Puerperal ulcer of a neck of uterus

Description:

The puerperal ulcer of a neck of uterus is directly connected with process of delivery and infection of patrimonial ways. The puerperal ulcer of a neck of uterus is carried to limited forms of a puerperal infection which develops against the background of traumatizing a neck of uterus at rapid, long or operational childbirth in natural patrimonial ways.
Internal gaps on a neck of uterus are most often formed at the end of the first period of childbirth at not completely open neck and can serve as entrance gate for an infection. Owing to infection of cracks or gaps mucous the cervical channel the puerperal ulcer of a neck of uterus can be created. On its surface there is a necrosis of fabrics to formation of a purulent plaque, hypostasis and a hyperemia of nearby fabrics develops.
The puerperal ulcer of a neck of uterus is considered as a certain stage of development of uniform infectious process in an organism of the given rise woman. At a stage of a puerperal ulcer of a neck of uterus the infection is localized within a uterus, but at extensive defeat and the wrong treatment can lead to development of complications, up to a generalized septic form. Processes of healing of a puerperal ulcer of a neck of uterus are quite often broken and considerably slowed down that can lead to synchronization of an inflammation.

Reasons of a puerperal ulcer of a neck of uterus:

The puerperal ulcer of a neck of uterus develops at penetration of microorganisms on a surface of a puerperal wound of the cervical channel. Pathogenic microflora can cause emergence of a puerperal ulcer of a neck of uterus: gonokokk, trichomonads, chlamydias, mycoplasmas. At decrease in immunity opportunistic microorganisms can act as causative agents of a puerperal ulcer of a neck of uterus: golden staphylococcus, hemolitic and anaerobic streptococci, laktozonegativny enterobakteriya (proteas, a klebsiyell), the hemolyzing colibacillus, strict and facultative anaerobes (clostridiums, bacteroids; peptokokk, peptostreptokokk, etc.), and also associations of microorganisms.
Risk factors of development of a puerperal ulcer of a neck of uterus are complications of patrimonial activity: premature izlity amniotic waters, long childbirth at a large fruit, uterine bleedings in the course of childbirth and an early puerperal period, operational childbirth with an injury of patrimonial ways (birth trauma), a long anhydrous interval in labor.
Disturbance of the sanitary and epidemiologic mode, invasive diagnosis during pregnancy and childbirth (transcervical amniocentesis and an amnioskopiya, a direct electrocardiography of a fruit), surgical treatment истмико - cervical insufficiency, frequent vaginal examonations at a rupture of covers of fetal egg and manual inspection of a cavity of the uterus) can serve as the reasons of puerperal complications, including a puerperal ulcer of a neck of uterus.
Existence at the woman in labor of persistent infections of generative organs promotes development of inflammatory process on site of a puerperal injury and to formation of a puerperal ulcer of a neck of uterus.

Symptoms of a puerperal ulcer of a neck of uterus:

The puerperal ulcer is formed on site a puerperal injury of a neck of uterus usually for 3 – 4 days after the delivery. The local symptomatology of a puerperal ulcer of a neck of uterus is characterized by existence of a dense purulent plaque of gray-yellow color on a wound surface, inflammation signs (reddening and puffiness) of peripheral fabrics, bleeding of an affected area.
The puerperal ulcer of a neck of uterus can be followed by the subfebrile temperature, morbidity, a febricula. At spread of an infection out of limits of a neck of uterus colpitises, vulvita with symptomatology, typical for them, – burning, belyam, an itch, a hyperemia mucous develop.
Usually in 4-5 days temperature is normalized, the health improves. At the favorable course of a puerperal ulcer of a neck of uterus there is a clarification of a wound from a plaque and its epithelization. Otherwise generalization of a septic infection is possible.

Diagnosis:

Diagnosis of a puerperal ulcer of a neck of uterus is based on clinical symptoms, the given gynecologic survey, laboratory and tool researches.
Gynecologic survey by means of mirrors reveals the wound defect on the surface of a neck of uterus covered with a fibrinopurulent or purulent plaque, puffiness and a hyperemia of surrounding fabrics.
In blood at acute process increase in leukocytes and SOE is found. Causative agents of a puerperal ulcer of a neck of uterus it is possible to establish by the PTsR method - diagnosis or a bacteriological research of allocations from the cervical channel. Bakposev carry out prior to antibacterial treatment.
In addition the gynecologist can appoint carrying out a kolposkopiya, ultrasonography, hysteroscopy, termografiya, etc.

Treatment of a puerperal ulcer of a neck of uterus:

At a puerperal ulcer of a neck of uterus the main method is topical treatment which is directed to removal purulent separated, antiseptic processing of a wound and acceleration of processes of regeneration. If on a neck of uterus stitches are put, they need to be removed for the period of treatment.
The puerperal ulcer of a neck of uterus is cleared of purulent plaques imposing of sterile gauze turundas from 10% sodium chloride solution, Furacilin, ointment applications with antibiotics (левомеколь, a synthomycin emulsion, Vishnevsky's ointment), nekrolitichesky enzymes (цигерол, trypsin, chymotrypsin). Napkins change every day, till that time until the ulcer is cleared of pus, - as a rule, it takes several days.
Epithelization of a puerperal ulcer of a neck of uterus usually comes to an end in 10 – 12 days. At the small surface of defeat the puerperal ulcer of a neck of uterus heals second intention, at extensive wounds put stitches.
After healing of the taken-in deep gaps cicatricial deformation of a neck of uterus can develop. This defect is adjusted afterwards by means of the laser, a radio knife or surgical methods – conization of a neck of uterus, bougieurage of the cervical channel.

Forecast:

Forecast of a puerperal ulcer of a neck of uterus in most cases favorable. At timely and adequate treatment the puerperal ulcer of a neck of uterus is cleared of pus and gradually epithelized. Now thanks to preventive actions, and also reasonable antibacterial therapy the gynecology seldom faces complications against the background of a puerperal ulcer of a neck of uterus.

Prevention:

Prevention of a puerperal ulcer of a neck of uterus has to include treatment of inflammatory gynecologic and extragenital diseases when planning pregnancy, sanitation of patrimonial ways, rational conducting childbirth and a puerperal period, processing of puerperal seams, observance of rules of an asepsis, antiseptics and personal hygiene.