Complication after Birth

Endometritis
Endometritis is an inflammation or irritation of the lining of the uterus (the endometrium). It is not the same as endometriosis. Endometritis is caused by infections such as chlamydia, gonorrhea, tuberculosis, or mixtures of normal vaginal bacteria. Endometritis is more likely to occur after miscarriage or childbirth, especially after a long labor or c-section. A medical procedure that involves entering the uterus through the cervix will increase the risk of developing endometritis. This includes a D and C, hysteroscopy, and placement of an intrauterine device (IUD). Endometritis can occur at the same time as other pelvic infections such as acute salpingitis, acute cervicitis, and many sexually transmitted infections (STIs).

Symptoms
Abdominal distention or swelling. Abnormal vaginal bleeding. Abnormal vaginal discharge. Discomfort with bowel movement (constipation may occur). Fever (100 to 104 degrees Fahrenheit). General discomfort, uneasiness, or ill feeling (malaise). Lower abdominal or pelvic pain (uterine pain).

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Signs and tests

The health care provider will perform a physical exam and a pelvic exam. The lower abdomen may be tender. Bowel sounds may be decreased. A pelvic exam may show the uterus and cervix is tender. There may be cervical discharge.

The following tests may be performed:

Cultures from the cervix for chlamydia, gonorrhea, and other organisms. Endometrial biopsy. ESR (sedimentation rate). Laparoscopy WBC (white blood count). Wet prep (microscopic exam of any discharge).

Treatment
Antibiotics are used to treat and prevent complications of endometritis. If you've been prescribed antibiotics following a gynecological procedure, it is very important to finish all the medication and follow up with your health care provider. You may need to be admitted to a hospital if you have a complicated case of endometritis, such as those that involve serious symptoms, or which occur after childbirth. Other treatments may involve: Fluids through a vein (by IV). Rest. Sexual partners may also need to be treated if the condition is caused by a sexually transmitted infection.

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Postpartum Perineal Care

The perineum is the anatomic area between the urethra, the tube that carries urine from the bladder, and the anus. In women, the perineum includes the vaginal opening. This area undergoes a lot of stress and change during pregnancy and delivery, and it needs special care afterward. Many women have a surgical cut called an episiotomy when they deliver a baby. Because an episiotomy lets the baby pass more easily, it may lessen damage to the perineum during delivery. An episiotomy is a clean cut, rather than a tear, so it may heal better. Sometimes the skin tears anyway and needs special care. Some women perform perineal massage during their pregnancy to try to prevent some of the pain and other problems after delivery. This method has not been shown to lessen or prevent any of the symptoms experienced after delivery.

Postpartum Perineal Symptoms

Injury to the vagina and the perineum during delivery may cause swelling, bruising, or a pool of blood under the skin called a ">hematoma. Any of these injuries can cause severe pain. Small hematomas usually go away without treatment. Painful, large hematomas may need drainage of the blood that collects in them. If a lot of tissue swelling occurs around the urethra, urinating may be difficult. If this happens, a small tube called a catheter can be put into the bladder until urination is possible. Lacerations are tears in the tissues. They may be repaired by suturing or sewing, but small ones will heal with normal care. As the episiotomy heals, it forms a scar. Women who have episiotomies should be careful to avoid opening the wound while it heals. After the baby is born, a discharge called lochia (pronounced LOE-kee-uh) will drain from the vagina. At first, this lochia will look red, because blood is mixed with it. As the woman heals, the lochia will become white or even clear, like mucus.

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Postpartum Perineal Care Follow-up and Treatment

See your doctor for a check-up about four to six weeks after delivery. Expect to receive a full physical examination, including pelvic, rectal, and breast examinations. Call your doctor sooner if you have any questions or concerns. For problems after childbirth, your doctor will give you a thorough physical examination, including a pelvic examination and a rectal examination. Blood or urine tests may be done. A sample of abnormal discharge may be sent to a laboratory for cultures or other studies. If an infection occurs from the episiotomy stitches, the stitches may be removed so the infection can drain. If a blood collection is present, such as a hematoma, it may be opened and allowed to drain. If the rectal exam shows infected or clotted hemorrhoids, they will be opened and allowed to drain. Depending on the type of infection, antibiotics may or may not be given. Not all infections need antibiotics to get better. If the physical exam is painful or leaves you with pain, you should ask for medicine to relieve the pain. Most changes that happen to the woman during and after delivery are normal and natural. After delivery of a baby, many women initially are not able to move around as easily or comfortably as before the delivery. Women gradually get back to their prepregnancy state, but the healing process takes several weeks.

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Bibliography
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002454/