Puerperal fever

The puerperal fever ( other names are puerperal sepsis, postpartum and puerperal fever ) is an infectious disease that can occur after childbirth during the puerperium or after a miscarriage, especially in the case of incomplete placenta.

Pathogen

Causative agent of this infection can be staphylococci, streptococci, Escherichia coli, Neisseria gonorrhoeae, and various anaerobes. They penetrate through the large wound surface in the uterus, which is caused by removal of the placenta, into the body and bloodstream. The cervix is still open gaping in the days after birth, so that a direct connection between the uterus and the vagina is. Even with good industrial hygiene germs can easily ascend to the uterus. You will find there before a warm, nutrient-rich environment in which they proliferate. Usually, the bacteria are also transported across the lochia. Are the aftermath and the lochia is weak, it may lead to infection.

Symptoms

The disease is manifested by elevated temperature or fever, tenderness in the abdomen, foul-smelling lochia and possibly bleeding. A deterioration becomes noticeable by guarding the entire lower abdomen, nausea and vomiting, and shock symptoms, such as restlessness, strong pulse and respiratory acceleration and drop in blood pressure, apparent.

The consequences are inflammation of the peritoneum, the lining of the uterus and other organs, associated with severe attacks of fever and run without effective treatment in most cases within a few weeks to sepsis ( " blood poisoning" ) and death.

The often very painful inflammation of the uterus is countered in two ways. Against the bacteria, antibiotics are prescribed, the involution of the uterus is supported with the ergot alkaloid methylergonovine. The infection usually heals without consequences. The incidence of puerperal fever has been significantly reduced by antibiotic therapy and better hygienic conditions compared to earlier times.

History

Until the 19th century, puerperal fever was one of the main causes of the high Wöchnerinnensterblichkeit. Was further exacerbated the situation, as in the hospitals of the major European cities Gebäranstalten were established (for example, at the Hôtel -Dieu in Paris in the 17th century ) and even doctors in obstetrics were active. Above all, the doctors came in contact with other patients and corpses; because the need for effective disinfection was unknown, they abducted on her hands and instruments germs in the birth canal of women. In some institutions at times two-thirds of all new mothers died from this iatrogenic infection. Considered as a whole for the epidemiology, however, this had only marginal importance, since the vast majority of women still gave birth outside of hospitals.

In 1843, it was argued by Oliver Wendell Holmes, the claim that even doctors would transmit the disease. Four years later, Ignaz Semmelweis was able to show then that the poor hygienic conditions in hospitals and lack of cleanliness and disinfection of the doctors were the reason for the particularly high spread of the disease in Gebäranstalten. Semmelweis examined the mid-1840s, which is why at the Vienna General Hospital in the first Obstetric station ten times as many women in childbed fever died like in the second station. By a process of elimination, he came to the knowledge:

" The unknown cause which wreaked such horrible devastation was, therefore, found in the adhesive at the hand Cadavertheilen the examiner at the first Gebärklinik. "

But even such luminaries as Rudolf Virchow denied for decades the relationships. Thus, even in a textbook of 1897 by already existing in the body of the woman " foreign matter " the speech beginning " ferment " through the birth process to. Virchow leaves it open but here, where, by what or by whom this " foreign matter " had come into the body of the mothers.

Mythology

In ancient Mesopotamia, Lilith was a demon of puerperal fever.

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