Elevated level of proinflammatory cytokines is an early symptom of endometritis after partus caesarius

Abstract

Objective: Postoperative endometritis in puerperium is a grave risk factor to mother’s invalidization and mortality. Preventive application of antibiotics leads to asymptomatic onset of the disease and delay of the full value complexive therapy.

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Methods: The study was performed on blood of 18 puerperas with a high risk of postoperative endometritis. Lymphocyte subpopulations were determined by indirect surface immunofluorescence cytokines (IL-l-alpha, IL-l-beta, IL-8, TNF-alpha) were tested by double-antibody enzyme immunoassay, hemostatic condition was examined by coagulation tests on 1-st, 3-rd, 5-th and 7-th days of puerperium.

Results: It was observed that the levels of inflammatory cytokines of women on the 1-st day after partus caesarius were elevated. In patients with an uncomplicated postoperative period (1-st group) the concentration of inflammatory cytokines decreased and normalized from 3-rd till 7-th days. Symptoms of endometritis appeared in cases when the levels of inflammatory cytokines increased from 3-rd till 7-th days after abdominal delivery (2d group). Contents of IL-l-alpha and TNF-alpha increased more considerably than the levels of IL-l-beta and IL-8. Concentrations of inflammatory cytokines correlated with immune and hemostasis parameters. In females of the 2-nd group hypercoagulation was intensified, levels of antithrombin III and protein C were decreased, fibrin degradation products were noted, the number of CD3+, CD22+ lymphocytes was decreased, the ratio CD4+/CD8+ was reduced neutrophil phagocytic activity was intensified.

Conclusion: Elevated levels of inflammatory cytokines in the blood of puerperas from 3-rd till 5-th days past partus caesarius can be regarded as a prognostic sign of postoperative endometritis.