1. Endometritis
[predilection time]: it mainly occurs about 2 weeks after delivery.
[source of infection]: cesarean section, long labor process and water breaking time, injury in the process of production, maternal anemia and lower socio-economic class were the five main factors. Endometritis is the most common cause of fever in puerperium. The incidence was about 3.8%. It may be the result of previous inflammation of the amniotic cavity, and subsequent inflammation of the uterine muscle layer, salpingitis, pelvic abscess, etc.
[treatment method]: antibiotics are still the main treatment. In the process of treatment, special attention should be paid to the bacteria resistant to penicillin. If the clinical treatment effect is not good, the direction of antibiotic use should be considered.
2. Wound inflammation after caesarean section
[predilection time]: mainly occurred in 1-2 weeks after cesarean section.
[source of infection]: as the wound of caesarean section is larger than that of natural birth, the amount of bleeding also increases; generally speaking, the average increase of bleeding is 100-1000 C.C., sometimes more. As long as the operation time is longer and the amount of bleeding is more, the chance of wound infection will increase, which is a complication of less natural production. After cesarean section, the wound healing time is longer than that of natural birth. In addition, there is a wound scar on the uterus. This wound may cause wound rupture or uterine rupture in the next pregnancy. Once it occurs, the maternal and fetal mortality is very high. In order to avoid this kind of tragedy, in addition to a period of time for the wound to recover, the disinfection of the wound, the use of suture, and surgical techniques are all methods to prevent uterine rupture.
[treatment method]: depending on the condition of the wound, if the inflamed part of the wound is small, oral antibiotics can be considered. If the inflamed area of the wound is large, oral antibiotics must be taken into consideration, and wound expansion operation, frequent dressing change, and subsequent wound re suture operation should be performed.
3. Mastitis
[predilection time]: usually 10-14 days after delivery.
[source of infection]: mastitis is caused by Staphylococcus aureus. The pathogenic bacteria usually come from the mouth and nose of the baby, and then reside in the nipple and areola of the mother. When the nipple has pathological changes or cracks, the pathogenic bacteria will go up to the lactation system, resulting in the retention of milk, forming a medium for the growth of bacteria. True mastitis is different from local inflammation of the breast caused by breast duct obstruction. The former is an infection caused by bacteria, which needs additional treatment to control the disease. The latter is a benign symptom, which can be improved by breast massage and frequent feeding. Pathologically, mastitis is more common in primipara, the main pathogenesis is the decline of postpartum body resistance, easy to make bacteria invasion, growth, reproduction.
[clinical features]: most of the patients begin with breast swelling and pain, and then a mass with obvious tenderness appears in the upper quarter of the breast. Breast swelling, pain, skin reddening, local skin temperature rising. If the treatment is not enough, symptoms such as high fever, shivering, pulse acceleration, ipsilateral lymph node enlargement and leukocytosis may appear.
[treatment method]: general treatment includes bed rest, hot compress, water intake and antibiotic treatment. Usually, after the breast milk is sucked out, the blockage of the breast feeding tube or mastitis will be improved within one day. If the symptoms are very serious, have obvious fever, fatigue symptoms, or the nipple is also cracked, or the milk is not improved within 24 hours after suction, you need to see a doctor. Once the use of drugs, even if the symptoms improve, still must eat a course of treatment, if early withdrawal, may relapse. These drugs will not affect the baby, can continue to feed. If the painful mass still exists after 5 days of continuous medication, it is necessary to consider whether it is suppurative. Aspiration of the contents of the mass with an empty needle is the simplest and correct way to judge. If it is suppurative, local anesthesia can be used for incision and drainage without hospitalization. Surgeons in the cut, will try to stay away from the areola, so as not to affect breastfeeding. Even if the doctor does not recommend feeding, or the mother does not want to feed the side, the contralateral breast can still be lactated.
[effect on baby]: the general nursing principle is to eliminate the milk and continue to feed and rest. During the period of infection, the mother should be able to continue to feed to avoid breast stagnation and breast swelling, which are the causes of infection and abscess. It is reported in the literature that feeding mother’s milk during the period of infection has no harm or adverse effect on the mother or infant, but some hospitals still think that feeding mother in the period of severe infection should be suspended to eliminate milk and prevent breast congestion and swelling.
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