Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model

Year 2022, Volume: 47 Issue: 3, 1121 - 1128, 30.09.2022

Duygu Tuğrul Ersak , Burak Ersak , Uğurcan Zorlu , Mahmut Kuntay Kokanalı , Özlem Moraloğlu Tekin , Melike Doğanay

https://doi.org/10.17826/cumj.1123893

Abstract

Amaç: Enfekte epizyotomi (EE) vajinal doğumun nadir bir komplikasyonudur. Ancak, EE’nin ortaya çıkmasında rol oynayan risk faktörlerinin pratikte kullanımı belirsizdir. Bu çalışmanın amacı, EE gelişimini tahmin etmek için belirleyeceğimiz risk faktörleri ile klinikte uygulanabilecek bir risk skorlama modeli oluşturmaktır.
Gereç ve Yöntem: Bu retrospektif çalışmaya 1 yıllık süreç içerisinde mediolateral epizyotomi ile vajinal yolla doğum yapan kadınlar dahil edildi. EE tanılı çalışmaya alınmaya uygun olan 42 kadın vaka grubunu oluştururken, rastgele seçilen ve EE saptanmayan 168 sağlıklı kadın kontrol grubunu oluşturdu. EE gelişimi için olası risk faktörleri çok değişkenli regresyon analizi ile değerlendirildi.
Bulgular: Yapılan analizde EE ile ilişkili 5 önemli bağımsız faktör bulundu. Bu faktörlerden 5 puan mevcut sigara içme durumuna, 4 puan gebelikte ≥11.5 kg kilo alımına, 3 puan postpartum nötrofil-lenfosit oranı ≥10.4’a verildi. Diyabetes mellitus varlığına 2 puan ve doğumun aktif evresinden önce hastaneye yatış varlığına 1 puan verildi. 5.5 cut-off değeri EE’yi tahmin etmede orta derecede etkili bulunmuştur.
Sonuç: Bu beş değişkenli model, yüksek bir etkinlikle EE varlığını predikte edebilir. Bu değişkenlerin varlığında, klinisyenler EE riski taşıyan hastaları belirleyebilir. Bu sayede bireyselleştirilmiş hasta risk değerlendirilmesi ve danışmanlık yapılabilir.

Keywords

Epizyotomi, Enfeksiyon, Risk skoru, Postpartum komplikasyonlar

A model to predict the risk of infected episiotomy in low-risk women

Abstract

Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE.
Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.

Keywords

Episiotomy, Infection, Risk score, Postpartum complications

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