Urogenital disorders

IV./4.3.: Course of the disease

Pathogens entering through the lesions of the birth canal and the internal surface of the uterine cavity are responsible for the development of genital origin febrile infection. The most common cause of puerperal infection is the penetration of the cervical-vaginal flora into the uterus and other direct forms of infection. The inflammation can be limited to the location of bacterial colonization, but through the mucosal surface, the uterine cavity, and the fallopian tube (canalicule), as well as via the lymphatic vessels (lymphogenic) and the blood vessels (haematogenic) it may spread even further. The majority of the evolved infections are mixed bacterial infections, where aerob and anaerobe, Gram positive and Gram negative bacteria are also involved (poly microbial infections).

• - Ulcus puerperale. Inflammation (ulceration, abscess) caused by the pathogens intruding through birth canal lesions and the episiotomy wound. In most of the cases it remains local, rarely progresses into sepsis.

• - Endometritis, endomyometritis puerperalis. In less severe cases the infection remains localized to the endometrium, in severe cases the myometrium is also affected. Parts of the placenta left in the uterus provide a particularly good substrate for inflammation.

• - Adnexitis puerperalis. The endometrial inflammation may canalicularly spread to the fallopian tubes and inflammation of the appendix may develop. If the abdominal tubal orifice is blocked pyosalpinx may occur and in the involvement of the ovaries tuboovarial abscess may form.

• - Parametritis puerperalis. Infections of the vagina and uterus - via the lymphatic vessels - may penetrate into the connective tissue around the uterus, and may cause inflammation or abscess. The inflammatory process occurs most frequently in the form of an adnexoparametritis.

• - Pelveoperitonitis puerperalis. Further canaliculary spread of the inflammatory process may lead to a pelvic abscess and/or diffuse peritonitis due to rupture of a tuboovarial and/or parametral abscess.

• - Sepsis puerperalis. Big quantities of pathogens can enter into the blood stream from any of the above mentioned lesions, which may present with the clinical features of pyemia, sepsis or septical shock. In patients with a severely weakened body and in immunosuppressed patients the initial signs and symptoms may be absent, and severe sepsis or septic shock develops immediately (foudroyans sepsis).