Прогнозирование внутриутробной инфекции при несвоевременном излитии околоплодных вод и преждевременных родах

Abstract

Objective. To study significant risk factors for predicting intrauterine infection (IUI) in patients with prelabor upture of membranes (PROM) and threatened preterm birth (PB). Patients and methods. A retrospective study was conducted, including the analysis of prenatal records, labor and delivery records, and neonatal development (n = 125). Labor and delivery records were selected considering the diagnoses of preterm birth” and “prelabor rupture of membranes”. Two patient groups were identified: group 1 (n = 59) consisted of patients diagnosed with IUI, group 2 (n = 66) – patients without diagnosis of IUI. Medical records of pregnant women and the results of clinical, laboratory, and instrumental examinations during pregnancy and at the time of hospitalization were analyzed. A comparative assessment of perinatal outcomes was performed. Results. Statistically significant risk factors for IUI regardless of gestational age included hereditary thrombophilia (OR: 2.837; 95% CI: 1.057–7.618), history of ≥2 pregnancies (OR: 2.494; 95% CI: 1.093–5.690), PB, and recurrent miscarriage (OR: 2.392; 95% CI: 1.019–5.615). Among pregnancy and delivery complications, the following were important in predicting IUI: the presence of isthmic-cervical insufficiency (ICI) (OR: 2.698; 95% CI: 1.058–6.878), the duration of waterless period (p = 0.037), gestational age at the onset of membrane rupture (p < 0.001) and delivery (p < 0.001). Conclusion. In case of expectant management, the prognostic model should be used to predict IUI in patients at risk of PB and PROM. Based on the calculation of the adjusted odds ratio, we identified the factors that have a statistically significant effect on IUI development, irrespective of other predictors, with a sensitivity of 86.7% and specificity of 92.6%. Key words: vaginal microbiota, intrauterine infection, intrauterine pneumonia, intraamniotic infection, prelabor rupture of membranes, preterm birth, chorioamnionitis