International Journal of Medical Sciences And Clinical Research
96
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VOLUME
Vol.05 Issue05 2025
PAGE NO.
96-104
10.37547/ijmscr/Volume05Issue05-20
The Role of Lipid Peroxidation and Activity of The Blood
Antioxidant System in The Development of Postpartum
Endometritis and Their Prognostic Significance
Iroda Kamilova
Obstetrics and gynecology in family medicine department Tashkent medical academy, Tashkent, Uzbekistan, Uzbekistan
Aziz Umarov
Obstetrics and gynecology in family medicine department, Tashkent medical academy, Tashkent, Uzbekistan
Received:
31 March 2025;
Accepted:
29 April 2025;
Published:
31 May 2025
Abstract:
Postpartum endometritis is one of the most common infectious complications in the postpartum period.
According to various authors, the incidence of endometritis after natural childbirth is 1-3%, while after cesarean
section, the rate is 27% [3,5,12,13,18]. The frequency of cesarean sections in Uzbekistan has been steadily
increasing from 9.58% in 1999 to 16.10% in 2019. In perinatal centers of Uzbekistan in 2017-2020. Thus, the
determining of predictor factors which play huge role in the development of postpartum endometritis is relevant.
In this article are given the results of scientific work which was done with 89 women who were after delivery in
order to predict postpartum endometritis.
Keywords:
Endometritis, postpartum period, lipid peroxidation, antioxidant system, systemic inflammation,
postpartum sepsis, malon dialdehyde.
Introduction:
Postpartum endometritis is one of the
most common infectious complications in the
postpartum period. According to various authors, the
incidence of endometritis after natural childbirth is 1-
3%, while after cesarean section, the rate is 27%
[3,5,12,13,18]. At the same time, postpartum
endometritis is the main cause of death associated with
purulent-septic complications occurring on the 3-7th
day after childbirth. [15]. Cesarean section is associated
with a 5- to 10-fold increase in the incidence of
postpartum infections and endometritis compared
with vaginal delivery [15]. Moreover, the incidence of
postpartum endometritis is approximately ten times
higher in cesarean sections performed after the onset
of labor than in elective ones [16]. To reduce obstetric
complications, the frequency of caesarean sections
recommended by WHO should not exceed 15
–
30% of
the total number of births.
The frequency of cesarean sections in Uzbekistan has
been steadily increasing from 9.58% in 1999 to 16.10%
in 2019. In perinatal centers of Uzbekistan in 2017-
2020. Moreover, the frequency of indications for CS
also increased and was noted: the frequency of CS
operations in perinatal centers in 2017 was 29.5%, in
2018 - 33.2%, in 2019 - 34.5% and in 2020 - 34.3%.
Although there are many factors that increase the risk
of developing intrauterine infection in the postpartum
period, the most common of them are: young maternal
age; different somatic diseases in the anamnesis:
immunosuppressive disorders, obesity, diabetes,
taking corticosteroid supplements; complications
during antenatal period or delivery: decreased
frequency of antenatal care, chorioamnionitis, history
of repeat cesarean section, emergency cesarean
section, stapled wound closure, and excessive blood
loss [1].
Inflammation is the basis of most diseases associated
with
postpartum
infectious
pathology.
The
inflammatory process is initiated by microbial, viral or
fungal infections and / or systemic pathology of various
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genesis, leading to tissue damage or autoimmune
reactions. Currently, in obstetrics and gynecology, the
prognostic potential of hematological markers of
inflammation
and
processes
associated
with
inflammation is widely used, studies are carried out on
the role of the systemic inflammatory state of a
pregnant woman and a woman in labor in the prenatal
and postpartum periods in the development of PE. The
severity of the inflammatory state is assessed using
immunological, biochemical and physiological changes,
markers of which are proinflammatory chemical
mediators of inflammation, such as chemokines,
cytokines, vasoactive amines, eicosanoids and
proteolytic cascade products, the levels of which are
important prognostic markers of PE development.
Systemic inflammation is associated with changes in
the number and function of blood cell components.
Hematological markers are considered to be a
reflection of the systemic inflammatory environment.
The neutrophil-to-lymphocyte ratio is widely used to
assess the severity of inflammation in postpartum
infectious pathology. The role of neutrophils and
lymphocytes in maintaining or spreading inflammatory
cascades
in
the
most
common
pregnancy
complications and the effectiveness of assessing the
neutrophil-to-lymphocyte ratio for diagnosing and
predicting
pregnancy-related
complications
as
potential predictors of acute and chronic inflammatory
gynecological and reproductive disorders have been
proven [1,2,4]. Factors causing an inflammatory
response are expressed by activation of circulating
leukocytes, increased production of neutrophil
activators and complement activity. In assessing the
risk of developing infection after CS, a high prognostic
potential was demonstrated by a complete blood count
and different full blood count variables. They include
hemoglobin level, red blood cell volume, red blood cell
distribution width, hematocrit, blood cells with their
morphology, and systemic markers of inflammation
based on the ratios of various forms of leukocytes [6,9].
However, the information content of clinical blood
analysis is low and changes characteristic of the
inflammatory process are detected in no more than
60% of women in labor with endometritis [8], while the
content of leukocytes and neutrophils, as predictors of
postpartum endometritis in women in labor, there is
not any test to exclude purulent-inflammatory diseases
in women in labor, which will be able to estimate
clinical condition and give prognostic value as a
screening [6]
Aim of the work
Thus, the determining of predictor factors which play
huge role in the development of postpartum
endometritis is relevant and the aim of our work was to
study the prognostic significance of lipid peroxidation
and the activity of the antioxidant system of the blood
in the early postpartum period in the development of
postpartum endometritis.
METHODS
During the study were collected 89 women who were
after delivery. Main group consist of 66 women after
labor with postpartum endometritis and they were
divided in to three subgroups according to the severity
of endometritis: 23 with mild; 22 with moderate and 21
with severe type. The control (comparison) group
consisted of 23 women after labor with a physiological
course of the postpartum period.
All parturient women were assessed for lipid
peroxidation levels and AOS enzyme activity on day 3
postpartum. Using standard aseptic precautions, 5 ml
of venous blood from the antecubital vein was
collected into a polyethylene Stoppard tube containing
60 μl of the anticoagulant k3 EDTA (tripotassium
ethylenediaminetetraacetic acid). After centrifugation
at 3000 rpm for 10 min, plasma was separated and
stored at -40°C until analysis in the research laboratory.
Data were collected using a pre-designed, validated
data collection sheet. The concentration of lipid
peroxidation products was estimated by the level of
malonic aldehyde (MDA) in a reaction with
thiobarbituric acid [8]; the total antioxidant activity of
blood plasma was estimated by the oxidation reaction
with paraphenylenediamine [7].
Statistical analysis was performed using SPSS. The
results are presented as the mean (M), dispersion (õ)
and standard deviation (± m); median (25% lower
quartile
–
75% upper quartile). The assumption of
normal distribution was tested by the Shapiro- Wilk
test (α=0.05). Comparison of intergroup differences for
independent samples was performed using Tukey's
pairwise comparison HSD / Tukey Kramer ANOVA
program, for comparing quantitative data having a
distribution different from normal, the Kruskal method
was used Wallis , Spearman's method was used to
identify correlations . Results were considered
statistically significant at an error level of p < 0.05. ROC
analysis was used to calculate the threshold level of
values, concentrations of LPO products and activity of
AOS enzymes, specificity and sensitivity of the
methods.
RESULTS
During our scientifis work the criteria for diagnosing
postpartum endometritis in women who gave the
delivery were the results of clinical and laboratory
examination of women in labor (table 1).
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TABLE I.
CLINICAL CHARACTERISTICS OF POSTPARTUM ENDOMETRITIS OF VARYING SEVERITY IN COMPARISON GROUP
(M,M)
Indicator
Severity of postpartum endometritis
Control
group m = 23
Light m =
23
Moderate
m = 22
Heavy m =
21
T ° div °C
37.6±1.3
5¹
38.4±1.62
¹²
38.8±1.13¹
²³
36.5±1.2
3
Pain
on
palpation
0.77±0.0
3¹
1.25±0.04
¹²
2.45±0.12¹
²³
0.3±0.01
Lochia
0.69±0.0
2¹
1.37±0.06
¹²
2.65±0.12¹
²³
0.20±0.0
1
Symptoms
of
intoxication
0.34±0.0
1¹
1.15±0.05
¹²
2.33±0.10¹
²³
0.35±0.0
2
Involution of the
uterus
0.47±0.0
2¹
0.85±0.03
¹²
1.77±0.08¹
²³
0.25±0.0
1
Hemostasisogra
m
0.55±0.0
2¹
1.08±0.04
¹²
2.41±0.4¹²³
0.25±0.0
1
Blood
biochemistry
0.40±0.0
1¹
1.25±0.06
¹²
1.92±0.09¹
²³
0.21±0.0
1
Blood formula
0.65±0.0
3¹
1.90±0.08
¹²
2.35±0.10¹
²³
0.37±0.0
2
Note: ¹-
p˂0.05 in relation to the control group; ²
-
p˂0.05 in relation to the mild course group; ³
-
p˂0.05 in
relation to the moderate and severe course group.
Despite the large number of primary etiological factors,
the immediate cause is microbial invasion followed by
inflammatory damage to the endometrium [2], an
indispensable attribute of inflammation is oxidative
stress [13], which determines the importance of
studying free radical oxidation processes. The content
of the final product of lipid peroxidation of cell
membranes is malonic dialdehyde (MDA) in the blood
plasma of women in labor with endometritis
statistically significantly exceeded the corresponding
control values and progressively increased in women in
labor with a more severe course (table 2).
TABLE 2.
LEVELS OF THE POL-AOS SYSTEM INDICATORS IN WOMEN IN LABOR WITH DIFFERENT SEVERITY OF
ENDOMETRITIS
Indicator
Stat
parameters
Severity of postpartum endometritis
Control
group m=23
Light
m = 23
Moderate
m = 22
Heavy
m = 21
MDA
mmol /l
Msr
4.24
5.38
8.95
3.71
S
0.50
0.56
0.76
0.36
± m
0.10
0.12
0.17
0.08
95%
DI
Min
3.9
5.2
8.7
3.5
Max
4.5
5.7
9.5
40
Tukey-Kramer : x1-x2, x1-x3, x1-x4, x2-x3, x2-x4, x3-x4
AOA
%
Msr
57.8
48.0
34.5
60.6
S
3.30
4.56
1.91
1.50
± m
0.73
0.97
0.41
0.32
95%
DI
Min
55
45
33
57
Max
61
51
35
62
Tukey-Kramer : x1-x2, x1-x3, x1-x4, x2-x3, x2-x4, x3-x4
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Post hoc comparisons of mean group MDA levels using
Tukey's method showed that statistically significant
differences in the analysis of variance were associated
with differences in mean MDA values in all three groups
(table 3).
TABLE 3.
EVALUATION OF THE RELIABILITY OF INTERGROUP DIFFERENCES IN PAIRWISE COMPARISON OF MEAN GROUP
VALUES OF MDA USING THE TUKEY-KRAMER CRITERIA IN ANOVA ANALYSIS
P
AIR
DIFFER
ENCE
S
E
Q
Lower CI
Upper CI
Cri
tical mean
p-
value
x1
-x2
11,02
1,
17
9,
52
6,
84
1
5,56
4,3
≤0,
001
x1
-x3
46,95
1,
19
3
9,43
4
2,54
5
1,37
4,4
≤0,
001
x1
-x4
5,47
1,
16
4,
70
1,
16
9,
79
4,3
≤0,
001
x2-x3
35,75
1,
203
2
9,7
3
1,28
4
0,2
4,4
≤0,
001
x2
-x4
16,68
1,
17
1
4,1
1
2,3
2
1,04
4,3
≤0,
001
x3
-x4
52,43
1,
19
4
4,03
4
0,02
5
6,85
4,4
≤0,
001
The difference in the results of the study of MDA
concentrations in the comparison groups is clearly seen
in Fig. 1. Moreover, with an increase in the severity of
postpartum endometritis, the concentration of MDA in
the blood increased reliably. As can be seen from Fig. 1,
the concentration of MDA in moderate PE exceeded
the level of mild PE by 1.12 μmol / l (p ≤ 0.001); in
severe PE, this difference was 4.70 μmol / l (p ≤ 0.001);
and the difference between mild PE and the control
was 0.55 μmol / l (p ≤ 0.001); between moderate PE
and the control 1.67 μmol / l (p ≤ 0.001); and between
severe PE and the control 5.24 μmol / l (p ≤ 0.001).
Fig. 1. Difference between the critical mean and mean group values of MDA in comparison groups
Oxidative stress is a condition in which the antioxidant
system fails to cope with the overproduction of
reactive oxygen species, leading to oxidation of key
cellular macromolecules and proteins of cell
membranes and molecular dysfunction. MDA is the end
product of peroxidation of polyunsaturated fatty acids
of cell membranes and is recognized as a marker of
oxidative stress and antioxidant status [10,14]. Thus,
the progression of PE contributes to an increase in the
production of reactive oxygen species (ROS) and an
increase in the severity of endometritis itself.
The assessment of antioxidant activity (AOA)
demonstrated the opposite direction: with increasing
severity of PE, the total AOA activity significantly
decreased (Table 2).
Post-hoc comparisons of mean group indicators of AOA
activity using the Tukey - Kramer method in ANOVA
analysis showed that statistically significant differences
in the analysis of variance are associated with
differences in the mean values of AOA in the
comparison groups (table 4).
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TABLE 4.
EVALUATION OF THE REABILITY OF INTERGROUP DIFFERENCES IN PAIRWISE COMPRISON AVERAGE GROUP
VALUES OF AOA (IN %) ACCORDING TO THE TURKEY-KRAMER CRITERION IN THE ANOVA ANALYSIS
P
AIR
DIFFER
ENCE
S
E
Q
Lo
wer CI
U
pper CI
Cri
tical mean
p-
value
x1
-x2
3,39
0
,6
5
,2
1
5,7
2,3
≤0,
001
x1
-x3
12,6
0
,64
1
9,5
10,
2
15
2,4
≤0,
001
x1
-x4
26,1
0
,65
3
9,8
23,
6
28,
5
2,4
≤0,
001
x2-x3
9,2
0
,64
1
4,2
6,8
11,
6
2,4
≤0,
001
x2
-x4
22,7
0
,65
3
4,6
20,
3
25,
1
2,4
≤0,
001
x3
-x4
13,4
0
,66
2
0,3
11
19,
9
2,4
≤0,
001
The difference between the critical average and
average group AOA activity (in%) in the comparison
groups demonstrates a decrease in AOA with
increasing severity of PE (fig. 2).
Fig. 1. Difference between the critical mean and mean group values of AOA in comparison groups
In fig. 2, the critical average value of AOA in % in group
4
–
severe course of PE
–
is taken as the critical average,
while the difference between the critical average and
average group activity of AOA in women in labor
without PE and with severe course (X1
–
X4) is -26.13
AOA units; with moderate and severe course (X2
–
X4)
–
22.74 AOA units; the corresponding difference
between moderate and severe course is 13.46 AOA
units, etc. (fig. 2).
The priority of studying oxidative stress in PE is
determined by the need to understand the
pathophysiological mechanisms underlying conditions
associated with the development of endometrial
inflammation in the postpartum period. The imbalance
between reactive oxygen species (ROS) and
antioxidants played as a marker role int the oxidative
stress, as with the help of them can be predected the
pathophysiology of endometritis and the general
inflammatory response of the div.
Total antioxidant capacity (activity) (AOA) is a biological
parameter representing the sum of antioxidant effects
of enzymatic antioxidants and molecules with
antioxidant properties in a living organism, reflecting
the ability to negate the negative impact of free radicals
at the cellular level [16,17]. Determination of total
antioxidant activity as the integration activity of several
antioxidants in plasma is important in the analysis of
biological systems. A decrease in AOA with increasing
severity of PE reflects the role of pathogenetic
mechanisms of oxidative stress in the severity of PE.
Prediction of the risk of developing postpartum
endometritis based on MDA and AOA levels was
performed using ROC analysis curves. The ratio of the
number of correctly classified positive examples (true
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positive) and the number of incorrectly classified
negative examples (false negative) was estimated, as a
result of which diagnostically significant levels of MDA
and AOA in blood plasma were established.
ROC curves represent graphical ranges of possible cut-
off points with sensitivity versus 1-specificity (i.e., false
positive rate). This illustrates the strengths of a
particular predictor/prognostic model, allowing
different cut-off points to be defined for specific
applications - depending on the "cost" of
misclassification. Area under the curve (AUC) estimates
provide insight into the usefulness of a predictor and
are a means of comparing (testing) two or more
predictive methods.
The diagnostic performance of a test is the accuracy of
the test in distinguishing disease cases from normal
controls. ROC curves can also be used to compare the
diagnostic performance of two or more laboratory
tests.
TABLE 5.
ESTABLISHING THE THRESHOLD CONCENTRATION OF MDA IN BLOOD PLASMA TO FORM A PROGNOSIS FOR
THE DEVELOPMENT OF POSTPARTUM ENDOMETRITIS
Diagnostic
level of MDA
µmol/l
Detected frequencies in
%
Diagnostic accuracy
Control
Women
in labor with
PE
Specificity
Sensitivity
8.00-8.40
4.35
40.91
4.35
39.71
8.39-7.78
4.35
27,27
8.70
66.18
7.77-7.18°
4.35
13.64
13.04
79.41
7.17-6.56
4.35
7.58
17.39
89.71
6.55-596
4.35
3.03
21.74
92.65
5.95-5.91
4.35
1.51
26.05
94.12
5.91-5.30
4.35
1.51
30.34
95.59
5.29-4.71
13.04
1.51
43,43
97.06
4.70-4.11
21.74
1.51
65.22
98.53
4.10-3.50
35.78
1.51
100,0
100,0
If the MDA concentration in the blood is more than 7.18
μmol/l, a conclusion can be made about a high risk of
developing postpartum endometritis with a diagnostic
sensitivity of 79.41% and a diagnostic specificity of
13.04%
TABLE 6.
ESTABLISHING THE THRESHOLD CONCENTRATION OF AOA IN BLOOD PLASMA TO FORM A PROGNOSIS FOR
THE DEVELOPMENT OF POSTPARTUM ENDOMETRITIS
Diagnostic
level of MDA
µmol/l
Detected frequencies in
%
Diagnostic accuracy
Control
Women
in labor with
PE
Specificity
Sensitivity
30-32
1
17
4.35
25.76
33-35
1
15
8.70
48,48
36-38
1
13
13.04
60.18
40-42°
1
8
17.39
80.30
43-45
1
4
21.74
86.36
47-49
2
3
30.43
90,91
52-54
2
2
39.13
93.41
55-58
2
2
47.83
96,97
59-60
3
1
60.87
98.48
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˃60
9
1
100,0
100,0
If the AOA concentration is less than 40%, a conclusion
can be made about a high risk of developing
postpartum endometritis with a diagnostic sensitivity
of 80.30% and a diagnostic specificity of 17.39%.
To compare the effectiveness ROC (Receiver Operator
Characteristic) analysis was performed on the MDA
level and AOA concentration, which is an analysis of
characteristic curves with the calculation of the area
under the ROC curves AUC (Area Under Curve). Clinical
informativeness of the MDA level and AOA
concentration using ROC analysis: the AUC (area under
the curve) value for MDA was 88.27%, R² = 85.67%; for
AOA, the AUC value was 82.40%, R² = 93.52%.
The AUC value of 88.27% for MDA corresponds to a
good model; the predictive value of AOA with an AUC
of 82.40% is lower than that of MDA.
The area of the AUC curve in the range of 0.9-1.0 is
considered the highest information content of the
diagnostic method, in the range of 0.8-0.9 - good
information content, in the range of 0.7-0.8 -
satisfactory, in the range of 0.6-0.7 - mediocre
information content, and below - useless classification.
MDA - Y = 0.12 ln ( x ) + 1 AOA - Y = 0.18 ln ( x ) + 1
R² = 85.67% R²=93.52%
Area under study 88.27% Area under study 82.40%
Fig. 3. ROC curve of the ratio of sensitivity and specificity of the prediction of the occurrence of postpartum
endometritis based on the level of MDA and AOA activity (in%) in blood plasma.
Linear regression models for the risk of developing PE
at different concentrations of MDA have the form: Y =
0.12ln(x) + 1; and for known values of AOA activity - Y =
0.18ln(x) + 1.
The quality of the predictability of the models was
assessed using the Nagelkerke determination
coefficient R², which is the main indicator of the quality
of the regression model describing the relationships
between the dependent and independent variables.
The Nagelkerke determination coefficient R² reflects
the specific weight of the contribution of changes in the
studied inflammatory factors to the prognosis of the
development of postpartum endometritis.
The R² value should be in the range from zero to one: 0
≤ R2 ≤ 1. The model is considered to
be of higher quality
if the value of the determination coefficient is close to
1. The statistical indicator shows what part of the
variability of the observed variable can be explained by
the constructed model, i.e. the value of the
determination coefficient determines the share (in
percent) of changes due to the influence of factor
characteristics in the total variability of the resultant
characteristic. R² for an increase in MDA concentration
is 85.67%; and for a decrease in AOA activity - 93.52%,
which proves the higher predictive significance of the
obtained regression models.
DISCUSSION
The presence of increased concentrations of free
radicals and decreased antioxidant potential leads to
oxidative stress. The development of oxidative stress
may be one of the links in the chain of events leading
to endometritis. Levels of oxidation -reduction
potential can modulate the severity and dynamics of
endometritis, and disease progression, biomarkers are
associated with the level of oxidative stress with the
severity of endometritis.
In uncomplicated pregnancy, there is a balance
between the antioxidant system and reactive
intermediates, but this balance can be disrupted by
pregnancy complications or delivery with an
unfavorable outcome [19]. The imbalance between
prooxidant and antioxidant factors leads to oxidative
stress, which contributes to the development of many
diseases. This oxidative aggression can be a precursor
to pathologies in the pregnant woman [5].
Analysis of the concentration of the end product of lipid
peroxidation of cell membranes - MDA in the blood
plasma of women in labor with endometritis of varying
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severity showed a statistically significant excess of
control levels and a progressive increase in women in
labor with a more severe course: the concentration of
MDA in moderate PE exceeded the level of mild course
by 1.12 μmol / l (p ≤ 0.001); in severe course this
difference was 4.70 μmol / l (p ≤ 0.001); and the
difference between mild course and control -
0.55 μmol
/ l (p ≤ 0.001); between mo
derate course and control
1.67 μmol / l (p ≤ 0.001); and between severe course
and control -
5.24 μmol / l (p ≤ 0.001).
It was found that against the background of increasing
MDA concentration, blood AOA progressively
decreased. Thus, if the AOA value in % in group 4
(severe PE) is taken as the critical average, then the
difference between the critical average and average
group AOA activity in women in labor without PE and
with a severe course is -
26.13 AOA units (p≤0.001); with
moderate and severe course 22.74 AOA units
(p≤0.001); the corresponding difference between
moderate and severe course is 13.46 (p≤0.001) AOA
units, etc. AOA activity in women in labor in all groups
was lower than in the control group (p≤0.001). The
obtained results are consistent with the literature data.
It is recognized that oxidative stress plays a central role
in the pathophysiology of many disorders of pregnancy
and the postpartum period, including pregnancy
complications
such
as
placental
pathology,
preeclampsia (PE), intrauterine growth restriction
(IUGR), gestational diabetes and miscarriage [1,2] in
the pathophysiology of oxidative stress in obstetric
complications, the role of harmful habits, including
alcohol abuse, is high [1,2,11, 19].
At the end of the research our results demonstrated
that compared to the control group there was a
significant increase in lipid peroxidation and a
significant decrease in antioxidant status in parturient
women with postpartum endometritis. This disrupted
balance leads to a remarkble increase in the oxidative
stress index in parturient women with postpartum
endometritis.
Oxidant-antioxidant system disturbances during
pregnancy in adverse pregnancy outcomes has been
proven. Oxidative stress can lead to numerous
pathological conditions during female reproductive
processes, contributing to the development of
endometriosis, polycystic ovary syndrome, and various
forms of infertility. Excessive ROS production can lead
to fetal developmental disorders and increases the risk
of miscarriage, intrauterine growth retardation,
preeclampsia, premature birth, and gestational
diabetes [5,7].
Thus, oxidative stress during pregnancy and in the
postpartum period can be a consequence of primary
etiologic factors that aggravate the development of
pathological processes and lead to inflammation of the
endometrium against the background of microbial
invasion. From a clinical point of view, it is important to
evaluate the threshold levels (cutoff points) of
diagnostically significant indicators in the prognosis of
pathology development. To assess the clinical
informativeness of MDA and AOA in blood plasma for
postpartum
endometritis,
their
diagnostically
significant levels were established using ROC analysis
curves. At a concentration of MDA in the blood of more
than 7.18 ng / ml, a conclusion can be made about a
high risk of postpartum endometritis with a diagnostic
sensitivity of 79.41% and a diagnostic specificity of
13.04%. At the AOA concentration less than 40%, a
conclusion can be made about a high risk of developing
postpartum endometritis with a diagnostic sensitivity
of 80.30% and a diagnostic specificity of 7.39%. The
clinical information content of the MDA level by AUC
was 88.27% and the AOA concentration - 82.40%. The
AUC value of 88.27% for MDA corresponds to a good
model; the prognostic significance of AOA with an AUC
of 82.40% is lower than the MDA value. The linear
regression models of the risk of developing PE at
different MDA concentrations are as follows: Y =
0.12ln(x) + 1; and with known values of AOA activity - Y
= 0.18ln(x) + 1.
The quality of the predictive ability of the models was
assessed using the Nagelkerke determination
coefficient R², R² for an increase in the concentration of
MDA is equal to = 85.67%; and for a decrease in the
activity of AOA - 93.52%, which proves the higher
predictive significance of the obtained regression
models
CONCLUSION
The development of postpartum endometritis is
characterized
by
a
complicated
obstetric-
gynecological, somatic, social history and postpartum
history with a high level of proinflammatory markers.
The developed method for predicting the development
of postpartum endometritis allows identifying women
in labor with a high risk of endometritis in an obstetric
hospital at the preclinical stage of the disease,
preventing the occurrence of severe purulent-septic
complications after childbirth and is one of the
measures to reduce maternal mortality.
Biochemical studies with determination of MDA and
AOA in blood serum are useful as diagnostic methods
for determining the risk of postpartum endometritis,
significantly narrowing the range of studies and
allowing to assess the risk of endometritis with high
diagnostic accuracy using a limited range of studies
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