Puerperální infekce

15.4.2012 , Kamila Burdová

puerperalni-infekce.jpg - kopie
puerperalni-infekce.jpg - kopie
Puerperální infekce jsou poporodní nákazy, které vznikají u ženy v období šestinedělí. Puerperální infekce mohou vzniknout i po potratu nebo umělém přerušení těhotenství. Projevy puerperální infekce mohou postihnout pouze určitou část pohlavního ústrojí, nebo se rozšířit do celého těla. Mezi příznaky místní infekce patří bolest, krvácení, hnisavý sekret, ve vážných případech může dojít i k rozpadu rány. Celková infekce se pak projevuje horečkami, třesavkou a zimnicí. Oba dva druhy puerperální infekce se dnes účinně léčí antibiotiky.

Puerperální infekce

Puerperální infekce jsou relativně častou komplikací u žen po porodu v období šestinedělí. Mohou však vzniknout i po potratu nebo umělém přerušení těhotenství. Řadí se sem infekce pohlavního ústrojí a jeho okolí, močového ústrojí a prsů. Projevy infekce mohou být místní a postihnout pouze určitou část pohlavního ústrojí, a to vnější pohlavní orgány, pochvu, dělohu, vaječníky, nebo celkové, kdy se choroboplodné zárodky rozšíří krví do celého těla. Takový stav se nazývá sepse a vážně ohrožuje život. V minulosti byly puerperální infekce častou příčinou smrti rodičky, dnes je však prognóza příznivá, díky účinným antibiotikům.

Vznik a příznaky u puerperální infekce

Puerperální infekci způsobují bakterie, které jsou do těla zaneseny zvenku při nedodržování hygienických zásad ženou nebo zdravotnickým personálem. Původcem mohou být i bakterie, které jsou v porodních cestách přítomné běžně a nepůsobí žádné obtíže, ale za podmínek oslabeného organismu a poranění tkání porodem nebo císařským řezem infekci vyvolají. Příznaky se objevují podle toho, kde se infekce nachází.

Infekce po nástřihu hráze

Pokud se puerperální infekce rozvine v ráně po nástřihu hráze nebo v ráně po císařském řezu, je celá oblast zarudlá, bolestivá a vyměšuje hnisavý sekret. Může dojít až k rozpadu rány, potom je třeba odumřelé tkáně odstranit, ránu vyčistit a řez opětovně sešít, ránu udržovat v absolutní čistotě, aplikovat antibiotika a podpořit hojení.

Infekce dělohy

Infekce děložní sliznice neboli endometritida bývá nejčastější puerperální infekcí. Po odloučení placenty zůstává v děloze poraněná plocha, která bývá vstupní branou infekce. Endometritida se projevuje zvýšenou teplotou, bolestmi v podbřišku, mohou být přítomny páchnoucí očistky neboli poporodní krvácení. Puerperální infekce dělohy se často rozvíjí druhý či třetí den po porodu. Pokud se infekce rozšíří až na svalovinu dělohy, mluvíme o myometritidě. Jedná se o závažnější typ infekce, při kterém vznikají ve svalovině dělohy dutinky naplněné hnisem, které se mohou přes stěnu dělohy provalit do břišní dutiny a způsobit vážný zánět břišní stěny. Příznaky bývají bouřlivější, např. horečky, zimnice, hnisavý výtok, nevolnost či krvácení. Léčba obou infekcí se provádí cíleně zvolenými antibiotiky.

Močové infekce

Puerperální infekce může zasáhnout i močové cesty. Po porodu bývá snížené svalové napětí močového měchýře a močovodů, dochází k nedokonalému vyprazdňování moči a k tomu časté cévkování přispívá k rozvoji puerperální infekce. Typickými příznaky jsou časté nucení na močení, zvýšené teploty, při vzestupu infekce do ledvin se přidávají horečky, bolesti zad a celkové zhoršení zdravotního stavu ženy. Základem léčby jsou opět cíleně zvolená antibiotika na příčinné bakterie, klidový režim a vysoký příjem tekutin.

Zánět prsu

Zánět prsu neboli mastitida je jednou z nejčastějších puerperálních infekcí postihující ženy v období kojení. Na bradavkách a kůži prsu vznikají trhlinky, kterými do prsní žlázy pronikají bakterie. Pokud se mlékovody dostatečně nevyprazdňují a mléko se v prsní žláze zadržuje, vzniká příznivé prostředí pro bakterie, které se zde rychle pomnoží. Zánět prsu se projevuje zatvrdnutím prsu, jeho citlivostí až bolestí, zarudnutím, pocitem napětí a horkosti v postiženém prsu a může být přítomen i hnisavý výtok z bradavky. Téměř vždy si žena v prsu nahmatá bolestivý útvar. Celkově je zvýšená teplota, zimnice, třesavka a zchvácenost. Dalšími příznaky mohou být bolesti hlavy, malátnost, celková slabost a nevolnost. Lékem volby jsou antibiotika. Dále se na prs aplikuje suché nebo vlhké teplo, které pomáhá mléko uvolňovat.

Rizikové faktory u puerperální infekce

Rizikovými faktory pro vznik puerperální infekce jsou dlouhodobé choroby matky již před těhotenstvím, obezita, cukrovka, velké krevní ztráty během porodu nebo operace císařským řezem, nedostatek krevního barviva a červených krvinek, infekce v pochvě, infekce v močovém ústrojí, předčasný odtok plodové vody, porod trvající déle než je obvyklé či častá vyšetření rodičky přes pochvu. Císařský řez je rizikovější než přirozený porod. Infekce nemusí zanechat vážnější následky. Infikované rány se ale déle hojí, prodlužuje se doba rekonvalescence a vznikají široké a ne příliš vzhledné jizvy. Těžká infekce dělohy šířící se na vejcovody a vaječníky i do prostoru kolem dělohy, pokud je úspěšně vyléčena, může v budoucnu způsobovat bolesti v kříži nebo v podbřišku, nepříjemné pocity během pohlavního styku a neplodnost. V léčbě těžkých případů je někdy nezbytné dělohu dokonce odstranit.

Puerperální infekce a poporodní péče

Lékaři na oddělení šestinedělí věnují rodičce pozornost a sledují, zda se příznaky infekce nerozvíjí. Důležitá je pravidelná a důsledná hygiena ženy, vysoký hygienický standard na oddělení, léčba přidružených onemocnění a veškerých infekcí, které se vyskytnou. Při císařském řezu je důležité dodržení správné operační techniky a preventivní podání antibiotik před operací. Matka zůstává s dítětem v porodnici ještě několik dní po porodu, je pod dohledem lékařů a měla by je informovat o všech potížích, které se vyskytnou.

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