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

References

• 1. Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Øian P. Anal incontinence, urinary incontinence and sexual problems in primiparous women–a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury. BMC Women's Health. 2014;14(1):1-7.
• 2. Ducarme G, Pizzoferrato A-C, de Tayrac R, Schantz C, Thubert T, Le Ray C, et al. Perineal prevention and protection in obstetrics: CNGOF clinical practice guidelines. Journal of gynecology obstetrics and human reproduction. 2019;48(7):455-60.
• 3. Graham ID, Carroli G, Davies C, Medves JM. Episiotomy rates around the world: an update. Birth. 2005;32(3):219-23.
• 4. Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Statistical trends of episiotomy around the world: Comparative systematic review of changing practices. Health care for women international. 2018;39(6):644-62.
• 5. Gommesen D, Nohr EA, Drue HC, Qvist N, Rasch V. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Archives of gynecology and obstetrics. 2019;300(1):67-77.
• 6. Bonet M, Ota E, Chibueze CE, Oladapo OT. Antibiotic prophylaxis for episiotomy repair following vaginal birth. Cochrane Database of Systematic Reviews. 2017(11).
• 7. Kamel A, Khaled M. Episiotomy and obstetric perineal wound dehiscence: beyond soreness. J Obstet Gynaecol. 2014;34(3):215-7.
• 8. Dudley L, Kettle C, Waterfield J, Ismail KM. Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study. BMJ open. 2017;7(2).
• 9. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118:1-203.
• 10. Bowyer L. The confidential enquiry into maternal and Child health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003–2005. The seventh report of the confidential enquiries into maternal deaths in the UK. SAGE Publications Sage UK: London, England; 2008.
• 11. Nassar AH, Visser GH, Ayres‐de‐Campos D, Rane A, Gupta S, Motherhood FS, et al. FIGO Statement: Restrictive use rather than routine use of episiotomy. International Journal of Gynecology & Obstetrics. 2019;146(1):17-9.
• 12. Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B. Antibiotic prophylaxis for third‐and fourth‐degree perineal tear during vaginal birth. Cochrane Database of Systematic Reviews. 2014(10).
• 13. Verspyck E, Sentilhes L, Roman H, Sergent F, Marpeau L. Episiotomy techniques. J Gynecol Obstet Biol Reprod (Paris). 2006;35(1 Suppl):1S40-1S51.
• 14. Uygur D, Yesildaglar N, Kis S, Sipahi T. Early repair of episiotomy dehiscence. Australian and New Zealand journal of obstetrics and gynaecology. 2004;44(3):244-6.
• 15. Jones K, Webb S, Manresa M, Hodgetts-Morton V, Morris RK. The incidence of wound infection and dehiscence following childbirth-related perineal trauma: A systematic review of the evidence. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019;240:1-8.
• 16. Mulder FE, Rengerink KO, van der Post JA, Hakvoort RA, Roovers J-PW. Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery. International urogynecology journal. 2016;27(1):55-60.
• 17. Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106(6):1357-64.
• 18. Steiner HL, Strand EA. Surgical-site infection in gynecologic surgery: pathophysiology and prevention. Am J Obstet Gynecol. 2017;217(2):121-8.
• 19. Mueck KM, Kao LS. Patients at high-risk for surgical site infection. Surg Infect (Larchmt). 2017;18(4):440-6.
• 20. Young PY, Khadaroo RG. Surgical site infections. Surgical Clinics. 2014;94(6):1245-64.
• 21. Ibrahimi OA, Sharon V, Eisen DB. Surgical‐site infections and routes of bacterial transfer: which ones are most plausible? Dermatol Surg. 2011;37(12):1709-20.
• 22. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013;173(22):2039-46.
• 23. Takahashi J, Shono Y, Hirabayashi H, Kamimura M, Nakagawa H, Ebara S, et al. Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery. Spine (Phila Pa 1976). 2006;31(9):1020-5.
• 24. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017;45(3):299-307.
• 25. Inose H, Kobayashi Y, Yuasa M, Hirai T, Yoshii T, Okawa A. Postoperative lymphocyte percentage and neutrophil–lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery. Journal of Orthopaedic Surgery. 2020;28(2):2309499020918402.
• 26. Shen C-J, Miao T, Wang Z-F, Li Z-F, Huang L-Q, Chen T-T, et al. Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery. Int Immunopharmacol. 2019;74:105705.