ABSTRACT
Background. Puerperal infection following caesarean section remains a major cause of maternalmorbidity and mortality. It is still one of actual problems in Obstetrics and has incidence rate 2-10%. It isestimated 150 000 maternal deaths due to infection worldwide, despite tendency to decline septicemiaafter C-section due to wide usage of antibiotics in the obstetric practice, postpartum infection hasincreased last decade. Post-Caesarean sepsis incidence rate is above 20%. An assortment of pathologicagents may cause puerperal infection including bacteria, virus and parasites. In 30-40s of last centurymain reason of infection was Streptococcus, then in 40-60s major role was played by Staphylococcus,later in 70-80s Gram-Negative Aerobic Bacteria took its place.Objective. To improve prevention and treatment of post-caesarean sepsis by detection of its causes andantibiotic sensitivity. Materials and methods: We reviewed patients admitted to First Maternity Hospitaland National Center for Maternal and Child Health and who had post-caesarean sepsis between 2011-2013. Statistics analysis had been performed by SPSS-17 software programme, whereas statisticsprocess by X2 test, Fisher test, and t-test. Confi rmation rate was 95%. P<0, 05.Results. The clinical course of 361 post-caesarean patients with septicemia was reviewed prospectively.Primary dysfunctional labour (P<0.033), preterm rupture of the membranes (P<0.0001), ineffectivelabour induction (P<0.001) are risk factors for infectious morbidity. Considerations should be given toprophylactic antibiotic therapy by choosing correct medicine at the correct time. E.coli 29,4%, Intestinalbacteria 9,1%, Staphylococcus epidermis’s 8,9%, Staphylococcus aureus 7,2%, Gram-NegativeBacteria 6,6%, Streptococcus 5,3%, Gram-Positive Bacteria 2,8%, Candida albicans 1,4%, Micoplasma1,1% were responsible for bacteremia, respectively.Conclusion. Bacteriology of all patients diagnosed with post-caesarean sepsis in 74, 7% was positivefor pathologic bacterial cultures. Infection caused by 1 bacteria in 141 cases (39, 1%), by 2 bacteria in 56cases (15, 5%), by 3 bacteria in 2 cases (0, 6%), without any detection of bacteria 162 cases (44, 9%).
ABSTRACT
Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.