Post-caesarean septic complications

Abstract

Introduction. Obstetrics and gynecology are facing various problems, one of them being septic-purulent disorders in the post-operative period, which increase the maternal mortality rate. WHO experts report that the rate of maternal mortality worldwide is inadmissibly high. Every day, due to complications caused by pregnancy and childbirth, around 800 women die in the world. Due to effective antimicrobial preparations, maternal deaths due to infection have become less frequent. The mortality rate related to the infection is almost 25 times in the case of caesarean section versus vaginal birth.Maternal mortality and morbidity after caesarean section is almost five times that of vaginal births, especially the risks of hemorrhage, sepsis, thromboembolism and embolism with amniotic fluid. In a subsequent pregnancy, caesarean section increases the risk of anterior placenta and adherent placenta, which may further lead to an increased risk of hemorrhage and peripartum hysterectomy, technical difficulties due to adhesions increase the risk of injury to the bladder and intestine. A large number of factors modify the risk of infection, the most important being prophylactic antibiotics. That is why the problem of septic-purulent complications is current and requires continuous study. Aim of the study. Analysis and highlighting of the factors associated with the high rate of post-cesarean complications compared to vaginal births. Materials and methods.To achieve the goal, a retrospective study was conducted, were studied the medical records of clinical observation of the patients hospitalized with septicpurulent complications in the septic gynecology section a IMSP SCM1 in 2016-2018. The study included 200 patients with puerperal septic complications, which according to the birth method are divided into two groups: Lot I -116 cases, patients with septic complications after birth per vias naturalis. Lot II- 84 cases patients with septic complication after caesarean section. Results. The study was carried out on a batch of 200 patients, selecting data from the archive, during the years 2016-2018, with extremes of 18 and 44 years respectively, the average age being 31 years. Age distribution: the patients aged 18-20 years were 25 patients (12.5%), 21- 30 years -108 patients (54%), 31-40 years -60 patients (30%),> 41 years -7 patients (3.5%). The vast majority of patients studied were primiparous, which constituted 120 (60%): group I- 55 (27.5%) cases and in group II - 65 (32.5%). In 48 (37.49%) cases. The multiparous patients were: group I in 43 (21.5%) cases and group II 37 (18.5%). We mention that the clinical picture of puerperal septic complications, both after birth per vias naturalis and after caesarean section, results with the same symptoms: fever over 38, once with chills, accelerated pulse, altered state of intoxication, pain and lower abdomen region , pathological eliminations - the slime becomes abundant, gray, then purulent, with a fetid odor in depending on the pathogen. The estimation of the results of the laboratory examination found pathological deviations in the hemolithogram, vaginal smear, smear bacteriology, ultrasonographic examination. Studying somatic anamnesia, we determined that extragenital pathologies were present in 36 (18%) patients in group I and in 13 (6.5%) patients in group II. In the structure of the supported extragenital pathology, the first place belongs to the chronic pyelonephritis present in 19 (9.5%) patients and the anemia found in 17 (8.5%) patients, the second place - cholecysto-pancreatitis, appreciated in 6 (3%), cases, obesity in 5 (2.5%) patients, autoimmune thyroiditis 2 (1%)patients, hemorrhoid disease 1 patient, pregnancy-induced HTA 4(4%) patients. According to the results obtained, the septic-purulent complications of puerperium determined in the study were Lot I- endometritis - 116 (58%), metroendometrita -8 (4%) patients, dehiscence of the suture in the perineal suppuration and -27 (23.2%).Lot number IIEndometritis 56 (28%) patients, methoendometritis 20 (10%) cases, paravezical hematoma- 7 (3.5%) patients, abscess with intra-abdominal fistula- 4 (2%) patients, suppuration and dehiscence of the wound in the uterus -12 (14.2%) . The average length of hospitalization for patients in Group I-13.36 days, patients in Group II-7.1 days. In the etiology of puerperal complications, bacterial infection plays a major role, the microbial agents determined in the vagina were in about 50-60% cases presented by E. Coli, Enteroco- 30-35%, Mixed flora 10- 15%. Conclusions. The predisposing are: complicated obstetric anamnesis, inflammatory extragenital pathology, birth complications and the presence of hematoma after birth . Early diagnosis and complex treatment reduce the generalization of the septic process that requires enlarged surgery, amputation of the uterus with / without appendages, which severely affects the woman's subsequent reproductive function.