DisordersinPuerperiumZhuJiepingShanghaiJiaotongUniversityAffiliatedSixthPeople'sHospital,DeptofObs&GynCONTENTSNormalpuerperiumPuerperalinfectionLatePPHNormalPuerperiumDefinition42daysafterdeliveryInvolutionofuterinecorpus子宮復(fù)舊Lowsegmentofuterine→uterineisthmusUterinecervixPelvicfloorBreast…ManifestationsinNormalPuerperiumFeverContractionspainLochia

Rubra

lochia3~7daysSerouslochia4~14daysAlbalochia2~4weeksCONTENTSNormalpuerperiumPuerperalinfectionLatePPHDefinitionReproductivetractinfections(RTIs)andinducedsystemicinfectioninpuerperium.Majorcausesofmaternalmortality

PPHPregnancycomplicatedheartdisease,HypertensivedisordersinpregnancyPuerperalinfectionPuerperalmorbidity(產(chǎn)褥病率)

Temperature38.0℃orhigher,thetemperaturetooccuronany2ofthefirst10dayspostpartum,exclusiveofthefirst24hours,andtotakenbymouthbyastandardtechniqueatleastfourtimesdaily------by

WilliamObstetricsPuerperalmorbidity

產(chǎn)褥病率

Temperature38.0℃orhigher,thetemperaturetooccuronany2ofthefirst10dayspostpartum,exclusiveofthefirst24hours,andtotakenbymouthbyastandardtechniqueatleastfourtimesdaily------by

WilliamObstetricsMostpersistentfeversafterchildbirtharecausedbygenitaltractinfection.Etiology

PoorhygieneinpregnancyPretermruptureofmembrane(PROM)AntenatalhemorrhageandPostpartumhemorrhageIatrogenicfactors:醫(yī)源性感染Post-operativeinfectionGauze:intrauterine,vaginal…PathogensAerobicbacteriaStreptococcus鏈球菌GroupBStreptococcushemolyticusBacillus桿菌EscherichiaColi大腸桿菌Klebsiella克雷伯式桿菌Staphylococcus葡萄球菌AnaerobicbacteriaCoccusBacillusClostridiumperfringens產(chǎn)氣莢膜桿菌Mycoplasmatales支原體,Chlamydia衣原體MixedinfectionRouteofInfectionEndogenousinfectionParasitism寄生菌ChangesofvaginalPHvalue,decreasesofimmunity…ExogenousinfectionpletesterilizationduringoperationIntercoursebeforedeliveryClinicalManifestation(1)Vulvitis,VaginitisPerinealincisioninfection切口部位感染Localpain,fever…CervicitisMetritisEndometritisMyometritis

Fever,chillPurulentdischarge膿性分泌物TendernessofuterusElevatedWBCcounts…ClinicalManifestation(2)Acutepelvicparametritis，AcuteadnexitisAcutepelvicperitonitisSpreaddirectlyorbylymphaticvesselsordirectlyFever,abdominalpain,diarrhea(腹瀉)Peritonealirritation(腹膜刺激征):abdominaltenderness,tension,reboundpain(反跳痛)Lab:SignificantlyelevatedWBCcountsandneutrophilsClinicalManifestation(3)Thrombophlebitis(血栓性靜脈炎)Pelvicveins,deepveinsoflowerlimbObstructionofvenousreflux:Legswelling,raisedskintemperature,skinwhite–股白腫Sepsis(敗血癥)Life-threateningDiagnosisPostpartumfeverIdentificationofinfectionsitePhysicalexaminationPerinealandpelvicexaminationLaboratorytestsBacterialcultureandantibioticssensitivitytest藥敏試驗(yàn)宮頸分泌物，穿刺液等UltrasonographyManagement

AntibiotictherapyEarly,Broadspectrum,Fulldose,Combination

Experiencebased→Evidencebased

Penicillin+Metronidazole甲硝唑Macrolideantibiotic+Aminoglycosides+Metronidazole

大環(huán)內(nèi)脂類

氨基糖甙類

甲硝唑

抗菌譜需覆蓋支原體、衣原體ChinesetraditionalmedicineDrainageofincision,pelvicabscess,abdominalabscessPreventionAntenatalcareAsepticmanipulationSuturingtechniqueAntibioticprophylaxisIndication?CONTENTSNormalpuerperiumPuerperalinfectionLatePPHLatePostpartumHemorrhageSuddenbleedingorprolongedorcontinuedlochiaduringpeurperiumHaemorrhagicShock失血性休克Usuallyoccurs1to2weeksafterdeliveryEtiologyRetainedplacentaltissueRetaineddecidue蛻膜Subinvolutionofplacentalsite復(fù)舊不全I(xiàn)nfectionofplacentalciteDehiscenceofcesareanincisionInfectionofincisionIncisionlocationSuturingtechniqueTumor:Myoma,GTD…DiagnosisSuddenbleedingorprolongedorcontinuedlochiaHistoryofdeliverySign&Symptoms:UntypicalDependentonetiologyandbloodlossPelvicexamLaboratorytest:BloodcellcountBacterialcultureUltrasoundManagement(1)AntibioticUterotonicIntravenousinfusion,bloodtransfusionManagement(2)SurgicaltherapyRetainedplacentaltissueorrecidueDilatation