After vaginal delivery the entry point of puerperal infection may be the episiotomy wound or the lesions of the perineum, vulva and vagina. In less severe cases the signs of the superficial inflammation are: redness or livid discoloration of skin, inflamed swelling, pain, excessive discharge, subfebrility or fever. In severe cases purulent ulcer (ulcus puerperalis) and abscess may also develop.
In case of an endometrial inflammation the fever occurs within 24-48 hours after delivery, and the temperature is typically around 37.5-39.5 0C. Typical clinical signs: tachypnoea, tachycardia, decreased uterine contractions (subinvolutio), lower abdominal pain and tactile sensitivity, excessive and odorous postpartum discharge (lochia) and uterine bleeding with varying intensity. During the progression of the process (adnexitis, parametritis, pelveoperitonitis, sepsis) the fever becomes decisively intermittent or persistently high. In case of a sepsis the high fever is usually accompanied by chills, but a temperature lower than the normal may also be a sign of sepsis.
In case of a pelvic abscess the pain and the sensitivity increases and - depending on its location - the pain may radiate towards the urinary bladder, the rectum and the ipsilateral lower limb. In case of a peritonitis the tongue is coated and dry, respiratory rate continues to rise, peripheral pulse can be easily suppressed, blood pressure is low, and there is a decrease in the amount of urine. The abdomen is distended, meteorism and muscular defense may occur. Due to pain and shortness of breath the patient may become restless, but altered consciousness, delirium or sleepiness may occur as well.
Utolsó módosítás: 2014. February 12., Wednesday, 10:54
