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Postpartum Endometritis

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261. Prevention of Surgical Site Infection After Cesarean Delivery

space/endometritis) will be documented. In addition to inpatient surveillance, the electronic clinic records for all patients will be reviewed, and data will be recorded for any SSI that is diagnosed and treated on an outpatient basis. Documentation from discharge to the six-week postpartum visit will be reviewed to ensure data fidelity, but only infections that occur within 30 days of cesarean delivery will be included in the final analyses. Active SSI will be treated according to prevailing (...) Infection After Cesarean Delivery (CAPISSI) 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 ClinicalTrials.gov Identifier: NCT02027324 Recruitment Status : Withdrawn (Another study with similar methods was recently published) First Posted : January 6, 2014 Last Update Posted : January 12, 2016 Sponsor: Brigham and Women's Hospital

2014 Clinical Trials

262. The Use of Levonorgestrel-Releasing Device (Metraplant-E) in the Treatment of Dysfunctional Uterine Bleeding

who are married or previously married. Failure of other medical treatment to control menorrhagia such as hemostatics. Women who did not tolerate copper IUD due to increased amount of menstrual blood loss which could lead to anemia. Exclusion Criteria: History of ectopic pregnancy . Pregnancy or suspicion of pregnancy. Congenital or acquired uterine anomaly including fibroids if they distort the uterine cavity. Acute pelvic inflammatory disease Postpartum endometritis or infected abortion (...) (100). Please remove one or more studies before adding more. The Use of Levonorgestrel-Releasing Device (Metraplant-E) in the Treatment of Dysfunctional Uterine Bleeding 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: NCT02326922 Recruitment Status : Completed First Posted : December 30, 2014 Last

2014 Clinical Trials

263. The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies. Full Text available with Trip Pro

higher rates of postpartum hemorrhage in the lowest-volume rural hospitals (category R1 adjusted odds ratio, 3.06; 95% confidence interval, 1.51-6.23). Rates of chorioamnionitis, endometritis, severe perineal lacerations, and wound infection did not differ between volume categories. Longer lengths of stay were observed after maternal complications (eg, chorioamnionitis) in the lowest-volume hospitals (16.9% prolonged length of stay in category 1 hospitals vs 10.5% in category 4 hospitals; adjusted (...) odds ratio, 1.91; 95% confidence interval, 1.01-3.61).After confounder adjustment, few maternal outcomes differed by hospital obstetric volume. However, elevated odds of postpartum hemorrhage in low-volume rural hospitals raises the possibility that maternal outcomes may differ by hospital volume and geography. Further research is needed on maternal outcomes in hospitals of different obstetric volumes.Copyright © 2015 Elsevier Inc. All rights reserved.

2014 American Journal of Obstetrics and Gynecology

264. Routine cervical dilatation during elective caesarean section. Should we continue? (Abstract)

Routine cervical dilatation during elective caesarean section. Should we continue? The caesarean section rate is on the increase globally, with its attendant complications. One of the measures adopted by obstetricians to decrease complications, such as endometritis and blood loss is intraoperative cervical dilatation during elective caesarean section. A multicentre double blind randomised controlled trial was carried out in Enugu, Nigeria, to ascertain the usefulness of this practice. A total (...) of 208 pregnant women were randomised: 104 had intraoperative cervical dilatation and the other 104 did not have their cervices dilated. All the patients had similar preoperative, intraoperative and postoperative care and were followed up to 6 weeks postpartum. There was no significant difference between the two groups. In conclusion, the study shows no benefit in routine intraoperative cervical dilation. Practitioners must make sure that neither the placenta nor fetal membrane is overlying

2014 Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology Controlled trial quality: uncertain

265. Threatened Abortion (Follow-up)

be inflated with up to almost 100 mL of sterile saline. The inflation should correlate with uterine size. Now a Bakri Balloon designed for post abortion or postpartum hemorrhage can be used. Uterine artery embolization can be used if placenta accreta is encountered, but very few of these procedures have been performed and statistical success rates are impossible to evaluate. If ineffective, hysterectomy should be performed as a life-saving measure. Damage to cervix The risk of cervical damage is increased (...) a week post procedure and then it should be when they feel ready. With antibiotic use as prophylaxis, postabortion infection rates in most population groups should be less than 1-2%. Antibiotic use for the procedure is usually limited to the day of the procedure or a 2- to 3-day course. The antibiotics used are typically broad in spectrum, and most centers use doxycycline at 100 mg bid, with azithromycin for those who are allergic. If bacterial vaginosis is discovered, then the use of Flagyl at 500

2014 eMedicine.com

266. Therapeutic Abortion (Follow-up)

be inflated with up to almost 100 mL of sterile saline. The inflation should correlate with uterine size. Now a Bakri Balloon designed for post abortion or postpartum hemorrhage can be used. Uterine artery embolization can be used if placenta accreta is encountered, but very few of these procedures have been performed and statistical success rates are impossible to evaluate. If ineffective, hysterectomy should be performed as a life-saving measure. Damage to cervix The risk of cervical damage is increased (...) a week post procedure and then it should be when they feel ready. With antibiotic use as prophylaxis, postabortion infection rates in most population groups should be less than 1-2%. Antibiotic use for the procedure is usually limited to the day of the procedure or a 2- to 3-day course. The antibiotics used are typically broad in spectrum, and most centers use doxycycline at 100 mg bid, with azithromycin for those who are allergic. If bacterial vaginosis is discovered, then the use of Flagyl at 500

2014 eMedicine.com

267. Bacterial Infections and Pregnancy (Follow-up)

both a high degree of clinical awareness and adequate screening. Group B Streptococcus Group B Streptococcus (GBS; Streptococcus agalactiae ) is the most common cause of life-threatening infections in newborns and can also affect the mother. Features of GBS infection are as follows: GBS can be found as part of normal vaginal, rectal, and oral flora Intrapartum transmission occurs via ascending spread or at the time of delivery In pregnant women, GBS causes cystitis, amnionitis, endometritis (...) , and stillbirth; occasionally, GBS bacteremia leads to endocarditis or meningitis In postpartum women, GBS can cause urinary tract infections (UTIs) and pelvic abscesses In newborns, early-onset GBS infection occurs before age 7 days (mean age at presentation is age 12 hours) and primarily manifests as nonfocal sepsis, pneumonia, or meningitis Late-onset disease in neonates occurs at age 7-89 days (mean age, 36 days), and nonfocal bacteremia and meningitis are the most common presentations Babies who survive

2014 eMedicine.com

268. Vaginitis (Diagnosis)

with an increased risk of adverse pregnancy outcomes, including , , preterm delivery, low birth weight, and postpartum endometritis. [ ] Previous Next: Patient Education Safe sex and STD counseling may help decrease the rates of reinfection. Discuss further preventive efforts, including proper hygiene and toilet techniques, when it is appropriate to do so. Remind patients that douching can spread a vaginal or cervical infection into the uterus, increasing the likelihood of PID; douching can also be associated (...) to prevent HIV, bacterial vaginosis and sexually transmitted infections, including trichomoniasis, are considered to be risk factors for HIV. Chronic vaginal infection can facilitate the transmission of various STDs, including HIV. Complications of bacterial vaginosis include endometritis and . Untreated bacterial vaginosis may result in complications (eg, vaginal wound infections) after gynecologic surgical procedures. In pregnancy, Trichomonas infection and bacterial vaginosis are associated

2014 eMedicine.com

269. Ureaplasma Infection (Diagnosis)

with salpingitis; M genitalium may also be involved in pelvic inflammatory disease and cervicitis. Whether Ureaplasma infection causes involuntary infertility remains speculative. Ureaplasma species can cause placental inflammation and may invade the amniotic sac early, causing persistent infection and adverse pregnancy outcomes, including premature birth. M hominis has been isolated from the blood of approximately 10% of women with postpartum or postabortal fever, but not from afebrile women who had abortions (...) to be more common in African Americans than in whites, but it is not clear whether this is a true racial difference as opposed to a socioeconomic factor. Sex No obvious sex predilection is reported for infections due to genital mycoplasmal species, except for the differences in urogenital diseases such as salpingitis and endometritis, which are gender-specific. The carriage rate of genital Mycoplasma species in the lower urogenital tract is somewhat greater for females than for males. Ureaplasma species

2014 eMedicine.com

270. Salpingitis (Diagnosis)

or postpartum uterus. Genetic factors Genetically mediated variation in immune response plays an important role in susceptibility to PID. [ ] Variants in the genes that regulate toll-like receptors (TLRs), an important component in the innate immune system, have been associated with an increased progression of C trachomatis infection to PID. [ ] Den Hartog et al found a possible contributing role of 5 single-nucleoside polymorphisms (SNPs) in 4 genes encoding pattern recognition receptors in local tubal (...) genitalium [ , ] Ureaplasma urealyticum Herpes simplex virus 2 (HSV-2) Trichomonas vaginalis (CMV) Haemophilus influenzae Streptococcus agalactiae Enteric gram-negative rods (eg, Escherichia coli ) Enterococcus, described in 2 individuals post IUD insertion [ ] Peptococcus species Anaerobes The microbiology of PID reflects the predominant sexually transmitted pathogens within a specific population, as well as some organisms less commonly seen in that population. Bacterial vaginosis (BV) may lead

2014 eMedicine.com

271. Normal and Abnormal Puerperium (Diagnosis)

that are effective for 12 weeks. Intrauterine devices can be placed immediately post partum (after delivery of the placenta) or after uterine involution occurs typically 4-6 weeks after delivery. Immediate postpartum insertion is associated with an increased risk of expulsion, approximately 24%. Immediate insertion is contraindicated in those with any postpartum infection including peripartum chorioamnionitis, endometritis or puerperal sepsis. [ ] Permanent methods of birth control (ie, tubal ligation, vasectomy (...) period with a validated instrument, such as the Edinburgh Postnatal Depression Scale. [ , ] The Edinburgh Postnatal Depression scale is a 10-item self-report questionnaire that includes symptoms of both anxiety and depression with exclusion of constitutional symptoms of mood disorders (i.e. change in sleep and eating patterns) that tend to be common in the postpartum period. It is recommended that providers who screen for depression have resources to initiate treatment and provide resources for those

2014 eMedicine.com

272. Premature Rupture of Membranes (Diagnosis)

and fetus, they are both determined to be clinically stable, expectant management of PPROM may be considered to improve fetal outcome. The primary maternal risk with expectant management of PPROM is infection. This includes chorioamnionitis (13-60%), endometritis (2-13%), sepsis (< 1%), and maternal death (1-2 cases per 1000). Complications related to the placenta include abruption (4-12%) and retained placenta or postpartum hemorrhage requiring uterine curettage (12%). [ ] The risks and potential (...) expectant management for as many as 4 days with induction of labor for complications. [ ] They concluded that, in women with PROM, induction of labor and expectant management resulted in similar rates of cesarean delivery and neonatal infection. However, induction with oxytocin resulted in a lower risk of maternal infection (endometritis) when compared with expectant management. Additionally, the women in the study viewed induction of labor more favorably than expectant management. Other smaller studies

2014 eMedicine.com

273. Pelvic Inflammatory Disease (Diagnosis)

or postpartum uterus. Genetic factors Genetically mediated variation in immune response plays an important role in susceptibility to PID. [ ] Variants in the genes that regulate toll-like receptors (TLRs), an important component in the innate immune system, have been associated with an increased progression of C trachomatis infection to PID. [ ] Den Hartog et al found a possible contributing role of 5 single-nucleoside polymorphisms (SNPs) in 4 genes encoding pattern recognition receptors in local tubal (...) genitalium [ , ] Ureaplasma urealyticum Herpes simplex virus 2 (HSV-2) Trichomonas vaginalis (CMV) Haemophilus influenzae Streptococcus agalactiae Enteric gram-negative rods (eg, Escherichia coli ) Enterococcus, described in 2 individuals post IUD insertion [ ] Peptococcus species Anaerobes The microbiology of PID reflects the predominant sexually transmitted pathogens within a specific population, as well as some organisms less commonly seen in that population. Bacterial vaginosis (BV) may lead

2014 eMedicine.com

274. Oophoritis (Diagnosis)

or postpartum uterus. Genetic factors Genetically mediated variation in immune response plays an important role in susceptibility to PID. [ ] Variants in the genes that regulate toll-like receptors (TLRs), an important component in the innate immune system, have been associated with an increased progression of C trachomatis infection to PID. [ ] Den Hartog et al found a possible contributing role of 5 single-nucleoside polymorphisms (SNPs) in 4 genes encoding pattern recognition receptors in local tubal (...) genitalium [ , ] Ureaplasma urealyticum Herpes simplex virus 2 (HSV-2) Trichomonas vaginalis (CMV) Haemophilus influenzae Streptococcus agalactiae Enteric gram-negative rods (eg, Escherichia coli ) Enterococcus, described in 2 individuals post IUD insertion [ ] Peptococcus species Anaerobes The microbiology of PID reflects the predominant sexually transmitted pathogens within a specific population, as well as some organisms less commonly seen in that population. Bacterial vaginosis (BV) may lead

2014 eMedicine.com

275. Salpingitis (Overview)

or postpartum uterus. Genetic factors Genetically mediated variation in immune response plays an important role in susceptibility to PID. [ ] Variants in the genes that regulate toll-like receptors (TLRs), an important component in the innate immune system, have been associated with an increased progression of C trachomatis infection to PID. [ ] Den Hartog et al found a possible contributing role of 5 single-nucleoside polymorphisms (SNPs) in 4 genes encoding pattern recognition receptors in local tubal (...) genitalium [ , ] Ureaplasma urealyticum Herpes simplex virus 2 (HSV-2) Trichomonas vaginalis (CMV) Haemophilus influenzae Streptococcus agalactiae Enteric gram-negative rods (eg, Escherichia coli ) Enterococcus, described in 2 individuals post IUD insertion [ ] Peptococcus species Anaerobes The microbiology of PID reflects the predominant sexually transmitted pathogens within a specific population, as well as some organisms less commonly seen in that population. Bacterial vaginosis (BV) may lead

2014 eMedicine.com

276. Normal and Abnormal Puerperium (Overview)

that are effective for 12 weeks. Intrauterine devices can be placed immediately post partum (after delivery of the placenta) or after uterine involution occurs typically 4-6 weeks after delivery. Immediate postpartum insertion is associated with an increased risk of expulsion, approximately 24%. Immediate insertion is contraindicated in those with any postpartum infection including peripartum chorioamnionitis, endometritis or puerperal sepsis. [ ] Permanent methods of birth control (ie, tubal ligation, vasectomy (...) period with a validated instrument, such as the Edinburgh Postnatal Depression Scale. [ , ] The Edinburgh Postnatal Depression scale is a 10-item self-report questionnaire that includes symptoms of both anxiety and depression with exclusion of constitutional symptoms of mood disorders (i.e. change in sleep and eating patterns) that tend to be common in the postpartum period. It is recommended that providers who screen for depression have resources to initiate treatment and provide resources for those

2014 eMedicine.com

277. Streptococcus Group B Infections (Overview)

> Group B Streptococcus (GBS) Infections Updated: Dec 06, 2018 Author: Christian J Woods, MD, FCCP; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Group B Streptococcus (GBS) Infections Overview Practice Essentials Group B Streptococcus (GBS), also known as Streptococcus agalactiae , is best known as a cause of postpartum infection and as the most common cause of neonatal sepsis. This organism is also causes infection in nonpregnant adults. Group B (...) , nuchal rigidity, or confusion GBS bacteremia: Common; most cases have no identifiable source of infection; fever, malaise, confusion, chest pain, shortness of breath, myalgia, or arthralgia Skin and soft-tissue infection, decubitus ulcers, colonization of diabetic foot infections: Fever, malaise, localized pain, cellulitis Osteomyelitis, arthritis, discitis: Fever, malaise, localized pain, cellulitis, arthralgia, arthritis, or weakness Chorioamnionitis, endometritis, UTIs (from asymptomatic

2014 eMedicine.com

278. Coccidioidomycosis (Infectious Diseases) (Overview)

and in the immediate postpartum period, are at higher risk for dissemination than the general population. [ , , ] All age groups can be affected. Primary infection of the newborn rarely occurs. [ ] Infection of the genital tract of the mother can result in placental involvement, coccidioidal endometritis, and aspiration of infected amniotic fluid by the fetus. Both congenital and perinatal transmission of Coccidioides species have been reported. However, infants can experience severe disease within the first few

2014 eMedicine.com

279. Cardiomyopathy, Peripartum (Overview)

, and cardiotoxic properties. This can be blocked with bromocriptine. [ ] Research also indicates that imbalances in angiogenic signaling increase the disease's severity. [ ] Previous Next: Epidemiology United States statistics Reports estimating the incidence of peripartum cardiomyopathy (PPCM) in the United States vary widely, ranging from 1 case per 15,000 live births to 1 case per 4000 live births to 1 case per 1300 live births. Approximately 75% of cases are diagnosed within the first month post partum (...) , and 45% present in the first week. When PPCM is suspected, one must establish the diagnosis rapidly. [ ] International statistics The prevalence is reported to be 1 case per 6000 live births in Japan, 1 case per 1000 live births in South Africa, and 1 case per 350-400 live births in Haiti. A high prevalence in Nigeria is caused by the tradition of ingesting kanwa (dried lake salt) while lying on heated mud beds twice a day for 40 days post partum. The high salt intake leads to volume overload. Age

2014 eMedicine.com

280. Cesarean Delivery (Overview)

with 5% dextrose) Placement of a Foley catheter (to drain the bladder and to monitor urine output) Placement of an external fetal monitor and monitors for the patient’s blood pressure, pulse, and oxygen saturation Preoperative antibiotic prophylaxis (decreases risk of endometritis after elective cesarean delivery by 76%, regardless of the type of cesarean delivery [emergent or elective]) [ ] Evaluation by the surgeon and the anesthesiologist Laboratory testing The following laboratory studies may (...) if patient received regional anesthesia, with/without a long-acting analgesic Ambulation on postoperative day 1; advance as tolerated If patient plans to breastfeed, initiate within a few hours after delivery; if patient plans to bottle feed, she may use a tight bra or breast binder in the postoperative period Discharge on postoperative day 2 to 4, if no complications [ ] Discuss contraception as well as refraining from intercourse for 4-6 weeks postpartum, unless the patient had LARC placed at the time

2014 eMedicine.com

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