1ST CITY CLINICAL HOSPITAL

Currently, there are groups of factors predisposing to the development of local intrauterine infection related to the state of the mother’s body before and during pregnancy and directly related to childbirth.

A comprehensive system of measures to prevent purulent-septic complications of the postpartum period involves the provision of preventive care at the outpatient (starting from the moment of pregnancy planning) and inpatient (during hospitalization for the purpose of delivery) stages, taking into account the risk prediction of postpartum endometritis based on identified risk factors.

I. Stage - provision of outpatient care:

a) before gestation – preconceptional preparation of women at risk;

b) during gestation - up to 12 weeks of pregnancy, a comprehensive examination of women to identify existing disorders, taking into account general clinical, immunological, bacteriological indicators in order to carry out timely correction of the identified pathology; from 16-18 weeks of gestation - prevention and treatment of isthmic-cervical insufficiency, gestosis, anemia and other complications of pregnancy; early detection of bacterial and other infections of various localizations, examination for sexually transmitted diseases, their timely treatment under the control of the results of bacteriological studies; timely identification of disorders in the formation of the psychological component of the gestational dominant (PCGD) with subsequent psychological risk correction.

II. The stage of providing inpatient obstetric care includes:

A. General preventive measures:

1) before birth - pathogenetic and reasonable therapy for the identified pathology;

2) during childbirth (surgery) - compliance with the medical and protective regime, aseptic and antiseptic rules; prevention of bleeding in the afterbirth and early postpartum period; careful suturing of ruptures of the cervix, vagina and perineum using synthetic absorbable suture material; suturing the incision on the uterus with separate or continuous sutures using synthetic absorbable sutures; thorough treatment of the uterine cavity with an antiseptic (alcohol 70 0 );

3) after childbirth (surgery ) - adherence to the principle of cyclical filling of the wards; measuring body temperature twice a day; carrying out adequate infusion therapy for 1-2 days after surgery and pathological birth; replenishment of blood loss; active management of postpartum women after surgical delivery (early getting up, exercise therapy, physical therapy); intestinal stimulation on the 2nd day after surgery; prevention of thromboembolic complications; prevention of uterine subinvolution (stimulation of lactation, regulation of bladder and intestinal function, early getting up, exercise therapy, etc.); prevention of wound infection by treating the postoperative suture with an antiseptic (1% iodonate, 5% potassium permanganate), from day 2 phototherapy on the area of ​​the postoperative suture; carrying out antibacterial therapy; timely non-drug correction of psychovegetative disorders.

b. Individual preventive measures:

1) before birth – identification and treatment of genital and extragenital pathologies; sanitation of foci of chronic infection; nonspecific stimulation of immune defense factors;

2) during childbirth (surgery) - intraoperative antibiotic prophylaxis.

3) in the postpartum period - differentiated antibiotic prophylaxis for postpartum women, depending on the degree of risk of complications; prescription of low-frequency magnetic therapy and HBOT.