Русский
Relationship between postpartum infection and somatic pathology of the puerperant woman: a comparative analysis of comorbidity indices
DOI: https://dx.doi.org/10.18565/pharmateca.2021.6.76-83
N.A. Korobkov, N.V. Bakulina, M.A. Repina
North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia
Background. The article presents modern data on the relationship between concomitant somatic pathology of pregnant women with maternal morbidity and the development of postpartum infectious complications. The terminological differences between the concepts of «comorbidity» and «polymorbidity» of concomitant pathology in the clinic of internal diseases and obstetric practice are discussed in detail. The main attention is paid to the role of primary extragenital diseases of a therapeutic profile in the development of postpartum infectious complications and methods for assessing comorbidity in pregnant women.
Objective. Evaluation of comorbidity in puerperant women with endometritis after cesarean section (CS) and identification of an effective tool for its assessment for the subsequent stratification of patients into therapeutic groups with varying degrees of intensity of antimicrobial treatment.
Methods. A retrospective study of 597 case histories of puerperant women delivered by CS surgery was carried out, of which 355 were diagnosed with endometritis after CS and 242 with the physiological course of the postoperative period.
Results. Analysis of the data obtained showed that comorbidity is important for predicting the unfavorable course of endometritis after abdominal delivery. The Cumulative Illness Rating Scale (CIRS) has the best informational content, because it reflects the largest number of nosological forms in obstetric patients that affect the course of postpartum infection and its outcome.
Conclusion. Among the comorbidity indices studied, the CIRS system correlates best with the severity of the course of endometritis after CS and the frequency of isolation of multiresistant pathogens determining an unfavorable prognosis of the disease and a high risk of failure when prescribing a standard scheme of empirical antimicrobial therapy.
Objective. Evaluation of comorbidity in puerperant women with endometritis after cesarean section (CS) and identification of an effective tool for its assessment for the subsequent stratification of patients into therapeutic groups with varying degrees of intensity of antimicrobial treatment.
Methods. A retrospective study of 597 case histories of puerperant women delivered by CS surgery was carried out, of which 355 were diagnosed with endometritis after CS and 242 with the physiological course of the postoperative period.
Results. Analysis of the data obtained showed that comorbidity is important for predicting the unfavorable course of endometritis after abdominal delivery. The Cumulative Illness Rating Scale (CIRS) has the best informational content, because it reflects the largest number of nosological forms in obstetric patients that affect the course of postpartum infection and its outcome.
Conclusion. Among the comorbidity indices studied, the CIRS system correlates best with the severity of the course of endometritis after CS and the frequency of isolation of multiresistant pathogens determining an unfavorable prognosis of the disease and a high risk of failure when prescribing a standard scheme of empirical antimicrobial therapy.
Keywords: multi-resistant microflora, obstetric comorbidity, comorbidity index, maternal morbidity, postpartum infection, endometritis after cesarean section, comorbid pathology, extragenital pathology, polymorbidity
About the Autors
Corresponding author: Nikolay A. Korobkov, Cand. Sci. (Med.), Associate Professor at the Department of Obstetrics and Gynecology n.a. S.N. Davydov, North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia; nikolai_korobkov@mail.ru
Address: 41 Kirochnaya St., St. Petersburg 191015, Russian Federation
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