Ultrasound diagnostics of inflammation
Ultrasound examination reveals a number of criteria indicating an inflammatory process. First, a pathological increase in the total uterine volume and an increase in its anteroposterior diameter are recorded. The structure of the myometrium also changes—pronounced hypoechogenicity of the myometrium is visualized.
The most important diagnostic marker is lochiometra. In this condition, the uterine cavity appears expanded along its entire length. The internal space is filled with specific anechoic contents, against which parietal hyperechoic structures are identified. Additionally, loss of the normal anatomical boundary is noted: the transition line between the uterine cavity and the myometrium becomes unclear and blurred.
Furthermore, ultrasound allows for the diagnosis of uterine subinvolution. This process is characterized by a significant slowdown in the rate of organ volume reduction by the 5th postpartum day compared to the physiological course.
Specifics of infection after Cesarean section
The development of the inflammatory process after surgical delivery has its own characteristics. In this clinical situation, assessing the condition of the postoperative uterine wound becomes paramount.
Ultrasound scanning reveals several reliable signs of inflammatory changes in the surgical intervention area:
- Hyperechoic formations are visualized in the area of the ligatures, indicating gas accumulation or the presence of fibrin deposits.
- A local decrease in echogenicity is determined in the area of the placed sutures—a direct consequence of inflammatory tissue infiltration.
- The most formidable sign is the niche sign. It represents a tissue defect directly in the lower uterine segment and indicates surgical suture dehiscence.
Comprehensive treatment of the inflammatory process
Therapeutic tactics for suspected infection must be comprehensive and staged.
1. Evacuation of the uterine cavity This manipulation is the primary measure. It includes washing the uterine cavity with antiseptic solutions and/or curettage with a large curette under mandatory ultrasound guidance. If inflammation develops in the late postpartum period and uterine dimensions correspond to 9–12 weeks, evacuation is performed under hysteroscopic guidance.
2. Drug therapy The basis of pharmacotherapy is the administration of broad-spectrum antibacterial drugs. Initially, they are prescribed empirically, and subsequently based on microflora sensitivity. Simultaneously with antibiotics, drugs for the prevention and treatment of candidiasis and dysbiosis are used. Uterotonics and antihistamines are also included in the regimen.
3. Detoxification therapy To relieve intoxication, infusion therapy is performed in a volume of up to 2000 ml. According to strict indications, both crystalloids and colloids are used.
Obstetric peritonitis: causes and specifics
Peritonitis is inflammation of the peritoneum that occurs when pathological contents enter the abdominal cavity. Sources may include:
- Contents of abdominal organs upon injury (urinary bladder, intestines).
- Pus from the uterus entering through the fallopian tubes.
- Pus upon rupture of tubo-ovarian inflammatory masses.
- Blood (in ovarian apoplexy, ectopic pregnancy).
Specifics in obstetric practice The most frequent cause of this complication is a prior Cesarean section (due to uterine infection or suture failure). Another factor is infection of the birth canal due to trauma during vaginal delivery operations. Extremely rare causes include gonococcal infection during pregnancy, in which peritonitis can develop either before or after spontaneous delivery.
To memorize the ultrasound signs of suture inflammation after Cesarean section, use the "HID" rule: Hyperechoic inclusions (gas/fibrin), Infiltration (decreased echogenicity), Defect in tissue (niche sign).
Class and exam questions
What is the primary measure in the treatment of postpartum uterine inflammation?
The main step is evacuation of the uterine cavity. It is performed by washing with antiseptic solutions or curettage under mandatory ultrasound guidance.
How does lochiometra appear on ultrasound?
The uterine cavity is visualized as expanded along its entire length. Anechoic contents are determined inside, and hyperechoic structures on the walls.
In what cases is hysteroscopy used for uterine evacuation?
Hysteroscopic guidance is necessary in the late postpartum period when uterine dimensions correspond to 9–12 weeks of gestation.
What is the most frequent cause of peritonitis in obstetrics?
Most often, peritonitis occurs after a prior Cesarean section. This happens as a result of uterine infection or the development of dehiscence of the sutures placed on it.
What else to study on this topic
- Mechanisms of formation of the niche sign and uterine suture dehiscence.
- Empirical selection of broad-spectrum antibacterial therapy.
- Indications for the use of colloid and crystalloid solutions in detoxification.
- Differential diagnosis of the causes of obstetric peritonitis (intestinal trauma, rupture of tubo-ovarian masses).
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