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Postpartum Endometritis

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201. Randomized Control Trial of Intracervical Balloon Placement vs Oxytocin in Women With Term PROM and Unripe Cervices

with associated maternal or fetal tachycardia Endometritis [ Time Frame: from time of delivery until 2 days after delivery for vaginal deliveries and 3 days after delivery for cesarean sections ] temperature >100.4 F in the postpartum period with initiation of antibiotics in postpartum period Postpartum hemorrhage [ Time Frame: at time of delivery and up to 24 hours after delivery ] Estimated blood loss (EBL) >500 cc from a vaginal delivery and EBL >1000 cc from a cesarean delivery Epidural use [ Time Frame (...) . ClinicalTrials.gov Identifier: NCT03172858 Recruitment Status : Not yet recruiting First Posted : June 1, 2017 Last Update Posted : June 14, 2017 See Sponsor: Northwestern University Information provided by (Responsible Party): Whitney You, Northwestern University Study Details Study Description Go to Brief Summary: This study is designed to determine if an intracervical balloon catheter (IBC) is better than oxytocin for induction of labor in the setting of premature rupture of membranes (PROM) or breaking

2017 Clinical Trials

202. Novii External Fetal Monitoring Device

validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03156608 Recruitment Status : Completed First Posted : May 17, 2017 Last Update Posted : November 1, 2017 Sponsor: Intermountain Health Care, Inc. Collaborator: GE Healthcare Information provided by (Responsible Party): Michael Sean Esplin, Intermountain Health Care, Inc. Study (...) 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

2017 Clinical Trials

203. Prophylactic Antibiotics After Cesarean

will be the administration of cephalexin and metronidazole post-operatively for 48 hours. The primary outcome measure will be surgical site infection (including superficial or deep incisional surgical site infection, endometritis, and other related infections, such as septic pelvic thrombophlebitis and abdominal or pelvic abscess) in the post-operative period. In order to most effectively and accurately analyze our primary and secondary research outcomes, the investigators will standardize our surgical operation (...) standard of care Outcome Measures Go to Primary Outcome Measures : Surgical site infection [ Time Frame: 6 weeks postpartum ] Including superficial or deep incisional surgical site infection, endometritis, and other related infections, such as septic pelvic thrombophlebitis and abdominal or pelvic abscess Secondary Outcome Measures : Maternal mortality [ Time Frame: 6 weeks (42 days) postpartum ] Maternal death Febrile morbidity [ Time Frame: 6 weeks (42 days) postpartum ] If the patient develops

2017 Clinical Trials

204. Pre-delivery Administration of Azithromycin to Prevent Neonatal Sepsis & Death

Africa. Post-partum and neonatal severe bacterial infections, namely sepsis, are leading causes of maternal and neonatal deaths in sub-Saharan Africa. Newborns can be infected during labour - when passing through the birth canal - and also during the first days/weeks of life, as a consequence of the close physical contact with the mother, when the latter carriers bacteria. As the mother is an important source of bacterial transmission to the newborn, treating mothers with antibiotics during labour (...) ; and ideally cover also bacteria responsible for severe post-partum disease in the mother. We will conduct a large trial in West Africa, The Gambia and Burkina Faso, with the main objective of determining if a single dose of an oral antibiotic given to women during labour decreases newborn mortality. The trial will also assess the effect of the antibiotic on lowering newborns and maternal hospitalization during the first week's post-partum. We have selected an antibiotic (azithromycin) that in sub-Saharan

2017 Clinical Trials

205. Early Term Delivery Versus Expectant Management of the Large for Gestational Age Fetus

.) First Posted : July 17, 2017 Last Update Posted : December 26, 2017 Sponsor: The University of Texas Health Science Center, Houston Collaborator: Harris Health System, Lyndon B Johnson Hospital obstetrics and gynecology clinic Information provided by (Responsible Party): Bahaeddine M Sibai, The University of Texas Health Science Center, Houston Study Details Study Description Go to Brief Summary: The purpose of this study is to compare the incidence of composite neonatal morbidity and birthweight (...) or IUFD. Number of children with birthweight above 4500 grams [ Time Frame: Immediately at birth ] Secondary Outcome Measures : Number of women presenting with CMM [ Time Frame: Up to 6 weeks after delivery ] Composite maternal morbidity (CMM) is any of the following: chorioamnionitis, shoulder dystocia, 3rd or 4th degree laceration or episiotomy, transfusion of blood products, endometritis, wound infection or separation, deep venous thrombosis, pulmonary embolism, admission to the intensive care unit

2017 Clinical Trials

206. Interest of Cervical Dilators in Second Trimester Termination of Pregnancy

° C, septicemia, endometritis defined by a fever associated with pelvic pain, positive bacteriological vaginal specimen and a biological infectious syndrome (leukocytosis greater than 15 000 / mm3 and C-Reactive Protein > 10 IU / mL). Cervical injury. Complications of prolonged decubitus: bedsores, thrombo-embolic complications. Uterine rupture. Post-partum hemorrhage defined by estimated blood losses greater than 500 mL. Duration of hospitalization. [ Time Frame: 48 hours ] Duration (...) of Cervical Dilators in Second Trimester Termination of Pregnancy (DILATOP) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03194230 Recruitment Status : Recruiting First Posted : June 21, 2017 Last Update Posted : August 28

2017 Clinical Trials

207. A proof-of Concept, Randomized 3-month Study to Evaluate the Effects of Three Contraceptive Intrauterine Systems Delivering Copper and a Daily Dose of 5, 20 or 40 μg of Ulipristal Acetate (UPA)

of enrollment in this study. Use of injectable contraceptives during the previous 3 months (e.g. Cyclofem) or 6 months (e.g. DMPA). Women who do not have at least two progesterone measurements ≥10nmol/L during the baseline cycle will be excluded from further participation in the study (See Section 13.4.1) Acute pelvic inflammatory disease or a history of pelvic inflammatory disease unless there has been a subsequent intrauterine pregnancy. Postpartum endometritis or infected abortion in the past 3 months (...) sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03230539 Recruitment Status : Recruiting First Posted : July 26, 2017 Last Update Posted : August 15, 2017 See Sponsor: Population Council Information provided by (Responsible Party): Population Council Study Details Study Description Go to Brief Summary

2017 Clinical Trials

208. Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis. (Full text)

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 PubMed abstract

209. Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review. (Full text)

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 PubMed abstract

210. 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 (...) Visual Analog Scale (VAS) at the time of insertion. Postpartum Depression [ Time Frame: 6 months ] Depression history will be determined from the initial data collection sheet upon entry into the study. The Edinburgh Postnatal Depression Scale will be filled out by the participant at their six week postpartum appointment (routine), and also at six months. Breastfeeding Status [ Time Frame: 6 months ] We will identify those who plan on breastfeeding their infants prior to discharge from the hospital

2010 Clinical Trials

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

. Levonorgestrel-Intrauterine System (LNG-IUS) Insertion in the Postpartum Period The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01088178 Recruitment Status : Unknown Verified September 2010 by United States Naval Medical Center, Portsmouth. Recruitment status was: Recruiting First Posted : March 17, 2010 Last (...) Update Posted : September 30, 2010 Sponsor: United States Naval Medical Center, Portsmouth Information provided by: United States Naval Medical Center, Portsmouth Study Details Study Description Go to Brief Summary: The investigators study is a prospective randomized trial of women undergoing the levonorgestrel intrauterine system (LNG-IUS: Mirena©, Bayer) at three separate time periods: immediate post placental (IPP) defined as insertion within 10 min delivery of placenta, early post partum (EP

2010 Clinical Trials

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

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 (...) 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

2010 Acta Obstetricia et Gynecologica Scandinavica

213. 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

214. 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

215. The Care of Women Requesting Induced Abortion

or partner 26 4. Commissioning and organising services 27 4.1 Access to services 28 4.2 Tailored care 30 4.3 Information provision 30 4.4 Initial assessment 32 4.5 Arrangements for the procedure 33 3270 RCOG Abortion guideline.qxd:3270 RCOG Abortion guideline.qxd 11/11/11 14:12 Page iii5. Adverse effects, complications and sequelae of abortion: what women need to know 37 5.1 Abortion complications 39 5.2 Failed abortion and continuing pregnancy 41 5.3 Post-abortion infection 42 5.4 Breast cancer 42 5.5 (...) . Other peer reviewers During the peer review stage, the draft document was posted on the RCOG website and comments were invited from any member of the public. A list of the individuals who sent comments, together with interests declared, comments received and actions taken, is available on request from the RCOG. Acknowledgements The GDG wishes to thank Mrs Charnjit Dhillon, Director of Standards, and Miss Benedetta La Corte, Office for Research and Clinical Audit (ORCA) Coordinator

2011 Royal College of Obstetricians and Gynaecologists

216. Operative Vaginal Delivery

the use of formal debriefing in reducing the risk of subsequent postnatal depression for women who have experienced operative vaginal delivery. Nonetheless, women report the need for a review following delivery to discuss the indication for delivery, the management of any complications and the implications for future deliveries. 87 The optimal timing, setting and healthcare professional for post-delivery review require further evaluation. 6.5 How should we advise women for future deliveries? Women (...) 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

2011 Royal College of Obstetricians and Gynaecologists

217. Cardiovascular Diseases during Pregnancy

during treatment. More- over, the raised renal perfusion and the higher hepatic metabolism increase drug clearance. The altered pharmacokinetics of drugs vary in magnitude during different stages of pregnancy, making careful monitoring of the patient and dose adjustments necessary. Uterine contractions, positioning (left lateral vs. supine), pain, anxiety, exertion, bleeding, and uterine involution cause signi?cant haemodynamic changes during labour and post-partum. Anaesthe- sia, analgesia (...) , haemorrhage, and infection may induce additional cardiovascular stress. SBP and DBP increase 15–25% and 10– 15%, respectively, during uterine contractions. Such increases are associated with a rise in pressure in the amniotic ?uid, and in the intrathoracic venous, cerebrospinal, and extradural ?uids. CO increases by 15% in early labour, by 25% during stage 1, and by 50% during expulsive efforts. 15 It reaches an increase of 80% early post-partum due to autotransfusion associated with uterine involution

2011 European Society of Cardiology

218. 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

219. 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

220. Prevention of infection after induced abortion

timing ofantibioticprophylaxisatthetimeofCesareansectionhave demonstrated a significant reduction in post-surgical infec- tions, including endometritis, when the prophylactic anti- bioticsareadministeredpriortoskinincisionascomparedto after cord clamping [93–95]. A meta-analysis that further evaluatedthetimingofprophylacticantibioticsatthetimeof cesarean section specifically found that preoperative admin- istration as compared to administration following cord clamping reduced post-partum endometritis (...) higher risk of post-procedure infection than induced abortion procedures. For instance, the rate of endometritis following cesarean section is 1–5% as compared to b1% following surgically inducedabortion[96].Formajorabdominalandgynecologic surgery, multiple studies have demonstrated that post- procedural continuation of antibiotics has no effect on the risk of infection [98–100]. For colorectal surgery, a single preoperative dose of antibiotics is recommended based on 182 randomized trials [98

2011 Society of Family Planning

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