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Abstract: The patient in this case had a history of vaginitis before delivery, which was not treated to minimize the effect on the fetus, and was delivered at 38 weeks of gestation. About a week after delivery, the patient developed fever, foul odor, abdominal pain, and other discomforts, and was diagnosed with puerperal infection after a significant increase in routine blood leukocytes and uterine pressure on gynecological examination. Through timely medication, the condition was controlled and all indicators improved, and the patient was discharged successfully.
Basic information】Female, 31 years old
Type of disease】Puerperal infection
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Time of consultation】April 2022
Treatment plan】Medication (Ceftriaxone sodium for injection, metronidazole injection, sodium lactate ringer injection)
Treatment period】Inpatient treatment for 8 days, outpatient review after 1 week
Treatment effect】The condition was controlled and all indicators improved, and the patient was discharged successfully.
I. Initial consultation
Patient’s description: During the labor and delivery examination at 36 weeks of pregnancy, bacterial vaginitis and group B streptococcal infection were detected by leukorrhea secretion examination, and the doctor prescribed medication for vaginitis, but she did not follow the doctor’s prescription for fear that the medication would affect the fetus. She recovered well after delivery, without fever, abdominal pain and other discomforts, and was discharged from the hospital 3 days after delivery. After discharge, the amount of malodorous fluid was sometimes high and sometimes low. 2 days later, malodorous odor began to appear, accompanied by fever and a temperature of up to 38.2°C. Immediately afterwards, the patient developed abdominal pain and went to the hospital. After disinfection, a gynecological examination revealed that the pain of cervical elevation and uterine pressure were evident, and the patient was diagnosed with puerperal infection and admitted to hospital.
II. Treatment history
We explained to the patient that the vaginitis infection occurred in late pregnancy, especially in the case of group B streptococcal infection, and that the patient’s body constitution declined after delivery, resulting in the proliferation of pathogenic bacteria, and that after the opening of the uterus after delivery, these pathogenic bacteria would infect the uterus, resulting in fever, abnormal malodour, lower abdominal pain and other symptoms of infection, and in severe cases, sepsis and systemic infection. The patient agreed to actively cooperate with the treatment. The patient was immediately given intravenous antibiotic drugs, including ceftriaxone sodium for injection and metronidazole injection, and was given lactated Ringer’s solution for rehydration treatment, as well as perineal disinfection and scrubbing, and blood was drawn for blood culture.
III. Treatment effect
After 4 days of treatment, the patient’s body temperature was normal and the abdominal pain and malodorous symptoms were reduced. When the blood was rechecked, the white blood cell was 11.90×10^9/L; the neutrophil percentage was 82.5%. After 8 days of treatment, the routine blood test was repeated, and the white blood cells were 9.61×10^9/L; the neutrophil percentage was 77.2%. The cervical lifting pain and uterine pressure pain on gynecological examination were significantly reduced. The patient requested to be discharged from the hospital and was given discharge with medication and recommended to be rechecked in outpatient clinic after 1 week.
IV. Notes
We are glad that the patient’s condition has improved after treatment. In addition to the medication as prescribed by the doctor, the patient should strengthen nutrition. It is recommended that light and nutritious food be the mainstay, and try to eat more high-calorie, high-protein and high-vitamin food such as eggs, tomatoes and milk during the recovery period, as well as drink more water; it is recommended to develop good personal hygiene habits, maintain local hygiene, choose comfortable and breathable underwear; ensure sleep, combine work and rest, live regularly, and recommend appropriate exercise during the recovery period. Relax, maintain a good state of mind, communicate more with your family and avoid depression.
V. Personal insight
For mothers with postpartum fever, the first thing to consider is puerperal infection, such as the patient in this case, and then gradually exclude other causes, such as breast distension and upper respiratory tract infection. Factors such as maternal weakness, premature rupture of fetal membranes and vaginitis in late pregnancy can all be causes of puerperal infection. Once puerperal infection occurs, the most common manifestations are fever, abdominal pain and abnormal malignant dew, and treatment with adequate and broad-spectrum antibiotics is the key to successful treatment, and the earlier the treatment, the better the results.