Infected postpartum wounds

Infected postpartum wounds may present in different ways. Clinical signs of infection in wounds that heal by primary intention include:

1. complaints:

• for intense, often pulsating pain in the area of the wound;
• for an increase in body temperature - subfebrile or up to 38-39 °C;

2. local changes:

• hyperemia around the wound without positive dynamics;
• the appearance of tissue edema, which gradually increases;
• palpation reveals tissue infiltration, which often increases; the development of deep-seated infiltrates is possible (necrotizing fasciitis, which can spread to the buttocks, anterior abdominal wall, often with a fatal outcome);
• serous exudate quickly turns into purulent.

Clinical signs of infection development in wounds that heal by secondary intention:

• progressive swelling and tissue infiltration around the wound;
• the appearance of dense painful infiltrates without clear contours;
• signs of lymphangitis and lymphadenitis;
• the wound surface is covered with a continuous fibrin-purulent coating;
• slowing or cessation of epithelialization;
• granulations become pale or bluish, their bleeding decreases sharply;
• the amount of exudate increases, its nature depends on the pathogen.

The type of pathogen also determines the clinical course of the wound infection:

• staphylococcal infection is characterized by the lightning-fast development of a local process with pronounced manifestations of purulent-resorptive fever;
• streptococcal infection tends to spread diffusely in the form of phlegmon with weakly expressed local signs;
• Pseudomonas aeruginosa is characterized by a sluggish, protracted course of the local process after an acute onset, with pronounced manifestations of general intoxication.

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How to recognize infected postpartum wounds?

Bacteriological examination of exudate is performed to determine the pathogen and its sensitivity to antibiotics. The material must be collected before the start of antibiotic therapy. The material for the study may be exudate, pieces of tissue, and wound swabs. The material is collected with sterile instruments and placed in sterile test tubes or bottles with a standard medium. The material must be seeded within 2 hours after collection. Simultaneously with the collection of material for bacteriological examination, it is necessary to make at least two smears stained according to Gram for the purpose of approximate express diagnostics.

Accelerated methods of wound infection pathogen identification can be used using multimicrotest systems. The duration of the method is 4-6 hours,

In the absence of microbial growth in clinical material, the following causes must be excluded:

• the presence of high concentrations of local or systemic antibacterial drugs in the submitted material;
• violation of the conditions for storing and transporting samples;
• methodological errors in the bacteriological laboratory;
• effective control of the infectious wound process with antibacterial drugs;
• presence of anaerobic infection.

Treatment of infected postpartum wounds

In most cases, local treatment is sufficient. Treatment includes surgical, pharmacological and physiotherapeutic methods.

Surgical treatment of the wound

Primary treatment of the brine is performed according to primary indications. Repeated primary surgical treatment of the wound is performed if the first surgical intervention was not radical for one reason or another and there was a need for repeated intervention even before the development of infectious complications in the wound.

Surgical treatment of a wound consists of the following stages:

• removal of non-viable tissue from the wound, which is the substrate for primary necrosis;
• removal of hematomas (especially deep ones);
• final stopping of bleeding;
• restoration of damaged tissues.

Secondary wound treatment is performed for secondary indications, usually in connection with purulent-inflammatory complications of the wound. Repeated secondary wound treatment in severe forms of wound infection can be performed multiple times. In most cases, secondary surgical wound treatment includes:

• removal of the source of infectious and inflammatory alteration;
• wide opening of pockets, swims;
• complete drainage with provision of exudate outflow;
• use of local antiseptics.

Pharmacological methods are antibiotic prophylaxis and antibiotic therapy.

Antibiotic prophylaxis is the systemic administration of an antibacterial drug at the time of microbial contamination of the wound or the development of postoperative wound infection, as well as in the presence of signs of contamination, provided that the primary treatment is surgical. Antibiotic prophylaxis is prescribed when there is a risk of infection of massive wounds of the perineum, vagina and laparotomy wound during cesarean section.

Principles of antibacterial prophylaxis:

• in case of cesarean section without complications, it is carried out after the extraction of the child by a single intravenous administration of an antibiotic in an average daily dose, taking into account the results of antibiotic resistance of the identified hospital strains;
• if complications arise during surgery or signs of inflammation are detected, this same drug can also be used for antibiotic therapy;
• continued administration of antibiotics for 24 hours after the end of surgery does not increase the effectiveness of wound infection prevention;
• Preventive premature administration of antibiotics before surgery is inappropriate, as it leads to disruption of the biocenosis of the digestive tract and colonization of its upper sections. Antibiotic therapy is the use of antibiotics for long-term treatment in the event of an inflammatory process. Antibiotic therapy can be:
• empirical - based on the use of broad-spectrum drugs that are active against potential pathogens;
• targeted - drugs are used in accordance with the results of microbiological diagnostics.

Local use of antiseptics is of great importance. To cleanse the wound, you can use a 10% solution of sodium chloride, 3% solution of hydrogen peroxide, 0.02% solution of chlorhexidine, etc. For faster healing, you can use pads with levomekol, or levosin, or synthomycin, or solcoseryl ointment, etc.

Physiotherapeutic procedures during the convalescence period include UHF induction therapy, ultraviolet irradiation, and electrophoresis with medications.

Prevention of wound infection consists of rational management of labor and the postpartum period, compliance with the rules of asepsis and antisepsis.