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Abstract: A 27-year-old young female patient presented with fever, lower abdominal pain with malaise and a small amount of vaginal bleeding after a cesarean section in another hospital, and was referred to our hospital for treatment due to her previous poor treatment. Through examination, she was diagnosed with puerperal infection, and through medication, the patient’s condition was significantly controlled and all indicators were improving at the time of discharge.
Basic information】Female, 27 years old
Type of disease】Puerperal infection
Hospital】Qilu Hospital of Shandong University
Date of consultation】May 2021
Treatment plan】Intravenous injection (benzathine penicillin for injection)
Treatment Period】1 week
Effectiveness】Recovery
I. Initial consultation
The patient, a 27-year-old female, underwent cesarean section in another hospital due to poor progress of labor after pregnancy. After the operation, she developed fever, lower abdominal pain with weakness and a small amount of vaginal bleeding, etc. She was suspected to have an infection, but was referred to our hospital for treatment due to her previous poor treatment. The patient was found to have a well healed abdominal wound from the cesarean section, but a routine blood test revealed a significant increase in the level of leukocytes and neutrophils, and an ultrasound examination showed a liquid dark area in the anterior lower wall of the uterus, which, when combined with the patient’s symptoms, was judged to be a puerperal infection.
II. Treatment history
After 3 days of infusion treatment, the patient’s blood count and ultrasound examination were reviewed again, and it was found that the white blood cells decreased and the liquid dark area of the uterus was absorbed, indicating that the treatment was effective. The patient was discharged after 4 days of this treatment, and the indicators were normal.
III. Treatment effect
After 1 week of intravenous antibiotic treatment, the patient’s condition recovered, and the patient’s symptoms such as fever, lower abdominal pain and small amount of vaginal bleeding had disappeared, and the patient’s spirit was also better than before admission, so the patient could be discharged to recuperate. The patient did not see any recurrence of the disease after discharge.
IV. Notes
We are glad that the patient’s condition was effectively treated, but we need to advise the patient to pay attention to.
1. Although the patient’s condition has recovered more than before, but because it is not completely cured, note that if any discomfort occurs again, outpatient follow-up is required.
2, during the recuperation period at home, pay attention to maintain the vulva hygiene, but avoid cleaning through the tub bath method, can be warm water wipe, so as to avoid re-occurrence of infection.
3. Pay attention to a comprehensive and balanced nutrition in the daily diet, and supplement protein, vitamins, iron, calcium and other trace elements such as meat, eggs, milk, fresh fruits and vegetables in appropriate amounts to help the body recover as soon as possible.
4. Since the patient is in the puerperium, she should pay attention to the timely emptying of milk to prevent mastitis caused by milk blockage.
V. Personal insight
Like the patient in this article, puerperal infection is common after cesarean section, and it may occur even after normal delivery. Such cases cannot be completely avoided, and patients need to actively cooperate with treatment. The prognosis is generally good, and if the condition is mild, it can usually be cured by adhering to medication, so patients and their families need not worry too much. Daily attention to good hygiene, and nutrition, proper exercise and other enhancements, to reduce the occurrence of the disease, to speed up the recovery of the disease is beneficial.