Obstetrics and gynecology

doi: 10.25005/2074-0581-2018-20-1-20-25
STRUCTURE OF NOSOCOMIAL INFECTIOUS AND INFLAMMATORY COMPLICATIONS AFTER ABDOMINAL DELIVERY

N.A. Korobkov

Department of Women’s Reproductive Health, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation

Objective: Analysis of the frequency and structure of postoperative infectious and inflammatory complications in the puerperae after abdominal delivery, which were under treatment in the specialized department of the third-level hospital for 2017.

Methods: s: Examined and treated of 66 parturient women with infectious complications after cesarean section. The spectrum of nosocomial microflora and resistance to antimicrobial agents determined using an automatic microbiological analyzer based on mass spectrometry.

Results: The main recorded nosological form was infection of the area of surgical intervention. In 3% of cases, postoperative metroendometritis complicated by the inconsistency of sutures on the uterus with the development of obstetric peritonitis, and in 7.6% by sepsis. The structure of isolated microflora in postoperative infection was different after planned and emerged delivery, which should be taken into account when developing a local form of perioperative antibiotic prophylaxis and therapy.

Conclusions: At present, there is an underestimation of the severity of metroendometritis after cesarean section with premature discharge or a belated transfer from the maternity hospital to the specialized observatory department of the multi-profile hospital. One in five postoperative metroendometritis caused by multidrug-resistant hospital microflora.

Keywords: Caesarean section, infectious complications, observational department, obstetric wound infection, postnatal metroendometritis, postpartum sepsis, obstetric peritonitis.

Download file:


References
  1. Korobkov NA. Rukovodstvo po puerperiyu [Guide to puerperium]. Saint Petersburg, RF: SpetsLit; 2015. 647 p.
  2. Adewunmi A, Ande A, Ezeanochie M, Olagbuji B, Ezeanochie M, Oyeniran A. Morbidity associated with failed vaginal birth after cesarean section. Acta Obstet Gynecol Scand. 2010;89(9):1229-32
  3. Earnshaw VA, Ickovics JR, Kershaw T, Wheeler R. Postpartum sexually transmitted disease: refining our understanding of the population at risk. Sex Transm Dis. 2012;39(7):509-13.
  4. Karsnitz DB. Puerperal infections of the genital tract: a clinical review. Midwifery Womens Health. 2013;58(6):632-42.
  5. Nabhan AF. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011876.
  6. Tita ATN, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Evolving concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol. 2009;113(3):675-82.
  7. Costantine MM, Rahman M, Ghulmiyah L, Byers BD, Longo M, Wen T, et al. Timing of perioperative antibiotics for cesarean delivery: a meta-analysis. Am J Obstet Gynecol. 2008;199(3):301-6.
  8. Kaimal AJ, Zlatnik MG, Cheng YW, Thiet M-P, Connatty E, Creedy P, et al. Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of post-cesarean delivery surgical-site infections. Am J Obstet Gynecol. 2008;199(3):310.e1-310.e5.
  9. Black LP, Duff P, Hinson L. Limited course of antibiotic treatment for chorioamnionitis. Obstet Gynecol. 2012;119(6):1102-5.
  10. Korobkov NA, Tekhova IG. Analiz perioperatsionnogo naznacheniya antimikrobnykh khimiopreparatov pri kesarevom sechenii [Analysis of perioperative prescribing of antimicrobial chemical in cesarean section]. Arkhiv akusherstva i ginekologii im. V.F. Snegiryova. 2018;5(1):41-4.
  11. Sorensen B. Postpartum infections: occurrence, healthcare contacts and association with breastfeeding. Acta Obstet Gynecol Scand. 2012;91(12):1440-4.
  12. Maharaj D. Post pregnancy genital tract and wound infections: History of obstetric infection. Obstet Gynecol. 2007;62(6):393-9
  13. Gilbert DN, Moellering RC, Sande MA (ed.). The Sanford guide to antimicrobial therapy, 33rd ed. Hyde Park, Vt., USA : Antimicrobial Therapy, Inc.; 2003. 150 p
  14. Abouzahr C, Aaahman E, Guidotti R. Puerperal sepsis and other puerperal infections. In Health dimensions of sex and reproduction: the global burden of sexually transmitted diseases, maternal conditions, perinatal disorders, and congenital anomalies. CJL Murray and AD Lopez, eds. WHO: 1998
  15. Managing puerperal sepsis. Education material for teachers of midwifery. WHO: 2008.

Authors informations:

Korobkov Nikolay Aleksandrovich

Candidate of Medical Sciences, Associate Professor of the Department of Women’s Reproductive Health, North-West State Medical University named after I.I. Mechnikov

Address for correspondence:

Korobkov Nikolay Aleksandrovich

Candidate of Medical Sciences, Associate Professor of the Department of Women’s Reproductive Health,

North-West State Medical University named after I.I. Mechnikov

191193, Russian Federation, St. Petersburg, str. Stremyannaya, building # 22/3, apt. 34

Tel.: (+7) 921 6557296

E-mail: nikolai_korobkov@mail.ru

Materials on the topic: