Identifying etiological pattern for postpartum complications

Abstract

Introduction. One of the leading places in the structure of gynecological diseases is occupied by postpartum complications.Aim: to study the clinical and laboratory features of the development of postpartum inflammatory complications.Materials and Methods. On the basis of the Research Institute of Obstetrics and Gynecology of the Ministry of Health of the Republic of Azerbaijan (Baku) in the period from 2019 to 2021 150 puerperas were examined, among which 2 groups were distinguished: the main group – puerperas with developed postpartum complications (n = 100) at the age of 29.9 ± 0.64 years and the control group – puerperas with a physiological course of the postpartum period (n = 50) at the age of 30.3 ± 0.86 years (p = 0.679). We studied the general and obstetric-gynecological anamnesis. The following structural elements of the blood were determined: the total number of leukocytes, the absolute and relative values of lymphocytes, the number of erythrocytes and platelets, the concentration of hemoglobin, the erythrocyte sedimentation rate, and the quantitative determination of interleukin-6 (IL-6).Results. In puerperas of the main group, as additional risk factors for the development of postpartum complications relative to the control group an increase in the level of pro-inflammatory cytokines from 24.26 ± 0,48 pg/ml vs. 10.36 ± 0,62 pg/ml (p = 0.001). In the reactions of cellular immunity, there is a decrease in the ratio of CD4+/CD8+ due to an increase in the number of CD8+ lymphocytes in the blood and a decrease in the subpopulation of CD4+ lymphocytes. The development of postpartum inflammatory complications is associated with menstrual disorders in 81.0 ± 3.92 % of cases, first births in 60.0 ± 4.90%, threatened miscarriage in 19.0 ± 3.92 % and gestosis in 52.0 ± 5.00 % of the total number of patients in the main group. Some risk factors are associated with diseases of the genitourinary system (chronic pyelonephritis 24.0 ± 4.27 % and 10.0 ± 4.24 %, respectively, in the main and control groups; p = 0.048) and respiratory organs, most often represented by chronic tonsillitis and sinusitis (20.0 ± 4.00 % vs. 4.0 ± 2.77 % in the control group; p = 0.007).Conclusion. The course of the postpartum period in primiparas and in women with a burdened history of obstetric-gynecological and extragenital pathology is characterized by a high percentage of inflammatory complications. Biochemical studies with the determination of T-lymphocytes in the blood serum and the level of the pro-inflammatory cytokine IL-6 can be used as an additional diagnostic method to identify, assess the nature and severity of early puerperal complications.