In the structure of inflammatory diseases postpartum endometritis (PE) retains its leading position. The likelihood of postpartum endometritis development after cesarean section increases by 5-10 times compared with spontaneous labor and its frequency has no tendency to decrease. The urgency of PE problem is determined not only by its high prevalence, economic losses, but its possible complications (uterine suture failure and generalization of infection as well). Clinical picture of PE currently is characterized by late manifastation, presence of atypical and asymptomatic forms with mismatched general reaction of the organism and severity of the local pathological process. The leading role in the etiology of PE belongs to conditionaly pathogenic microflora, in the most cases (90%) presence of strict anaerobic nonsporeforming microorganisms, composing part of the normal flora of the genital tract in women. The aim of the study was the development of the principles of active prevention of postpartum endometritis in women with severe vaginal anaerobic dysbiosis while planning cesarean section.
Aim. Prevention of purulent and septic complications in females after planned caesarean section.Methods. Out of 60 pregnant women, who underwent comprehensive examination during the trial, 35 (58.3%) were included in the study group and were delivered off by planned cesarean section; 25 (41.7%) pregnant women, included in the control group, were delivered off by urgent cesarean section. Considering the goal of the study, bacteriology of vaginal discharge, amniotic fluid and placental tissues, DNA detection of vaginal discharge bacterial flora before and after treatment (using «Femoflor-16» test system) according to classification by M.N. Boldyreva (2010), uterine cavity aspirate cytology according to classification by M.A. Kupert (2003), sonography of the uterus and uterine adnexa on the 4-5 day after the surgery according to classification of A.P. Milovanov were added to the training program for pregnant women. In the study group, pregnant patients with severe anaerobic vaginal dysbiosis at the 36-38 weeks of gestation were administered causal treatment of severe anaerobic vaginal dysbiosis, pregnant patients of the control group were not treated if severe anaerobic vaginal dysbiosis was diagnosed.Results. Performed correction of vaginal microbiota in the study group has significantly improved the course of postoperative period, reduced the incidence of uterine subinvolution, signs of chorioamnionitis as a manifestation of ascending infection compared to the control group. Postpartum endometritis has developed in 1 (2.8%) patient of the study group and in 5 (20.0%) cases in the control group. Offered method for preparing the patients with vaginal dysbiosis to cesarean section reduced the risk for postpartum endometritis by 6.8 times.Conclusion. Strategy of preparation for planned Caesarean section should include vaginal discharge bacteriology and treatment of severe anaerobic vaginal dysbiosis, which reduces the risk for postpartum endometritis by 6.8 times.
In the structure of inflammatory diseases postpartum endometritis (PE) retains its leading position. The likelihood of postpartum endometritis development after cesarean section increases by 5-10 times compared with spontaneous labor and its frequency has no tendency to decrease. The urgency of PE problem is determined not only by its high prevalence, economic losses, but its possible complications (uterine suture failure and generalization of infection as well). Clinical picture of PE currently is characterized by late manifastation, presence of atypical and asymptomatic forms with mismatched general reaction of the organism and severity of the local pathological process. The leading role in the etiology of PE belongs to conditionaly pathogenic microflora, in the most cases (90%) presence of strict anaerobic nonsporeforming microorganisms, composing part of the normal flora of the genital tract in women. The aim of the study was the development of the principles of active prevention of postpartum endometritis in women with severe vaginal anaerobic dysbiosis while planning cesarean section.
Clinical features of vaginal dysbiosis as a factor in the high risk of septic complications, especially in pregnant women diagnosed with anaerobic vaginal dysbiosis were examined. Low efficiency of the traditional methods of treating bacterial dysbiosis, a high rate of recurrences and the risk of preterm delivery dictate the need to find alternative methods of treatment and prevention of antenatal and post-natal complications. The widespread introduction of caesarean section into obstetric practice contributed to the reduction of perinatal loss. However, together with the expansion of indications for cesarean section, increase in the frequency and severity of post-natal chronic inflammatory diseases is associated. The number of purulent-inflammatory diseases in the early postoperative period and in the long-term period after C-section is large, reaching 3,3-54,3%. Postpartum period, even in physiological course and particularly in the presence of risk factors is favorable for the development of infectious complications. Almost all the authors identify caesarean section as a significant risk factor for postpartum endometritis, since, making only 10 - 20% of the total number of deliveries, cesarean section causes 80% of all postpartum endometritis. We propose a diagnostic algorithm, drug correction and prevention for this common group of patients.
Clinical features of vaginal dysbiosis as a factor in the high risk of septic complications, especially in pregnant women diagnosed with anaerobic vaginal dysbiosis were examined. Low efficiency of the traditional methods of treating bacterial dysbiosis, a high rate of recurrences and the risk of preterm delivery dictate the need to find alternative methods of treatment and prevention of antenatal and post-natal complications. The widespread introduction of caesarean section into obstetric practice contributed to the reduction of perinatal loss. However, together with the expansion of indications for cesarean section, increase in the frequency and severity of post-natal chronic inflammatory diseases is associated. The number of purulent-inflammatory diseases in the early postoperative period and in the long-term period after C-section is large, reaching 3,3-54,3%. Postpartum period, even in physiological course and particularly in the presence of risk factors is favorable for the development of infectious complications. Almost all the authors identify caesarean section as a significant risk factor for postpartum endometritis, since, making only 10 20% of the total number of deliveries, cesarean section causes 80% of all postpartum endometritis. We propose a diagnostic algorithm, drug correction and prevention for this common group of patients.
