Оптимізація профілактики септичних ускладнень у роділь з високим інфекційним ризиком

Abstract

Despite the introduction of modern diagnostic technologies, prophylaxis and treatment techniques in obstetrical practice, the incidence of postpartum purulent-septic complications (PPSC) remains rather high and is an important medical and social problem, as they take one of the leading places in the structure of maternal morbidity and mortality. The objective: to improve the management of parturient womenwith a perineal birth injury in anamnesis, as part of an effective prevention of purulent-septic complications of puerperium. Materials and methods. The study included 77parturient women. Main and comparative groups were formed by women with a violation of the integrity of the perineum in the previous labor and with a high risk of developing infectious complications in puerperium. Women of the main group (n = 24) during each vaginal examination in labor (and an additional injection in 15-30 minutes after the rupture of the membranes) and twice a dayat a dose of 5 ml for 5 days postpartum, an antiseptic agent in the form of a vaginal gel, which consists of: 0.02% decamethoxin (antiseptic component), 0.5% hyaluronic acid (regenerating component) and lactate buffer (regulatory component). The comparison group included 27 women, without using vaginal gel in laborand using traditional wound treatment techniques in the postpartum period. The control group consisted of 26 women with uncomplicated somatic status, physiological course of pregnancy and labor. The evaluation of the effectiveness of the prescribed treatment was based on subjective symptoms (pain, discomfort, burning in the region of the perineal sutures), clinical data (swelling, hyperemia, nature of suturing healing), generally accepted indicators in dynamics (bacterioscopy of vaginal contents, pH-metry of the vaginal environment). Results. At the background of the use of three-component vaginal gel in the main group, the level of injury of soft tissues of the birth canal in these deliveries was lower by 19.9% than in the comparison group, prevalence of the 1st degreeperineumruptures, decreased the need for repeated episio- and perineotomy, which reduced the duration stay at hospital and improved postpartum rehabilitation in relation to the comparison group. On the third day of puerperium, hyperemia and edema of the wound area in women of the main group were observed almost three times less compared with the comparison group. On the fifth day of the puerperium in the main group the complaints were insignificant and appeared on the average 5 times less often, the healing was by the primary tension without infectious complications. The use of vaginal gel reduced the number of leukocytes in wound secretions by shortening the time of wound epithelization (1.5 times faster than in the parous from the comparison group). On the fifth day of using vaginal gel, 2/3 of the patients observed normalization of the vaginal microflora, the restoration of pH was observed. The results indicate the benefits of early onset of prophylactic measures and high effectiveness of topical antiseptic therapy in women with high infectious risk. Conclusions.In order to prevent antibiotic resistance tactics of prevention of PPSC in the group of high-risk septic complications provides one of the elements of anintegrated approach to use local antiseptics. Inclusion of the latter into a complex of prophylactic and treatment measures in the management of a high-riskwomen in puerperium contributes to the reduction of traumatic and infectious complications and provides more favorable course of labor and the postpartum period. Key words: labor traumatism, postpartum purulent-septic complications, local antiseptic.