Assessment of the risk of progression of purulent-inflammatory complications and the possibility of organ-preserving surgeries in puerperas with obstetric peritonitis

Abstract

BACKGROUND: This study aimed to improve the results (justify the possibility) of organ-preserving surgeries in puerperas with peritonitis after cesarean section, through a comprehensive assessment of the clinical and laboratory parameters of operated patients based on mathematical analysis.
 MATERIALS AND METHODS: A prospective, comparative cohort study was performed in parallel groups of puerperas whose delivery was performed by cesarean section, and the postoperative period was complicated by suture dehiscence on the uterus with symptoms of peritonitis. A total of 428 patients, distributed into two groups, were examined, and treated. The main group included 194 puerperas who, in accordance with the prognosis, retained the possibility of undergoing organ-preserving surgery; the comparison group included 234 puerperas with a high risk of progression of purulent inflammatory complications, and who underwent hysterectomy. In the main group, after the laparotomy was conducted again, lymphotropic therapy was performed, optimized by laser irradiation of regional lymph nodes. Patients in the comparison group received conventional treatment.
 RESULTS: Based on the developed scale for the risk of progression of purulent-inflammatory complications after cesarean section, the conditions for organ-preserving surgery and the technology for intensive care after relaparotomy were determined. The sensitivity of the prognostic model was 93.3%, and the specificity was 87.7%. Only 2 (1.03%) of the 194 patients in the main group showed progression of purulent-inflammatory complications after organ-preserving surgery, which required relaparotomy, and hysterectomy.
 CONCLUSIONS: Based on the results of this study, it was concluded that there remains a possibility for performing organ-preserving surgeries in case of peritonitis after cesarean section, provided there is no decompensated stage of the systemic inflammatory response syndrome and multiple organ failure.