Volume 03 Issue 05-2023
37
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The article presents the results of a prospective cohort study, which included 26 pregnant women at high risk of
infection, who in the postpartum period were divided into 2 groups: I
–
the main (n=14) and II
–
the comparison group
(n=12). The groups were comparable in age, according to somatic and obstetric-gynecological anamnesis. The
comprehensive examination included an assessment of anamnestic data and the results of clinical, microbiological,
and instrumental research methods.
KEYWORDS
Intrauterine infection, postpartum endometritis, antibiotic prophylaxis.
INTRODUCTION
To date, numerous foreign and domestic studies have
proven the role of infectious pathology of a woman's
reproductive tract in the genesis of a large range of
obstetric complications. Causing local and systemic
inflammatory responses, infectious agents can cause
termination of pregnancy at any time, formation of
placental insufficiency, pathology of the fetus and
newborn. At the same time, if earlier, when studying
this problem, issues related to the infectious pathology
of the lower genitals were mainly discussed, today
Research Article
RISK PREDICTION AND PREVENTION OF POSTPARTUM ENDOMETRITIS
IN MATERNITY PATIENTS
Submission Date:
May 09, 2023,
Accepted Date:
May 14, 2023,
Published Date:
May 19, 2023
Crossref doi:
https://doi.org/10.37547/ajbspi/Volume03Issue05-05
Yakubova Komila Toir kizi
Tashkent Medical Academy, Uzbekistan
Ataxodjaeva Fatima Abduraimovna
Department of Obstetrics and Gynecology-2 Tashkent, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajbspi
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 05-2023
38
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
there are more and more reports about the role of
intrauterine infection (IUI) in the genesis of premature
birth and unfavorable perinatal outcomes [2, 4, 5]. The
implementation of IUI in pregnant women may be a
consequence of ascending infection with the presence
of infection of the lower reproductive tract, as well as
the persistence of microorganisms in the endometrium
in women with a history of chronic endometritis [1, 3].
Considering that accurate verification of IUI is possible
only with a pathomorphological examination of the
afterbirth, there is currently no consensus on the
terminology, diagnostic criteria and management
tactics of such patients. The search continues for non-
invasive criteria for the diagnosis of IUI during
pregnancy in order to timely prescribe therapeutic and
preventive measures.
It is known that the dynamics of development, the
severity and consequences of any infectious process
caused
by
pathogenic
or
opportunistic
microorganisms depend on many factors, the most
important of which is the state of the immune system
of the macroorganism. The same infectious agents, in
some cases cause complications of pregnancy, and in
others - practically do not affect its course. Thus, during
pregnancy, the reactions of the maternal immune
system become no less important than the direct
influence of the pathogen. It is the immune
mechanisms that play an exceptional role in the
development and preservation of pregnancy [3, 5, 6].
The purpose of the study. Reducing the frequency of
postpartum endometritis (PE) in women at risk of
infection through the development of methods for
forecasting and improving preventive measures.
Material and methods of research. A prospective
cohort study was conducted, which included 26
pregnant women of high infectious risk, who in the
postpartum period were divided into 2 groups: I - the
main (n=14) and II - the comparison group (n=12). The
groups were comparable in age, according to somatic
and
obstetric-gynecological
anamnesis.
The
comprehensive examination included an assessment
of anamnestic data and the results of clinical,
microbiological, and instrumental research methods.
The sampling of the material for microbiological
examination was carried out at the period of 12-16
weeks of pregnancy. The inclusion criteria were the
exacerbation of genital and extragenital diseases of an
infectious nature during pregnancy.
In the postpartum period, molded sorbent was
administered
simultaneously
with
intravenous
administration of an antibiotic to prevent infectious
complications of intrauterine delivery. The size of the
porous applicator: length 6 cm, width 1 cm, thickness 1
cm. In the comparison group, only traditional antibiotic
prophylaxis
of
postpartum
purulent-septic
complications was carried out.
Evaluation of the microflora of the birth canal in
patients was carried out by polymerase chain reaction
(PCR), microbiological examination was carried out
Volume 03 Issue 05-2023
39
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
according to the standard method. The material for the
study was the vaginal discharge, cervical canal,
aspirate from the uterine cavity. The material was
collected under aseptic conditions. During the aspirate
from the uterine cavity, sterile conductors in the form
of a silicone tube were used, eliminating the possibility
of contamination of the sample with vaginal and
cervical microflora.
The determination of the subpopulation composition
of lymphocytes was carried out on a flow
cytofluorimeter with sample preparation, and the
cytokine content was determined by enzyme
immunoassay on test systems.
Statistical processing of the material was carried out
using the STATISTICA-6 application software package,
standard Microsoft Excel mathematical tables. To
characterize
the
indicators
devoted
to
the
retrospective analysis of the birth histories of pregnant
women. Fisher's exact criterion was used to select the
most informative features.
Research results and discussion. The analysis of
gynecological diseases in maternity patients of the
infectious risk group showed that inflammatory
diseases of the pelvic organs were most common
–
in
49.6% of those observed; acute vaginitis was noted in
38.5%; cervicitis
–
in 23.9%; surgical interventions on the
fallopian tubes were registered in 8.5%; menstrual
disorders
–
in 7.7%; fibroids uterus
–
in 3.4%; infertility in
the anamnesis occurred in 3.4% of women.
Among the extragenital pathology in this group of
patients,
anemia
prevailed
(59.0%);
chronic
inflammatory diseases of the urinary tract (27.4%);
obesity (17.1%); arterial hypertension (10.3%); thyroid
pathology (5.1%); diabetes mellitus in 2.6% of cases.
During sonographic examination during pregnancy,
the following markers of intrauterine infection were
identified: lack of water was diagnosed in 42.9% of
cases; violation of fetal-placental blood flow
–
in 39.5%;
polyhydramnios
–
in 17.9%; thickening of the placenta
exceeding the appropriate standards for this period of
pregnancy was detected in 15.5%.
The most frequent complication of pregnancy in the
observed patients was a recurrent threat of
termination (46.7%), which was combined with
inflammatory changes in the vagina. In second place in
frequency was premature discharge of amniotic fluid
(42.7%). Preeclampsia of varying severity occurred in
41.9% of the observed patients, including in
combination with fetal growth retardation in 26.5% of
cases. Exacerbation of infectious diseases of the
urinary tract was noted in 17.9% of pregnant women.
The study of the vaginal biotope in the observed
patients at the stage of pregnancy showed the
predominance of the following microorganisms:
Enterococcus (faecalis, faecium)
–
33.9%; E. coli
–
27.4%;
Staphylococcus
(epidermidis,
haemolyticus,
chromogenes)
–
17.4%; yeast
–
like fungi of the genus
Candida
–
15.8%; Ureaplasma urealyticum - 12.7%; a
combination of pathogens was observed in 83.2%.
Volume 03 Issue 05-2023
40
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Growth of the same pathogens was observed in the
cervical canal: Enterococcus (faecalis, faecium)
–
28,2%;
E. coli
–
22,5%; Ureaplasma urealyticum
–
10,3%.
Exacerbation of viral infection was noted in 33% of the
observed. During the PCR examination of the cervical
canal during pregnancy, the following pathogens were
identified: Epstein
–
Barr virus
–
17.2%; herpes simplex
virus (HSV) type 6 - 8.0%; HSV type 1
–
4.6%; HSV type 2
- 2.3%; cytomegalovirus
–
2.3%; rotavirus
–
2.3%.
When assessing the immune status in pregnant
women, data were obtained indicating the tension of
the cellular link of immunity, which manifested itself in
a change in the ratio of lymphocytes with a reduced
immunoregulatory index (p=0.0040) against the
background of increased activity of proinflammatory
cytokines (interleukin (IL)-1ß. 33% of pregnant women
with viral infection activation have a higher level of T-
NK cells (p=0.001), which in our opinion indicates
increased killer activity of lymphoid cells.
All patients underwent rehabilitation of the birth canal
with local antiseptics before delivery. In the
postpartum period, on the first day, sowing was
carried out from the uterine cavity in order to assess
the presence of pathogenic microflora. According to
the results of primary sowing, the degree of
contamination of the uterine cavity was assessed
within 24 hours.
The results of the primary seeding of the patient of
both groups were comparable: in the main group,
massive growth of pathogenic microflora was
determined in 67.3% of cases, moderate
–
in 26.5%,
meager
–
in 6.1%; in the comparison group, massive
growth was determined in 55.9% of cases, moderate
–
in 27.9%, meager
–
in 16.2%. At the same time,
Ureaplasma urealyticum was detected in 29.9% of
cases; Staphylococcus (haemolyticus, chromogenes)
was detected in 23.1% of cases; Enterococcus faecalis
was detected in third place in frequency
–
16.2%; E.coli
was 7.7%; Corynebacterium
–
6.8%; Mycoplasma
hominis 6.8%; Enterobacter cloacae - 2.6%; Klebsiella
and Pseudomonas aeruginosa
–
1.7%.
In the main group, monoinfection occurred in 37.5% of
cases; in the comparison group
–
in 36.8%. The most
frequently observed associations were Enterococcus
and Ureaplasma urealiticum (12.5%), Enterococcus and
Staphylococcus (8.1%), Enterococcus and Candida
(6.8%), Enterococcus and E. coli (2.7%).
When conducting tests for antibiotic sensitivity, a high
frequency of resistance of pathogenic flora was
revealed: Enterococcus faecalis in 66.7% of cases
showed resistance to azithromycin, in 47.6%
–
to
benzylpenicillin and co-trimoxazole, in 42.8%
–
to
doxycycline. Staphylococcus haemolyticus showed
resistance to benzylpenicillin in 72.2% of cases,
erythromycin in 66.7%, ofloxacin in 55.6% and
cefotaxime in 33.3%. Ureaplasma urealyticum showed
resistance to josamycin in 74.5%, clarithromycin in
29.5%, erythromycin in 22.9% and clindamycin
resistance in 14.8%.
Volume 03 Issue 05-2023
41
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Based on the data obtained, a scale for predicting
infection risk was developed, based on the calculation
of the individual number of points, taking into account
the data of anamnesis, sonographic examination,
immunoreactivity indicators, both during pregnancy
and childbirth, bacteriological examination.
In the postpartum period, the mothers of the main
group underwent complex preventive therapy:
traditional antibiotic prophylaxis and intrauterine
applications of molded sorbent. The sorbent is injected
three times into the uterine cavity. The duration of a
single application was 24 hours, after which the used
sorbent was extracted and a new one was introduced.
At the same time, only traditional antibiotic
prophylaxis was carried out in the comparison group.
Antibiotic prophylaxis in both groups was carried out
with cephalosporins of the second generation
according to the scheme: 1.0 g of antibiotic
intravenously drip once 30 minutes before delivery.
In the maternity patients of the main group, three
control seeding was carried out from the uterine cavity
after each sorbent was extracted. After the extraction
of the first sorbent after 24 hours, 21.7% of patients
maintained a massive growth of pathogenic
microflora, 43.5% showed moderate and 34.8% showed
scant growth of microorganisms. After extraction of
the second sorbent, no microflora growth was
detected in 52.2% of patients, moderate microflora
growth remained in 39.1% and scant microflora growth
in 8.7%. In the control of crops after the extraction of
the third sorbent, the growth of microorganisms was
not detected in 100% of cases. In the comparison group
of maternity patients in the control gravidar
endometrial culture, three days after antibiotic
prophylaxis, pathogenic microflora continued to be
determined in 66.2% of maternity women.
The problem of prevention and treatment of purulent-
inflammatory postpartum diseases is complicated by
the fact that proinflammatory cytokines accumulating
during the inflammatory process in the uterine cavity,
as well as toxins secreted by pathogens, lead to
disruption of local hemostasis processes, reduced
tissue perfusion and to the additional development of
tissue hypoxia, complicating the regeneration and
epithelialization of the endometrium. In this regard,
the level of proinflammatory cytokines and lactoferrin
in the aspirate from the uterine cavity was determined.
The sampling of the material was carried out before
and after the completion of preventive therapy. The
volume of the uterine cavity was also assessed,
ultrasound examination was performed on the 1st and
3rd days of the postpartum period.
When analyzing the data obtained, there was a
significant (p=0.01172) decrease in the activity of the
acute-phase protein lactoferrin by 1.3 times and the
proinflammatory cytokine IL-1ß by 2.3 times
(p=0.01252) in the aspirate from the uterine cavity in
patients of the main group in comparison with similar
indicators of the comparison group.Indicators of the
number of leukocytes and the leukocyte index of
Volume 03 Issue 05-2023
42
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
peripheral blood intoxication after preventive
treatment decreased equally in both groups. In the
main group, after using the molded sorbent, there was
a decrease in the volume of the uterine cavity by 1.2
times, while with the use of traditional antibiotic
prophylaxis, there was a decrease in the volume of the
uterine cavity by 1.05 times.
CONCLUSIONS
1.
In the development of purulent-inflammatory
diseases in pregnant women of the infectious risk
group, mixed infection is of the greatest
importance, in which the leading role in the
formation of pathology belongs to the bacterial
gram-positive microflora with a high level of
antibiotic resistance, as a result of which traditional
antibiotic prophylaxis is ineffective.
2.
For pregnant women of the infectious risk group,
the presence of tension of the immune system due
to inflammatory diseases of the genital tract
suffered during pregnancy or exacerbation of
somatic chronic infectious diseases has been
proven.
3.
After traditional antibiotic prophylaxis, despite a
decrease in leukocytes and leukocyte intoxication
index in peripheral blood, pathogenic microflora
continues to be detected in crops from the uterine
cavity in more than 50% of cases, and at the same
time, high activity of local proinflammatory
cytokines remains, which indicates the risk of
delayed, sluggish endometritis.
4.
The proposed method for the prevention of
postpartum endometritis in women at risk of
infection by intrauterine injection of a molded
porous carbon sorbent is more effective than the
traditional approach and reduces the frequency of
PE.
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Volume 03 Issue 05-2023
43
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
37-43
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
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