Sepsis

Etiology and pathogenesis

Infection contamination generalisation, or sepsis, in obstetric practice in 90 % of cases is bound to the infectious locus in a uterus and educes as a result of attrition of anti-infectious immunodefence. The complicated flow of pregnancy contributes to sepsis development (the Serotinal toxicosis, an iron deficiency anaemia, virus infection contaminations, etc.), long flow of a childbed with the anhydrous interspace exceeding 24 hours, traumas of soft patrimonial pathes, an operative delivery, a bleeding and other complications of sorts which promote depression of nonspecific protective forces of an organism and frame conditions for infection contamination generalisation.

The sepsis proceeds in two forms: hematosepses and septicopyemias which meet approximately peer frequency. The hematosepsis arises at the relaxed women in childbirth in 3-4 days after sorts and proceeds roughly. As originators the Gram-negative flora acts, E. coli, the Proteus, is rarer a pyocyanic rod, is frequent in a combination with not sporogenous anaerobic flora. The septicopyemia proceeds wavy: the seasons of an aggravation of symptoms bound to an innidiation of an infection contamination and formation of the new locuses, are replaced by relative enriching. Septicopyemia development is caused by presence of Gram-positive flora, more often a golden staphilococcus.

Diagnostics

The diagnosis put taking into account following signs: presence of the locus of an infection contamination, a high fever with a fever, originator detection in blood. Though last sign tap only at 30 % of patients, in the absence of its diagnosis of a sepsis it should not be denied. At a sepsis observe disturbances of function a CNS, showing in euphoria, depression, sleep disturbance. The dyspnea, a cyanosis also can be implication of a generalised infection contamination. Pallor, a greyness or yellowness of integuments testify to sepsis presence. The tachycardia, lability of sphygmus, predilection to a hypotension also can be sepsis implication. The liver and a lien are enlarged. The important information is given by usual clinical analysis of blood: depression of a haemoglobin content and number of erythrocytes; a high leukocytosis and a lymphocytopenia, absence of eosinocytes, appearance of toxic granularity in neutrophils. The broken homeostasis shows a hypoproteinemia and a disproteinemia, a hypoglycaemia, a hypovolemia, a hyponatremia, a hyperosmolarity.

Treatment

Patients with a sepsis treat taking into account two directions: liquidation of the locus of an infection contamination and the complex therapy including antibacterial, detoxification, immunocorrigate, desensitizing, fortifying components. Sepsis treatment - business labour-consuming and expensive, but for salvage of the patient is not present other pathes. If necessary resort to a hemosorption and a lymphosorption. If the infection contamination locus is the uterus in 3 days of unsuccessful medicamental therapy effect its extirpation with excision of uterine tubes.