Why does the uterus become inflamed after childbirth?
After the placenta is separated, the inner surface of the uterus is a large wound with open vessels, and the cervical canal remains slightly open for several days. Blood and decidual tissue debris provide a good environment for bacteria that normally live in the vagina. Usually the uterus copes: it actively contracts and cleanses itself. Inflammation develops when contractions are insufficient, parts of the placenta or clots remain in the cavity, or there are too many microbes. After a cesarean section, an additional factor is the suture on the uterus and a slower recovery.
- Wound surface at the placenta insertion site
- Partially open cervical canal in the first days
- Retention of parts of placenta and clots
- Insufficient uterine contraction
- Suture on the uterus after cesarean section
- Bacteria ascending from the vagina
Who's at risk
The most significant factor is a caesarean section, especially an emergency one performed during childbirth. The risk is increased by a long anhydrous interval, prolonged labor with a large number of vaginal examinations, manual examination of the uterine cavity, ruptures and injuries of the birth canal. Conditions that weaken protection are also important: severe anemia, diabetes mellitus, obesity, untreated genital tract infections and bacterial vaginosis during pregnancy. In women with multiple risk factors, it is common for a doctor to prescribe prophylactic antibiotics during surgery.
- Caesarean section, especially emergency
- Anhydrous period of more than 12 hours
- Frequent vaginal examinations during labor
- Manual separation of the placenta and examination of the uterus
- Anemia, diabetes, obesity
- Genital tract infections during pregnancy
Symptoms and how they differ from the norm
Normally, after childbirth, the discharge gradually becomes lighter: the first days it is bloody, then it becomes bloody and mucous, and the uterus descends every day and ceases to be painful. With endometritis, everything goes differently: on the third to fifth day or later, the temperature rises, chills appear, the pain in the lower abdomen does not subside, and the discharge becomes cloudy and acquires an unpleasant odor. The uterus remains large and soft. It is also worth remembering that the temperature on the first day may be associated with the arrival of milk, but it is not accompanied by pain and a putrid smell of discharge.
- Temperature 38 °C or higher, chills
- Pain and tenderness of the uterus when pressed
- Cloudy or purulent discharge with an odor
- The uterus contracts more slowly than usual
- Weakness, sweating, rapid pulse
- Sometimes - a sudden cessation of discharge
Diagnostics
The doctor examines the woman, assesses the size and tenderness of the uterus, the nature of the discharge and the condition of the sutures. A general blood test shows signs of bacterial inflammation. An ultrasound shows the expansion of the uterine cavity, the presence of clots or tissue debris in it, and after a cesarean section, the condition of the suture. Be sure to take the material for culture and determine sensitivity to antibiotics: this allows you to adjust the treatment. In severe cases, inflammation indicators are additionally examined and blood cultures are taken. Hysteroscopy helps to clarify the picture and at the same time remove tissue remains.
- Examination and assessment of uterine contractions
- General clinical blood test
- Ultrasound of the uterus and appendages
- Culture of secretions with antibiotic sensitivity
- Assessment of the condition of the suture after cesarean section
- Hysteroscopy according to indications
Treatment and recovery
Treatment is carried out in a hospital. The basis is broad-spectrum antibiotics, which are started intravenously without waiting for the culture result, and then adjusted according to sensitivity. Additionally, medications are prescribed that contract the uterus and replenish fluid loss. If parts of the placenta or clots remain in the uterine cavity, they are removed - optimally under the control of hysteroscopy. In most cases, breastfeeding is continued; the doctor selects medications that are compatible with it. Prevention includes treatment for infections during pregnancy, antibiotics for cesarean section, and follow-up ultrasound after birth.
- Hospitalization and intravenous antibiotics
- Correction of the scheme based on sowing results
- Means that contract the uterus
- Emptying the uterine cavity during tissue retention
- Selection of drugs compatible with breastfeeding
- Follow-up examination and ultrasound after treatment
