The clinical and epidemiological characteristics of risk factors for postoperative endometritis in puerperas

Postpartum infectious and inflammatory diseases are one of the main causes of maternal morbidity and mortality. Due to the higher frequency of operative delivery, the incidence of pyoseptic diseases in puerperas has increased up to 30-35%. Caesarean section remains a risk factor for postpartum infections, the most common disease of which is considered to be endometritis. The incidence of endometritis after spontaneous birth and cesarean section is 3-5 and 10-20%, respectively. Objective. To provide the clinical and epidemiological characteristics of risk factors for postoperative endometritis in puerperas at the present stage of obstetric care. Materials and methods. The investigators used official registration data on healthcare-associated infections (HAI) in puerperas, as well as additional reporting forms designed by the authors to account and register HAI cases in the healthcare facilities of the Sverdlovsk Region. The follow-up period was 28 years (from 1991 to 2018). A total of 16,413 cases of postpartum infections were analyzed in puerperas, including 3,194 cases of postoperative endometritis. The study was conducted in the perinatal center, by using 168 operative delivery histories, including 82 histories with a postpartum physiological course and 86 ones with the development of endometritis. Epidemiological and statistical methods were applied. Results. The proportion of postoperative endometritis in the structure of postpartum infections of the uterine cavity was found to increase substantially from 26.6% in the 1990s to 40.8% at the present time (фemp = 7.908; р < 001). Operative delivery was noted to increase the risk of severe septic endometritis by 1.8 times (RR = 1.825; 95% CI, 1.732-1.924) and postpartum sepsis by 14 times (RR = 12.109; 95% CI, 6.331-23.157), which determines the importance of the problem. The clinical manifestations of postoperative endometritis are typical and in most cases develop during hospital stay in the postpartum unit. In 60% of the female patients, the diagnosis of postoperative endometritis was confirmed bacteriologically, by isolating monocultures and microbial associations in 77 and 23%, respectively. Conclusion. The risk factors of postoperative endometritis are pelvic diseases during pregnancy (OR = 7.1), a longterm membrane rupture to delivery interval (OR = 2.4), frequent vaginal examinations (more than once during childbirth) (OR = 3.4), and open fetal bladder surgery (OR=2.4).

postoperative endometritis, clinical and epidemiological characteristics, risk factors, puerperas