Postpartum cervical ulcer is a limited wound defect of the mucous membrane and underlying tissues of the cervix, which occurred at the site of internal postpartum ruptures or wounds. The course of postpartum cervical ulcer is characterized by a local infectious and inflammatory reaction, subfebrility, colpitis, vulvitis. Diagnosis of postpartum cervical ulcer is based on gynecological examination, colposcopy, smear examination. Local treatment of ulcerative defect of the cervix is the application of napkins with hypertonic solution, enzymes, antibacterial ointments.
Postpartum cervical ulcer is directly related to the process of delivery and infection of the birth canal. Postpartum cervical ulcer refers to limited forms of postpartum infection, which develops against the background of injury to the cervix during rapid, prolonged or operative childbirth through the natural birth canal.
Internal ruptures on the cervix are most often formed at the end of the first period of labor with the neck not fully open and can serve as an entrance gate for infection. Due to infection of cracks or ruptures of the mucous membrane of the cervical canal, a postpartum ulcer of the cervix may form. Tissue necrosis occurs on its surface with the formation of purulent plaque, edema and hyperemia of nearby tissues develop.
Postpartum cervical ulcer is considered as a certain stage in the development of a single infectious process in the body of a woman who gave birth. At the stage of postpartum cervical ulcer, the infection is localized within the uterus, but with extensive damage and improper treatment, it can lead to the development of complications, up to a generalized septic form. The healing processes of postpartum cervical ulcers are often disrupted and significantly slowed down, which can lead to chronic inflammation.
Postpartum cervical ulcer develops when microorganisms penetrate the surface of the postpartum wound of the cervical canal. The appearance of a postpartum cervical ulcer can be caused by pathogenic microflora: gonococci, trichomonas, chlamydia, mycoplasma. With a decrease in immunity, the causative agents of postpartum cervical ulcers can be conditionally pathogenic microorganisms: Staphylococcus aureus, hemolytic and anaerobic streptococci, lactose-negative enterobacteria (proteus, klebsiella), hemolytic E. coli, obligate and facultative anaerobes (clostridia, bacteroids; peptococci, peptostreptococci, etc.), as well as associations of microorganisms.
Risk factors for the development of postpartum cervical ulcers are complications of labor: premature outpouring of amniotic fluid, prolonged labor with a large fetus, uterine bleeding during childbirth and the early postpartum period, operative labor with trauma of the birth canal (birth trauma), a long anhydrous interval in childbirth.
Violation of the sanitary and epidemiological regime, invasive diagnostics during pregnancy and childbirth (transcervical amniocentesis and amnioscopy, direct electrocardiography of the fetus), surgical treatment of cervical insufficiency, frequent vaginal examinations with rupture of the membranes of the fetal egg and manual examination of the uterine cavity) can cause postpartum complications, including postpartum ulcers of the cervix. The presence of chronic genital infections in a woman in labor contributes to the development of an inflammatory process at the site of postpartum trauma and the formation of a postpartum ulcer of the cervix.
A postpartum ulcer forms at the site of a postpartum injury to the cervix, usually 3 to 4 days after delivery. Local symptoms of postpartum cervical ulcer are characterized by the presence of a dense purulent plaque of gray-yellow color on the surface of the wound, signs of inflammation (redness and swelling) of peripheral tissues, bleeding of the affected area.
Postpartum cervical ulcer may be accompanied by subfebrile fever, soreness, general malaise. When the infection spreads beyond the cervix, colpitis, vulvitis develop with typical symptoms for them – burning, itching, mucosal hyperemia.
Usually, after 4-5 days, the temperature normalizes, the well-being improves. With a favorable course of postpartum ulcers of the cervix, the wound is cleaned of plaque and its epithelization occurs. Otherwise, the generalization of septic infection is possible.
Diagnosis of postpartum cervical ulcer is based on clinical symptoms, gynecological examination data, laboratory and instrumental studies. Gynecological examination with the help of mirrors reveals a wound defect on the surface of the cervix, covered with fibrinous-purulent or purulent plaque, swelling and hyperemia of surrounding tissues.
In the blood during the acute process, an increase in leukocytes and ESR is detected. The causative agents of postpartum ulcers of the cervix can be established by PCR diagnostics or bacteriological examination of secretions from the cervical canal. Bakposev is carried out before the start of antibacterial treatment. Additionally, the gynecologist may prescribe colposcopy, ultrasound, hysteroscopy, thermography, etc.
With postpartum cervical ulcer, the main method is local treatment, which is aimed at removing purulent discharge, antiseptic wound treatment and accelerating regeneration processes. If stitches are applied to the cervix, they must be removed during treatment.
The postpartum ulcer of the cervix is cleaned of purulent plaque by applying sterile gauze turundum with 10% sodium chloride solution, furacilin, ointment applications with antibiotics (chloramphenicol + methyluracil, synthomycin emulsion), necrolytic enzymes (cyherol, trypsin, chymotrypsin). The wipes are changed every day, until the ulcer is cleared of pus – as a rule, it takes several days.
Epithelialization of postpartum cervical ulcer usually ends after 10-12 days. With a small lesion surface, the postpartum ulcer of the cervix heals by secondary tension, with extensive wounds stitches are applied. After healing of sutured deep ruptures, scarring of the cervix may develop. This defect is subsequently corrected with the help of a laser, a radionog or surgical methods – conization of the cervix, augmentation of the cervical canal.
Prognosis and prevention
The prognosis of postpartum cervical ulcer is favorable in most cases. With timely and adequate treatment, the postpartum ulcer of the cervix is cleared of pus and gradually epithelized. Currently, thanks to preventive measures, as well as reasonable antibacterial therapy, gynecology rarely faces complications against the background of postpartum cervical ulcers.
Prevention of postpartum cervical ulcers should include treatment of inflammatory gynecological and extragenital diseases during pregnancy planning, rehabilitation of the birth canal, rational management of childbirth and the postpartum period, treatment of postpartum sutures, compliance with the rules of asepsis, antiseptics and personal hygiene.