Lohiometra - is the result of violations of the outflow of postpartum discharge (lochia) of the uterine cavity.Lohiometra is an early complication of postpartum vaginal delivery, can also be diagnosed after surgical delivery (cesarean section). Moreover, if the presence of postpartum uterine discharge is related to the physiological norm, its accumulation in the uterus without adequate timely evacuation can provoke serious complications.
lochia appear immediately after birth and shall terminate when the uterus is completely cleansed, and mucous restore its original, pre-natal, condition.
Lohiometra after cesarean section is more common, so how to handle the uterus is in a low tone and reduced worse.However, this process in all cases less than six weeks, and may take less time.
Lohiometra after abortion can not be formed, since the concept of lochia related only to childbirth.Postnatal discharge have a distinctive composition, which is present in the liquid, and thrombosed blood
Within six weeks after the birth of the uterine cavity is separated about 500 - 1500 ml of lochia.Their number and the color gradually changes from bright red and heavy at the beginning to a transparent and lean.After delivery, the uterus retains large size and its cavity is similar to the extensive bleeding wound with bare bleeding vessels and destroyed the mucous layer.
The postpartum period begins involution - the recovery period and the size of the uterus healing its inner surface.The most intensive processes of involution occur in the first two days after birth, when the pelvic floor muscles contract and return the hard womb "in place", and the muscular wall of the uterus strongly reduced.Just a day after the birth the uterus is reduced by half.As the uterine wall, the contents of the uterus is torn away and out.After leaving lochia uterus joins them discharge cervical canal and vaginal contents.
thus manifest lochia postpartum involution processes.They end when uterine involution is complete.
way lochia If there is an obstacle, they do not leave the uterus, and it accumulates in the cavity forming lohiometru.Among the reasons lohiometry can be mechanical (delayed piece of the placenta, blood clot, etc.) and physiological (spasm of the cervix or a decrease uterine tone).
only reliable lohiometry symptom is the sudden cessation of lochia against the backdrop of deteriorating health.The final diagnosis is made after a pelvic exam and ultrasound.Most
eliminate lohiometru help reinforce uterine contractions means.The presence of residues of the placenta in the uterus it requires mechanical removal.
lochia continued presence in the uterine cavity is fraught with development of infectious complications.Lohiometra leader among the causes of postpartum endometritis and metroendometrity.
Lohiometra formed as a result of the expiration of the difficulties lochia.This can occur if:
- The uterine cavity appears a mechanical obstacle to the free evacuation of postpartum content.
During pregnancy in the mucous layer of the uterus (the endometrium) is undergoing structural changes.The outer, functional layer of the endometrium, which is rejected by the pregnancy cycle, is transformed into decidual tissue.It is lining the entire inner surface of the masterbatch, and performs the function of a protective sheath that surrounds the fetus.At birth, thanks to uterine contractions, it is peeled from the underlying layer and collapses.In the following pieces of decidua tissue should leave the uterus as part of lochia, and if this process is disrupted, they can accumulate in the uterus and literally "clog" the uterus.
also free flowing lochia may be delayed in the uterus to prevent pieces of the placenta (afterbirth).The placenta in pregnant firmly attached to the uterine wall, place it seam to the endometrium is called "placental site."At birth the placenta must be completely detached from the uterine wall and come out after the fetus.If the uterus is a piece of the placenta, it also creates a mechanical barrier to evacuate lochia and provokes the formation lohiometry.
Close the cervical canal and stop lochia may be a large blood clot (thrombus).After the rejection of the decidua, and especially the placenta, the uterus is bleeding heavily.Gradually, the blood vessels in the damaged folds, and the bleeding subsides.Sometimes, however, after a difficult birth, it lasts longer in the womb have more clusters, including large.
- Lack of contractile activity of uterine muscles (hypotonia) or lack thereof (atonic).If the uterine wall is badly reduced, it is not able to push all the lochia out.Often this state is a consequence burdened labor (large fetus, multiple pregnancy, polyhydramnios), during which the uterus pererastyagivaetsya and "tired."
Lohiometra after cesarean section is also associated with poor contractile activity of the myometrium.During the operation, cut the uterine wall, thus disrupting the normal structure of the muscle layer.Operated uterus contracts worse.
Symptoms and signs lohiometry
lohiometra usually makes itself felt in the first week after vaginal delivery or cesarean section.Number of selections begins to significantly decrease, and then stops altogether.Lochia accumulate in the uterine cavity and stretched it appear dull nagging pain in the projection of the uterus, to subfebrile values may increase the temperature.
Gynecology palpable painful, enlarged uterus irregular shape testovatoy consistency.
vaginal ultrasound scanning sensor helps confirm the presence lohiometry.Possible signs are lohiometry:
- increasing the size of the uterus;
- the wrong contour of the uterus;
- expanded, with deformed contours of the uterine cavity;
- the existence in the womb of the liquid and clotted blood (clots) on the screen, they appear as hyperechoic areas (ie, high density);
- the possible presence in the uterine cavity parts of the placenta;
- a significant narrowing of the lumen or deformity of the cervical canal or complete closure of its walls;
- the presence of "foreign" inclusions (blood clot fragment decidua or placental tissue) in the lumen of the open cervix.
Usually when lohiometre overall health in the absence of inflammation does not change, and its clinical signs of the woman who gave birth correlates with postpartum symptoms.An exception is the disappearance of the lochia, that this symptom manifests lohiometry education.
After birth, women held a conversation in which, in addition to hygiene and feeding, explains the need for self-control of postpartum discharge.Do not worry if:
- the amount of lochia decreases gradually, but they do not stop prematurely, especially in the first week after giving birth;
- postpartum discharge changes color from red to clear;
- with lohiyami not have pain and fever;
- as part of lochia no pus and major bleeding clots;
- lochia cease completely in 3-6 weeks.
So lochia appear immediately after birth and accompany the process of involution before its completion.In appearance lochia can be roughly defined as the uterus is recovering from childbirth.
Immediately after birth allocated abundant bright red lochia.They continue for no longer than three days, and then their appearance changes according to changes in the uterine cavity.Since bleeding from damaged vessels stopped, the blood begins to clot, getting dark, brown color.A week after birth as part of lochia appear slime, and they acquire a yellowish tint.Bright, appear mucous lochia the tenth day, and mean that the endometrium is fully recovered.
Breastfeeding reduces the period of involution of the uterus and prevents the formation of lohiometry.Breastfeeding is synthesized hormone oxytocin.It is a natural uterotonic that is, causes uterine contractions and rapid evacuation of its contents.The number of cases among nursing lohiometry significantly lower than those who do not breast-feed.
Set lohiometry presence as early as possible is crucial.The continued presence of a large amount of blood and rotting tissue in the uterine cavity on a background of postpartum fatigue and reduce the body's immune defenses can lead to dangerous complications - postnatal metroendometrity.Unfortunately, often mothers are beginning to pay attention to the unsatisfactory condition only after the first signs of infection.
Postpartum metroendometritis on background lohiometry begins acutely in the third or fourth day after delivery.In 80-90% of infectious inflammation are the source of the association of aerobic and anaerobic bacteria, which are part of the pathogenic microflora of the genital tract.With declining local immunity and the presence of an "open" cervical they freely penetrate into the uterus, and accumulated in her lochia create ideal conditions for the growing season.The general state of health is deteriorating rapidly, there is a high fever and severe abdominal pain.The contents of the uterus is fast becoming a festering.In the context of the impossibility of its outflow from the uterus lohiometry turns into a pyometra - a cavity filled with purulent contents.
lohiometra quickly detected after birth can be quickly liquidated, while it emerged on the background of infectious complication can lead to infertility or even loss of the organ.
prolonged violation of physiological outflow lochia and their accumulation in the uterine cavity often provoke infectious complications.To avoid the development of undesirable purulent processes in the uterus, lohiometru should be eliminated as quickly as possible.
lohiometry The only treatment is to remove the obstacles to the free expiration lochia outside the uterus.The choice of treatment is selected according lohiometry reasons.
If muscle elements of the uterus completely or partially lost the ability to reduce the physiological, and can not "push" lochia out required drug muscle stimulation.Used Injectables Group uterotonics (oxytocin, metilergometrina) administered intramuscularly.
Often hypotension or atony of the uterus accompanied by a spasm in the area of the external os, which must be eliminated.This task handle spasmolytics (papaverine, no-spa).
If lohiometra provoked obstruction cervical clots and fragments of decaying tissues are subjected to forced extension of the cervical cavity and the subsequent evacuation of its contents.
To reduce the amount of accumulated blood in the uterine cavity to prevent the spread of the infection and relieve pain, we recommend periodically applying an ice compress on the lower abdomen.
Physical activity helps new mothers after childbirth quicker recovery of uterine tone.Do not spend much time in bed without moving, and in the hours of rest is recommended to lie down on his stomach.
At the first sign of incipient infectious inflammation (deterioration of health, increasing pain, fever) connects antibiotic.
Unfortunately, conducted therapy is not always effective and sometimes have to eliminate lohiometru instrumentally.Most to remove uterine contents using vacuum aspiration, with the participation of antibiotics.