Yagur Yael, Barcilon-Tiosano Lisa, Segal Dana, Pinchas-Cohen Tally, Gnaiem Nagam, Daykan Yair, Schonman Ron, Kovo Michal, Weitzner Omer
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
BMC Pregnancy Childbirth. 2024 Dec 28;24(1):877. doi: 10.1186/s12884-024-07090-x.
We aim to identify risk factors contributing to extended rehospitalizations in patients diagnosed with postpartum endometritis requiring intravenous antibiotics.
This retrospective cohort study examined postpartum endometritis patients readmitted for treatment from 2014 to 2022, comparing short (≤ 48 h) and prolonged hospitalization (> 48 h). Data included patient demographics, medical history, presentation parameters, vaginal examination findings, sonographic data, laboratory results, and details of the current labor to create a scoring system predicting prolonged hospitalization risk.
During the study, 270 women with postpartum endometritis were hospitalized. Among them, 61 (22.6%) had hospital stays ≤ 48 h, while 209 (77.4%) experienced hospitalization > 48 h. Upon readmission, compared to the group with short stays, patients in the > 48 h group exhibited significantly elevated heart rates (97.9 ± 18.3 vs. 89.7 ± 12.9 bpm; p < 0.002) and CRP levels (13.8 ± 9.8 mg/dL vs. 8.1 ± 7 mg/dL; p < 0.001), respectively. Ultrasound revealed higher rates of pelvic hematoma or abscess in the > 48 h group (35.4% vs. 13.1%, respectively; p = 0.02). Multivariable logistic regression identified independent associations between hospitalization > 48 h and rupture of membranes > 14.5 h adjusted odds ratio (aOR 1.29, 95% CI 0.16-0.6, p = 0.016), temperature > 37.25 °C at readmission (aOR 1.31, 95% CI 0.013-0.42, p < 0.001), and CRP > 6.5 mg/dL at readmission (aOR 1.27, 95% CI 0.09-0.4, p = 0.002). A predictive scoring system was developed, indicating risks for prolonged hospitalization from 0.5 to 0.8.
The scoring system developed to predict prolonged hospitalization in postpartum endometritis can provide clinicians with valuable insights for improved diagnosis and prognosis.
我们旨在确定导致诊断为产后子宫内膜炎且需要静脉使用抗生素的患者再次住院时间延长的危险因素。
这项回顾性队列研究检查了2014年至2022年因再次入院治疗的产后子宫内膜炎患者，比较了短期（≤48小时）和长期住院（>48小时）的情况。数据包括患者人口统计学、病史、临床表现参数、阴道检查结果、超声数据、实验室检查结果以及当前分娩的详细情况，以创建一个预测长期住院风险的评分系统。
在研究期间，270例产后子宫内膜炎女性患者住院。其中，61例（22.6%）住院时间≤48小时，而209例（77.4%）住院时间>48小时。再次入院时，与短期住院组相比，>48小时组患者的心率（97.9±18.3对89.7±12.9次/分钟；p<0.002）和CRP水平（13.8±9.8mg/dL对8.1±7mg/dL；p<0.001）显著升高。超声检查显示，>48小时组盆腔血肿或脓肿的发生率更高（分别为35.4%对13.1%；p=0.02）。多变量逻辑回归确定了住院>48小时与胎膜破裂时间 >14.5小时（调整优势比[aOR]1.29，95%置信区间[CI]0.16 - 0.6，p = 0.016）、再次入院时体温>37.25°C（aOR 1.31，95% CI 0.013 - 0.42，p < 0.001）以及再次入院时CRP>6.5mg/dL（aOR 1.27，95% CI 0.09 - 0.4，p = 0.002）之间的独立关联。开发了一个预测评分系统，显示长期住院风险为0.5至0.8。
所开发的用于预测产后子宫内膜炎患者长期住院的评分系统可为临床医生提供有价值的见解，以改善诊断和预后。
