
septik garbhachhidram

garbhaavasthayude 20 aazhchakalkkidayilo athinusheshamo endometriyathinte veekkam ulppedeyulla janananaalathile bacteria anubadha moolamundaakunna eathu tharatthilulla garbhachhidratheyum (manappoorvvam avasaanippikkal allengil garbhachhidram) septik garbhachhidram vivarikkunnu. eee kaalayalavil jananendria naalam anubaadhaykk prathyekichum irayaakunnu, mikka kesukalilum sepsis undaakunnath soukarya saahacharyangalum koodaathe/allengil vyakthigatha munkaruthalukalum moolamaanu. garbhaashayathe badhikkaan saadhyathayulla sankeernathakalode, palappozhum marupilla garbhapindatthilum anubadha aarambikkunnu, ithu sepsis chuttumulla avayavangalilekku padarunnathino pelvik anubaadhakalkko kaaranamakum.
kaaranagal.
nirvachanamanusarichu, septik garbhachhidram vividatharam bacteria anubadhakal moolamaanu undaakunnath. bakteeriyakal yoniyilum endoservical sasyajaalangalilum ninnu varaam allengil laingikamaayi pakaraam. sepsisinte vikaasam pradhaanamaayum rund saahacharyangal moolamaanu. rogakaarikal moolamundaakunna apoornnamaaya garbhachhidram shareerathil avasheshikkunna garbhadhaarana uthppannangalkk kaaranamaakumbol. randaamathe sahacharyam manappoorvamaaya septik nadapadikramangal sambhavikkunnath marupillayil ninno garbhapindatthil ninno garbhaashayathilekku anubadha padarunnathilekku nayikkunnu; ithu pinneedu pelvik septeeseemiyaykk kaaranamakum. neeseriya gonorrhea, chlamydia trachomatis, escherichiya koolii, micoplasma hominis", "clostridium perfrinchens, clebsyella, proteus" enangal, staafailokokkal strainukal, mattu gram-positteev allengil gram-negatteevu bakteeriyakal enniva saadhyamaaya rogakaarikalil ulppedunnu. septik garbhachhidram ulppede niravadhi rogangalkk kaaranamakunna group bii streptococcus garbhiniyaya sthriye parishodhikkanamo ennu nirnnayikkaan 2011 ll oru vishakalanam nadatthi. moonnaam loka rajyangalil, rogakaarikalude valia shreniyil, tetanus aanu ettavum saadhaaranamaaya kaaranam, athesamayam yuu.ezz. "clostridium perfrinchens" aanu ettavum saadhaaranamaaya kaaranam, prathyekichu nirbandhitha garbhachhidrangalil. niyamavirudhamaayo daridra raajyangalilo manahpoorvamaaya garbhachhidram nadathunna saahacharyangalil, septik sankeernathakalkkulla saadhyatha kooduthalaanu, kaaranam shuchithvamillaatha krameekaranangalil professionalukalallaathavaraanu eee nadapadikramam nadathiyathu, ithu pakarchavyaadhikalumaayi kooduthal sanbarkkam pularthaan vazhiyorukkunnu. kazhchappadil paranjaal, anubadha 62 sathamaanam niyamavirudhamaaya garbhachhidrathinum 51 sathamaanam garbhachhidrathinum kaaranamaayi, ennirunnaalum niyamaparamaayi nadatthiya septik garbhachhidrangal moolam 21 sathamaanam maranangalkk maathramaan anubadha kaaranamaayath.
epidemiology.
<aii. dii. 1> muthal, oro varshavum lokamembaadum ekadesham 73.3 dasalaksham garbhachhidrangal nadakkunnu. koodaathe, eee garbhachhidrangalil 45 sathamaanavum surakshithamallaatha garbhachhidrangalaanennum ithil 98 sathamaanavum vikaswara rajyangalilaanu nadannathennum aii. dii. 1ll ninnulla kanakkukal kaanikkunnu. prathyekichum, 50 sathamaanathiladhikam surakshithamallaatha garbhachhidrangal eshyayilum, bhooribhaagavum thekk, madhya eshyayilum aafrikkayilumaanu nadannathennu kanakkaakkappedunnu. 2008leeii chittayaya vishakalanathil ninnulla aagola daattayum, surakshithamallaatha garbhachhidrangalil ninnulla sankeernathakal maathrmaranangalil 13 sathamaanavum undennu kanakkakkunnu. koodaathe, oru munkaala padanatthil, septik garbhachhidravumaayi bandhapetta maathrmarddanam ekadesham 19 shathamaanamaanennu kandethi; ennirunnaalum aagola daattayude chittayaya avalokanam ippozhum aavasyamaanu.
vibhava-daridra parithasthithikalil thamasikkunna durbalaraaya janangalil septik garbhachhidram ettavum kooduthalaanu, eee janasamkhyayil 86 sathamaanam vare vyaapanam athunnu. atharam parithasthithikalil, septik garbhachhidrathinte sambhavangal kaumaarakkaaril ettavum kooduthalaanu, koodaathe garbhachhidram nedunnathile antharleenamaaya thadassangal kaaranam doctormarallathavar nadathunna niyamaviruddha garbhachhidra nadapadikramangal kooduthalaayi upayogikkunnathinaal niyantritha garbhachhidra niyamangalulla pradesangalilaanu. athinaal, "uyarnna prathyulpaadana nirakk, kuranja garbhanirodhana upayogam, surakshithamaaya garbhachhidrathinulla niyamaparamaaya thadassangal ennivayulla samoohangal" septik garbhachhidrathinte uyarnna vyaapanathilekku samoohathe nayikkunnu.
ennirunnaalum, septik garbhachhidram baadhicha janasamkhyayude moonnil rund bhaagavum varunna 16 num 24 num idayil praayamulla kaumaarakkaaril septik garbhachhidram ettavum kooduthalaanengilum, jananasamayath sthriyaayi niyamikkappedunna prayamaaya vivaahitharile septik sankeernathakal ippozhum saadhaaranamaanu. athinaal surakshithamaaya garbhachhidrathinulla apakada gadakangalum thadassangalum septik garbhachhidrathinte epidemiology nirnnayikkunnu.
antibiotic prathirodhasheshiyulla bakteeriyakalude aavirbhavam kanakkiledukkumbol, septik garbhachhidram medical samoohathe sambandhichidatholam uyarnna aashankayundaakkunnu.
adayaalangalum lakshanangalum.
septik garbhachhidravumaayi bandhapetta adayaalangalum lakshanangalum pradhaanamaayum ivayaanu
jaladosham allengil moothranaaliyile anubadha pala lakshanangaleyum anukarichekkaam.
avastha kooduthal gurutharamaakumbol, septik shokkinte lakshanagal prathyakshappedaam, avayil iva ulppedunnu
septik shock vrukka thakaraarilekkum rakthasraavam diathesis, intravascular koguleshan (dic) ennivayilekkum nayichekkaam. kudal avayavangalum rogabaadhithamaakaam, ithu vittumaaraatha vedana, kudal thadassam, vandhyatha ennivayulla vadu tissue undakkaan saadhyathayund.
septik garbhachhidram vegathilum falapradamaayum chikilsichillenkil, sthree marichekkaam.
roganirnayam.
garbhadharanam kazhinju 20 aazhchaykkullil garbhachhidram nadatthiya sesham garbhaashayathil anubaadhayude adayaalangalum lakshanangalum ulla aalukalil klinikkal vilayiruthal, baakteeriyal kalcharukal, ultrasonography enniva upayogichaanu septik garbhachhidram nirnnayikkunnath. septik garbhachhidram undennu samshayikkunna aalukale thirichariyunnathinulla aadya variyayi medical charithravum shaareerika parisodhanayum upayogikkunnu. oru sthreek thudakkathil panii, aswasthatha, vayaruvedana, yoniyil ninnu rakthasraavamundaakuka, servixil aaghaatham, anubaadhayude mattu aashankaajanakamaaya lakshanagal enniva undakam. septik garbhachhidrathinte vyathyastha roganirnayathil panii moolamulla apoornnamaaya garbhachhidram allengil garbhaashayathinte paaliyude veekkam chuvappullathinte lakshanangalulla swamedhayaa garbhachhidram enniva ulppedunnu.
klinikkal moolyanirnnayavum laab parisodhanayum.
kadinamaaya vayaruvedana peritonitisum durgandhamulla yoniyile discharge ulla 38 digri selshyasil kooduthalo <aii. dii. 1> digri eph. ll kooduthalo panii ulla eathoru rogiyilum undaakunna anubaadhayude theevrathaye adisthaanamaakkiyullathaanu klinikkal kandethalukal. anubaadhayude adayaalangalaaya leukocytosisinteyum brandemikkinteyum saannidhyam vilayiruthaan panii ullavaril deferential ulla oru complete blud kaundu (cbc) nadatthanam. electrolyte alavu, glucose, blud euria naitrajan (bunn), kriyettinin, liver function testt (elft), antibody screening, laaktett alavu, prothrombin time (pidi), activated paarshyal thromboplastin time (aaptti), fibrinogen thudangiya koguleshan padanangal polulla laabukal prathyekichum amithamaya rakthasraavamulla aalukalil enthengilum asaadhaaranathakal undengil parisodhikkanam.
microbiology.
septik garbhachhidram undennu samshayikkunna vyakthikalil, kooduthal roganirnayathinum chikilsaykkum vendi samskaarangalude chila vyathiyanangal edukkunnu. kuttakaramaya sookshumaanukkalude septik tharangalum speesheesukalum thirichariyaan vaayurahita bacteria, uyarnna yoniyile, servical kalcharukal enniva upayogikkaam. clostridial allatha vaayurahita, microaerophilic bacteria, vaayurahita streptococki ennivayaanu verthirichedutha praadhamika jeevikal. beetaa haemolitic streptocosy" group eiii ettavum rogakaariyaan, avaa saadhaaranayaayi saadhaarana yoniyile sasyajalangalil kaanappedaathathinaal saadhaaranayaayi jananendriyathilekku puratthekku praveshikkunnu. bii, dii grouppukal vairal kuravaanengilum ithu yoniyile sasyajaalangalude bhaagamaayi kaanapedunnilla.
pattika 1: septik garbhachhidrathile rogakarikalaaya jeevikal
ultrasonography mattu imaging saankethikavidyakalum.
ultraasoundu" ennum ariyappedunna ultrasonography, septik garbhachhidrathinte nirddishta sthaanavum uthbhavavum sthireekarikkunnathinu oru klinikkal roganirnayathe thudarnnu palappozhum upayogikkunnu. computed tomography (sidi) allengil magnetic resonance imaging (emri) ennivayum upayogikkaam. septik garbhachhidrathinte kandethalukalil iva ulppedunnu
apakadasaadhyatha gadakangal.
garbhachhidraananthara sepsis undakanulla saadhyatha pradhaanamaayum thaazhepparayunna gadakangalaal vardhikkunnu
sankeernathakal.
chikitsa vaikiyal prathyekichum sambhavikkaavunna chila sankeernathakal ivayaanu 
chikitsa.
rakthasammardhavum moothrathinte ulppaadanavum nilanirthaan sthreek intravinus draavakangal undaayirikkanam (oliguria allengil hyporasis enniva "mathiyaya moothram illa" ennartham varunna verukalil ninnulla perukalaanu; eee padangal moothrathinte kuranja ulppaadanathe soochippikkunnu). panii illaathaakunnathuvare broad spectrum intravinus antibioticukal nalkanam. intravinus clindamycin, pensilin plus chloramphenicol, sephalothin plus canamycin enningane eathaandu thulyamaaya vyathyastha antibiotic rejimensukalundu. pensilin jii-yekkaal panii samayam kuraykkaan tetracycline kooduthal phalapradamaanennu oru gaveshanam maathramaan kandethiyathu. ennirunnaalum, septik garbhachhidrathil ettavum phalapradamaaya antibiotic sthaapikkaan puthiya padanangal aavasyamaanu.
eathenkilum sheshikkunna tissuevinte garbhaashayathe vrithiyaakkaan dailetteshan aandu curetteju (dii & sii) allengil misoprostol enniva ultilise cheyyaam. pithaav arh negatteevu aanennu ariyunnillengil, arh immyoon globulin kuthivayppinu purame arh negatteevu raktham sthreek nalkanam. rogabadhithamaaya tissue neekkam cheiyunnathu palappozhum septik garbhachhidrathinulla ettavum phalapradamaaya chikilsakalilonnaanu. andaashayathilum tyoobukalilum kurukkal roopappedunnathra kadinamaaya kesukalil, garbhaashayamoothrachhedanathiloode orupakshe mattu rogabadhithamaaya avayavangaliloodeyum garbhaashayamukham neekkam cheyyendathu aavashyamaayi vannekkaam.
septik garbhachhidram vijayakaramaayi chikilsicha sesham, oru sthree aazhchakalolam sheenithayaayirikkaam. ganyamaaya rakthasraavamundaayaal, irumbu supplementation sahaayakamaayekkaam. aarogya parirakshaa daataav shupaarsha cheiyunnathuvare laingikabandhamo taambanukalude upayogamo ozhivaakkanam.
prathirodham.
praadhamika prathirodham.
samagramaya laingika vidyaabhyaasathiloodeyum phalapradamaaya garbhanirodhana maarggangalude opttimal upayogathiloodeyum anaavashya garbhadhaaranathinulla saadhyatha kuraykkunnathiloode septik garbhachhidravumaayi bandhapetta mikka sankeernathakalum maranangalum thadayaan kazhiyum. sthreekale nirbandhitha laingika bandhangalil ninnu thadayunna saamoohika samathvam mechappeduthunnathiloodu anaavashya garbhadaaranangal ozhivaakkaanum kuraykkaanum kazhiyum. 2015 leeii oru mettaa-analysis patanam kaanikkunnath garbhanirodhana maarggangalude upayogathekkurichulla prachodanaathmakamaaya abhimukham abhimukhathinu thottupinnaleyum edapedalinu sheshamulla naalu maasam vare athinte phalapradamaaya upayogam vardhippikkumennu. surakshithamallaatha garbhachhidram thadayunnathinulla mattoru ghadakam surakshithavum niyamaparavum samagravumaaya garbhachhidra sevanangal labhyamaakkalaan. lokaarogya samghadanayude (aarr) kanakkanusarichu, aagolathalathil oro varshavum 22 dasalaksham surakshithamallaatha garbhachhidrangal nadakkunnu. garbhachhidra niyanthranangalekkurich niyamangalekkurichum sthreekalkku avarude raajyangalile arivu kuravaanennu padanangal theliyichittundu. mattoru vidhathil paranjaal, garbhachhidrathinte niyamaparamaaya avasthayekkurichulla arivinte abhavam sthreekal surakshithamallaatha garbhachhidra sevanangal thedaan kaaranamakum. garbhachhidra sevanangalude niyamaparamaaya saahacharyathekkurichulla vidyaabhyaasavum axus cheyyaavunna surakshita sevanangalekkurichulla arivum septik garbhachhidram polulla sankeernathakalilekku nayikkunna surakshithamallaatha oopshanukal thedunna sthreekalude saadhyatha kuraykkumennu chittayaya avalokanangal theliyichittundu.
dvitheeya prathirodham.
kooduthal gurutharamaaya anubadhakal thadayaan kazhiyunna garbhaashayathinte paaliyude veekkam neratthe kandethukayum chikilsikkukayum cheiyunnathiloode septik garbhachhidrangalude dvitheeya prathirodham nedaanaakum. rogiyude charithravum lakshanangalum praadhamika vilayiruthalukal prashnatthinte theevratha manasilakkaan sahayikkum. anubaadhayude pradhana kaaranam nirnnayikkaan shaareerika parishodhanakalum pelvik parishodhanakalum rakthasamskaaravum upayogikkanam. vividatharam bakteeriyakal rogabadhithamaaya garbhachhidrathilekku nayikkumennum oru antibioticinum munganana nalkunnillennum kandethiyittundu. athinaal, rakthasamskaarangal anweshikkunnathu antibiotic therapy nayikkunnathinulla oru pradhana ghattamayirikkum. kaalikamaaya maarganirddeshangalum nannayi padicha chikitsa reethikalum pinthudaraan shupaarsha cheiyunnu.
moonnaamghatta prathirodham.
septik garbhachhidrathinte moonnaam ghatta prathirodham avayava vaikalyamo anubaadhayil ninnulla maranasaadhyathayo kuraykkunna sameepanangalaan. anubadha unmoolanam cheyyukayum niyanthrikkukayum cheythillengil, athu septik shokilekkum acute respiratory distress syndrome (ards) yilekkum (ards) nayichekkaam. kadinamaaya kesukalil, uyarnna panii, pelvis perittonitis, tachycardia ennivayulla sthreekale antibioticukalude oru kozhsinum sheshikkunna garbhakala tissue neekkam cheiyunnathinum ashupathriyil praveshippikkanam. garbhaashayathinte shoonyathayil ninnu prathikaranamonnum illengil, rogiye laparotamy enna mattoru nadapadikramatthinu nirddeshikkaam. oduvil, kadinamaaya sepsis ulla rogikalkku ards vikasichekkaam. anganeyaanengil, rakthathile ooksijan saachureshan nireekshikkukayum saachureshan level opttimal levelil thaazheyaanenkil mathiyaya vaayusanjaaram aarambikkukayum venam.

