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Abstract: Patient’s description: She underwent emergency cesarean section at the local county hospital for “37 weeks of pregnancy + live fetus, breech position, premature rupture of membranes”, after the operation, she had repeated fever and abdominal pain, and her symptoms gradually worsened. She was given anti-inflammatory treatment, which was ineffective. She was given laparoscopic surgery to explore the pelvic peritoneal adhesions, and was given a treatment to release the adhesions and remove the abscess, supplemented with anti-inflammatory drugs.
Basic information】Female, 34 years old
Disease Type】Pelvic peritoneal adhesions, puerperal infection, pelvic abscess, post-cesarean section
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of Consultation】August 2021
【Treatment plan】Surgical treatment (laparoscopic release of adhesions) + medication (Ceftriaxone sodium for injection, metronidazole injection)
Treatment period] 14 days in hospital
Treatment effect] The condition was controlled, the body temperature returned to normal, and the abdominal pain was relieved.
I. Initial consultation
Patient’s description: On July 23, 2021, she had an emergency cesarean section at the local county hospital for “37 weeks + live fetus, breech position and premature rupture of membranes”, and the operation went smoothly. She had recurrent fever after the operation and was discharged 6 days after antibiotic treatment for 3 days. On August 3, she had a high fever again with a temperature of 38.7℃ and abdominal pain, and went to the county hospital. After arriving at our hospital, her body temperature was measured at 38.9℃ and abdominal pain was obvious, so she was diagnosed with “puerperal infection” and admitted to our hospital.
II. Treatment process
The patient was admitted to the hospital immediately to complete relevant tests, including routine blood results: leukocytes: 20.45×10^9/L, ultrasensitive C-reactive protein: 93.58 mg/L. Ultrasound results: postpartum uterus, pelvic and abdominal cavity with multiple confined liquid dark areas, the largest being about 41×23 mm, with no obvious abnormalities in the bilateral adnexa. The patient’s fever and abdominal pain were obvious. She was considered to have puerperal infection induced by high-risk factors such as “premature rupture of fetal membranes and surgical trauma of cesarean section”, and abdominal abscess formation was not ruled out, so she was given blood culture and drug sensitivity test. After 2 days of treatment, she still had high fever and abdominal pain, and the liquid dark area was enlarged on review of color ultrasound.
III. Treatment effect
5 days after the operation, the patient’s temperature returned to normal, abdominal pain was reduced, and the routine blood test was repeated: leukocyte: 12.61×10^9/L, ultrasensitive C-reactive protein: 25.08 mg/L. The blood culture results showed the presence of lactococcal infection. The drug sensitivity results of the currently used antibiotics were sensitive, indicating that the treatment was effective, and the original protocol of intravenous anti-inflammatory medication was continued. Ten days after surgery, vital signs were normal, the patient had no abdominal pain and the abdominal wound was healing well. Routine blood results: leukocytes 8.74×10^9/L, ultrasensitive C-reactive protein: 7.22 mg/L. The patient was then successfully discharged after 14 days of hospitalization with a recommendation to follow up with an outpatient clinic in 1 week.
(Diagnosis certificate of illness discharged from hospital on August 17)
IV. Notes
We are glad that after treatment the patient’s condition was controlled, temperature returned to normal and abdominal pain symptoms were relieved, the patient should be followed up with the following points.
1, after cesarean section plus laparoscopic surgery, the patient’s body is relatively weak, daily should ensure adequate sleep and rest, do not be too fatigued, appropriate increase in diet nutrition and vitamin supplementation, more conducive to recovery.
2, after cesarean delivery should pay attention to contraception for more than 18 months, after surgery can not be premature sexual intercourse, otherwise affect the body recovery.
3, 2 operations in a row, for the patient’s physical and mental harm, it is recommended that family members give care and help, to avoid maternal postpartum depression.
4, the patient saw serious intraoperative inflammatory infection, and gave anti-inflammatory treatment, but there is still the possibility of recurrence of infection and adhesions, it is recommended that 1 week after the outpatient follow-up.
V. Personal insight
Patients should be routinely examined for vaginitis and lactic-free streptococcus in late pregnancy because inflammatory infections can easily lead to premature rupture of membranes in pregnant women, and coupled with the trauma of cesarean section, patients’ resistance decreases, which can easily lead to aggravation of postpartum lactic-free streptococcus and other pathogenic infections, and if postpartum antibiotics are not used symptomatically or the course of treatment is not sufficient, these inflammatory conditions will gradually worsen, leading to postpartum fever, abdominal pain, pelvic peritoneal adhesions, abscesses and other These inflammatory diseases will gradually aggravate and lead to postpartum fever, abdominal pain, pelvic peritoneal adhesion, abscess, etc., which seriously affect the physical and mental health of mothers and require active symptomatic treatment. In this case, the patient had recurrent postpartum abdominal pain and fever without attention, but fortunately, after active treatment, the patient recovered to health.