Obstetrics and Gynecology - A.M. Gromova 2000

Postpartum Septic Conditions
Modern approaches to the treatment of postpartum septic conditions

1. Laser Blood irradiation.

2. Ultraviolet blood irradiation (UBI).

3. Hemo- and lymphosorption.

4. Plasmapheresis.

5. Uterine cavity flushing or lavage.

1. Laser blood irradiation.

The positive photobiological effect of low-intensity laser radiation involves the activation of the body's enzyme systems, the Generation of reactive oxygen species, the induction of oxidation processes, and the interaction of the electromagnetic field of the laser radiation with the cellular electromagnetic field, which facilitates the redistribution of free electrical charges within The Cell.

At THE CELLULAR LEVEL, the following reactions take place:

- increased mitotic activity and DNA and RNA Synthesis;

- accelerated biosynthetic and bioenergetic activity;

- accelerated reactions of Oxidative Phosphorylation, the Krebs cycle, and ATP synthesis;

- enhanced antioxidant defense;

- activation of superoxide dismutase, catalase, and ceruloplasmin;

- antimutagenic effect resulting from action on cellular DNA.

Because the helium-neon laser beam has an emission spectrum similar to that emitted by a living Organism, it activates cellular vitality.

The beam of a low-intensity quantum generator does not act directly on microbial Cells, but rather through boosting the body's defense mechanisms, which is a manifestation of the General adaptation syndrome.

In the comprehensive Treatment of septic postpartum and postoperative complications, both intravascular and external low-intensity laser blood irradiation are used.

During intravascular blood irradiation, a fiber-optic light guide is inserted through a puncture in the cubital or subclavian vein area. The irradiation mode is continuous, the radiation power is 4-5 mW, the exposure time is 30 minutes, and the wavelength is 0.63 mkm. A course of 7-10 sessions is used.

During external irradiation, the fiber-optic tip is placed over the projection site of the carotid artery in the carotid sinus region. The radiation power is 10 mW, and the exposure time is 600 s. The number of sessions and the irradiation mode are the same as for intravascular low-intensity laser blood irradiation.

External blood irradiation is more favorable than intravascular irradiation due to its non-invasiveness, simplicity of performance, and dual action (affecting both the blood flow moving through the vessels and the reflexogenic zone of the carotid sinus region).

2. UBI is performed using the "Isolda" apparatus. As early as 3-5 minutes after the Procedure begins, patients experience an increase in blood oxygen saturation. This elevated oxygenation persists for 30 days. Metabolic processes improve, and regeneration processes are stimulated.

3. Extracorporeal body detoxification.

Recently, a new and sufficiently effective method of extracorporeal detoxification—sorption of biological fluids, namely BLOOD AND Lymph—has been introduced into obstetrical and gynecological practice. The most widespread Methods are lympho- and hemosorption using activated charcoal.

Indications for hemo- and lymphosorption include escalating intoxication with signs of renal and hepatic insufficiency, despite ongoing intensive detoxification therapy and the elimination of the cause of Peritonitis.

Before starting the procedure, hemodilution is performed to reduce the hematocrit to 0.35. In case of circulating blood volume (CBV) deficit, adequate correction is carried out. Access to two large vessels is then established for blood withdrawal and return to the patient. Before connection to the apparatus, the patient is administered heparin at a dose of 500 IU/kg and premedication is prescribed.

During lymphosorption, external drainage of the thoracic lymphatic duct is performed in the neck area. The collected lymph is purified using sorbents and reinfused into the patient's vein.

4. Plasmapheresis.

Indications for plasmapheresis and patient preparation are similar to those for hemosorption. The plasmapheresis device consists of two circuits: in the first, the patient's blood is mixed with a heparinized isotonic sodium chloride solution and enters a rotor, where plasma and erythrocytes are separated. The plasma is extracted, while erythrocytes are mixed with plasma expanders and returned to the patient.

5. Uterine cavity lavage.

This procedure is performed to reduce the absorption of toxic substances in endometritis resulting from late-term abortion and the postpartum period. Under these conditions, the cervical canal easily accommodates a drainage tube, which is inserted into the uterine cavity under visual control.

Lavage can be performed using an aspiration-irrigation method with double-lumen silicone or polyvinyl chloride tubes. Fluid enters the Uterus through a narrow channel connected to an infusion set, while the contents are evacuated through a wider channel using electric aspirators.

A simplified approach can also be used: a single-lumen rubber catheter replaces the drainage tube, and the lavage fluid flows out of the uterine cavity by gravity. The antiseptic solutions, administered chilled, along with the catheter itself, act as potent stimulants that induce uterine contractions.

Antiseptics such as furacilin, dioxidine, an aqueous solution of chlorhexidine, as well as antibacterial agents, are widely used for lavage.

Lavage sessions are conducted daily for 3–5 days. The procedure lasts 1–2 hours, with a fluid volume of 500–1000 ml. Before the procedure, the solution is cooled to 4–5 С.

Review Questions

1. Incidence of purulent-septic diseases in the postpartum period.

2. Factors promoting infection development in the postpartum period.

3. Sazonov-Bartels Classification of septic conditions.

4. Main symptoms of endometritis.

5. Complications of Postpartum Endometritis.

6. Symptoms of generalized forms of postpartum infection.

7. Modern Methods of treating Postpartum septic conditions.