1
Ministry of Health of Uzbekistan
TASHKENT MEDICAL ACADEMY
Obstetrics and gynecology GP TRAINING
Lecture on
Fever during pregnancy, at delivery, and postpartum
(For students of medical and preventive health
departments)
ТАШКЕНТ – 2012
2
Ministry of Health of Uzbekistan
TASHKENT MEDICAL ACADEMY
Of obstetrics and gynecology GP TRAINING
"APPROVED"
Dean of the Faculty of
Medicine
Professor Khalmatova B.T
___________________
____ _____________ 2012 y
Fever during pregnancy, at delivery, and
postpartum
Speaker: Professor, MD A.K Karimov.
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TECHNOLOGY TRAINING
Number of students 25-26
Form of lesson
Time – 2 hr
Lecture - presentation
1. A definition of fever during pregnancy,
childbirth and after delivery period
2. Discuss methods of diagnosis and
management of fever in pregnancy, childbirth
and after delivery period
3. Form of knowledge about the disease during
pregnancy and the postpartum period, followed
by a fever.
4. Teach students to diagnose and treat
complications of pregnancy, childbirth and
the postpartum period in feverish conditions
The purpose of the training session: To introduce students, future general practitioners, on the
basis of knowledge about the features of the current fever like symptoms of many diseases,
including complicated pregnancy, childbirth and the postnatal period to provide students general practice new approaches to the diagnosis, clinical features diseases in obstetrics,
febrile, principles of antibiotic therapy and prevention, WHO recomended
Tasks the teacher:
Learning outcomes:
Plan of the lecture
1. Generate knowledge of obstetric
complications associated with fever.
2. Learn to recognize the disease during
pregnancy and the postpartum period,
followed by a fever.
3. Teach students to diagnose complications
of pregnancy, childbirth and the postpartum
period in feverish conditions.
4.
Conduct
proper
selection
of
antimicrobial therapy.
Methods and techniques of teaching
Learning tools
Forms of learning
Conditions of Learning
The student should know:
1. Factors that contribute to development.
disease during pregnancy and the postpartum
period, accompanied by fever,
2. About the disease during pregnancy and the
postpartum period, accompanied by fever.
3. Diagnose complications of pregnancy,
childbirth and the postpartum period in feverish
conditions.
4. Conduct proper selection of antimicrobial
therapy.
Lecture - visualization, presentation, technique: a
quiz, focusing questions, the technique of "yesno"
Laser projector, visual materials, information
technology
Collective
Audience, work with TSO
4
Technology card of LECTURES
Stages, time
stage 1
introduction
(5 min)
stage 2
actualization of
knowledge
(20 min)
stage 3
The Information
(55 min)
stage 4
concluding
(10 min)
Activities
преподавателя
1. Reported the topic name, purpose,
deliverables lectures and plan for its
performance (lyrics № № 1-3 in English.
Language)
2.1. Displays and offers to get acquainted
with the plan and purpose of the lecture.
Comments on the content of the slides.
Slides № 4-5
2.2. With a view to mainstreaming gives
students focusing problem: Slide №6
Pregnant or have recently given birth to a
woman who:
- Has a fever
- She complained of headache, weakness,
chills, back pain and abdominal
Conducts blitz poll.
2.3. Displays the slide number six
студентов
1. listen
2.1. Examine the contents
of a slide № 4-5
2.2. Answer questions
2.3. Examine the contents
of the slide number six
3.1. Consistently presents the material 3.1. Discuss the content of
lectures on the plan, using visual materials the proposed materials,
and a system of focusing questions:
clarify and ask questions.
Plan on one question: Define the feverish
conditions during take-minute, delivery and
after delivery period.
Plan on 2 issue: list methods of diagnosis
and management of fever during pregnancy
ti, delivery and after delivery period.
3 questions on the plan: Describe the
disease during pregnancy and the
postpartum period, febrile
To 4 issue plan: to diagnose and treat Write down the main
complications of pregnancy, childbirth and
postpartum in feverish conditions. Focuses
on key topics, offers them down.
4.1. Asks the question:
4.1. Answer questions
1. What is the differents. sign between
endometritis and peritonitis?
4.2. Listen and write
2. Initial first aid for fevers?
4.2. Gives the task for independent work:
Contraception after birth against fever
Topic:
and postpartum "
"Fever
during
pregnancy,
childbirth
5
I. Introduction.
Despite ongoing prevention efforts, the incidence of postpartum septic disease does
not tend to decrease. Often, all prerequisites for the development of this pathology has
been in pregnancy. Septic complications in obstetrics are always accompanied by fever.
Widespread use of antibiotics unjustified led to the development of resistant strains and
difficult recovery of pregnant and postpartum women. Until now, in obstetric practice to
use the classification of postpartum septic diseases Bartels-Sazonov, considering septic
process in the degree distribution. WHO guidelines for GPs provided posimptomnaya
localization
diagnosis
of
septic
process.
This lecture presents new patterns of antibiotic therapy as recommended by the WHO,
which uses well-known antibiotics, but in a totally new regime. Effectiveness of the new
scheme, and the lack of teratogenicity proved by WHO using the methods of medicine.
The purpose of this lecture is: on the basis of knowledge about the features of the
current fever like symptoms of many diseases, including complicated pregnancy,
childbirth and the postnatal period to provide students - general practice new approaches
to the diagnosis, clinical features of diseases in obstetrics, accompanied by fever,
principles of antibiotic therapy and prevention, recommended WHO.
References:
1. L. Butler Fever of unknown origin in internal diseases. M, 1997.
2. Congenital, perinatal and neonatal infections: Per. from English. / Ed.
A.Grinou, J. Osborne, S. Sutherland. - M.: Medicine, 2000. - 287.
3. American College of Obstetricians and Gynecologists (ACOG) Educational Bulletin:
Antimicrobial Therapy for Obstetric Patients, March 1998. p. 292-300.
4. French LM and FM Smaill. Antibiotic regimens for endometritis after delivery
(Cochrane Review), in The Cochrane Library. 2000. Issue 4. Update Software: Oxford.
5. Hopkins L and F Smaill. Antibiotic prophylaxis regimens and drugs for cesarean
section (Cochrane Review), in The Cochrane Library. Update Software: 2000.Oxford.
6. Pregnancy and childbirth in extragenital diseases .. Edited by Radzinsky, VE, 2009,
464
p.
"GEOTAR
Media"
7. Obstetrics. Textbook. Savelyev GM and others 2009, 656 p. "GEOTAR Media"
8. www.medland.ru, www.medscape.com, www.med-lib.ru
Problematic
issues:
1. Generate knowledge of obstetric complications associated with fever.
2. Form of knowledge about the disease during pregnancy and the postpartum period,
followed
by
a
fever.
3. Teach students to diagnose complications of pregnancy, childbirth and the postpartum
period
in
feverish
conditions.
4. Conduct proper selection of antimicrobial therapy.
Introduction.
Fever has long been regarded as a sign of human disease.
Fever - typical pathological process is to temporarily increase the temperature of the body
to the action of pyrogenic stimuli in connection with the restructuring of the regulation of
heat transfer to a higher level. Fever is fundamentally adaptive response that increases the
body's
natural.
The immediate cause of the fever are pyrogenic (zharonesuschie) substances or
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pyrogens. By origin pyrogens divided into exogenous and endogenous. Among
exogenous isolated infectious and noninfectious cake, which shows you ¬ infectious and
non-infectious fever. The most common infectious fevers are caused by bacteria, viruses,
parasites, which contain the structural elements or as products of metabolism "pyrogenic"
started lipopolysaccharides, proteins, and nucleic acids (aseptic) fever. They arise from
the mechanical damage of tissue Crush, etc.), necrosis (heart attacks, bleeding, etc.),
aseptic inflammation ¬ tions, hemolysis, etc. A special group is represented noninfectious
fevers that occur in certain immunopathological and allergic states, with the introduction
of sera with medical diagnostic purposes, blood and other fluids and blood
belkovosoderzhaschih. In these cases, pyrogens form of cell-tissue structures of the body.
In addition to infectious and non-infectious fever, found another group of hyperthermia,
which can be called without the required participation pyrogens. They name
lihoradopodobnye state. These include neurogenic, and medicinal lihoradopodobnye
state. Neurogenic "fever" may have Centrogenic (CNS damage to structures),
psychogenic (functional disorders of higher nervous activity) and the reflex
(nephrolithiasis, cholelithiasis, etc.) origin. Endocrine lihoradopodobnye states occur at
some endocrinopathy (hyperthyroidism, lesions of the hypothalamus), and the drug - with
some pharmaceutical drugs (caffeine, ephedrine, hyperosmolar solutions, etc.).
Primary infectious and noninfectious pyrogens themselves do not cause fever
characteristic reorganization of the system of thermoregulation. Previously they interact
with granulocytes and freely circulating in the blood, fixed and semi fixed tissue
macrophages. Leukocytes fagotsitiruya pyrogens are activated and acquire the ability to
synthesize the active compounds, including secondary endopirogeny. produce
"leukocyte" pyrogen two hours after exposure to pyrogens, highlighting it for 16-18
hours. Synthesis macrophage endopirogena continues for 30-35 hours. Endopirogenov
lymphocytes do not synthesize, secrete lymphokines but factors that stimulate the
production of monocyte leukocyte ¬ container pie. Lymphokines, which are synthesized
under the influence of macrophage pyrogens, received the name of interleukin-1. Besides
pyrogenic, interleukin-1 has other biological effects.
In the future, interleukin-1 interferes with the metabolism of neurons
thermoregulatory center by stimulating the synthesis of prostaglandins of E, which act as
a mediator of fever. Some importance in the mediation of prostaglandins and the activity
of hypothalamic neurons is adenosine monophosphate (c-AMP), which accumulates in
the cells and changes the temperature-sensitive center thresholds are "cold" and "heat" of
neurons so that the normal temperature of the blood center receives the signals of cooling
and includes mechanisms of heat production . Thus, under the influence of prostaglandin
E and c-AMP is changing the "installation" of the point thermoregulation center to a
higher level, and the starting point of the normal temperature is shifted up. Now, the new
temperature is the basis of regulation, and the body is made all the necessary ¬ mine to
ensure the maintenance of this particular new high temperature.
Each
fever
in
its
development
goes
through
three
stages:
rise, the relative standing on an elevated level and the temperature drop. Warming up the
body in the first step may be for 2-3 hours on one of several options for heat transfer. In
the second stage of feverish reaction heat transfer generally equated with the heat
production. This balance thermoregulatory processes, set at a higher level than normal,
which
ensures
retention
of
elevated
body
temperature.
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In the third stage of fever "set point" thermoregulation center returns to its original level,
and restores normal temperature homeostasis. The process of heat transfer in this stage of
heat production exceeds the rate, which can not be changed from the previous stage, or
reduced (increased sweating, dilates peripheral vessels, and so on). There are two
extreme types of the third stage of fever: a gradual, or political, and fast, or critical, the
drop in temperature. At the critical fall, when the temperature for 1-2 hours may be
reduced by 3-4 ° C by commonly observed sweating, accompanied by a sharp expansion
of peripheral blood vessels, which can lead to a drop in blood pressure and acute
circulatory failure. Lytic temperature decrease is slower for 12-16 hours.
Duration of fever varies from a few hours to many months. The level of temperature
increase in the second stage of the following types of fever: weak (subfertil) when the
temperature rises to 38 °; moderate (febrile - increase to 38-39 °); high (piretic increasing to 39 - 41 °) and excessive ( hyperpiretic - increase to 41-42 °).
Temperature of the human body is exposed to daily fluctuations, up to 17-19, at least 4-6
hours. This temperature rhythm in the majority of cases of fever persists. Therefore, the
course of the temperature curve of the body is the resultant of febrile diurnal variation
and stage of development of our feverish reaction. During prolonged hyperthermia
depending on the progress of temperature curve are following main types of fever:
constant - daily fluctuations do not exceed 1 °; remittent or laxative ~ daily fluctuations
of more than 1 °; intermittent - diurnal variations from normal to high; hectic, or draining
- very big ups to the rapid decline in temperature, sometimes recurring several times a
day; perverted - a perversion of the daily rhythm with higher temperature rises in the
morning, incorrect - temperature fluctuations during the day without a definite pattern,
return - the return of fever after normalization of temperature.
Changes in the body during fever. The most significant changes during fever occur
in the circulation. A temperature increase of 1 ° C is accompanied ¬ nied by increased
heart rate 8-10 beats / min, an increase in stroke and cardiac output, due to overheating of
cells peismeker sinoatrial node, resulting in a slow diastolic depolarization of pacemaker
cells reach a critical level of depolarization before, earlier the action potential and
reduction of infarction. There are, however, exceptions. So, when typhoid fever occurs
with bradycardia. Perhaps the development of arrhythmias, fibrillation, and even cardiac
arrest. During the various stages of a fever caused by numerous bacteria, blood pressure
may rise or fall (infectious collapse during the critical temperature drop).
Central nervous system. With infectious fevers disturbed functional state of the central
nervous system and higher nervous activity. Concomitant toxicosis can cause depression
functions, often braking, sometimes excitement (delusions, hallucinations, lethargy, sleep
and so on). These disorders, however, the pathogenesis is not linked to the rise in
temperature, but are the result of intoxication.
The endocrine system. Sympathoadrenal system is characterized by the involvement in
the activity of the pituitary (ACTH, TSH, GH) and on the respective target glands adrenal (catecholamines, glucocorticoids), thyroid (iodine-containing hormones,
thyroxine, triiodothyronine), pancreas (insulin).
High temperature (fever) during pregnancy and childbirth
Problem
The woman was a high temperature (38 ° C and above) during pregnancy and childbirth.
The main tactics
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• Provide bed rest.
• Encourage the consumption of large amounts of fluid orally.
• Use a fan or tepid sponge to help reduce temperature.
Urinary tract infection
• Assume that the urinary tract infection affects all its levels, from the renal pelvis to the
urethra;
• Assign ampicillin 1g orally 4 times a day or amoxicillin 1 g orally three times daily for
14 days.
• Alternative treatment should be dependent on the local sensitivity of infection to
antibiotics. • Perform maintenance treatment and examine the woman.
Tests
Test strip, microscopy and tank. A urine culture can be used to determine the presence of
urinary tract infections, but not for the differentiation between cystitis and acute
pyelonephritis.
• The test strip can be used to determine the white blood cells, and the nitrate reductase
test can be used to determine nitrite.
• urine microscopy can reveal clusters of white blood cells, bacteria, and sometimes red
blood cells.
• Buck. urine culture and sensitivity test should be performed, if possible, to identify the
micro-organisms and to determine their sensitivity to antibiotics.
Note: For a urine sample should be taken purely urine collected from the middle portion
of it to minimize the possibility of contamination.
Cystitis
Cystitis - an infection of the urinary bladder.
• Antibiotics (p.40):
• Amoxicillin 500 mg orally three times a day for 3 days;
• or trimethoprim / sulfamethoxazole 1 tablet (160/800 mg) orally twice a day for 3 days.
• If the treatment is ineffective, give the tank. urine culture and, if possible, check the
sensitivity of the flora to antibiotics, treat the most appropriate in terms of the sensitivity
of flora with antibiotics;
• If the infection is repeated two or more times:
• Make a tank. urine culture and, if possible, check the sensitivity of the flora to
antibiotics, treat the most appropriate antibiotics;
• to prevent infections in the future assign antibiotics orally once daily at bedtime to the
end of pregnancy and 2 weeks postpartum. Assign:
• trimethoprim / sulfamethoxazole 1 tablet (160/800 mg);
• or amoxicillin 250 mg.
Note: Preventive treatment prescribed after repeated infections, not after individual
episodes. ,
• Recurrence of acute pyelonephritis during the pregnancy occurs in 10-18% of cases
• suppressive therapy: 2.7% again have urinary tract infections
• No suppressive therapy: 20-30% again have urinary tract infections
Acute pyelonephritis
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Acute pyelonephritis - is an acute infection of the upper urinary tract, mainly the renal
pelvis, which can also affect the renal parenchyma.
• If diagnosed or suspected shock, immediately begin treatment.
• Make bakposev urine and, if possible, check the sensitivity of the flora by antibiotics,
treat the most appropriate antibiotics.
• When conducting urine culture impossible provoditelechenie antibiotics as long as the
woman will not be out the heat for at least 48 hours:
• ampicillin 2 g / every 6 hours, plus gentamicin 5 mg / kg of body weight in each 24
hours. I
• If a woman has a high temperature for 48 hours, give amoxicillin 1 g orally 3 times to
complete 14 days of treatment.
Note: The clinical response is expected within 48 hours. If there is no clinical response
within 72 hours, and re-evaluate the results of the action spectrum antibiotic
• To prevent infections in the future assign oral antibiotics
once a day before going to bed until after 2 weeks of pregnancy and the postpartum
period. Assign:
• trimethoprim / sulfamethoxazole 1 tablet (160/800 mg);
• OR amoxicillin 250 mg.
• Ensure adequate oral or / hydration.
• If necessary, assign paracetamol 500 mg orally to relieve boleysnizheniya temperature.
If palpable uterine contractions and is krovjanisto-mucous discharge from the vagina,
imagine premature birth
Septic abortion
• Is the cause of 12.9% of maternal deaths
• post-abortion care has had a huge impact on reducing mortality
particularly for the manual vacuum aspiration
Metritis
Metritis is an inflammation of the uterus after delivery, which is the main cause of
maternal mortality. Delayed or inadequate treatment of metritis can lead to pelvic
abscess, peritonitis, septic shock, deep vein thrombosis, pulmonary embolism, chronic
pelvic infection with constant pain in the pelvis and dyspareunia, obstruction of the
fallopian tubes and infertility.
• If necessary, a blood transfusion. If possible, use blood components.
• Use a combination of antibiotics for as long as a woman is not a normal temperature for
48 hours:
• ampicillin 2g / in every 6 hours;
• PLUS gentamicin 5mg/kg weight / every 24 hours;
• PLUS metronidazole 500 mg / in every 8 hours.
• If the fever lasts 72 hours from the start of antibiotic treatment, the woman re-evaluate
and revise the diagnosis.
Note: There is no need to prescribe antibiotics given after termination of / in the
introduction.
• If you suspect that the delay in the fragments of the placenta in the uterus make finger
study cancer for accent pieces and large clots. Use tongs and a large oval curette if
necessary.
• If conservative treatment does not improve, and there are common signs of peritonitis
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(fever, symptoms of peritoneal irritation, abdominal pain), perform laparotomy for
drainage of pus.
• If it is determined necrotic and septic uterus, perform subtotal hysterectomy.
Pelvic abscess
Assign a combination of antibiotics before abscess drainage and continue to use them, as
long as women are not there will be no fever for 48 hours:
• ampicillin 2g / in every 6 hours;
• PLUS gentamicin 5mg/kg weight / every 24 hours;
• PLUS metronidazole 500 mg / in every 8 hours.
• Perform maintenance treatment and examine a woman
• If the abscess is fluctuant in Douglas space, drain the pus through kuldotsenteza. If you
save a hectic fever, perform laparotomy.
Peritonitis
• Ensure passage of gastric contents through a nasogastric tube.
• decant liquids in /
• Assign a combination of antibiotics as long as women are not there will be no heat for
48 hours of ampicillin 2g / in every 6 hours, plus gentamicin 5mg/kg of weight / every 24
hours;
On the plus metronidazole 500 mg / in every 8 hours.
• If necessary, a laparotomy for peritoneal lavage (dialysis).
Stagnation in the mammary glands
Stagnation in the mammary glands is due to expansion of lymphatic and venous vessels
and stagnation in them, which occurs before lactation. This stagnation is the result of
overdistension breast milk.
Breastfeeding
• If a woman is breastfeeding and the child is not capable of sucking, persuade a woman
to express milk by hand or breast pump.
• If a woman is breastfeeding and the child is capable of sucking, persuade a woman to
feed more often, putting the baby to both mammary glands at each feeding;
• show a woman how to hold the baby and help her to put him to the breast;
• Spend a relaxing activity to feeding:
• apply a warm compress to the breast immediately before feeding, or to convince the
woman to take a warm shower;
• massage the woman's back and neck;
• Ask the woman to express a little milk before feeding your hands and wet the area
around his nipples to help the child to suck on the teat of mother properly and easily;
• relaxing activities after feeding:
• Keep your chest bandage or a bra;
• apply a cold compress to the breast between feedings to reduce swelling and pain;
• assign paracetamol 500 mg orally if necessary;
• Continue activities for 3 days after they started to fix the result.
If breast-feeding is not
• If a woman does not breastfeed,
• Keep your chest bandage or a bra;
• apply a cold compress to the breast to reduce the swelling and pain;
• Avoid massage and applying heat to the breast;
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• Avoid nipple stimulation;
• assign paracetamol 500 mg orally if necessary.;
• Continue activities for 3 days after they started to fix the result.
Mastitis is an infection of the breast
• Assign antibiotics:
• floksatsillin 500 mg orally four times daily for 10 days;
on or erythromycin 250 mg orally 3 times a day for 10 days.
• Reassure the woman:
continue on breast-feeding;
on chest bandage or support bra, put a cold compress on the breast between feedings to
reduce swelling and pain.
• Assign paracetamol 500 mg orally as needed.
• Continue activities for 3 days after they started to fix the result.
Breast abscesses
• Assign antibiotics:
of cloxacillin 500 mg orally four times daily for 10 days;
o OR erigromitsin 250 mg orally 3 times a day for 10 days.
• Drain the abscess:
usually required for general anesthesia (eg, ketamine);
conduct of radial section from the alveolar region toward the periphery of the breast to
avoid damage to the milk ducts;
of using sterile gloves, fingers or pick the festering clip pockets of the cavity loosely
zatamponiruyte;
remove tampons after about 24 hours and replace tampons smaller.
• If you stayed in the pus cavity, place the swab in a small cavity and remove it from the
end of the wound to drain the remaining pus.
• Encourage woman
o continue breastfeeding even if the accumulation of pus in the breast, prostate;
on chest bandage or support bra;
of applying a cold compress to the breast between feedings to reduce swelling and pain.
• Assign paracetamol 500 mg orally as needed.
• Continue activities for 3 days after they started to fix the result.
Perineal wound infection and abdominal wall Wound abscess, hematoma, seroma and
wound
• If there is pus or fluid, open and drain the wound.
• Remove the infected skin or subcutaneous sutures and wound care. Do not remove the
stitches from the aponeurosis.
• If there is an abscess without cellulitis, there is no need to use antibiotics.
• Apply moist wound dressings, and assign a woman dressing every 24 hours.
• Instruct the woman to respect hygiene and often change pads and clothing.
Wound cellulitis and necrosis of the fascia
• If there is pus or fluid, open and drain the wound.
• Remove the infected skin or subcutaneous sutures and wound care. Do not remove the
stitches from the aponeurosis.
• If the infection is superficial and does not affect the deeper tissues, the development of
an abscess sledkte and assign a combination of antibiotics:
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of ampicillin 500 mg orally four times a day for 5 days, plus metronidazole 400 mg orally
3 times a day for 5 days.
• If the infection has penetrated deeply impressed muscle and cause necrosis
(necrotisation fasciitis), give a combination of antibiotics for as long as the necrotic tissue
and not reject a woman's temperature will not be out for 48 hours:
of penicillin 2 million units in / every 6 hours plus gentamicin 5mg/kg weight / every 24
hours plus metronidazole 500 mg / in every 8 hours
If a woman has no temperature for 48 hours, give:
• ampicillin 500 mg orally four times a day for 5 days, plus metronidazole 400 mg orally
3 times a day for 5 days.
Necrotisation fascia requires extensive surgical treatment. Make the secondary wound
closure after 2-4 weeks, depending on the resolution of inflammation.
• If a woman is defined by severe infection or necrotisation fascias, send her to the
hospital for treatment and bandaging the wound twice a day.
Conclusion.
Finally it must be noted that, according to the WHO criteria therapeutic antibiotics occurs
only if it is established - a disease duration of treatment depends on the disease, on
whether or not to C-section and the presence of bacteremia. Thus, knowledge of general
practitioners features the diagnosis and treatment of diseases in obstetrics, febrile will
reduce the frequency of severe septic complications, which are often the cause of
maternal mortality.
Self-study:
1. Determination as fever syndrome.
2. Types of fever.
3. The development of fever as a common process in the body.
4. Changes in the body during fever.
Test questions:
1. Obstetric complications during pregnancy, childbirth and the postpartum period,
accompanied by fever.
2. Common (present) disease symptoms during pregnancy, childbirth and the postpartum
period with fever.
3. Antibiotic treatment schemes recommended by WHO.
4. Scheme of anti-antibiotic treatment recommended by the WHO for general
practitioners.
5. Differences in preventive and therapeutic use of antibiotics.
Answering questions after the lecture.
13
ABSTRACT
a lecture by Professor A.H.Karimova 7 courses for students of the medical faculty of
Tashkent Medical Academy on "Fever during pregnancy, childbirth and the postpartum
period."
Despite ongoing prevention efforts, the incidence of postpartum septic disease does not
tend to decrease. Often, all prerequisites for the development of this pathology has been
in pregnancy. Septic complications in obstetrics are always accompanied by fever.
Widespread use of antibiotics unjustified led to the development of resistant strains and
difficult recovery of pregnant and postpartum women. Until now, in obstetric practice to
use the classification of postpartum septic diseases Bartels-Sazonov, considering septic
process in the degree distribution. WHO guidelines for GPs provided posimptomnaya
localization diagnosis of septic process.
The purpose of this lecture is: on the basis of knowledge about the features of the current
fever like symptoms of many diseases, including complicated pregnancy, childbirth and
the postnatal period to provide students - general practice new approaches to the
diagnosis, clinical features of diseases in obstetrics, accompanied by fever, Principles of
antibiotic therapy and prevention, recommended WHO.
RESUME
of lecture “Fever during pregnancy, labor and postnatal period” of professor
A.H.Karimov for seventh-years students of medical faculty of Tashkent Medical
Academy.
14
In spite of carrying out of preventive measures the frequency of septic diseases in
postnatal period is not decreased. The septic complication in obstetrics always is
accompanied by fever. Wide unwarranted treatment by antibiotics leads to development
of stable strains and to difficult treatment of pregnant women and women during labor.
To present time the classification of Bartels-Sazonov of postnatal septic diseases used in
obstetrics practice, which handle septic process as spread degree. WHO recommendation
includes symptomatic diagnosis of septic process localization for doctors of common
practice.
The aim of lecture is to learn the students- doctors of common practice new ways in
diagnostic, properties of clinic diseases with fever in obstetrics and principles of
antibacterial treatment and prevention recommended by WHO on the basis of knowledge
of fever as syndrome of diseases including complicated pregnancy, labor and postnatal
period.
RESUME
of lecture “Fever during pregnancy, labor and postnatal period” of
professor A.H.Karimov for seventh-years students of medical faculty of
Tashkent Medical Academy.
In spite of carrying out of preventive measures the frequency of septic
diseases in postnatal period is not decreased. The septic complication in
obstetrics always is accompanied by fever. Wide unwarranted treatment by
antibiotics leads to development of stable strains and to difficult treatment of
pregnant women and women during labor. To present time the classification
of Bartels-Sazonov of postnatal septic diseases used in obstetrics practice,
which handle septic process as spread degree. WHO recommendation
15
includes symptomatic diagnosis of septic process localization for doctors of
common practice.
The aim of lecture is to learn the students- doctors of common practice new
ways in diagnostic, properties of clinic diseases with fever in obstetrics and
principles of antibacterial treatment and prevention recommended by WHO
on the basis of knowledge of fever as syndrome of diseases including
complicated pregnancy, labor and postnatal period.