urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.6.18CZALAAurmj-1638Research ArticleОригинальные статьи | Original articlesOriginal articlesКлиническая характеристика и результаты лечения женщин с различными формами инфекционно-воспалительных заболеваний послеродового периодаClinical Characteristics and Treatment Results of Women with Various Forms of Infectious and Inflammatory Diseases of the Postpartum Periodhttps://orcid.org/0000-0002-0895-4066ЛазареваО. В.LazarevaO. V.

Оксана Вячеславовна Лазарева — кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2

Омск

Oksana V. Lazareva — Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

lazow@mail.ruhttps://orcid.org/0000-0002-0357-7097БариновС. В.BarinovS. V.

Сергей Владимирович Баринов — доктор медицинских наук, профессор, заведующий кафедрой акушерства и гинекологии № 2

Омск

Sergey V. Barinov — Doctor of Sciences (Medicine), Professor, Head of the Department of Obstetrics and Gynecology No. 2

Omsk

barinov_omsk@mail.ruhttps://orcid.org/0000-0002-6113-8498ШифманЕ. М.ShifmanE. M.

Ефим Муневич Шифман — доктор медицинских наук, профессор, профессор кафедры анестезиологии и реаниматологии, Московский областной научно-исследовательский клинический институт имени М. В. Владимирского; профессор кафедры анестезиологии и реаниматологии, Российский национальный исследовательский медицинский университет имени Н. И. Пирогова

Москва

Efim M. Shifman — Doctor of Sciences (Medicine), Professor, Professor of the Department of Anesthesiology and Intensive Care, Moscow Regional Research and Clinical Institute; Professor of the Department of Anesthesiology and Intensive Care, N. I. Pirogov Russian National Research Medical University

Moscow

eshifman@mail.ruhttps://orcid.org/0000-0001-6080-1828ШкабарняЛ. Л.SckabarnyaL. L.

Людмила Леонидовна Шкабарня — заведующий отделением гинекологии

Омск

Lyudmila L. Sckabarnya — Head of the Department of Gynecology

Omsk

l_shka@mail.ruhttps://orcid.org/0000-0001-5365-7119ТирскаяЮ. И.TirskayaYu. I.

Юлия Игоревна Тирская — доктор медицинских наук, профессор кафедры акушерства и гинекологии № 2

Омск

Yulia I. Tirskaya — Doctor of Sciences (Medicine), Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

yulia.tirskaya@yandex.ruhttps://orcid.org/0000-0002-0348-5985КадцынаТ. В.KadtsynaT. V.

Татьяна Владимировна Кадцына — кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2

Омск

Tatyana V. Kadtsyna — Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

tatianavlad@list.ruhttps://orcid.org/0000-0002-4806-6880ЧуловскийЮ. И.ChulovskijJu. I.

Юрий Игоревич Чуловский — кандидат медицинских наук, доцент кафедры акушерства и гинекологии No 2

Омск

Jurij I. Chulovskij — Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

akusheromsk@rambler.ruhttps://orcid.org/0000-0002-3777-1648ПухаА. Е.PukhaA. E.

Анастасия Евгеньевна Пуха — клинический ординатор кафедры акушерства и гинекологии № 2

Омск

Anastasiya E. Pukha — Clinical Resident of the Department of Obstetrics and Gynecology No. 2

Omsk

alpitts@yandex.ruОмский государственный медицинский университетРоссияOmsk State Medical UniversityRussian FederationМосковский областной научно-исследовательский клинический институт имени М. Ф. Владимирского; Российский национальный исследовательский медицинский университет имени Н. И. ПироговаРоссияMoscow Regional Research and Clinical Institute; N. I. Pirogov Russian National Research Medical UniversityRussian FederationОбластная клиническая больницаРоссияRegional Clinical HospitalRussian Federation20241112202423618–34Copyright © Лазарева О.В., Баринов С.В., Шифман Е.М., Шкабарня Л.Л., Тирская Ю.И., Кадцына Т.В., Чуловский Ю.И., Пуха А.Е., 20242024Лазарева О.В., Баринов С.В., Шифман Е.М., Шкабарня Л.Л., Тирская Ю.И., Кадцына Т.В., Чуловский Ю.И., Пуха А.Е.Lazareva O.V., Barinov S.V., Shifman E.M., Sckabarnya L.L., Tirskaya Y.I., Kadtsyna T.V., Chulovskij J.I., Pukha A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1638Введение

Введение. Вопросы ведения родильниц с инфекционно-воспалительными заболеваниями (ИВЗ) крайне актуальны в современных условиях.

Цель исследования — представить клиническую характеристику и особенности лечения родильниц с различными формами ИВЗ послеродового периода.

Материалы и методы

Материалы и методы. Проведено ретроспективное обследование 181 родильниц с ИВЗ, которые были разделены на 3 группы: A (n = 122) — пациентки с неосложненным эндометритом; B (n = 43) — с осложненными формами (несостоятельностью шва, метротромбофлебитом); C (n = 16) — с тяжелыми септическими осложнениями (параметритом, акушерским перитонитом).

Результаты

Результаты. В группах B и C достоверно чаще диагностирован хориоамнионит в сравнении с группой A (рA–B = 0,002, рA–C < 0,001). При поступлении количество баллов по шкале NEWS2 статистически значимо выше в группах B (p = 0,050) и C (p = 0,007) в сравнении с группой A. У 25,42 % обследуемых отмечалось несовпадение назначенной эмпирической антибактериальной терапии высеваемому патогену. В группе B органосберегающая операция проведена у 55,81 % родильниц на 6,5 [4,8; 11,0] сутки, гистерэктомия— на 9,0 [6,0; 12,0] сутки после родов.

Заключение

Заключение. Хориоамнионит в родах, оценка состояния по шкале NEWS2 в 2 и более баллов предполагают развитие осложненных форм послеродового эндометрита. При лечении следует отдавать предпочтение антибиотикам групп аминопенициллинов, амоксициллина и ингибиторов бета-лактамаз, карбапенемов и своевременно принимать решение о проведении повторного оперативного вмешательства, позволяющего выполнить органосберегающую операцию.

Introduction

Introduction. The issues of managing postpartum women with infectious and inflammatory diseases (IID) are extremely relevant in modern conditions.

The aim of the study is to present the clinical characteristics and features of treatment of women in labor with various forms of postpartum pulmonary dysfunction.

Materials and methods

Materials and methods. A retrospective examination of 181 postpartum mothers with IID was carried out, who were divided into 3 groups: A (n = 122) — patients with uncomplicated endometritis; B (n = 43) — with complicated forms (suture failure, metrothrombophlebitis); C (n = 16) — with severe septic complications (parametritis, obstetric peritonitis).

Results

Results. In groups B and C, chorioamnionitis was statistically significantly more often diagnosed during labor compared to uncomplicated endometritis (pA–B = 0.002, pA–C < 0.001). In the integrated the number of points on the NEWS2 scale was statistically significantly higher in group B (p = 0.050) and group C (p = 0.007) compared to group A. In 25.42 % of the subjects, there was a discrepancy between the prescribed empirical antibacterial therapy and the pathogen isolated. In group B, organ-preserving surgery was performed in 55.81 % of the mothers on day 6.5 [4.8; 11.0], and hysterectomy was performed on day 9.0 [6.0; 12.0] after delivery.

Conclusion

Conclusion. Chorioamnionitis during childbirth, a score on the NEWS2 scale of 2 or more points suggests the development of complicated forms of postpartum endometritis. When treating, preference should be given to antibiotics of the aminopenicillin group, amoxicillin and beta-lactamase inhibitors, carbapenems and a timely decision should be made on repeated surgical intervention, allowing for organ-preserving surgery.

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The authors declare that there are no conflicts of interest present.