Prediction of the development of inflammatory complications in the postpartum period

Abstract

Background. The main etiological reasons for the still high level of serious postpartum complications are frequent isolation of aggressive pathogenic microorganism associations, an increase in their virulence and antibiotic resistance, and an increase in the frequency of surgical methods of delivery.

Aim. Assessment of the significance of clinical, instrumental and laboratory parameters in the diagnosis of early inflammatory complications of the postpartum period.

Material and methods. To study the risk factors for the development of the inflammatory process, they were registered in the postpartum period during the examination of 150 patients who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology in Baku for the period 2017–2020. Depending on the presence or absence of the studied pathology, the patients were divided into two groups: the main group included puerperas with developed postpartum complications (n=100), the comparison group included puerperas with a physiological course of the postpartum period (n=50). The average age of puerperas in groups was 29.9±0.64 and 30.3±0.86 years, respectively (p=0.679). Complications were diagnosed based on the analysis of the results of clinical and laboratory studies, the study of anamnestic data and the results of ultrasound examination. The information content of the obtained data was determined by the Kullback method.

Results. In the course of research, it was found that an important reason for the development of postpartum complications of an inflammatory nature is the long-term use of contraception. Women of the main group more often use means for intrauterine contraception and barrier contraceptives — 24 and 29%, and in the comparison group — 6 and 12% (p=0.006; p=0.024). When studying the structure of clinical manifestations of complications of the early postpartum period, pain in the lower abdominal cavity was most often recorded — 89.0±3.13%, and in the comparison group — 6.0±3.36% (p <0.0001). Among the studied ultrasound diagnostic criteria for inflammatory complications in the postpartum period, cases of an increase in the size of the uterus and thickening of the endometrium were detected in 98 and 97 out of 100 people in the main group and only in 1 case out of 50 patients in the comparison group (p <0.0001). The absolute number of T-lymphocytes, hemoglobin, the concentration of the pro-inflammatory cytokine interleukin-6, and the erythrocyte sedimentation rate are recognized as the most informative diagnostic indicators of biochemical studies in patients with postpartum complications.

Conclusion. The reasons for the development of inflammatory complications in the postpartum period are the presence of a history of spontaneous abortions, intrauterine contraception and the use of barrier contraceptives.

Keywords

postpartum complications / contraceptives / information content / ultrasound / blood test

References

[1] Kaku Sh, Kubo T, Kimura F, Nakamura A, Kitazawa J, Morimune A, Takahashi A, Takebayashi A, Takashima A, Kushima R, Murakami T. Relationship of chronic endometritis with chronic deciduitis in cases of miscarriage. BMC Womens Health. 2020;20:114. DOI: 10.1186/s12905-020-00982-y.

[2] Zagrtdinova RM, Bogolyubskaya AL, Dimakova EV. Optimization of urogenital mycoplasma infection treatment in women. Akusherstvo i ginekologiya. 2015;(9):103–107. (In Russ.)

[3] Загртдинова Р.М., Боголюбская А.Л., Димакова Е.В. Оптимизация лечения урогенитальной микоплазменной инфекции у женщин. Акушерство и гинекология. 2015;(9):103–107.

[4] Belizário JE, Napolitano M. Human microbiomes and their roles in dysbiosis, common diseases, and novel therapeutic approaches. Front Microbiol. 2015;6:1050. DOI: 103389/fmicb201501050.

[5] Ngonzi J, Bebell LM, Fajardo Y, Boatin AA, Siedner MJ, Bassett IV, Jacquemyn Y, Van geertruyden J-P, Kabakyenga J, Wylie BJ, Bangsberg DR, Riley LE. Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth. 2018;18:270. DOI: 10.1186/s12884-018-1891-1.

[6] Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U, Verma A. Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol. 2018;31(1):79–85. DOI: 10.1007/s40620-017-0466-y.

[7] Yakovenko LA Etiological aspects of chronic endometritis (literature review). Mezhdu­narodnyy zhurnal prikladnykh i fundamentalnykh issledovaniy. 2016;(4):574–577. (In Russ.)

[8] Яковенко Л.А. Этиология эндометрита (обзор литературы). International Journal of Applied and Fundamental Research. 2016;(4):574–577.

[9] Akintomide H, Brima N, Mansour DJ, Shawe J. Copper IUD continuation, unwanted effects and cost consequences at 1 year in users aged under 30 — a secondary analysis of the EURAS-IUD study. Eur J Contracept Reprod Health Care. 2021;26(3):175–183. DOI: 10.1080/13625187.2021.1879783.

[10] Levin G, Dior UP, Gilad R, Benshushan A, Shushan A, Rottenstreich A. Pelvic inflammatory disease among users and non-users of an intrauterine device. J Obstet Gynaecol. 2021;41(1):118–123. DOI: 10.1080/01443615.2020.1719989.

[11] Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018;3:9. DOI: 10.1186/s40834-018-0064-y.

[12] Ivanets TYu, Kessler YuV, Kolodko VG. The reference ranges for min parameters of clinical blood ana­lysis in dynamics of physiological pregnancy. a comparative analysis with pregnancy after extra corporal fertilization and embryo transfer into uterine cavity. Clinical laboratory dia­gnostics. 2017;62(1):18–24. (In Russ) DOI: 10.18821/0869-2084-2017-62-1-18-24.

[13] Иванец Т.Ю., Кесслер Ю.В., Колодько В.Г. Референсные интервалы для основных параметров клинического анализа крови в динамике физиологической беременности. Сравнительный анализ с беременностью после ЭКО и ПЭ. Клиническая лабораторная диагностика. 2017;62(1):18–24. DOI: 10.18821/0869-2084-2017-62-1-18-24.

[14] Gubler EV. Vychislitel'nye metody analiza i raspoznavaniya patologicheskikh protsessov. (Computational methods for the analysis and recognition of pathological processes.) M.: Meditsina; 1978. 296 р. (In Russ.)

[15] Гублер Е.В. Вычислительные методы анализа и распознавания патологических процессов. М.: Медицина; 1978. 296 с.

[16] Tirskaya JuI, Barinov SV, Dolgikh TI, Pyanova LG, Chernyshev AK, Kovaleva JuA, Korneev DV, Shamina IV. The prediction of an infection risk and the way to prevent postpartum endometritis in puerperas at risk for infections. Akusherstvo i ginekologiya. 2014;(5):37–42. (In Russ.)

[17] Тирская Ю.И., Баринов С.В., Долгих Т.И., Пьянова Л.Г., Чернышёв А.К., Ковалёва Ю.А., Корнеев Д.В., Шамина И.В. Прогнозирование инфекционного риска и способ профилактики послеродового эндометрита у родильниц инфекционного риска. Акушерство и гинекология. 2014;(5):37–42.

[18] De Lima THB, Amorim MM, Buainain Kassar S, Katz L. Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):271. DOI: 10.1186/s12884-019-2381-9.

[19] Bratchikova OA, Chekhonackaya ML, Yannaeva NE. Ultrasound diagnostics of postpartum endometritis (review). Saratov journal of medical scientific research. 2014;10(1):65–69. (In Russ.)

[20] Братчикова О.А., Чехонацкая М.Л., Яннаева Н.Е. Ультразвуковая диагностика послеродового эндометрита (обзор). Саратовский научный медицинский журнал. 2014;10(1):65–69.

[21] Galushhenko EM. Intrauterine contraception and inflammatory diseases of the pelvic organs (literature review). International journal of experimental education. 2016;(9-1):32–36. (In Russ.)

[22] Галущенко Е.М. Внутриматочная контрацепция и воспалительные заболевания органов малого таза (обзор литературы). Международный журнал экспериментального образования. 2016;(9-1):32–36.

[23] Flick RP, Hebl JR. Pain management in the postpartum period. Issues of Clinics in Perinatol. 2013;40(3):337–600. DOI: 10.1016/j.clp.2013.05.016.

[24] Afanasova YeP, Agarkov NM, Budnik IV. Diagnosis and prediction of acute endometritis according to informative features of cell immunity. Journal of obstetrics and women's diseases. 2014;(6):15–20. (In Russ.) DOI: 10.17816/JOWD63615-20.

[25] Афанасова Е.П., Агарков Н.М., Будник И.В. Диагностика и прогнозирование острого эндометрита по информативным параметрам клеточного иммунитета. Журнал акушерства и женских болезней. 2014;(6):15–20. DOI: 10.17816/JOWD63615-20.

[26] Kolmyk VA, Nasyrov RA, Kutusheva GF, Petrov VV. The role of specific immunohistochemical techniques in the dia­gnosis of chronic endometritis. Bulletin of the Russian Military medical academy. 2015;(1):34–37. (In Russ.)

[27] Колмык В.А., Насыров Р.А., Кутуисева Г.Ф., Пет­ров В.В. Роль специфической иммуногистохимической методики в диагностике хронического эндометрита. Вестник российской военно-медицинской академии. 2015;(1):34–37.

RIGHTS & PERMISSIONS

Eco-Vector