10 women with purulent mastitis are admitted to the surgical hospital from home, since this disease most often begins at the end of the 2nd and during the 3rd week, and sometimes a month after birth.

This is a disease of nursing mothers: if there is no lactation, there is no postpartum. In 80-90% of cases it is caused Staphylococcus aureus. Infection occurs when a microorganism penetrates through a crack in the nipple in the lactating gland. This is the main difference between mastitis and lactostasis (accumulation and “stagnation” of milk in the mammary gland), since lactostasis develops without the presence of cracked nipples. Mastitis is usually one-sided, but can occur on both sides.

Symptoms
  • Increase in body temperature to 38.5-39°C and above.
    • Pain in the mammary gland that is local in nature.
    • Redness of the mammary gland in the affected area (most often in the area of ​​the upper outer quadrant of the mammary gland. The mammary gland is conventionally divided into 4 quadrants: upper and lower outer and upper and lower posterior), swelling.
  • During palpation (manual examination) of this area of ​​the mammary gland, painful, hardened areas are identified. Expressing milk is extremely painful and, unlike lactostasis, does not bring relief.
    • Phenomena of general intoxication: chills, headaches, weakness, etc.
Diagnostics

The initial stage of mastitis should be distinguished from lactostasis. With lactostasis, there is a feeling of heaviness and tension in the mammary gland, there is no redness or swelling of the skin, milk is released freely, pumping, unlike mastitis, brings relief. General condition Few women suffer from lactostasis; after pumping, the body temperature normalizes and the pain stops.

Treatment of lactostasis

If you have lactostasis, you can massage your breasts under the shower with a stream of warm water, after which pumping will become much easier. Physiotherapy procedures are also used (for example, warming up, high-frequency current exposure - "Ultraton", "Vityaz" devices, etc.), without inhibiting lactation, milk is expressed (20-30 minutes before this, 2 ml of No-shpa is injected intramuscularly, immediately before pumping - intramuscularly). If there is no effect from physiotherapeutic procedures in combination with expressing milk, lactation is inhibited with parlodel or similar drugs.

Treatment of mastitis

Treatment should begin at the first symptoms of the disease, which significantly reduces the possibility of developing purulent inflammation of the mammary gland and surrounding tissues. Previously, when treating mastitis, they limited the amount of liquid they drank, which is now considered a gross mistake: to combat intoxication, a woman should drink up to 2 liters of liquid per day. Nutrition should be complete, aimed at increasing the body's resistance.

  • Antibacterial therapy is quite effective in stages 1 and 2 of mastitis
  • At purulent mastitis(when an abscess develops - limited inflammation of the mammary gland - or phlegmon - diffuse purulent inflammation mammary gland) is carried out surgical treatment(opening an abscess, removing dead tissue within healthy tissue) against the background of antibacterial therapy.
  • Suppressing lactation with drugs increases the effectiveness of treatment several times. No type of mastitis can be treated without suppressing or inhibiting lactation. IN modern conditions Complete suppression of lactation is rarely used, only for purulent mastitis, but more often they resort to inhibition of lactation. If lactation is inhibited or suppressed by drugs, pumping should not be used, since this stimulates the production of prolactin by the pituitary gland and, accordingly, stimulates lactation. Even with initial stage mastitis, you should not breastfeed your baby due to high risk its infection, as well as the entry of antibiotics and other medicines, inferior milk. Question about renewal breastfeeding is decided individually and only after control milk culture after treatment.

Prevention

Begins during pregnancy and includes rational nutrition, familiarizing women with the rules and techniques of breastfeeding, timely treatment cracked nipples, lactostasis, wearing a bra that does not compress the mammary glands, washing hands before feeding, air baths within 10-15 minutes after feeding.

High risk factors for the development of postpartum mastitis: