Urogenital disorders

IV./4.6.: Therapy

Medical treatment. In case of puerperal fever, the treatment should be started as soon as possible. In less severe cases broad-spectrum cephalosporin and penicillin products given intravenously can be effective in monotherapy too. Of the cephalosporins cefotetan, cefipime and ceftizoxime, while of the penicillins ticarcillin-clavulanate and ampicillin-sulbactam treatment is a cost-effective solution. The antibiotic treatment is supplemented by adding uterine contractors (im or iv oxytocin, ergot im)

In severe cases combined intravenous antibiotic treatment should be carried out. As a first choice clindamycin (900 mg every 8 hours)-gentamicin (2-3 mg/kg once a day) or ampicillin (2 g every 6 hours)-gentamicin-metronidazol (500 mg every 12 hours) combination is recommended. The intravenous antibiotic treatment should be continued as long as the patient becomes persistent afebrile (≥48 hours).

In case of puerperal sepsis carbapenem (imipenem/cilastatin or meropenem) + metronidazol or clindamycin + aminoglycosid combination is recommended. The combined antibiotic treatment should be supplemented by standard anti-shock therapy.

Surgical treatment. Treating the wound infections (injuries, perineum wound, cesarean wound) which consist of antiseptic wound treatment, opening up and draining of the developed abscess and anti-staphylococcus antibiotic therapy.

In case of lochiometra or the retention of placenta parts, dilatation of the cervix and abrasion is necessary, and after the intervention irrigation of the uterine is recommended with iodine containing cold water. In case of a tuboovarial or pelvic abscess, if the process has already been demarcated, colpotomy and drainage may be enough. Otherwise laparotomy and the removal of the purulent nodule is recommended, with extensive irrigation of the abdominal cavity with antiseptic solution and drainage. In large proportion of the cases it may be necessary to remove the uterus as well. In case of sepsis or septic shock after the stabilization of the general condition hysterectomy and drainage is indicated, and in certain cases the removal of the adnexes is inevitable too.