PELVIC INFECTION FOLLOWING DELIVERY AND ABORTION

The common organisms producing acute infection following delivery are anaerobic streptococcus, staphylococcus pyogenes, non-hemolytic streptococcus, E. coli and Bacteroides group. Too often, multiple organisms are present and it is difficult to pinpoint a particular organism responsible for a particular type of infection.

As previously mentioned, the defense is lost following childbirth and abortion. Malnutrition, unhygienic environment during delivery, dehydration and ketoacidosis during labor are the additional factors in underprivileged women. Infections are common following cesarean section.

Following abortion, especially when induced criminally, exogenous infection is quite likely and potentially virulent.

PATHOLOGY: -

The infection is either localized to the cervix, producing acute cervicitis or may affect the placental site producing endometritis. The infection may spread to the myometrium producing endomyometritis which is limited by a leucocytic barrier. On occasion, the infection spreads to the parametrium, usually to one side, through lymphatics or directly through the tear of the cervix; thereby gaining access to the base of the broad ligament. The infection may also spread upwards through the tubal openings into the tubal lumen producing endosalpingitis. Thus, the fallopian tube is affected either from outside following parametritis, through lymphatics producing perisalpingitis or through endosalpingitis. The ovary may be affected through involvement of the tube or following pelvic peritonitis. Thus, an acute tubo-ovarian mass is formed.

Spread of infection: Depending upon the virulence of the organisms and resistance of the host, the following events may occur.

The infection is localized principally to the cervix and subsequently develops into chronic cervicitis. The parametrial exudate may resolute completely leaving behind scarring or fibrosis or may undergo suppuration. The abscess so formed usually points above the inguinal ligament.

The tubal affection results in cornual block, hydro-salpinx or pyosalpinx following blockage of the fimbrial end. There may be peritonitis either localized or at times generalized.

In others, the tube may be adherent with the ovary, intestine and omentum producing tubo-ovarian mass, the abdominal ostium usually remaining patent. The pelvic veins may be involved producing thrombophlebitis, which is either confined to the pelvis or spreads upwards along the ovarian veins or downwards along the iliofemoral veins. The systemic effect varies from minimal to a fatal one, especially with gramnegative organisms following criminal abortion. The serious complications include septic shock, acute renal failure and disseminated intravascular coagulopathy.

CLINICAL FEATURES: -

The onset may be acute or insidious and the clinical picture varies widely depending upon the severity and spread of infection. But the chief complaints of varying magnitude are fever, lower abdominal and pelvic pain and offensive vaginal discharge following delivery or abortion.

On examination, the patient looks ill and may be restless. She likes to lie on her back with the legs flexed.

Pulse rate is rapid and is out of proportion to the temperature.

Abdominal examination reveals tenderness or even rigidity on lower abdomen.

Vaginal examination is painful. The discharge is offensive. The uterus is tender, more with movement of the cervix. The fornices are tender. Depending upon the spread, there may be unilateral or bilateral mass (tubo-ovarian), a unilateral tender indurated mass pushing the uterus to the contralateral side (parametritis) or a bulging fluctuating mass felt through the posterior fornix (pelvic abscess). Rectal examination is useful to corroborate the pelvic findings.

HOMOEOPATHIC MANAGEMENT OF PELVIC INFECTION: -

There is an excellent scope of managing many Gynecological conditions including Pelvic infections.

Sepia: - For pelvic infections with marked pain in lower abdomen or Pelvic area. Along with Pelvic pain, a prominent bearing down sensation in pelvis assists. In some cases, there is burning or griping in the uterus is present.

Merc Sol: - Used when there is excessive vaginal discharge. The symptoms that indicate the need for merc Sol include acrid, excoriating, and itchy discharge that cause a burning sensation in the vagina.

Phosphorus: - Where there is bleeding from the uterus between periods. The uterine bleeding tends to be profuse. Weakness usually follows the menstrual bleeding. Other symptoms include ovarian pain.

Sabina: - When there are heavy periods. The periods are profuse and gushing in nature. The bleeding is bright red colored with dark clots in it. The blood may have an offensive odour.

Medorrhinum:- When women experience intensely painful periods. There is an excruciating pain the pelvic area along with ovarian pains that get better with pressure