Puerperal infections occur more frequently among pregnant women, and we need to be aware of their harm. We also need to understand the pathogenic factors and take reasonable prevention measures during or after childbirth.
Causes of puerperal infection
1. Infection
(1) Self infection: Pathogens that parasitize the reproductive tract or other parts of normal pregnant women, causing a decrease in the body's resistance to infection and causing disease. Pregnant women's reproductive tract pathogens can not only cause postpartum infections, but also indirectly infect the fetus through the placenta, membranes, and amniotic fluid during pregnancy, leading to miscarriage, premature birth, stillbirth, IUGR, premature rupture of membranes, and so on. Some pathogens are infected, and during pregnancy, only local symptoms such as vaginitis and cervix are present, often not taken seriously by patients. It occurs when the body's resistance is low after childbirth.
(2) External infection: Infection caused by contact with contaminated clothing, tools, various surgical instruments, coatings, etc. Often related to lax aseptic procedures. The unclean care and contact of visitors and companions during postpartum hospitalization are extremely important sources of postpartum infection and are also easily overlooked infection factors, which should be highly valued by obstetricians, hospital managers, and the general public.
(3) Infectious pathogens: There are various types of pathogens in postpartum infections, including Streptococcus, Escherichia coli, anaerobic bacteria, etc. Among them, the occurrence of mixed infections of endogenous aerobic and anaerobic bacteria tends to gradually increase.
① Aerobic Streptococcus: The main pathogen of exogenous infections, especially group B β- Hemolytic Streptococcus (GBS) produces exotoxins and tissue lytic enzymes, which have strong pathogenicity, virulence, and emanation, and can cause serious postpartum infections. Its clinical characteristics are early fever, body temperature often exceeding 38 ℃, accompanied by chills, increased heart rate, abdominal distension, anorexia, nausea, poor uterine involution, pain in the parauterine or adnexal area, and rapid development. People are prone to complications such as bacteremia and sepsis.
② Escherichia coli is one of the main pathogens of exogenous infections, including Escherichia coli and its related Gram negative bacteria, Proteus, etc. It is also the most common pathogen of bacteremia and septic shock. There are parasites around the vagina, urethra, and perineum, which usually do not get sick. During the postpartum period, when the body's resistance is low, it can quickly proliferate and develop diseases.
③ Staphylococcus aureus mainly consists of Staphylococcus aureus and Staphylococcus epidermidis. Staphylococcus aureus is mostly an exogenous infection, and Staphylococcus epidermidis, which is prone to causing severe wound suppurative infections, exists in the vaginal microbiota with mild infection. It is worth noting that Staphylococcus can produce penicillinase and is resistant to penicillin.
④ Anaerobic Streptococcus: It exists in the normal vagina and can rapidly multiply in large quantities when the production tract is damaged or the body's resistance is reduced. It can be mixed with Escherichia coli for infection, and the secretion is abnormally foul smelling.
⑤ Anaerobic bacteria, including fragile bacteria, pigmented bacteria, etc., are absolutely anaerobic Gram negative bacteria. This type of bacteria accelerates blood clotting and can easily cause thrombophlebitis.
⑥ Non tuberculosis Mycobacterium: Although rare, it is highly pathogenic and highly infectious. Prolonged non healing of perineal and cesarean section incisions can lead to contact infection of newborns.
⑦ External infection: In addition, due to many negative social phenomena, there is a trend of increasing postpartum infections caused by various infectious pathogens such as gonococcal, mycoplasma, and chlamydia. In addition, Clostridium can also cause postpartum infections, but it is relatively rare.
2. Inducing factors related to childbirth
(1) Premature rupture of membranes: The intact membranes play an effective barrier role against the invasion of pathogens. Rupture of membranes causes upward infection of pathogens in the vagina, which is the main reason for pathogens to enter the uterine cavity and further invade the fallopian tubes, pelvis, and abdominal cavity. If it is difficult to merge intrauterine fetuses, fetal defecation contaminates amniotic fluid and feces, which is also one of the good cultivation bases for pathogens.
(2) Prolonged labor process: Prolonged labor process, delayed production, multiple anal and vaginal examinations increase the chance of pathogen invasion.
(3) Cesarean section: Strict aseptic measures during cesarean section, improper suturing of uterine incisions, and a 20 times higher incidence of endometritis compared to vaginal delivery, accompanied by severe abdominal wall incision infections, especially caused by mycobacteria.
(4) Improper use of instruments: Improper or excessive use of intrauterine instruments during production, such as intrauterine fetal electrocardiogram monitoring, fetal scalp blood collection, etc., can directly bring vaginal and cervical pathogens into the uterine cavity for infection.
(5) Surgical procedures: Various obstetric surgical procedures, birth canal injuries, prenatal and postpartum bleeding, uterine cavity filling with gauze, foreign bodies in the birth canal, and residual placenta are all causes of postpartum infection.
Preventing puerperal infections
1. Pay attention to postpartum hygiene: Pay attention to rest and ensure sufficient sleep. Postpartum is in a state of fatigue, excitement, and joy, and postpartum women are prone to insufficient sleep. Adequate sleep and rest can help their bodies recover quickly. Husbands and family members should actively share household chores, take care of their babies and postpartum women, and take sleeping pills. Maintain personal hygiene. Adhere to hygiene habits such as washing face, brushing teeth, and washing feet. Pay special attention to the cleanliness of the perineum, wash it at least once a day in the morning and evening, and replace the perineal pad immediately.
2. Postpartum activities are reasonable: The postpartum period is the stage for the mother's physical recovery, but the mother is not completely bedridden and unable to move. Appropriate activities and reasonable exercise can help the mother recover. If there is no disease, the amount of activity can be gradually increased and postpartum gymnastics can be performed. After 1-2 days postpartum, bedridden and bedridden, one can get out of bed for bowel movements. After 2-3 weeks postpartum, one can engage in daily light labor, but it is necessary to avoid squatting and increased abdominal pressure.
3. Psychological regulation: To maintain a happy and relaxed mood, and have confidence in one's own recovery and the growth of the newborn. In addition, psychological balance can increase milk.
4. Sexual activity and contraception: Sexual activity is prohibited during the postpartum period. During this period, the uterus is in a stage of wound bleeding and easy infection. Postpartum lochia cleaning takes 6-8 weeks, and sexual activity is prohibited within 2 months after delivery. Once sexual activity resumes after childbirth, corresponding contraceptive measures must be taken, and the practice of replacing contraception with breastfeeding is unreliable.
5. Changing Bad Hygiene Habits: Chinese women are accustomed to having a confinement after giving birth. They cannot go out for 100 days, cannot be exposed to the wind, cannot touch cold water, and must close doors and windows in the summer. They also have to urinate and urinate in the room. There are also taboo customs, such as not eating fruits, afraid of bad teeth, and cannot take a shower, wash their hair, or feet after giving birth
6. Ensure adequate rest: If a new mother experiences significant physical exertion and discomfort after giving birth, it is important to rest more. If family members can help, try to entrust the baby to their care, and the mother should focus on rest and accelerate physical recovery.
7. Ensure sufficient water: Some new mothers do not want to drink too much water due to traditional taboos, but for new mothers who have already experienced mattress infections and poor urination, water supplementation is very important, so it is best to supplement around 2000 milliliters of water every day.
8. Keep the wound dry: New mothers who undergo a cesarean section can start showering and wiping their bodies with a damp towel 7-10 days postpartum to reduce wound infections. The wound should be kept dry at all times.
9. Moderate increase in nutrition: Postpartum nutrition is important for new mothers, but moderate intake can help with physical recovery and increased resistance, reducing the incidence of postpartum infections. If the new mother has already developed a postpartum infection, it is best to stop using rice, wine, and vegetable supplements, such as sesame oil chicken, to prevent the situation from becoming more serious.