The postpartum period is dangerous due to the occurrence of complications. During this period, a woman needs special care and attention so as not to miss life-threatening health consequences. Postpartum complications can occur both early and late. late period after childbirth.

The early postpartum period lasts two hours after the end of the third stage of labor, during this entire time the woman is monitored on the delivery table medical personnel. The late postpartum period continues for another month and a half after birth. During this time the woman visits antenatal clinic, they conduct preventive conversations with her to prevent complications.

Classification of postpartum complications

A separate group identified complications arising from a dead fetus and complications after epidural anesthesia of childbirth.

Complications after epidural anesthesia for childbirth in a woman

Epidural anesthesia – effective method pain relief for women during childbirth. Epidural anesthesia is carried out strictly according to indications in the first stage of labor, and no later. With the help of this type of anesthesia, it is possible to relieve pain from contractions, but further labor (pushing and the contractions that precede them) is not anesthetized.

Epidural anesthesia is most often used for abnormalities labor activity, rarely during physiological labor. Contraindications to its implementation are:

• Individual intolerance to the components of the drug.
• Deformations of the bone canal of the spine.
• Thrombocytosis and increased coagulability blood.
• Skin infection at the puncture site.
• Second stage of labor, cervical dilatation more than 6 cm.

Epidural anesthesia has its consequences, including:

1. Allergic reactions up to anaphylactic shock. In this case, a malfunction occurs in all body systems, which requires medical care. To avoid this, before administering the drug, tests are carried out to determine the tolerability of the anesthesia components.
2. Asphyxia, difficulty in entering and exhaling. Occurs when the drug was administered above lumbar region and with good absorption of the mixture components. Operation failure occurs intercostal muscles. A serious consequence that can be relieved by connecting the woman to the device artificial ventilation lungs.
3. Pain in the lumbar region.
4. Headaches.
5. Decline blood pressure due to the impact on cardiovascular system components of epidural anesthesia.
6. Difficulties in urination and defecation.
7. Paralysis or paresis lower limbs.
8. The entry of anesthesia components into the general bloodstream, which leads to intoxication, metabolic disorders, headaches and nausea.
9. Lack of analgesic effect from anesthesia or anesthesia of only one half of the body.
10. One of the most dangerous complications of epidural anesthesia is labor anomalies. If the components of the drug circulate for too long in the cerebrospinal fluid or absorbed into the blood, the doctor and the woman herself may miss the moment of complete dilatation of the cervix. At the birth table, it is important for a woman to understand the period of pushing so that the baby passes through the birth canal according to labor. During anesthesia, a state of incoordination occurs; the woman does not perceive periods of pushing. There is a high risk of ruptures and injuries birth canal, weakness of contractions and pushing occurs.

Complications after a dead fetus

Intrauterine fetal death can occur in both early and early later pregnancy or during childbirth. The complications of stillbirth are the same as after normal births. physiological birth. Most frequent complications– infectious. Therefore, it is especially important to remove the dead fetus from the mother's womb as quickly as possible.

On early stages most often a miscarriage occurs. If this does not happen, curettage of the uterus is performed. If the fetus dies in the later stages, a miscarriage does not occur. To extract the fetus, labor is artificially stimulated, followed by the application of obstetric forceps or a fetal destruction operation. To prevent infection, a thorough examination of the uterine cavity is performed and ultrasonic testing. The woman is seen by a gynecologist for six months, where the cause of the miscarriage is also determined.

One more thing possible complication late miscarriages and stillbirths – mastitis. Milk is produced in the mammary glands for several weeks after the death of the fetus, which leads to lactostasis. For prevention, it is recommended to take medications that suppress lactation and express milk from the breast daily.

To eliminate psychological complications, the woman is referred to a psychologist if necessary. Bleeding, ruptures, eversion and atony of the uterus after a dead fetus are practically not observed.

Bleeding

Bleeding often complicates the postpartum period. Normal physiological blood loss is no more than 300-400 ml of blood. Anything higher is considered abnormal bleeding, which requires immediate intervention medical personnel and stop bleeding. The diagnosis of massive blood loss is made when more than 1 liter of blood fluid is lost. Massive blood loss is the main cause of maternal mortality.

Bleeding can occur in both the early and late postpartum period. Prevention this complication carried out throughout all periods of labor, right up to the patient’s discharge from the maternity ward.

Important to remember! Bleeding may also occur after discharge, at home. If you notice scarlet-colored bloody discharge from the genital tract, call immediately ambulance or go to the emergency room.

The causes of bleeding are varied. Basic preventive measures The doctor undertakes: the woman in labor is given hemostatic drugs and drugs that contract the uterine muscles and increase their tone.

Infectious complications in women

Also quite common pathology, which can occur in a latent, erased form or with a detailed clinical picture and severe consequences for health. Let's look at the most common pathologies.

Postpartum endometritis and chorioamnionitis

These diseases begin with an increase in body temperature to subfebrile (up to 39 C) and febrile temperatures (over 39 C), chills, weakness, loss of appetite, pain in the lower abdomen. Vaginal discharge changes color: it becomes profuse, with unpleasant smell. Involution and contraction of the uterus are disrupted. In severe cases, infection can spread from local forms into a generalized infection - sepsis and septicopyemia.

Prevention begins with the administration of antibiotics immediately after childbirth, thorough disinfection of postpartum sutures and examination of the birth canal. Even if there is the slightest doubt about the presence of remnants of placenta or membranes in the uterus, a manual examination of all walls of the uterus is carried out, and if necessary, curettage.

What you can do:

The basic rule for preventing infection is maintaining personal hygiene. Listen to your doctor's recommendations.

1. Wash yourself daily warm water, better after every trip to the toilet.
2. Change pads at least 4-5 times a day.
3. Sanitize chronic foci of infection, especially the genital tract.
4. Process daily postpartum sutures disinfectant solution until they are completely healed.

Postpartum mastitis

Mastitis is an inflammation of the mammary glands. Mastitis occurs in mild forms. However, if it is not recognized in time, gangrene may occur, which will entail the removal of one breast.

Sometimes there may be various pathologies during the postpartum period. We will consider here the main ones, indicate the reasons for their occurrence and preventive measures.

Delayed postpartum discharge(lochia) occurs when the uterus is bent backwards (with prolonged bed rest) and its slow contraction. The woman notes a sharp decrease in lochia secretion, a feeling of heaviness in the lower abdomen, chills, and an increase in temperature. In order to prevent delayed discharge, it is recommended to get up as early as possible after childbirth, postpartum therapeutic exercises, timely emptying of the bladder and bowels.

Postpartum ulcer occurs on the 3rd – 4th day after birth as a result of infection of the wound surface of the perineum, vagina and cervix. The inflammatory process is accompanied by the formation of necrotic plaque. Sometimes noted low-grade fever. The diagnosis is made by gynecological examination of the perineum, vagina and cervix. An ulcer is a wound surface covered with a grayish coating that sits tightly on the base. Peripheral tissues are edematous and hyperemic. In order to prevent postpartum ulcers, the external genitalia of the postpartum woman are toileted (washed) 2 times a day. If stitches were placed on the perineum, they are treated with an antiseptic solution.

Postpartum endometritis usually develops as a result of the penetration of microbes into the remnants of the decidua of the uterus with the involvement of adjacent areas of the myometrium in the process. The cause of the inflammatory process is usually a staphylococcal, streptococcal or colibacillary infection. The disease begins on the 3rd – 4th day after birth. The temperature rises to 380C, the pulse quickens, but corresponds to the temperature, and there is a single chill. General condition is almost not disturbed. Local changes: subinvolution of the uterus, pain “along the ribs of the uterus” - the location of large lymphatic vessels, lochia mixed with pus. The disease lasts 8–10 days.

Postpartum parametritis– a consequence of the spread of infection (staphylo-streptococci, Escherichia, etc.) by the lymphogenous route from a postpartum ulcer or infected uterus. The penetration of infectious agents into the parametrial tissue is facilitated by ruptures of the cervix and the upper third of the vagina. The inflammatory effusion quickly becomes dense, which gives the affected tissues a characteristic consistency. The disease begins acutely in the 2nd week after birth with a deterioration in general condition, chills, high fever, and difficulty urinating.

Endometritis often accompanies parametritis. Peritoneal symptoms are mild or absent, since the inflammatory infiltrate is located extraperitoneally. Diagnosis is based on clinical picture and data gynecological examination. On the side of the uterus, a dense infiltrate (unilateral or bilateral) is palpated, reaching the walls of the pelvis.

Postpartum salpingoophoritis– inflammation of the uterine appendages. The causative agents of infection are microbes of the septic group; most often a complication of endometritis. The infection spreads lymphogenously or through the fallopian tubes. The inflammatory process first takes over fallopian tubes, then moves to the ovaries, forming a single conglomerate. The disease develops on the 8th - 10th day after birth, accompanied by a deterioration in the general condition, an increase in temperature to 38 - 39 o C, chills, tachycardia, severe abdominal pain, nausea, bloating; symptoms of peritoneal irritation are noted. Vaginal examination reveals endometritis and pasty uterine appendages on one or both sides. The uterine appendages are sharply painful on palpation. Differentiate with parametritis, thrombophlebitis of the pelvic veins, acute appendicitis.

Postpartum pelvic peritonitis(pelvioperitonitis). The causative agent of the infection is microbes of the septic group, less commonly gonococcus. The infection spreads mainly through the lymphogenous route from the uterus. It is often a complication of salpingoophoritis. Damage to the peritoneum leads to the formation of serous or purulent exudate. The process tends to be limited to the pelvic area. Occurs 1–2 weeks after birth. The onset is acute: chills, high fever, sharp pains lower abdomen, flatulence.

After a few days the patient's condition improves, lower section In the abdomen, a border groove begins to be palpated, delimiting the inflammatory process in the pelvis. During vaginal examination, at the onset of the disease, only sharp pain in the posterior vaginal vault is found. In the following days, an effusion begins to be clearly palpated, protruding the posterior vaginal vault in the form of a dome.

Postpartum thrombophlebitis There are superficial veins of the lower extremities, veins of the uterus, pelvic veins or deep veins of the lower extremities. Thrombophlebitis of the superficial veins of the lower extremities usually occurs against the background varicose veins veins The inflamed veins are tense, painful on palpation, the skin over the affected area is hyperemic, the temperature is low-grade, and there is slight tachycardia.

Thrombophlebitis of the uterine veins is characterized by symptoms of uterine subinvolution, prolonged bloody discharge from the vagina, increased temperature, increased heart rate. A vaginal examination may reveal tortuous cords (veins) on the surface of the uterus. Thrombophlebitis of the pelvic veins develops at the end of the 1st week after birth, accompanied by high temperature, increased heart rate, chills, deterioration of general condition. During vaginal examination, tortuous and painful veins are identified on the lateral walls of the pelvis.

Thrombophlebitis of the deep veins of the lower extremities occurs in the 2nd week of the postpartum period. The onset of the disease is acute, accompanied by pain in the leg, swelling, chills, fever, and the pulse is significantly increased (more than 120 beats per minute). At objective research pay attention to the smoothness of the inguinal fold of the affected limb; Palpation in the area of ​​Scarp's triangle with thrombophlebitis of the deep veins of the thigh is painful. There is also pain along the large vascular trunks of the thigh and lower leg. The duration of the disease is 6–8 weeks.

After giving birth, a woman often feels like all her worries are behind her. But, alas, sometimes the first, the most happy days or weeks life together mothers and babies are overshadowed by a variety of complications, not the least of which are postpartum purulent-septic diseases mother.
REASONS

Postpartum inflammatory diseases are often caused by opportunistic microbes that inhabit the body of any person. They constantly live on the skin, mucous membranes, and in the intestines, without disturbing their “owner,” but under certain conditions they can cause disease. And childbirth, especially if it is accompanied by large blood loss, leading to anemia and, accordingly, a decrease in the body’s defenses, can become this favorable condition to activate microbes. Reason inflammatory processes V postpartum period There may also be sexually transmitted infections (gonococci, chlamydia, mycoplasma, etc.). There are also associations of 2-3 microbes that enhance each other’s pathogenic properties.
Blood loss during childbirth, anemia, vitamin deficiency, disorders of the blood coagulation system, remnants of placental tissue or membranes in the uterine cavity, surgical interventions during childbirth, cracked nipples, severe pregnancy and childbirth, a long anhydrous interval during childbirth - these are the main conditions that support the infection.
Currently, the most common postpartum endometritis (inflammation of the uterus), chorioamnionitis (inflammation of the membranes and uterus during childbirth), mastitis (inflammation of the mammary gland), pyelonephritis (inflammation of the kidneys) and, much less frequently, thrombophlebitis of the pelvic veins (inflammation of the pelvic veins, often complicated by thrombosis), peritonitis (inflammation of the peritoneum) and sepsis (general blood poisoning).
To avoid development severe complications very important early diagnosis of these diseases at the first symptoms; it's even better to warn them with preventive measures in a group of women high risk.
Let's look at the most common ones postpartum complications inflammatory nature.
POSTPARTUM ENDOMETRITIS (INFLAMMATION OF THE UTERINE CAVITY)

Most common after cesarean section, manual examination postpartum uterus, manual separation placenta and placenta discharge (if independent separation of the placenta is difficult due to a violation contractile function uterus), with a long anhydrous interval (more than 12 hours), in women admitted for childbirth with inflammatory diseases genital tract (for example, against the background of sexually transmitted infections), in patients with a large number abortions in the past.
There is a pure form of endometritis, which is much less common (in 15% of cases) and develops without remnants of placental tissue, and endometritis against the background of remnants of placental tissue, retained membranes, blood clots, sutures placed with catgut after cesarean section.
Endometritis is classified into mild, moderate and severe. As a rule, these forms differ from each other in the degree of severity, the degree of general intoxication of the 2 organism and the required duration of treatment.
Symptoms

Increased body temperature, usually from 1 to 7 days after birth, depending on the severity of the disease. With a mild form of endometritis, body temperature usually rises only on the 5-7th day after birth, usually up to 38 ° C; in severe cases, the first symptoms appear already on the 2-4th day; body temperature can reach 40° C.
Pain in the lower abdomen. They may be minor and intermittent in the lower abdomen with endometritis mild degree and intense, constant, radiating throughout the abdomen and lower back in severe forms of the disease.
Lochia ( postpartum discharge from the genital tract) long time(more than 14 days after birth) remain bright, then acquire a brown-brown color, with an unpleasant odor.
The uterus contracts poorly, the height of the uterine fundus does not correspond to the day of the postpartum period.
Phenomena of general intoxication: chills, weakness, loss of appetite, headaches.

Diagnostics
IN general analysis blood is detected increased amount leukocytes, i.e. leukocytosis, sometimes - a decrease in hemoglobin levels.
At ultrasound examination in the uterine cavity, remains of placental tissue, membranes, blood clots, and subinvolution of the uterus are found (the uterus contracts poorly, its size does not correspond to the day of the postpartum period).

Treatment
If subinvolution of the uterus is detected, a careful expansion of the cervical canal is carried out in order to create conditions for the outflow of the contents of the uterine cavity; if there is a lot of content, vacuum aspiration or curettage is performed 3.
Currently, in many clinics and maternity hospitals, the uterine cavity is washed with chilled antiseptic solutions.
Antibacterial therapy- the main method of treatment. Antibiotics are used wide range, since many infections are caused by the association of several microbes. When choosing an antibiotic, it is based on which microbe most often causes a particular inflammation, whether the antibiotic is excreted in milk, and whether it affects the child. If the antibiotic does not provide sufficient effect within 2-3 days, it is changed to another. The method of taking antibacterial drugs depends on the severity of endometritis: for the disease light form you can limit yourself to tablets antibacterial drugs; in severe cases of endometritis, antibiotics are administered intramuscularly or intravenously.
Infusion (detoxification) therapy ( intravenous administration drugs) is carried out to eliminate the effects of intoxication and improve blood circulation. Infusion therapy must be carried out for both mild and severe course endometritis. To carry it out, glucose solutions are used (5, 10, 20%), saline solution(0.9% sodium chloride solution), etc.
For all forms of endometritis, immunocorrective therapy is carried out, which helps strengthen the body's defenses and increases immunity (drugs such as Viferon, Kipferon, etc. are used).
HBO ( hyperbaric oxygen therapy) is a type of therapy that helps saturate the body's cells with oxygen. At infectious diseases Cells of any nature suffer from hypoxia - lack of oxygen. The therapy process consists of allowing the woman to breathe a mixture of increased content oxygen through a mask. This therapy is very effective for initial manifestations endometritis, enhances protective forces body.

Prevention
Frequency postpartum endometritis can be significantly reduced by prophylactic antibiotics when the risk of its development is relatively high (after cesarean section, manual entry into the uterine cavity, with an anhydrous interval of more than 12 hours). Also, before giving birth (ideally before pregnancy), it is necessary to conduct an examination and eliminate the infection of the birth canal.
CHORIOAMNIONITIS (INFLAMMATION OF THE AMIGONAL MEMBRANES)

Most often occurs with premature rupture of membranes. As the anhydrous interval during labor increases, the risk increases intrauterine infection fetus

Symptoms
During a relatively long anhydrous period (6-12 hours), a pregnant woman or woman in labor experiences an increase in body temperature, chills, purulent discharge from the genital tract, and an increase in heart rate. In every fifth woman, chorioamnionitis turns into postpartum endometritis.

Treatment
When signs of chorioamnionitis appear, intensive delivery is carried out (labor stimulation, and in case of persistent weakness of labor forces - C-section) against the background of antibacterial and infusion therapy.

Prevention
During childbirth or surgery, it is imperative to monitor the state of the function of the woman’s vital organs, especially the state of the blood coagulation system, since due to poor contraction of the uterus and/or a decrease in blood coagulation ability, blood clotting may develop. heavy bleeding, which sometimes leads to the need to remove the uterus.
POSTPARTUM MASTITIS (INFLAMMATION OF THE BREAST GLAND) AND LACTOSTASIS (MILK STAGNATION)

Postpartum mastitis occurs in 2-5% of cases, more often in primigravidas. 9 out of 10 women with purulent mastitis are admitted to surgical hospital from home, since this disease most often begins at the end of the 2nd and during the 3rd week, and sometimes a month after birth.
This is a disease of nursing mothers: if there is no lactation, there is no postpartum mastitis. In 80-90% of cases it is caused Staphylococcus aureus. Infection occurs when a microorganism penetrates through a crack in the nipple in the lactating gland. This is the main difference between mastitis and lactostasis (accumulation and “stagnation” of milk in the mammary gland), since lactostasis develops without the presence of cracked nipples. Mastitis is usually one-sided, but can occur on both sides.

Symptoms
Increase in body temperature to 38.5-39° C and above.
Pain in the mammary gland that is local in nature.
Redness of the mammary gland in the affected area (most often in the area of ​​the upper outer quadrant of the 1st mammary gland), swelling.
During palpation (manual examination) of this area of ​​the mammary gland, painful, hardened areas are identified. Expressing milk is extremely painful and, unlike lactostasis, does not bring relief.
Phenomena of general intoxication: chills, headaches, weakness, etc.

Diagnostics
Examination, palpation of the mammary glands.
Ultrasound of the mammary glands.
Bacteriological research milk.
The initial stage of mastitis should be distinguished from lactostasis. With lactostasis, there is a feeling of heaviness and tension in the mammary gland, there is no redness or swelling of the skin, milk is released freely, and pumping, unlike mastitis, brings relief. The general condition of women with lactostasis suffers little; after pumping, the body temperature normalizes and the pain stops.

Treatment of lactostasis
If you have lactostasis, you can massage your breasts under the shower jet. warm water, after which pumping becomes much easier. Physiotherapy procedures are also used (for example, warming up, electric current high frequency- devices “Ultraton”, “Vityaz”, etc.), without inhibiting lactation, milk is expressed (20-30 minutes before this, 2 ml of no-shpa is injected intramuscularly, immediately before expressing - oxytocin is administered intramuscularly). If there is no effect from physiotherapeutic procedures in combination with expressing milk, lactation is inhibited with parlodel or similar drugs.

Treatment of mastitis
Treatment should begin at the first symptoms of the disease, which significantly reduces the possibility of developing purulent inflammation of the mammary gland and surrounding tissues. Previously, when treating mastitis, they limited the amount of liquid they drank, which is now considered a gross mistake: to combat intoxication, a woman should drink up to 2 liters of liquid per day. Nutrition should be complete, aimed at increasing the body's resistance.
Antibacterial therapy is quite effective in stages 1 and 2 of mastitis.
At purulent mastitis(when an abscess develops - limited inflammation of the mammary gland - or phlegmon - diffuse purulent inflammation mammary gland) is carried out surgical treatment(opening an abscess, removing dead tissue within healthy tissue) against the background of antibacterial therapy.
Suppressing lactation with drugs increases the effectiveness of treatment several times. No type of mastitis can be treated without suppressing or inhibiting lactation. IN modern conditions Complete suppression of lactation is rarely used, only for purulent mastitis, but more often they resort to inhibition of lactation. If lactation is inhibited or suppressed by drugs, pumping should not be used, since this stimulates the production of prolactin by the pituitary gland and, accordingly, stimulates lactation. Even with initial stage mastitis, you should not breastfeed the child, due to the high risk of infection, as well as the entry into the child’s body of antibiotics and other medicines, inferior milk. Question about renewal breastfeeding is decided individually and only after control milk culture after treatment.

Prevention
Begins during pregnancy and includes rational nutrition, familiarizing women with the rules and techniques of breastfeeding, timely treatment cracked nipples, lactostasis, wearing a bra that does not compress the mammary glands, washing hands before feeding, air baths for 10-15 minutes after feeding.

High risk factors for the development of postpartum mastitis:
hereditary predisposition;
foci of purulent infection in the body;
mastopathy (the presence of compactions and small nodules in the mammary gland);
anatomical features nipples (inverted or flat nipples);
available chronic diseases internal organs, especially in the acute stage.
POSTPARTUM PYELONEPHRITIS (INFECTIOUS AND INFLAMMATORY KIDNEY DAMAGE)

Sometimes an increase in body temperature in the postpartum period is associated with an exacerbation of pyelonephritis (days 4-6 and 12-14 are considered critical periods). Chronic pyelonephritis worsens after childbirth or develops for the first time after them as a result of the ascending spread of infection from the bladder and genital tract.

Symptoms:
Temperature rises to 40° C.
Pain in the side (if pyelonephritis is unilateral).
Painful urination, constipation, general weakness.
Chills.

Diagnostics
With an increase in body temperature in the postpartum period, along with clinical analysis blood, it is also necessary to conduct a urine test so that pyelonephritis is not missed under the guise of endometritis or mastitis.

Treatment
Treatment is carried out with antibacterial drugs (depending on the severity of the disease, tablet drugs or antibiotics in the form of injection solutions are used). For support normal function kidneys are recommended drinking plenty of fluids using kidney tea. Same as with other inflammatory diseases postpartum diseases, infusion (detoxification) therapy is widely carried out.

During pregnancy, a woman has to deal with various diseases and difficulties. And after the baby is born, the woman thinks that all the troubles are over. But, unfortunately, sometimes various complications arise after childbirth.

Any woman should understand that during pregnancy, various changes and disturbances in the functioning of internal organs occur in the body. For everything to return to normal after childbirth, it takes some time - a month or two. It is at this stage that a young mother may encounter various complications.

Condition of the uterus after childbirth

Immediately after the birth of the baby, the uterus begins to contract very intensively and becomes like a ball. In the first day after the birth of the baby, the weight of the uterus is about a kilogram. After a week, her weight is halved. And only after a month and a half does it return to its previous size - approximately 50 grams.

All this time, uterine contractions cause a lot of discomfort to the young mother: pain in the lower abdomen very often occurs. Especially severe pain a woman experiences in the first few days. These painful sensations worsen during breastfeeding. The thing is that when a baby suckles, the woman begins to actively produce the hormone oxytocin. This hormone is responsible for stimulating uterine contractions, so the pain intensifies when feeding.

The cervix takes much longer to regain its shape - approximately fourteen weeks after birth. However, no matter how easy the birth is and no matter how much the baby weighs, the cervix will not fully recover to its previous size. But this does not in any way affect the woman’s well-being.

If a new mother's body lacks the hormone oxytocin, or if the uterus is too distended (if the baby weighed too much at birth), the uterus does not contract properly. This means that the uterine cavity is poorly cleaned. Because of this, the risk of developing postpartum acute endometritis increases significantly. Endometritis is an inflammation of the lining of the uterus. With this disease, a woman experiences very strong pain in the lower back and lower abdomen, a possible increase in temperature, weakness and profuse vaginal discharge with an unpleasant odor.

Injuries to the external genitalia

Many women soon after giving birth turn to gynecologists with complaints of severe pain in the vagina. Typically, such sensations occur after sexual intercourse. This is not surprising, since during childbirth the vagina is greatly deformed and stretched. After some time it is restored - after about one and a half to two months. By this time, the vaginal mucosa is also restored. Even if the birth took place without complications, the vaginal membrane is still injured - microcracks appear on it. And if the birth was difficult, then there may have been ruptures or cuts in the perineum. In such cases, recovery time will take much longer.

Gynecologists warn that after giving birth it is necessary to abstain from sexual intercourse for some time. But not all girls adhere to these recommendations. But in vain, because the risk of repeated injury to the vaginal mucosa by the penis is very high. Moreover, sometimes the injuries are very serious, and doctors have to stitch them up again.

Through unhealed microtraumas on the mucous membranes of the vagina during sexual intercourse, various microorganisms can enter, which can provoke an inflammatory process. During the inflammatory process, pain, deterioration, weakness, and fever also occur. If a girl who has recently given birth notices such symptoms, she needs to see a gynecologist as soon as possible. If help is not provided promptly, symptoms may worsen and serious complications may occur.

Complications from the cardiovascular system

If a woman gives birth to a baby late, after 35 years, then she may have problems with the cardiovascular system. Of course, no one is immune from this, even young mothers. The thing is that during pregnancy the volume of blood circulation increases. As soon as the baby is born, this volume begins to decrease and after about a week it returns to normal. But such drastic changes often affect blood vessels and the heart. Therefore, if a woman has any problems with the cardiovascular system, then she should be constantly examined by a doctor and monitor her health. Very often in the postpartum period they begin various complications: increased heart rate, pain in the heart area, etc.

In the first two weeks after birth, a young mother’s blood contains a large number of platelets. This is due to the fact that the blood clotting system begins to actively work about a day before birth, as the body prepares itself for bleeding. This natural process helps prevent excessive blood loss. But due to the increased platelet content, there is a high risk of blood clots that can clog blood vessels. Thromboembolism is a very serious disease that can lead to serious complications and even to death.

Bladder complications

Often after childbirth, a woman has problems with bladder. The tone of the smooth muscles of the bladder decreases, as a result of which a woman may not feel the urge to urinate. Therefore, in the first few days after childbirth, a woman should visit the toilet every two hours. If bladder will be overcrowded, it will prevent the uterus from contracting fully. Because of this, the uterus will not remove postpartum secretions, which can lead to inflammatory processes.

Problems with the gastrointestinal tract

After childbirth, the tone of the gastrointestinal tract decreases. As a result, women often experience constipation. Every third woman in labor suffers from this problem. To get rid of this problem, doctors recommend:

• Physical impact. This method is not only the simplest, but also the most effective. Direct the warm shower stream towards bottom part belly. Water pressure stimulates receptors and enhances intestinal motility. You can massage the abdomen. Simply stroke your belly in a clockwise direction in a circular motion. This must be done for ten minutes three times a day.
• Proper nutrition. It is very important to eat right. Include apples, prunes, zucchini and pumpkin in your diet.

In addition to constipation, there is another problem -. Approximately 75% of women giving birth experience this disease. In mild cases, hemorrhoids are small and disappear on their own in about a week. If hemorrhoids are large, they cause a lot of discomfort and have to be removed surgically.

In what cases should you consult a doctor?

Let's summarize the above. A young mother very often has to deal with postpartum complications. Some of them do not pose a health threat, but some can lead to serious complications. And to avoid these complications, you need to consult a doctor in time.

• Pain in the abdominal area. Moderate pain is normal physiological phenomenon, but if the pain is too strong and radiates to the lower back, then the woman needs to see a gynecologist as soon as possible. Perhaps inflammatory processes have begun to develop. The doctor will order an examination and identify the cause, after which he will prescribe treatment.
• Condition of seams. If a woman has had stitches, they must be constantly monitored. If the sutures begin to bleed, turn red, or appear bloody spots, you should immediately consult a doctor.
• Vaginal discharge. If after childbirth they have changed vaginal discharge: they have become more abundant, have changed their consistency, smell or color, then this should be a cause for concern. Therefore, it is necessary to contact a gynecologist.

After giving birth, a woman often feels like all her worries are behind her. But, alas, sometimes the first, happiest days or weeks of the life together of mother and baby are overshadowed by various complications, not the least of which are postpartum purulent-septic diseases of the mother.

Reasons

Postpartum inflammatory diseases are often caused by opportunistic microbes that inhabit the body of any person. They constantly live on the skin, mucous membranes, and in the intestines, without disturbing their “owner,” but under certain conditions they can cause disease. And childbirth, especially if it is accompanied by large blood loss, leading to anemia and, accordingly, a decrease in the body’s defenses, can become this favorable condition for the activation of microbes. The cause of inflammatory processes in the postpartum period can also be sexually transmitted infections (gonococci, chlamydia, mycoplasma, etc.). There are also associations of 2-3 microbes that enhance each other’s pathogenic properties.

Blood loss during childbirth, anemia, vitamin deficiency, disorders of the blood coagulation system, remnants of placental tissue or membranes in the uterine cavity, surgical interventions during childbirth, cracked nipples, severe pregnancy and childbirth, a long anhydrous interval during childbirth - these are the main conditions that support the infection.

Currently, the most common postpartum endometritis (inflammation of the uterus), chorioamnionitis (inflammation of the membranes and uterus during childbirth), mastitis (inflammation of the mammary gland), pyelonephritis (inflammation of the kidneys) and, much less frequently, thrombophlebitis of the pelvic veins (inflammation of the pelvic veins, often complicated by thrombosis), peritonitis (inflammation of the peritoneum) and sepsis (general blood poisoning).

To avoid the development of severe complications, early diagnosis of these diseases at the first symptoms is very important; it is even better to prevent them through preventive measures in a group of high-risk women.

Let us dwell on the most common postpartum complications of an inflammatory nature.

Postpartum endometritis (inflammation of the uterine cavity)

Most often occurs after cesarean section, manual examination of the postpartum uterus, manual separation of the placenta and discharge of the placenta (if independent separation of the placenta is difficult due to impaired contractile function of the uterus), with a long anhydrous interval (more than 12 hours), in women admitted for childbirth with inflammatory diseases of the genital tract (for example, due to sexually transmitted infections), in patients with a large number of abortions in the past.

There is a pure form of endometritis, which is much less common (in 15% of cases) and develops without remnants of placental tissue, and endometritis against the background of remnants of placental tissue, retained membranes, blood clots, sutures placed with catgut (one of the types of suture material made from animal tendons, which often causes inflammatory reactions. Now rarely used) after cesarean section.

Endometritis is classified into mild, moderate and severe. As a rule, these forms differ from each other in the degree of severity, the degree of general intoxication (from the Greek toxikon - poison) - a painful condition caused by the action of bacteria, viruses, harmful substances) of the body and the required duration of treatment.

Symptoms

• Increased body temperature, usually from 1 to 7 days after birth, depending on the severity of the disease. With a mild form of endometritis, body temperature usually rises only on the 5-7th day after birth, usually up to 38°C; in severe forms, the first symptoms appear already on the 2-4th day, body temperature can reach 40°C.
• Pain in the lower abdomen. They can be insignificant and intermittent in the lower abdomen with mild endometritis, and intense, constant, extending throughout the abdomen and lower back with a severe form of the disease.
• Lochia (postpartum discharge from the genital tract) remains bright for a long time (more than 14 days after birth), then acquires a brownish-brown color, with an unpleasant odor.
• The uterus contracts poorly, the height of the uterine fundus does not correspond to the day of the postpartum period.
• Phenomena of general intoxication: chills, weakness, loss of appetite, headaches.

Diagnostics

A general blood test reveals an increased number of leukocytes, i.e. leukocytosis, sometimes - a decrease in hemoglobin levels. Ultrasound examination in the uterine cavity reveals the remains of placental tissue, membranes, blood clots, subinvolution of the uterus (the uterus contracts poorly, its size does not correspond to the day of the postpartum period).

Treatment

• If subinvolution of the uterus is detected, a careful expansion of the cervical canal is carried out in order to create conditions for the outflow of the contents of the uterine cavity; if the contents of the uterine cavity, vacuum aspiration or curettage is performed (Vacuum aspiration - suction of the contents of the uterine cavity using a special device. Curettage - removal of the contents of the uterine cavity and the surface layer of the endometrium using special tool- curettes).
• Currently, in many clinics and maternity hospitals, the uterine cavity is washed with chilled antiseptic solutions.
• Antibacterial therapy is the main method of treatment. Broad-spectrum antibiotics are used, since many infections are caused by the association of several microbes. When choosing an antibiotic, it is based on which microbe most often causes a particular inflammation, whether the antibiotic is excreted in milk, and whether it affects the child. If the antibiotic does not provide sufficient effect within 2-3 days, it is changed to another. The method of taking antibacterial drugs depends on the severity of endometritis: for mild cases of the disease, you can limit yourself to tableted antibacterial drugs; in severe cases of endometritis, antibiotics are administered intramuscularly or intravenously.
• Infusion (detoxification) therapy (intravenous administration of drugs) is carried out to eliminate the effects of intoxication and improve blood circulation. Infusion therapy should be carried out for both mild and severe endometritis. To carry it out, glucose solutions (5, 10, 20%), physiological solution (0.9% sodium chloride solution), etc. are used.
• For all forms of endometritis, immunocorrective therapy is carried out, which helps strengthen the body's defenses and increases immunity (drugs such as Viferon, Kipferon, etc. are used).
• HBOT (hyperbaric oxygen therapy) is a type of therapy that helps saturate the body's cells with oxygen. In infectious diseases of any nature, cells suffer from hypoxia - lack of oxygen. The therapy process consists of allowing the woman to breathe a mixture with a high oxygen content through a mask. This therapy is very effective in the initial manifestations of endometritis and strengthens the body's defenses.

Prevention

The incidence of postpartum endometritis can be significantly reduced by prophylactic antibiotics when the risk of its development is relatively high (after cesarean section, manual entry into the uterine cavity, with an anhydrous interval of more than 12 hours). Also, before giving birth (ideally before pregnancy), it is necessary to conduct an examination and eliminate the infection of the birth canal.

Chorioamnionitis (inflammation of the membranes)

Most often occurs with premature rupture of membranes. As the anhydrous interval during labor increases, the risk of intrauterine infection of the fetus increases.

Symptoms

• During a relatively long anhydrous period (6-12 hours), a pregnant woman or woman in labor experiences an increase in body temperature, chills, purulent discharge from the genital tract, and an increase in heart rate. In every fifth woman, chorioamnionitis turns into postpartum endometritis.

Treatment

When signs of chorioamnionitis appear, intensive delivery is carried out (labor stimulation, and in case of persistent weakness of labor forces - cesarean section) against the background of antibacterial and infusion therapy.

Prevention

During childbirth or surgery, it is imperative to monitor the state of function of the woman’s vital organs, especially the state of the blood coagulation system, since due to poor contraction of the uterus and/or a decrease in blood clotting ability, severe bleeding may develop, which sometimes leads to the need to remove the uterus .

Postpartum mastitis (inflammation of the mammary gland) and lactostasis (milk stagnation)

Postpartum mastitis occurs in 2-5% of cases, more often in primigravidas. 9 out of 10 women with purulent mastitis are admitted to the surgical hospital from home, since this disease most often begins at the end of the 2nd and during the 3rd week, and sometimes a month after birth.

This is a disease of nursing mothers: if there is no lactation, there is no postpartum. In 80-90% of cases it is caused by Staphylococcus aureus. Infection occurs when a microorganism penetrates through a crack in the nipple in the lactating gland. This is the main difference between mastitis and lactostasis (accumulation and “stagnation” of milk in the mammary gland), since lactostasis develops without the presence of cracked nipples. Mastitis is usually one-sided, but can occur on both sides.

Symptoms

• Increase in body temperature to 38.5-39°C and above.
  • Pain in the mammary gland that is local in nature.
  • Redness of the mammary gland in the affected area (most often in the area of ​​the upper outer quadrant of the mammary gland. The mammary gland is conventionally divided into 4 quadrants: upper and lower outer and upper and lower posterior), swelling.
• During palpation (manual examination) of this area of ​​the mammary gland, painful, hardened areas are identified. Expressing milk is extremely painful and, unlike lactostasis, does not bring relief.
  • Phenomena of general intoxication: chills, headaches, weakness, etc.

Diagnostics

• Examination, palpation of the mammary glands.
• Ultrasound of the mammary glands.
• Bacteriological examination of milk.

The initial stage of mastitis should be distinguished from lactostasis. With lactostasis, there is a feeling of heaviness and tension in the mammary gland, there is no redness or swelling of the skin, milk is released freely, and pumping, unlike mastitis, brings relief. The general condition of women with lactostasis suffers little; after pumping, the body temperature normalizes and the pain stops.

Treatment of lactostasis

If you have lactostasis, you can massage your breasts under the shower with a stream of warm water, after which pumping will become much easier. Physiotherapy procedures are also used (for example, warming up, high-frequency current exposure - "Ultraton", "Vityaz" devices, etc.), without inhibiting lactation, milk is expressed (20-30 minutes before this, 2 ml of No-shpa is injected intramuscularly, immediately before pumping - intramuscularly). If there is no effect from physiotherapeutic procedures in combination with expressing milk, lactation is inhibited with parlodel or similar drugs.

Treatment of mastitis

Treatment should begin at the first symptoms of the disease, which significantly reduces the possibility of developing purulent inflammation of the mammary gland and surrounding tissues. Previously, when treating mastitis, they limited the amount of liquid they drank, which is now considered a gross mistake: to combat intoxication, a woman should drink up to 2 liters of liquid per day. Nutrition should be complete, aimed at increasing the body's resistance.

• Antibacterial therapy is quite effective in stages 1 and 2 of mastitis
• For purulent mastitis (when an abscess develops - limited inflammation of the mammary gland - or phlegmon - diffuse purulent inflammation of the mammary gland), surgical treatment is performed (opening the abscess, removing dead tissue within healthy tissue) against the background of antibacterial therapy.
• Suppressing lactation with drugs increases the effectiveness of treatment several times. No type of mastitis can be treated without suppressing or inhibiting lactation. In modern conditions, complete suppression of lactation is rarely used, only for purulent mastitis, but more often they resort to inhibition of lactation. If lactation is inhibited or suppressed by drugs, pumping should not be used, since this stimulates the production of prolactin by the pituitary gland and, accordingly, stimulates lactation. Even at the initial stage of mastitis, you cannot breastfeed a child, due to the high risk of infection, as well as the intake of antibiotics and other medications into the child’s body, and the inferiority of milk. The issue of resuming breastfeeding is decided individually and only after control milk culture after treatment.

Prevention

It begins during pregnancy and includes a balanced diet, familiarizing women with the rules and techniques of breastfeeding, timely treatment of cracked nipples, lactostasis, wearing a bra that does not compress the mammary glands, washing hands before feeding, air baths for 10-15 minutes after feeding.

High risk factors for the development of postpartum mastitis:

• hereditary predisposition;
• foci of purulent infection in the body;
• mastopathy (the presence of compactions and small nodules in the mammary gland);
• anatomical features of nipples (inverted or flat nipples);
• existing chronic diseases of internal organs, especially in the acute stage.