Organ-preserving treatment options in obstetric peritonitis: a systematic review and meta-analysis

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Abstract

Postpartum purulent-inflammatory diseases remain one of the leading causes of maternal mortality, second only to extragenital pathologies and amniotic fluid embolism in frequency. According to several authors, the incidence of postpartum inflammatory diseases (PID) ranges from 2.0 to 54.3%, while in high-risk women, the frequency of such complications reaches 80.4%. Objective — to conduct a systematic review and meta-analysis of current data on the effectiveness of organ-preserving surgical methods for treating obstetric peritonitis after cesarean section, with an evaluation of favorable outcomes regarding uterine preservation and postoperative complications (adverse events). This study presents a systematic review and meta-analysis of the effectiveness of organ-preserving metroplasty for obstetric peritonitis, conducted in accordance with the PRISMA 2020 international standards and GRADE criteria. The analysis included 12 studies (n = 1,386 patients) published since 2010, ensuring data completeness, reliability, and relevance. The results showed that the average clinical success rate of metroplasty was 79.96% (95% CI: 20.7–100.0%), with significant variability depending on the surgical technique. Classical methods demonstrated an efficacy of 85–100%, while innovative approaches (ultrasonic cavitation, local antibiotic therapy) showed only 33–70%. The hysterectomy rate as an adverse outcome was 20.04%, reaching 66.7% in some studies. The complication profile included: generalized peritonitis (33.64%), surgical site infection (14.04%), sepsis (6.13%), uterine suture dehiscence (11.38%). High heterogeneity (I²=97.41%) and signs of publication bias indicate the need for cautious data interpretation. The meta-analysis highlights the importance of strict patient selection for organ-preserving techniques and standardization of surgical protocols. The uniqueness of this review lies in its comprehensive analysis of complications and comparison of different metroplasty techniques, which is absent in similar studies. The findings may be used to develop clinical guidelines for reducing risks in organ-preserving surgeries during the puerperium.

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About the authors

Daria E. Churina

Krasnoyarsk State Medical University Named after Professor V.F. Voino-Yasenetsky

Author for correspondence.
Email: dashsemch@mail.ru
ORCID iD: 0000-0001-7516-5203
SPIN-code: 4757-7940

MD, PhD, Assistant Professor

Russian Federation, Krasnoyarsk

Tatiana A. Makarenko

Krasnoyarsk State Medical University Named after Professor V.F. Voino-Yasenetsky

Email: makarenko7777@yandex.ru
ORCID iD: 0000-0002-2899-8103
SPIN-code: 3133-7406

MD, PhD, Professor

Russian Federation, Krasnoyarsk

Dmitriy V. Cherdancev

Krasnoyarsk State Medical University Named after Professor V.F. Voino-Yasenetsky

Email: gs7@mail.ru
ORCID iD: 0000-0002-4743-4565
SPIN-code: 6760-3354

MD, PhD, Professor

Russian Federation, Krasnoyarsk

Igor G. Noskov

Krasnoyarsk State Medical University Named after Professor V.F. Voino-Yasenetsky

Email: igornoskov@mail.ru
ORCID iD: 0000-0002-1221-030X
SPIN-code: 5808-9047

MD, PhD

Russian Federation, Krasnoyarsk

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Supplementary files

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2. Fig. 1. PRISMA 2020 search strategy (GRADE)

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3. Fig. 2. Forest plot of the distribution of clinical success (organ-preserving surgery) across studies, proportion

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4. Fig. 3. Bubble plot of the relationship between the proportion of clinical success (organ-preserving surgery) and the proportion of hysterectomy (adverse outcome). Bubbles represent studies; bubble size corresponds to sample size

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5. Fig. 4. Forest plot of the distribution of the total number of adverse events across studies, proportion

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6. Fig. 5. Distribution of the proportion of adverse events reported in the studies, %. Note: MODS — multiple organ dysfunction syndrome; AAW — anterior abdominal wall.

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