Клиническая характеристика и результаты лечения женщин с различными формами инфекционно-воспалительных заболеваний послеродового периода

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. 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. В группах B и C достоверно чаще диагностирован хориоамнионит в сравнении с группой A (р_A–B = 0,002, р_A–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. 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.

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