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Postpartum Endometritis

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181. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment Full Text available with Trip Pro

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD - 2-7% will experience sound infections and 2-16 (...) % will develop endometritis. Many risk factors for SSI have been described. These include maternal factors (such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic

2017 Maternal health, neonatology and perinatology

182. Effects of subcutaneous calcium administration at calving on mineral status, health, and production of Holstein cows. Full Text available with Trip Pro

ratio was >1 for development of metritis, and clinical and subclinical endometritis in control cows relative to 2SC250 cows, which indicates a higher risk of developing disease for control cows (2.03, 1.7, and 1.8 times, respectively). These results suggest that prophylactic s.c. infusions of Ca at calving can improve postpartum Ca status in Holstein cows and intake at 1 DIM. Given the reduction of metritis, clinical and subclinical endometritis, and subclinical hypocalcemia with treatment (...) (9.27mg/dL), and 2SC250 (9.07mg/dL) was greater during the first week postpartum compared with control (8.45mg/dL). Serum concentrations of P, Mg, BHB, glucose, and milk yield were not affected by treatments. The dry matter intake during the first 24h after calving was higher for treatments 1SC250 (13.5kg), 1SC500 (15.0kg), and 2SC250 (15.6kg) relative to control (12.5kg). Milk somatic cell counts were lower for 1SC500 (90.5 cells/mL) and 2SC250 (82.2 cells/mL) than control (132.8 cells/mL). Risk

2017 Journal of dairy science Controlled trial quality: uncertain

183. Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review. Full Text available with Trip Pro

Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review. The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We conducted a systematic review to inform up-to-date evidence-based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related to antepartum antibiotic exposure in infants.Four bibliographic databases (...) % (relative risk 0.72, 95% confidence interval 0.56-0.92, nine studies, 4342 women, high quality of evidence) less likely to show infectious morbidity as compared with those who received antibiotics after cord clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (relative risk 0.57, 95% confidence interval 0.40-0.82, 13 studies, 6250 women, high quality of evidence) and the risk of wound infection by 38% (relative risk 0.62, 95% confidence interval 0.47-0.81, 14 studies, 6450 women

2017 Acta Obstetricia et Gynecologica Scandinavica

184. Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis. Full Text available with Trip Pro

received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model

2017 Obstetrics and Gynecology Controlled trial quality: predicted high

185. LCS16 vs. COC User Satisfaction and Tolerability Study

the Screening Visit) Infected abortion or postpartum endometritis within 3 months prior to the Screening Visit. Chronic, daily use of drugs that may increase serum potassium levels. Undiagnosed abnormal genital bleeding. Acute cervicitis or vaginitis (until successfully treated). Lower urinary tract infection (until successfully treated). Acute or recurrent pelvic inflammatory disease or conditions associated with increased risk for pelvic infections. Congenital or acquired uterine anomaly including (...) Visit [Visit 1] or a normal result has to have been documented within the previous 6 months). The subject has a history of regular (i.e., endogenous cyclicity without hormonal contraceptive use) cyclic menstrual periods (length of cycle 21 - 35 days), as confirmed by the subject. The subject is willing and able to attend the scheduled study visits and to comply with the study procedures. Exclusion Criteria: Pregnancy or current lactation (less than 6 weeks postpartum or since abortion before

2017 Clinical Trials

186. Novii External Fetal Monitoring Device

Nursing time required for care: [ Time Frame: Time of randomization until time of delivery (up to 48 hours) ] Nurses will record the time and reasons that they enter the room Overall cost of care: [ Time Frame: Hospitalization for labor, delivery, and recovery - 2-4 days ] Total charge for care from admission to Labor and Delivery to transfer to postpartum care will be recorded for all patients Overall cost of care: [ Time Frame: Hospitalization for labor, delivery, and recovery - 2-4 days ] Delivery (...) or triple I) [ Time Frame: Hospitalization for labor, delivery, and recovery - 2-4 days ] Infections documented Maternal outcomes - Presence of clinical endometritis [ Time Frame: Hospitalization for labor, delivery, and recovery - 2-4 days ] Endometritis diagnosis recorded Neonatal outcomes - APGAR Scores [ Time Frame: Hospitalization after delivery - 2-4 days ] APGAR scores recorded at 1 minute, 5 minutes, and 10 minutes Neonatal outcomes - Need for ICU Admission [ Time Frame: Hospitalization after

2017 Clinical Trials

187. Committee Opinion No. 712 Summary: Intrapartum Management of Intraamniotic Infection. (Abstract)

will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. Recognition of intrapartum intraamniotic infection

2017 Obstetrics and Gynecology

188. Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. (Abstract)

will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. Recognition of intrapartum intraamniotic infection

2017 Obstetrics and Gynecology

189. New local hemostatic treatment for postpartum hemorrhage caused by placenta previa at cesarean section. (Abstract)

New local hemostatic treatment for postpartum hemorrhage caused by placenta previa at cesarean section. Cesarean section in women with placenta previa is associated with the risk of heavy bleeding. We describe a new method where local hemostasis is obtained by applying a hemostatic fleece directly onto the lower uterine segment. During a 2-year period women undergoing cesarean section due to placenta previa were treated with this hemostatic fleece if they had ongoing bleeding during (...) the surgical procedure despite routine treatment. Data were obtained retrospectively from the hospital records. Fifteen patients were treated by 15 different surgeons. No patients required reoperation. Three patients required blood transfusion due to anemia. No patients were readmitted to the hospital due to endometritis. We conclude that the application of a hemostatic fleece directly onto the bleeding surfaces in patients with post-cesarean bleeding due to placenta previa is technically unproblematic

2010 Acta Obstetricia et Gynecologica Scandinavica

190. A Multicenter Analysis of Levonorgestrel-Intrauterine System (LNG-IUS) Use in the Postpartum Period

hypothesize that Immediate placement of IUD in the postpartum period will result in a 20% decrease in continuation rates at six months compared to Interval placement. Secondary outcome measures that we will obtain include: Pain at the time of placement Postpartum Depression Breastfeeding status Postpartum weight retention Expulsion Rates Bleeding Profile Uterine Infection(Endometritis) Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment (...) appointment and at six months Bleeding Profile [ Time Frame: 6 months ] Each Participant will be asked to complete a monthly menstrual flow calendar to document light, medium, or heavy bleeding. These will be collected at the postpartum appointment and at six months. Infectious morbidity [ Time Frame: 6 months ] Postpartum endometritis and pelvic inflammatory disease will be tracked with record review and direct participant questioning at their postpartum appointment and at six months Eligibility Criteria

2010 Clinical Trials

191. Levonorgestrel-Intrauterine System (LNG-IUS) Insertion in the Postpartum Period

: Contraindications to the LNG-IUS include: Pregnancy or suspicion of pregnancy, Congenital or acquired uterine anomaly including fibroids if they distort the uterine cavity, Postpartum endometritis within the past 3 months, Known or suspected uterine or cervical neoplasia or unresolved, abnormal pap smear, untreated acute cervicitis or vaginitis including bacterial vaginosis or other lower genital tract infections, acute liver disease or liver tumor, hypersensitivity to any component of the product, known (...) Levonorgestrel-Intrauterine System (LNG-IUS) Insertion in the Postpartum Period Levonorgestrel-Intrauterine System (LNG-IUS) Insertion in the Postpartum Period - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more

2010 Clinical Trials

192. Mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity. (Abstract)

moderate-to-high risk of bias. None of the three trials reported our primary outcome of postpartum haemorrhage. In one study of 400 women, blood loss was significantly lower in the cervical dilatation group compared with the no dilatation group (mean difference (MD) -48.49 ml, 95% confidence interval (CI) -88.75 to -8.23). The incidence of febrile morbidity and haemoglobin concentrations in the postoperative period in women undergoing intraoperative cervical dilatation was not significantly different (...) from those who did not receive cervical dilatation (risk ratio (RR) 1.07, 95% CI 0.52 to 2.21 (three trials, 735 women) and MD -0.05 g/dl, 95% CI -0.17 to 0.06 (two trials, 552 women), respectively. There were no significant differences in wound infection, change of haemoglobin level, hematocrit level at postoperative period, endometritis, infectious morbidity, or urinary tract infection. There was a significant difference in operative time, which was reduced in cervical dilatation group (MD -1.84

2011 Cochrane

193. Cardiovascular Diseases during Pregnancy

support services are available. The method, including the need for anaesthesia, should be considered on an individual basis. High risk patients should be managed in an experienced centre with on-site cardiac surgery. Endocarditis pro- phylaxis is not consistently recommended by cardiologists, 81 but treatment should be individualized. Gynaecologists routinely advise antibiotic prophylaxis to prevent post-abortal endometritis, which occurs in 5–20% of women not given antibiotics. 82,83 Dilatation

2011 European Society of Cardiology

194. Operative Vaginal Delivery

in place in case of failure to deliver. When conducting mid-cavity deliveries, theatre staff should be immediately available to allow a caesarean section to be performed without delay (less than 30 minutes). A senior obstetrician competent in performing mid-cavity deliveries should be present if a junior trainee is performing the delivery. Anticipation of complications that may arise (e.g. shoulder dystocia, postpartum haemorrhage) Personnel present that are trained in neonatal resuscitation * Adapted (...) obstetric anal sphincter injury in vacuum extraction (4.3% with episiotomy versus 5.5% without episiotomy) and forceps delivery (11.7% versus 10.6%). However, episiotomy was associated with a greater incidence of postpartum haemorrhage (28.4% versus 18.4%, OR 1.72, 95% CI 1.21–2.45). This conflict in findings between the two studies may be due to variations in practice of the threshold for episiotomy and use of different instruments. 5.7 Should prophylactic antibiotics be given? There are insufficient

2011 Royal College of Obstetricians and Gynaecologists

196. Antepartum Haemorrhage

Haemorrhage emerges as the major cause of severe maternal morbidity in almost all ‘near miss’ audits in both developed and developing countries. 10 Obstetric haemorrhage encompasses both antepartum and postpartum bleeding. This green-top guideline is restricted in scope to the management of APH. The causes of APH include: placenta praevia, placental abruption and local causes (for example bleeding from the vulva, vagina or cervix). It is not uncommon to fail to identify a cause for APH when (...) it is then described as ‘unexplained APH’. Green-top guidelines that are relevant to this topic and are cited in this guideline include: RCOG Green-top Guideline No. 47 Blood Transfusions in Obstetrics 3 RCOG Green-top Guideline No. 22 The Use of Anti-D Immunoglobulin for Rhesus D Prophylaxis 11 RCOG Green-top Guideline No. 27 Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management 12 RCOG Green-top Guideline No. 52 Prevention and Management of Postpartum Haemorrhage 13 RCOG Green-top

2011 Royal College of Obstetricians and Gynaecologists

197. WITHDRAWAN. Antibiotic prophylaxis for cesarean section. (Abstract)

WITHDRAWAN. Antibiotic prophylaxis for cesarean section. The single most important risk factor for postpartum maternal infection is cesarean delivery.The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing cesarean delivery.We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001).Randomized trials (...) comparing antibiotic prophylaxis or no treatment for both elective and non-elective cesarean section.Two reviewers assessed trial quality and extracted data.Eighty-one trials were included. Use of prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different

2010 Cochrane

198. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections. (Abstract)

endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, significant decrease in the risk of chorioamnionitis (RR 0.29, 95% CI 0.10 to 0.82). No serious adverse effects were reported.Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess (...) assessed the results of the only available trial and extracted data on maternal and neonatal outcomes.We included one study with 120 pregnant women. It compared ampicillin-salbactam (N = 60) versus normal saline (N = 60) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum

2010 Cochrane

199. Lactational mastitis and breast abscess. Diagnosis and management in general practice

Lactational mastitis affects approximately 20% of breastfeeding Australian women in the first 6 months postpartum. 7 It is most common in the first 6 weeks of breastfeeding 1,5 with the highest incidence occurring during the second and third weeks. 6,9 It is initially localised to one segment of the breast, but untreated can spread to affect the whole breast. 5 Around 3% of lactating women with mastitis will develop a breast abscess, 1,10 although an incidence of up to 11% has been reported. 10 Risk (...) factors and prevention The main risk factor for mastitis is breastfeeding during the early postpartum period. 6 Milk stasis and cracked nipples may contribute to the development of mastitis, 1,3–6 although the evidence for this is inconclusive. 1 Other implicated factors include previous mastitis, 6 maternal fatigue 1,3 and primiparity. 9 Reported risk factors for breast abscess include a past history of mastitis, maternal age over 30 years and gestational age greater than 41 weeks. 5

2011 Clinical Practice Guidelines Portal

200. Breastfeeding. Evidence based guidelines for the use of medicines

Breastfeeding. Evidence based guidelines for the use of medicines clinical Lisa H Amir Marie V Pirotta Manjri Raval Breastfeeding Evidence based guidelines for the use of medicines Background General practitioners may consider prescribing medicines for breastfeeding women during the postpartum period. Most medicines can be used safely during breastfeeding at the recommended dose, however there are exceptions that necessitate caution. Objective This article provides an evidence based review (...) of medicines used for common situations and their compatibility with breastfeeding. Discussion Breastfeeding women typically use relatively few medicines, and generally these are compatible with breastfeeding. If other medicines are required, information on their safety during breastfeeding can be accessed from pharmacy departments at maternity hospitals or from online resources. Keywords: breastfeeding; postpartum; therapeutics In Australia, 50% of women breastfeed their babies for at least 6 months. 1

2011 Clinical Practice Guidelines Portal

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