[Sepsis and SIRS (systemic inflammatory response syndrome) in the puerperium--pathogenesis and clinical management]

We report about 5 cases of "puerperal sepsis" to elucidate the clinical significance and resulting therapeutic management of Sepsis, SIRS (Systemic inflammatory response syndrome) and MODS (Multiple organ dysfunction syndrome), whose definitions were introduced at the Consensus Conference of the American College of Chest Physicians/Society of Critical Care Medicine in 1992.

All patients had documented endomyometritis, 3 of them in combination with ovarian vein thrombosis. None of the patients responded adequately to conservative treatment with antibiotics and intravenously applied Heparin. After 12 to 72 hours, because of clinical deterioration, all women underwent laparotomy with hysterectomy combined with an ovarectomy in 3 cases. Although the inflammatory "septic" source was removed by the surgical intervention, the clinical condition of 3 of the patients further deteriorated; they were suffering from SIRS, and 2 developed MODS. Symptoms of MODS were DIC, hypotension, kidney failure and encephalopathy.

Our results support the theory that infection or trauma may initiate an endogenous inflammatory response which could progress to MODS even after removal of the initial source. Our findings, however, do not support the view that septic endomyometritis and postpartum ovarian vein thrombosis should be treated nonsurgically, because the clinical course in our patients was less complicated the earlier the surgical intervention was initiated.