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.
