Sustainable Postoperative Care After Cesarean Section

Abstract

Rationale: puerperal endometritis is the major cause of formation of incompetent uterine scar and spread of infection. By contrast, reparative processes concerning uterine walls are the basis for formation of a competent uterine scar. In the past decades, there have been observed significant changes in the clinical course of puerperal endometritis. Apart from other factors, they are caused by improper antibiotics prophylaxis and antibiotic treatment. The key factors responsible for uterine scar incompetence also include improper surgery methods, namely: application of uninterrupted, continuous suture of uterus, reactogenic material, inappropriate hemostasis, pathological blood loss, surgery duration over two hours, using technique of manual fetal exteriorization.
 The aim of the present research is to identify a group of maternity patients that could avoid being administered perioperative antibiotic prophylaxis and the further antibiotic therapy on condition that their lower uterus segments are processed with interrupted sutures. It also involves the assessment of the early postoperative care period as well as eliminating possible complications. Materials and methods: The article analyses a group of 63 maternity obstetrics patients in early postoperative care period. They had their lower uterus segments processed with interrupted sutures. In all cases we used peritonization with help of plica vesicouterina. Antibiotic prophylaxis was avoided in both perioperative and early postoperative care periods. The article also presents the lab test values, data on thermometry and ultrasound diagnostic. The latter analyzed the following: length, width, thickness and the size of uterus, thickness of the front part of the uterus in the scar area, echoicity and echo structure of the mentioned area. Ultrasound examination allows us to estimate the uterus size, the scar condition, possible pathologic elements in the uterus body. The article also presents data on physical examination and bacteria culturing of the content of the uteri cavity during three days.
 The results: the complications were not presented by such nosological forms as endometritis or postoperative peritonitis, as well as inflammatory urinary conditions. No cases of any partial suture line disruption have been observed on the anterior abdominal wall or hyperthermia over 37,5 within the first three days of the postoperative period.
 Conclusions: during the rehabilitation period for the lower uterus segments by using synthetic suture material for the low-risk group of obstetrics patients it is not necessary to provide antibiotics prophylaxis and antibiotic treatment in the case of a planned or postponed caesarian section