Puerperal diseases

　　1. Types of pathogens Currently, it is believed that the vaginal ecosystem during pregnancy and puerperium is extremely complex, with a large number of aerobic bacteria, anaerobic bacteria, fungi, and chlamydiae, mycoplasmas, etc.寄生, but anaerobic bacteria are dominant. In addition, many non-pathogenic bacteria can also cause disease in specific environments.

　　(1) Aerobic Streptococcus: Beta-hemolytic streptococci can be divided into 18 groups. Group B Streptococcus (GBS) produces exotoxins and tissue-necrotizing enzymes, making it highly pathogenic and virulent, closely related to puerperal infection, and can cause severe infections. Its clinical characteristics include early fever (on average 11 hours postpartum), body temperature over 38°C, chills, rapid heart rate, abdominal distension, poor uterine involution, tenderness in the parauterine or adnexal area, and even sepsis. Aerobic Streptococcus is the main pathogenic bacteria of exogenous infection.

　　(2) Escherichia coli: Escherichia coli and its related Gram-negative bacilli, Proteus, are the main bacterial species responsible for exogenous infections and are the most common pathogens of sepsis and septic shock. Escherichia coli resides in the vagina, perineum, and urethral orifice and can rapidly multiply and cause disease during the puerperium. The sensitivity of Escherichia coli to antibiotics varies greatly in different environments, and drug sensitivity tests are required.

　　(3) Staphylococcus: The main pathogenic bacteria are Staphylococcus aureus and Staphylococcus epidermidis, which have significant differences in pathogenicity. Staphylococcus aureus is mainly an exogenous infection, which can easily cause severe wound infections. Staphylococcus epidermidis exists in the vaginal flora and causes relatively mild infections. Staphylococcus is resistant to penicillin due to its ability to produce penicillinase.

　　(4) Anaerobic Streptococci: Diphtheroids and Sarcinae are more common, existing in the normal vagina. When the birth canal is injured, residual tissue necrosis, local redox potential is low, and the bacteria rapidly multiply, mixed with Escherichia coli infection, emitting an abnormal foul smell.

　　(5) Anaerobic Bacilli: A group of strictly anaerobic Gram-negative bacilli, including Bacteroides fragilis, Bacteroides pigmentans, etc., which have the characteristic of accelerating blood coagulation and can cause thrombophlebitis of the adjacent area.

　　In addition, Clostridium botulinum and Neisseria gonorrhoeae can also cause puerperal infection, but they are less common. Mycoplasma and Chlamydia can also be one of the pathogens causing puerperal infection.

　　2. Source of Infection There are two sources of infection: one is self-infection, which refers to pathogens that寄生 in the reproductive tract or other parts of normal pregnant women. They can cause disease when infection triggers occur; the other is external infection, which is caused by contact with contaminated clothing, utensils, various surgical instruments, and items after being contaminated.

　　2. Infection Etiology The response of the body to invasive pathogens depends on the type, quantity, virulence of the pathogens, and the body's defense ability. Any factor that weakens the reproductive tract and overall defense ability of the mother is conducive to the invasion and reproduction of pathogens. For example, anemia, malnutrition, chronic diseases, the proximity to the expected delivery date, premature rupture of membranes (the amniotic fluid contains lysozyme with bactericidal activity, which decreases after the amniotic fluid is lost), amniotic cavity infection, various obstetric surgical procedures, birth canal injury, bleeding before and after birth, uterine cavity packing, birth canal foreign bodies, prolonged labor, placental retention, and others can all become etiological factors for puerperal infection.

      1. Puerperal Fever

　　If a new mother develops a fever symptom after giving birth to a baby, it is usually called puerperal fever if it occurs between 24 hours to 10 days after delivery. Severe puerperal fever infection can affect the health of new mothers and even threaten their lives.

　　2. Uterine Prolapse

　　Some mothers may feel a downward sagging or lower back pain after giving birth, which is due to the relaxation of the uterine ligaments and pelvic floor muscles after delivery, causing the uterus to change position and move downward along the vaginal direction, leading to uterine prolapse.

　　3. Mastitis

　　The first 1-4 weeks after giving birth are a common period for acute mastitis, as milk is not drained smoothly and accumulates in the breast, causing bacterial infection. New mothers may experience breast pain and fever symptoms.

　　4. Urinary Retention

　　Some new mothers are afraid to urinate after giving birth due to the fear of pain from the incision, or the long labor process may compress the bladder, causing postpartum urinary weakness and the bladder to swell, with urine dribbling out very poorly during urination, which is known as urinary retention.

　　5. Low Back Pain

　　In the period immediately after giving birth, the pelvic ligaments of new mothers are still in a relaxed state, and the abdominal muscles have become weak and无力. The uterus has not yet fully复位, and if one does not pay attention and suddenly bends over to pick up something, or sits or squats for a long time, new mothers may feel pain in their lower back.

　　6. Mom's hand

　　After childbirth, the body is weak, using a breast pump to extract milk or some household chores that are considered very light in daily life, if not paid attention to during the postpartum period, will feel numbness and pain in the fingers. Numbness and pain points often occur in the position from the thumb to the middle finger. It is mainly caused by overuse of the wrist and thumb area, causing inflammation of the two tendons in the wrist. It is different from carpal tunnel syndrome caused by slow blood circulation during pregnancy, edema, and increased pressure in the carpal tunnel, compressing the median nerve.

　　7. Postpartum muscle and joint pain

　　Due to the fact that the baby sleeps while feeding, the feeding time is long, mothers maintain a sitting posture for too long, and many babies have the situation of day and night reversal, crying all night, and in severe cases, the parents have to hold the baby up and down all night. Therefore, after a month, the waist, back, elbows, and wrists are extremely painful. To avoid these phenomena of muscle and joint pain, mothers should pay attention to the posture when holding the baby, and the waist and back should have a place to rely on; rest more, move less, and do not get out of bed for more than one hour. You can cook Du Zhong pork kidney soup, and after the lochia is clean, you can eat the Ten Full Supplement Soup (which contains Du Zhong and Xu Duan), which has a good effect on relieving muscle and joint pain.

　　Postpartum depression refers to the occurrence of depressive symptoms in women after childbirth, which is the most common type of puerperal psychiatric syndrome. Regarding its incidence, there is very little information in China. Symptoms usually appear two weeks after childbirth,表现为易激惹、恐怖、焦虑、沮丧和对自身及婴儿健康过度担忧，常失去生活自理及照料婴儿的能力，有时还会陷入错乱或嗜睡状态。 Often lose the ability to take care of themselves and their babies, and sometimes may fall into a state of confusion or drowsiness.

　　1. Strengthen health education during the perinatal period, maintain cleanliness of the whole body and perineum, avoid sexual intercourse in the late pregnancy, enhance nutrition, appropriate exercise during pregnancy, strengthen physical fitness, and treat vulvovaginitis and cervicitis early if present.

　　2. Before labor, pay attention to avoid premature rupture of membranes, and deal with abnormal labor promptly to avoid causes of infection such as prolonged labor, birth canal injury, and postpartum hemorrhage. Strict aseptic operation should be performed during delivery, and the indications for surgery should be correctly grasped.

　　3. Postpartum, closely observe for potential puerperal infections, and preventively apply antibiotics. Control the number and time of visitors, and provide necessary medical guidance to caregivers.

　　4. The delivery room and operating room should be strictly disinfected daily, and the concentration and immersion time of the disinfectant for the instruments should be verified daily. The bedsheets and clothing of the patients in the ward should be changed daily, and the bedsheets should be cleaned with a wet sweeping method; the floor should be wet mopped twice a day with 1/5000 “84” disinfectant solution. Regularly perform bacterial culture on the surfaces of items, the hands of medical staff, and the air in the ward, twice a month.

　　There is no unified diagnostic criteria for postpartum depression. The American Psychiatric Association (1994) established the diagnostic criteria for postpartum depression in the book 'Diagnostic and Statistical Manual of Mental Disorders'.

　　1. If the following 5 or more symptoms appear within 2 weeks after childbirth, it is necessary to have both ① and ②.

　　① Depressed mood

　　② Marked lack of interest or pleasure in all or most activities

　　③ Significant weight loss or gain

　　④ Insomnia or excessive sleep

　　⑤ Psychomotor excitement or retardation

　　⑥ Fatigue or weakness

　　⑦ Feeling of meaninglessness or guilt in all matters

　　⑧ Decreased mental or attentional impairment

　　⑨ Recurring thoughts of death

　　2. Onset within 4 weeks after childbirth

　　Dietary注意事项 for postpartum diseases should avoid cold, spicy, and balanced diet. In addition to eating more nutritious food during the postpartum period, women should also pay attention to the cooking methods, try to avoid eating fried and grilled foods, as these foods can seriously affect the recovery of the woman's body. Since women are prone to sweating during the postpartum period, they should drink more soup and water to replenish the lost water, but they should not forget to eat more meat while drinking soup, as meat is much more nutritious than soup. Most women's digestion is affected to some extent, and the cooking methods should be mainly steamed, stewed, braised, and boiled.

　　Postpartum depression usually requires treatment, including psychological treatment and drug treatment.

　　1. Psychological treatment is through psychological counseling to eliminate the psychological factors causing the disease (such as poor marital relationships, wanting a boy but giving birth to a girl, a history of mental disorders, etc.). Pay more attention to and care for postpartum women, try to adjust various relationships in the family, and guide them to develop good sleep habits.

　　2. Drug treatment involves the application of antidepressants, mainly including serotonin reuptake inhibitors, tricyclic antidepressants, and others. For example, paroxetine starts with a dose of 20mg/d and gradually increases to 50mg/d orally; sertraline starts with a dose of 50mg/d and gradually increases to 200mg/d orally; fluoxetine starts with a dose of 20mg/d and gradually increases to 80mg/d orally; amitriptyline starts with a dose of 50mg/d and gradually increases to 150mg/d orally, and so on. The advantages of these drugs are that they do not enter breast milk, so they can be used for postpartum depression.