METROTHROMBOPHLEBITIS (Greek metra a uterus + thrombophlebitis) — the inflammation of veins of a uterus which is followed by their thrombosis. As a rule, precedes M.'s development postnatal or postoperative metroendometritis (see).
The etiology and a pathogeny
Activators M. are staphylococcus, a bacterium of intestinal group, streptococci and other Microbes causing inflammatory diseases of generative organs in a puerperal period. M.'s development is promoted by complications of pregnancy and childbirth. M.'s emergence is possible after operation of Cesarean section, manual department of a placenta, massage of a uterus on a fist, owing to deep ruptures of a neck of uterus. The contributing factors are anomalies of patrimonial activity, the long anhydrous period, massive blood loss. Much less often M. develops after a conservative myomectomy, excision of the centers of endometriosis from a uterus, plastic surgeries, corrective anomalies of development of a uterus. In the anamnesis at patients thrombophlebitis of the lower extremities, late toxicoses of pregnant women, operation of removal varicose of expanded veins of the lower extremities can take place.
In the beginning at women in childbirth the periphlebitis develops, then phlebitis (see) with formation of blood clots in veins of a uterus, i.e. metrothrombophlebitis. The process which began in veins of a uterine part of a placenta extends to veins of other part of a uterus. Also other option when formation of blood clots in veins of a uterus is primary is possible, to-rye then are exposed to infection.
As usually M.'s development is preceded by a metroendometritis, there are all morfol, symptoms of this pathology which is followed by involvement in inflammatory process of veins of a uterus. Most often thrombosis of expanded veins of a uterus with inflammatory infiltration of their walls develops (see. Thrombophlebitis ). Desquamation of an endothelium is observed in places; blood clots in gleams of veins can be pristenochny and occluding. On a section the reinforced and infiltrirovanny wall of a uterus has a cellular structure and reminds corroded worms a tree (tsvetn. fig. 2).
One of forms M. is the so-called otslaivayushchy metritis, at Krom as a result of thrombosis circulatory and limf, vessels the necrosis and sequestration of sites of a wall of a uterus develop.
The clinical picture
the Clinical picture is characterized by fervescence, long, sometimes plentiful bloody allocations from patrimonial ways that can mistakenly be qualified as manifestation of a placental polyp. At patients the general state and a dream worsens, there are dull aching aches in the bottom of a stomach, the general weakness, slackness. Unlike a metroendometritis of allocation from patrimonial ways not purulent, but bloody tachycardia is also more expressed; pulse of 100 — 120 blows in 1 min., soft, labile, its frequency does not correspond to body temperature (quite often tachycardia precedes fervescence).
The palpation of lower parts of a stomach is painful. Morbidity of a uterus, especially its side departments, clearly is defined at vaginal examonation. At the expense of the expanded and thrombosed veins the uterus can have a pulled fasetchaty surface. Besides, subinvolution of a uterus takes place.
The m after uterus operations usually develops against the background of disturbance of food of the rest of a uterus and is shown by pains in the bottom of a stomach and in the depth of a basin, a feverish state; there can be symptoms of irritation of a peritoneum and dysfunction of intestines and bladder. At a two-handled research the expressed morbidity of a uterus comes to light.
At suppuration of blood clots that can be observed already on 5 — the 7th days, and at a long current of M. a condition of patients considerably worsens, body temperature against the background of a fever increases to 40 ° above, function of intestines and bladder is broken.
At M. can arise a heart attack pneumonia (see. Pneumonia ), a thromboembolism of a pulmonary trunk (see. Embolism of a pulmonary artery ); generalization of process in the form of thrombophlebitis of a basin and legs is possible. These complications can be caused by a rough palpation of a uterus. At suppuration of blood clots and an otslaivayushchy metritis the septicopyemia can develop (see. Sepsis ).
the Diagnosis is based on features a wedge, pictures (discrepancy of pulse rate to fervescence at the beginning of a disease), existence in the anamnesis of the factors promoting development of an inflammation and a vein thrombosis. These researches of tests of system of a hemostasis are important, to-rye are characterized by shift towards hypercoagulation (shortening of a blood clotting time, decrease in fibrinolitic activity, strengthening of fibrinogen and a prothrombin ratio, shortening of a calcium clotting time of plasma, change of indicators of a thrombotest).
Treatment consists in use of antibacterial drugs (antibiotics and streptocides), anticoagulants direct (heparin) and indirect action (Phenilinum, Pelentanum, Syncumarum, etc.) and the drugs improving rheological properties of blood (Polyglucinum, etc.). Treatment is carried out under control of tests of system of a hemostasis, blood tests, urine and other researches. The prothrombin ratio in the course of treatment by anticoagulants is controlled every day.
Regime of patients with metrothrombophlebitis shall be sparing, but not strictly bed in order to avoid deterioration in blood circulation and spread of blood clots.
At suppuration and plentiful uterine bleeding because of an otslaivayushchy metritis surgery — removal can be required uterus (see). An operative measure can be shown also at M. in combination with a necrosis of fabric after uterus operations. In the postoperative period treatment by anticoagulants continues.
The forecast and Prevention
the Forecast at timely begun antibacterial therapy with use of anticoagulants favorable; it considerably worsens at a late initiation of treatment, development of suppuration and tromboembolic episodes, the greatest danger from to-rykh is constituted by a thromboembolism of a pulmonary trunk.
Prevention consists in rational conducting childbirth, careful delivery, prevention of plentiful blood losses, timely and adequate compensation of blood loss, recovery of normal coagulative properties of blood, in active maintaining the postoperative period, timely and vigorous treatment of inflammatory complications puerperal period (see).
Bibliography: Bartels A. V. Puerperal infectious diseases, page 3, M., 1973; B about d I and N and V. I. and m and-kin K. N. Ginekologiya, page 3, 118, M., 1977.
V. P. Baskakov.