Puerperal fever
| Classification according to ICD-10 | |
|---|---|
| O85 | Puerperal fever puerperal fever |
| O86 | Other postpartum infections |
| ICD-10 online (WHO version 2019) | |
The puerperal fever is an infectious disease that after delivery during the puerperium or after a miscarriage may occur, particularly in the case of incomplete placenta , and by an outgoing from the pelvic region uterine or peritonitis a life-threatening sepsis represents. Other names are puerperal fever , puerperal fever or puerperal sepsis .
Pathogen
This infection can be caused by staphylococci , streptococci , Escherichia coli , Neisseria gonorrhoeae and various anaerobes . They penetrate the body and bloodstream through the large area of the wound in the uterus , which was created by the detachment of the placenta . The cervix is still open gaping in the days after birth, so that a direct connection between the uterus and the vagina is. Even with good hygienic conditions, germs can so easily ascend into the uterus. There you will find a warm, nutrient-rich environment in which they multiply strongly. Usually the bacteria are transported beyond the weekly flow . However, if the after-pains and the weekly flow are weak, infection can occur.
Symptoms
The disease manifests itself as a high temperature or fever , pressure pain in the abdomen, foul-smelling weekly flow and possibly bleeding. A worsening is noticeable through immune tension in the entire lower abdomen, nausea and vomiting as well as shock symptoms such as restlessness, rapid pulse and breathing speed and a drop in blood pressure.
The consequences are inflammation of the peritoneum , the lining of the uterus and other organs, which are accompanied by strong attacks of fever and, without effective treatment, in most cases lead to sepsis ("blood poisoning") and death within a few weeks .
The often very painful inflammation of the uterus is countered in two ways. Antibiotics are prescribed against the bacteria, the regression of the uterus is supported with the ergot alkaloid methylergometrine . The infection usually heals without consequences. The incidence of puerperal fever has been significantly reduced compared to earlier times thanks to the better hygienic conditions.
Reporting requirement
Puerperal fever is notifiable in Austria in accordance with Section 1, Paragraph 1, Number 1 of the 1950 Epidemic Act in the event of suspicion, illness or death . Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).
history
Up until the 19th century, childbed fever was one of the main causes of high maternal mortality. The situation was further exacerbated when building establishments were established in the hospitals of major European cities (for example in the Hôtel-Dieu in Paris, from where the first reports of this disease come from 1788) and doctors also began working in obstetrics . The doctors in particular came into contact with other sick people and corpses; Since the need for effective disinfection was unknown, they carried germs into the women's birth canals on their hands and instruments. In some institutions, two thirds of all women who had recently given birth died from this iatrogenic infection . For the epidemiology as a whole, however, this was only of marginal importance, since the vast majority of women continued to give birth outside of hospitals.
In 1843 Oliver Wendell Holmes put forward the thesis that doctors would also transmit the disease. Four years later, Ignaz Semmelweis was able to show that the poor hygienic conditions in the hospitals as well as the poor cleanliness and disinfection of the doctors were the reason for the particularly high spread of the disease in buildings. In the mid-1840s, Semmelweis investigated why ten times as many women died of childbed fever in the first obstetric ward in the Vienna General Hospital as in the second ward. Through a process of elimination he came to the conclusion:
"The unknown cause, which caused such terrible devastation, was therefore found in the cadaver parts of the examiner at the first maternity clinic that were stuck to the hand."
But even luminaries like Rudolf Virchow denied the connections for decades. In a naturopathic textbook from 1896, for example, “foreign substances” already present in the woman's body are mentioned, which begin to “ferment” during the birth process. The author leaves it open here, however, from where, by what or by whom these “foreign substances” got into the mother's body.
mythology
In ancient Mesopotamia , Lilith was considered a demon of childbed fever.
See also
Individual evidence
- ↑ Barbara I. Tshisuaka: Puerperal fever. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1200.
- ↑ puerperal fever - puerperal fever - puerperal fever . Duden online
- ↑ Horst Kremling : Historical considerations on preventive medicine. In: Würzburg medical history reports. No. 24, 2005, pp. 222-260, here p. 224 f.
- ↑ Cedric Mims, Hazel M. Dockrell, et al. a. (Ed.): Medical Microbiology. 2nd Edition. Elsevier, 2004.
- ↑ Detailed description of the discovery of Semmelweis (as an example of a hypothetical-deductive procedure): Dagfinn Føllesdal, Lars Walløe, Jon Elster: Rationale Argumentation. A basic course in the theory of reasoning and science. Walter de Gruyter, Berlin / New York 1988, pp. 54–60.
- ↑ Irene Meichsner: Fighter against child bed fever. In: Calendar sheet (broadcast on Deutschlandfunk ). March 22, 2011, accessed March 22, 2011 .
- ↑ Semmelweis criticizes Virchow's stance on puerperal sepsis. Institute for Pathology at the University of Würzburg, September 4, 2012, accessed on March 5, 2013 .
- ↑ L. Kuhne: Women's diseases of all kinds, their origin, nature and healing. In: Neue Heilwissenschaft , Leipzig 1896, p. 6.
