12.1. SEPTIC DISORDERS IN POSTPARTUM PERIOD
Although antibiotics found their way into obstetric practice almost a century ago, which promoted a sharp decrease in the rate of postpartum infection, pyoinflamma-tory complications of the puerperium still remain a major issue of modern obstetrics. The rate of postpartum infection varies significantly due to the fact that there are no universally accepted criteria for its diagnosis; the rate amounts to 2-10% in different countries. An important role in the incidence of infectious complications belongs to the level of social and economic development of the country, patterns of health care (free of charge or private), local culture, educational background, religion, etc. On the whole, the number of women who died of septic complications is higher than the toll of all epidemics, pandemics or wars. Even nowadays, in the 21st century, over 50 thousand women die of sepsis every year. In economically backward countries septic complications in the puerperium remain one of the three leading causes of maternal death sharing the credit with obstetric hemorrhage and preeclampsia.
12.1.1. Definition
Postpartum infection is a disease of puerperal women related to pregnancy and delivery and caused by infection.
Infections revealed during the puerperium but not associated with pregnancy and delivery (the flu, dysentery) are not classified as postpartum conditions.
12.1.2. Historical background
The story of struggle against pyoinflammatory conditions dates back to ancient times. However, the first scientifically reliable historical documents appeared in the second half of the 18th century: contemporaries totally overlooked a small book by a Manchester physician Charles White published in 1773 in his Treatise on the Management of Pregnant and Lying-in Women; it discussed issues of patient's hygiene, including washing and boiling of patients' clothes and underwear. This could be regarded as the first reform of medical practice comparable with smallpox vaccination if the principles stated by White had become widespread. Unfortunately, this did not happen.