Predicting the risk of postpartum infectious complications

• Nataliia G. Zhilinkova
• Alina V. Solovieva
• Tatevik N. Zulumyan
• Krsitina E. Botasheva
• Konstantin V. Teplov
• Gulnoza К. Eldаshova

Abstract

Aim. To determine clinical-anamnestic factors and features of delivery in women with infectious postpartum complications.

Material and methods. A cohort retrospective study of medical records of 72 patients admitted to the gynecological department of a state medical institution in Moscow was carried out. The women were divided into 2 groups depending on the method of delivery: vaginal delivery or cesarean section.

Results. The largest number of women with postpartum infectious were after vaginal birth, aged 25 to 34 years. Their BMI was significantly more often in the range from 25 to 30 kg/m². Patients with a BMI over 35 kg/m² were found only in the group of patients who had undergone cesarean section. In both groups there was a high employment rate of women, married women and patients with higher education prevailed. Among the extragenital diseases in both groups, mild and moderate anemia, chronic pyelonephritis, and varicose veins of the lower extremities accounted for a large share. Uterine fibroids and endometriosis were equally frequent. Ovarian neoplasms and infertility were more common in patients undergone cesarean section. Most of the examined patients were primiparous (61.11%). 51.39% had their first pregnancy.

On admission, the most common complaint was a rise in temperature over 38.6±0.94 °С, most often at 10.76±9.69 days. Women also complained of pain in the lower abdomen in 61.1%, vaginal bleeding in 33.3%. Physical examination showed an increase in the size of the uterus up to 11.9±2.34 weeks. The average delivery time was 39.3 weeks. In 34 (47.22%) childbirth began spontaneously, in 2 (2.78%) amniotic fluid ruptured before the onset of labor. In 25 (34.72%) labor was programmed, in 20 (80.00%) pre-induction of labor using a dilatation balloon was used, in 5 (20.00%) programmed labor began with amniotomy.

The duration of labor in primiparous women averaged 538.64±130.84 minutes, and in multiparous women 350.00±197.68 minutes. Weakness of labor was observed in 21 (29.17%) patients. 8 (38.09%) showed oxytocin stimulation whithout effects and undergone cesarean section. Complications of the third stage of labor were observed in 10 (23.81%). Blood loss during childbirth ranged from 355.26±240.44 ml. Hyperthermia was observed in 11.11% in childbirth. In 22 (30.6%), antibacterial drugs were prescribed immediately after delivery.

Conclusion. In the examined women, risk factors for postpartum infectious complications were identified: a large proportion of patients over the age of 35, operative delivery, programmed delivery, post-term pregnancy, emergency caesarean section after the onset of labor, routine use of antibacterial drugs in the postpartum period.

Keywords:puerperial period, postpartum infectious complications, risk factors

References

1. Abubakar U., Syed Sulaiman S.A., Adesiyun A.G. Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria. PLoS One. 2019; 14 (3): e0213395.

2. Letter of the Ministry of Health of the Russian Federation of September 18, 2019 No. 15-4/and/2-8714 «Maternal Mortality in the Russian Federation in 2018». (in Russian)

3. Moussa H.N., et al. Obesity epidemic: impact from preconception to postpartum. Future Sci. OA. 2016; 2 (3): FSO137.

4. Chen K.T., Berghella V., Barss V.A. Postpartum endometritis. Jul 24, 2018. URL: https://www.uptodate.com/contents/postpartum-endometritis#H22

5. Radzinsky V.E. Obesity. Diabetes. Pregnancy. Versions and Contra-versions. Clinical Practice. Prospects. Moscow: GEOTAR-Media, 2020: 528 p. (in Russian)

6. Boushra M., Farci F. Antepartum Infections [Electronic resource]. StatPearls, 2020.

7. Radzinsky V.E. Obstetric aggression, v. 2.0. Moscow: StatusPrae-sens, 2017. (in Russian)

8. Eriksson E. Potential Predictive Factors for Postpartum Endometritis and the Microbiology in Cervical Cultures. 2018.

9. Greer O., Shah N.M., Johnson M.R. Maternal sepsis update: current management and controversies. TOG (The Obstetrician and Gynaecologist). 2020; 22 (1): 45-55.

10. Letter of the Ministry of Health of the Russian Federation dated February 6, 2017. No. 15-4/10/2-728 “Septic Complications in Obstetrics”. (in Russian)

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