Prognostic Factors for the Development of Sepsis in Postpartum Women Who Have Suffered Critical Obstetrical Conditions

The aim of the research . To identify prognostic factors for the development of sepsis in postpartum women who have suffered critical obstetric conditions (CAC). Materials and methods . We retrospectively examined 39 postpartum women after CAC, who were divided into groups: A – main group, with advanced sepsis (n = 18), B – control group without sepsis (n = 21). An analysis of clinical data upon admission was carried out. The results were processed using Statistica 12.0, Microsoft Excel and in the R environment. Results. Statistically significantly more often, patients in the main group gave birth before the 34th week of pregnancy, p = 0.04. About 50% of the subjects gave birth in first-level maternity facility. Preeclampsia and obstetric hemorrhage were the main causes of CAC development. Hemorrhagic shock occurred in 84,6% of subjects. All women underwent total hysterectomy. Sepsis developed on day 9 (4; 9) after delivery. It was shown that the chance of developing obstetric sepsis is 28 times more often in the case of artifical ventilation and at AVPU, 10 times – in case of adult respiratory distress syndrom, 7 times – in case of developed kidney failure, 6 times – in case of cerebral edema. When assessing the condition of postpartum women using the integral scales APACHE II, APACHE III, SOFA, NEWS2, a statistically significant OR in the development of sepsis remains only for the NEWS2 index; with a score of 4 points, the resulting model predicts the development of sepsis. The risk of developing obstetric sepsis is associated with MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45; in the presence of at least one of these factors, it increases by 7-8 times in terms of odds ratio (OR). Conclusion . The risk of developing obstetric sepsis in critical obstetric conditions is associated with the presence of mechanical ventilation and AVPU, adult RDS, renal failure, cerebral edema, a NEWS2 score of 4 or more points, MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45. The effectiveness of the developed prognostic model is: sensitivity – 94,5%, specificity – 90,5%.