Prediction of the development of inflammatory complications in the postpartum period

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.