The incidence of postpartum endometritis in women who gave birth in Moldavian hospital in the period 2017-2021

Abstract

Introduction. Puerperal or postpartum endometritis (PE) has been defined by the World Health Organization (WHO) as a infection of the genital tract occurring at any time between the onset of rupture of membranes or labor and the 42nd day postpartum in which two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge, abnormal smell/foul odor discharge or delay in uterine involution. According to the available dates the incidence of PE is affected mainly by the mode of delivery: vaginal deliveries in 1 to 3%, scheduled caesarean deliveries (done before labor starts) in 5 to 15%, unscheduled caesarean deliveries (done after labor starts) in 15 to 20% cases. There is a paucity of data on the prevalence of postpartum infections in the Republic of Moldova. Aim of study. The aim of the study was to assess the prevalence of different degrees of postpartum endometritis in women who gave birth in Moldavian hospital, and to determine some risk factors for the incidence of clinically relevant endometritis. Methods and materials. We performed a retrospective multicenter cohort study that included the patient records of all women giving birth (vaginal delivery or cesarean section) in Municipal Hospital ‘’Gheorghe Paladi’’ and Institute of Mother and Child during the period 2017-2021. Results. In the analysis were included dates from 60,955 patients' records, the PE were identified in 658 cases (1.07%). Out of a total of 26916 births from the Institute of Mother and Child were recorded 181 cases complicated with PE 75 (41,4%) after vaginal delivery and 106 (58,6%) post cesarean section. In the hospital Municipal Hospital ‘’Gheorghe Paladi’, with unique unit of septic gynecology from total number of 34039 births, 477 (1,4%) cases were established PE. 370 (77,6%) of these cases, were after vaginal birth of and 107 (22,4%) post cesarean section. The qualitative analysis of dates reveals that the majority of infections were mild and resolved with antibiotic therapy; however, in some cases the infection extended into the peritoneal cavity resulting in peritonitis, intraabdominal abscess, or sepsis. Rare patients developed necrotizing myometritis, necrotizing fasciitis of the abdominal wall, septic pelvic thrombophlebitis, or toxic shock syndrome. Conclusion. Among Moldavian women, postpartum infection incidence was low overall, mostly associated with vaginal birth. A more in-depth analysis is needed to assess the risk factors associated with postpartum endometritis and the profile of patients in order to develop targeted strategies to reduce the incidence of postpartum infections.