A prognostic tool to predict the development of postpartum endometritis and haematometra

Abstract

Introduction: Obstetric sepsis remains one of the top 5 causes of maternal death in Ukraine, according to the data collected between 2009 - 2015. Postpartum purulent-inflammatory diseases are the reason of sepsis occurrence. Currently, there is a lack of methods of early diagnostics of postpartum endometritis (PPE). Objectives: The main aim is to evaluate the risks of postpartum endometritis (PPE) among postpartum women and development of means of its early diagnosis using fluorescent spectroscopy. In addition, the reliability of such approach is tested via creation of a prognostic model. Methods: Fluorescent spectroscopy was used, along with the standard diagnostic tools in order to diagnose 170 postpartum patients of the participants cohort and 40 postpartum patients of the control group with uncomplicated course of postpartum period. Results: By statistical analysis using logistic regression, the data was evaluated according to more than 40 indicators and as a result, a prognostic model was derived. This prognostic model enables to assess the probability of development of postpartum endometritis among postpartum patients. ROC-analysis was implied in order to evaluate the quality of the proposed model. Conclusion: Proposed multi-structured model for prognosis of the development of PPE among postpartum women, which enables determination of the patient groups susceptible to develop PPE. The major risk factors in the finalised multi-structured model of the development of PPE are: extragenital pathology, risk of miscarriage, TORCH-infections, colpitis, labour duration > 12 hrs, abnormal labour, lambda (λ) max, fluorescence intensity ≤ 0,845, a number of bed days and the presence of foetal distress. It was confirmed, that the results obtained by using fluorescent spectroscopy have the highest significance among the prognostic tools used in the investigation. Therefore, application of this prognostic tool in clinical practice is a highly feasible way to improve diagnosis and prognosis of the development of postpartum endometritis.