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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

 

 

 

 

 

 

 

 

ABSTRACT 

The article presents the results of a prospective cohort study, which included 26 pregnant women at high risk of 

infection, who in the postpartum period were divided into 2 groups: I – the main (n=14) and II – the comparison group 

(n=12). The groups were comparable in age, according to somatic and obstetric-gynecological anamnesis. The 

comprehensive examination included an assessment of anamnestic data and the results of clinical, microbiological, 

and instrumental research methods. 

KEYWORDS 

Intrauterine infection, postpartum endometritis, antibiotic prophylaxis. 

INTRODUCTION 

To date, numerous foreign and domestic studies have 

proven the role of infectious pathology of a woman's 

reproductive tract in the genesis of a large range of 

obstetric complications. Causing local and systemic 

inflammatory responses, infectious agents can cause 

termination of pregnancy at any time, formation of 

placental insufficiency, pathology of the fetus and 

newborn. At the same time, if earlier, when studying 

this problem, issues related to the infectious pathology 

of the lower genitals were mainly discussed, today 

  Research Article 

 

RISK PREDICTION AND PREVENTION OF POSTPARTUM ENDOMETRITIS 

IN MATERNITY PATIENTS 
 

Submission Date: May 09, 2023, Accepted Date:  May 14, 2023,  

Published Date: May 19, 2023  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume03Issue05-05 

 

 

Yakubova Komila Toir kizi 
Tashkent Medical Academy, Uzbekistan 

 

Ataxodjaeva Fatima Abduraimovna 
Department of Obstetrics and Gynecology-2 Tashkent, Uzbekistan 

 

Journal Website: 

https://theusajournals.

com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 03 Issue 05-2023 38 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

there are more and more reports about the role of 

intrauterine infection (IUI) in the genesis of premature 

birth and unfavorable perinatal outcomes [2, 4, 5]. The 

implementation of IUI in pregnant women may be a 

consequence of ascending infection with the presence 

of infection of the lower reproductive tract, as well as 

the persistence of microorganisms in the endometrium 

in women with a history of chronic endometritis [1, 3]. 

Considering that accurate verification of IUI is possible 

only with a pathomorphological examination of the 

afterbirth, there is currently no consensus on the 

terminology, diagnostic criteria and management 

tactics of such patients. The search continues for non-

invasive criteria for the diagnosis of IUI during 

pregnancy in order to timely prescribe therapeutic and 

preventive measures. 

It is known that the dynamics of development, the 

severity and consequences of any infectious process 

caused by pathogenic or opportunistic 

microorganisms depend on many factors, the most 

important of which is the state of the immune system 

of the macroorganism. The same infectious agents, in 

some cases cause complications of pregnancy, and in 

others - practically do not affect its course. Thus, during 

pregnancy, the reactions of the maternal immune 

system become no less important than the direct 

influence of the pathogen. It is the immune 

mechanisms that play an exceptional role in the 

development and preservation of pregnancy [3, 5, 6]. 

The purpose of the study. Reducing the frequency of 

postpartum endometritis (PE) in women at risk of 

infection through the development of methods for 

forecasting and improving preventive measures. 

Material and methods of research. A prospective 

cohort study was conducted, which included 26 

pregnant women of high infectious risk, who in the 

postpartum period were divided into 2 groups: I - the 

main (n=14) and II - the comparison group (n=12). The 

groups were comparable in age, according to somatic 

and obstetric-gynecological anamnesis. The 

comprehensive examination included an assessment 

of anamnestic data and the results of clinical, 

microbiological, and instrumental research methods. 

The sampling of the material for microbiological 

examination was carried out at the period of 12-16 

weeks of pregnancy. The inclusion criteria were the 

exacerbation of genital and extragenital diseases of an 

infectious nature during pregnancy. 

In the postpartum period, molded sorbent was 

administered simultaneously with intravenous 

administration of an antibiotic to prevent infectious 

complications of intrauterine delivery. The size of the 

porous applicator: length 6 cm, width 1 cm, thickness 1 

cm. In the comparison group, only traditional antibiotic 

prophylaxis of postpartum purulent-septic 

complications was carried out. 

Evaluation of the microflora of the birth canal in 

patients was carried out by polymerase chain reaction 

(PCR), microbiological examination was carried out 

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Volume 03 Issue 05-2023 39 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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according to the standard method. The material for the 

study was the vaginal discharge, cervical canal, 

aspirate from the uterine cavity. The material was 

collected under aseptic conditions. During the aspirate 

from the uterine cavity, sterile conductors in the form 

of a silicone tube were used, eliminating the possibility 

of contamination of the sample with vaginal and 

cervical microflora. 

The determination of the subpopulation composition 

of lymphocytes was carried out on a flow 

cytofluorimeter with sample preparation, and the 

cytokine content was determined by enzyme 

immunoassay on test systems. 

Statistical processing of the material was carried out 

using the STATISTICA-6 application software package, 

standard Microsoft Excel mathematical tables. To 

characterize the indicators devoted to the 

retrospective analysis of the birth histories of pregnant 

women. Fisher's exact criterion was used to select the 

most informative features. 

Research results and discussion. The analysis of 

gynecological diseases in maternity patients of the 

infectious risk group showed that inflammatory 

diseases of the pelvic organs were most common – in 

49.6% of those observed; acute vaginitis was noted in 

38.5%; cervicitis – in 23.9%; surgical interventions on the 

fallopian tubes were registered in 8.5%; menstrual 

disorders – in 7.7%; fibroids uterus – in 3.4%; infertility in 

the anamnesis occurred in 3.4% of women. 

Among the extragenital pathology in this group of 

patients, anemia prevailed (59.0%); chronic 

inflammatory diseases of the urinary tract (27.4%); 

obesity (17.1%); arterial hypertension (10.3%); thyroid 

pathology (5.1%); diabetes mellitus in 2.6% of cases. 

During sonographic examination during pregnancy, 

the following markers of intrauterine infection were 

identified: lack of water was diagnosed in 42.9% of 

cases; violation of fetal-placental blood flow – in 39.5%; 

polyhydramnios – in 17.9%; thickening of the placenta 

exceeding the appropriate standards for this period of 

pregnancy was detected in 15.5%. 

The most frequent complication of pregnancy in the 

observed patients was a recurrent threat of 

termination (46.7%), which was combined with 

inflammatory changes in the vagina. In second place in 

frequency was premature discharge of amniotic fluid 

(42.7%). Preeclampsia of varying severity occurred in 

41.9% of the observed patients, including in 

combination with fetal growth retardation in 26.5% of 

cases. Exacerbation of infectious diseases of the 

urinary tract was noted in 17.9% of pregnant women. 

The study of the vaginal biotope in the observed 

patients at the stage of pregnancy showed the 

predominance of the following microorganisms: 

Enterococcus (faecalis, faecium) – 33.9%; E. coli – 27.4%; 

Staphylococcus (epidermidis, haemolyticus, 

chromogenes) – 17.4%; yeast–like fungi of the genus 

Candida – 15.8%; Ureaplasma urealyticum - 12.7%; a 

combination of pathogens was observed in 83.2%. 

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Volume 03 Issue 05-2023 40 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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Growth of the same pathogens was observed in the 

cervical canal: Enterococcus (faecalis, faecium) – 28,2%; 

E. coli – 22,5%; Ureaplasma urealyticum – 10,3%. 

Exacerbation of viral infection was noted in 33% of the 

observed. During the PCR examination of the cervical 

canal during pregnancy, the following pathogens were 

identified: Epstein–Barr virus – 17.2%; herpes simplex 

virus (HSV) type 6 - 8.0%; HSV type 1 – 4.6%; HSV type 2 

- 2.3%; cytomegalovirus – 2.3%; rotavirus – 2.3%. 

When assessing the immune status in pregnant 

women, data were obtained indicating the tension of 

the cellular link of immunity, which manifested itself in 

a change in the ratio of lymphocytes with a reduced 

immunoregulatory index (p=0.0040) against the 

background of increased activity of proinflammatory 

cytokines (interleukin (IL)-1ß. 33% of pregnant women 

with viral infection activation have a higher level of T-

NK cells (p=0.001), which in our opinion indicates 

increased killer activity of lymphoid cells. 

All patients underwent rehabilitation of the birth canal 

with local antiseptics before delivery. In the 

postpartum period, on the first day, sowing was 

carried out from the uterine cavity in order to assess 

the presence of pathogenic microflora. According to 

the results of primary sowing, the degree of 

contamination of the uterine cavity was assessed 

within 24 hours. 

The results of the primary seeding of the patient of 

both groups were comparable: in the main group, 

massive growth of pathogenic microflora was 

determined in 67.3% of cases, moderate – in 26.5%, 

meager – in 6.1%; in the comparison group, massive 

growth was determined in 55.9% of cases, moderate – 

in 27.9%, meager – in 16.2%. At the same time, 

Ureaplasma urealyticum was detected in 29.9% of 

cases; Staphylococcus (haemolyticus, chromogenes) 

was detected in 23.1% of cases; Enterococcus faecalis 

was detected in third place in frequency – 16.2%; E.coli 

was 7.7%; Corynebacterium – 6.8%; Mycoplasma 

hominis 6.8%; Enterobacter cloacae - 2.6%; Klebsiella 

and Pseudomonas aeruginosa – 1.7%. 

In the main group, monoinfection occurred in 37.5% of 

cases; in the comparison group – in 36.8%. The most 

frequently observed associations were Enterococcus 

and Ureaplasma urealiticum (12.5%), Enterococcus and 

Staphylococcus (8.1%), Enterococcus and Candida 

(6.8%), Enterococcus and E. coli (2.7%). 

When conducting tests for antibiotic sensitivity, a high 

frequency of resistance of pathogenic flora was 

revealed: Enterococcus faecalis in 66.7% of cases 

showed resistance to azithromycin, in 47.6% – to 

benzylpenicillin and co-trimoxazole, in 42.8% – to 

doxycycline. Staphylococcus haemolyticus showed 

resistance to benzylpenicillin in 72.2% of cases, 

erythromycin in 66.7%, ofloxacin in 55.6% and 

cefotaxime in 33.3%. Ureaplasma urealyticum showed 

resistance to josamycin in 74.5%, clarithromycin in 

29.5%, erythromycin in 22.9% and clindamycin 

resistance in 14.8%. 

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Volume 03 Issue 05-2023 41 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

Based on the data obtained, a scale for predicting 

infection risk was developed, based on the calculation 

of the individual number of points, taking into account 

the data of anamnesis, sonographic examination, 

immunoreactivity indicators, both during pregnancy 

and childbirth, bacteriological examination. 

In the postpartum period, the mothers of the main 

group underwent complex preventive therapy: 

traditional antibiotic prophylaxis and intrauterine 

applications of molded sorbent. The sorbent is injected 

three times into the uterine cavity. The duration of a 

single application was 24 hours, after which the used 

sorbent was extracted and a new one was introduced. 

At the same time, only traditional antibiotic 

prophylaxis was carried out in the comparison group. 

Antibiotic prophylaxis in both groups was carried out 

with cephalosporins of the second generation 

according to the scheme: 1.0 g of antibiotic 

intravenously drip once 30 minutes before delivery. 

In the maternity patients of the main group, three 

control seeding was carried out from the uterine cavity 

after each sorbent was extracted. After the extraction 

of the first sorbent after 24 hours, 21.7% of patients 

maintained a massive growth of pathogenic 

microflora, 43.5% showed moderate and 34.8% showed 

scant growth of microorganisms. After extraction of 

the second sorbent, no microflora growth was 

detected in 52.2% of patients, moderate microflora 

growth remained in 39.1% and scant microflora growth 

in 8.7%. In the control of crops after the extraction of 

the third sorbent, the growth of microorganisms was 

not detected in 100% of cases. In the comparison group 

of maternity patients in the control gravidar 

endometrial culture, three days after antibiotic 

prophylaxis, pathogenic microflora continued to be 

determined in 66.2% of maternity women. 

The problem of prevention and treatment of purulent-

inflammatory postpartum diseases is complicated by 

the fact that proinflammatory cytokines accumulating 

during the inflammatory process in the uterine cavity, 

as well as toxins secreted by pathogens, lead to 

disruption of local hemostasis processes, reduced 

tissue perfusion and to the additional development of 

tissue hypoxia, complicating the regeneration and 

epithelialization of the endometrium. In this regard, 

the level of proinflammatory cytokines and lactoferrin 

in the aspirate from the uterine cavity was determined. 

The sampling of the material was carried out before 

and after the completion of preventive therapy. The 

volume of the uterine cavity was also assessed, 

ultrasound examination was performed on the 1st and 

3rd days of the postpartum period. 

When analyzing the data obtained, there was a 

significant (p=0.01172) decrease in the activity of the 

acute-phase protein lactoferrin by 1.3 times and the 

proinflammatory cytokine IL-1ß by 2.3 times 

(p=0.01252) in the aspirate from the uterine cavity in 

patients of the main group in comparison with similar 

indicators of the comparison group.Indicators of the 

number of leukocytes and the leukocyte index of 

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Volume 03 Issue 05-2023 42 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

peripheral blood intoxication after preventive 

treatment decreased equally in both groups. In the 

main group, after using the molded sorbent, there was 

a decrease in the volume of the uterine cavity by 1.2 

times, while with the use of traditional antibiotic 

prophylaxis, there was a decrease in the volume of the 

uterine cavity by 1.05 times. 

CONCLUSIONS 

1. In the development of purulent-inflammatory 

diseases in pregnant women of the infectious risk 

group, mixed infection is of the greatest 

importance, in which the leading role in the 

formation of pathology belongs to the bacterial 

gram-positive microflora with a high level of 

antibiotic resistance, as a result of which traditional 

antibiotic prophylaxis is ineffective. 

2. For pregnant women of the infectious risk group, 

the presence of tension of the immune system due 

to inflammatory diseases of the genital tract 

suffered during pregnancy or exacerbation of 

somatic chronic infectious diseases has been 

proven. 

3. After traditional antibiotic prophylaxis, despite a 

decrease in leukocytes and leukocyte intoxication 

index in peripheral blood, pathogenic microflora 

continues to be detected in crops from the uterine 

cavity in more than 50% of cases, and at the same 

time, high activity of local proinflammatory 

cytokines remains, which indicates the risk of 

delayed, sluggish endometritis. 

4. The proposed method for the prevention of 

postpartum endometritis in women at risk of 

infection by intrauterine injection of a molded 

porous carbon sorbent is more effective than the 

traditional approach and reduces the frequency of 

PE. 

REFERENCES 

1. Dolgushina V.F., Dolgushin I.I., Kurnosenko I.V., 

Lebedeva Yu.V. Clinical and immunological criteria 

of intrauterine infection //Obstetrics and 

gynecology, 2017, No. 1, pp. 40-45. 

2. Lebedeva O.P. Prognosis, early diagnosis and 

justification of prevention of infectious and 

inflammatory complications of the gestational 

process //Abstract diss ... PhD, M., 2014, 28 p. 

3. Samchuk P.M. Purulent-inflammatory 

complications in the postpartum period: 

Prognosis, early diagnosis, treatment, prevention 

//Abstract diss ... MD, Irkutsk, 2002, 54 p. 

4. Christodoulakos G. Pathogenesis of endometriosis: 

The role of defective immunosurveillance 

/G.Christodoulakos, A.Augoulea, I.Lambrinoudaki 

[et al.] //Eur. J. Contr. Reprod. Health Care, 2007, 

Vol. 12, №3, P. 194-202. 

5. Donders G. Aerobic vaginitis in pregnancy / 

G.Donders, G.Bellen, D.Rezeberga //Br. J. Obstet. 

Gynecol. 2011, Vol. 118, №10, P. 1163-1170. 

6. Higgins R.D. Evaluation and Management of 

Women and Newborns With a Maternal Diagnosis 

of Chorioamnionitis / R.D.Higgins, G.Saade, 

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Volume 03 Issue 05-2023 43 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 05     Pages: 37-43 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

R.A.Polin [et al.] //Obstet. Gynecol, 2016, Vol. 127, 

№ 3, P. 426-436. 

 

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