Мать и дитя в Кузбассе (May 2017)
RISK FACTORS AND PECULIARITIES OF POSTPARTUM ENDOMETRITIS
Abstract
The most common manifestation of postpartum infection is postpartum endometritis. Its frequency in the general population pretends to be from 3 up to 8 %, and among patients with postpartum inflammatory complications – is more than 40 %. The aim of the study. To study the clinical features of postpartum endometritis in postpartum period after spontaneous and operative delivery, and to determine the risk factors of complications of the postpartum period. Materials and methods. The retrospective study of 103 cases with postpartum endometritis was conducted. Results. Risk factors for postpartum endometritis in pregnancy are bacterial vaginosis (70,9 %) and sexually transmitted infections (25,2 %). Risk factors for postpartum endometritis during labor are: soft tissue injuries of the birth canal (22,4 %), chorioamnionitis (8,7 %) premature rupture of membranes (7,8 %), and the long anhydrous period (10,7 %). The frequency of postpartum endometritis in 13 times higher in emergency cesarean section than with planned surgical intervention. The study of the microflora revealed that a contamination of pathogenic flora is registered in consequence of low immune barrier of the pregnant woman. This situation is characterized by a change of the leadership position microbial agent to predominance of Enterococcus faecalis and Enterococcus faecium according to the scheme: the vagina is 19,4 % → cervical canal 28,2 % → uterus of 10,7 %. The first clinical picture of postpartum endometritis after operative delivery appears for 6 ± 2 days, while after spontaneous delivery for 4 ± 2 days, whith the combination of the latent clinical picture can lead to untimely started therapy. Conclusion. The creation of new bacterial strains with higher virulence, resistance to antibiotics is often the result of inappropriate empiric antibiotic therapy. The increasing of number of operative delivery, as well as the reduction of immunological reactivity of the organism of the pregnant woman suggests the need for a comprehensive approach to the development of new methods in postpartum women with postpartum endometritis.
