Development of a prognostic scoring system for predicting hospitalization duration in postpartum endometritis.

Background: We aim to identify risk factors contributing to extended rehospitalizations in patients diagnosed with postpartum endometritis requiring intravenous antibiotics.

Methods: 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.

Results: 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.

Conclusion: The scoring system developed to predict prolonged hospitalization in postpartum endometritis can provide clinicians with valuable insights for improved diagnosis and prognosis.