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Postpartum Endometritis

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321. Maternal Chorioamnionitis (Diagnosis)

or metronidazole when endometritis is suspected (postdelivery) Vancomycin for penicillin-allergic patients Alternatives: Monotherapy with ampicillin-sulbactam, ticarcillin-clavulanate, cefoxitin, cefotetan, or piperacillin-tazobactam Penicillin G: Used exclusively for GBS intrapartum prophylaxis; if intraamniotic infection is suspected, broaden the antibiotic coverage. Nonpharmacotherapy Supportive care of the septic neonate may include the following: Warmth, monitoring of vital signs Preparedness to perform (...) of chorioamnionitis. [ , , ] Previous Next: Prognosis Maternal sequelae Acute chorioamnionitis may result in labor abnormalities (dysfunctional labor) that increase the risk for cesarean delivery, uterine atony, and postpartum bleeding, as well as the need for blood transfusion. [ , ] These complications are likely to occur more often when the amniotic fluid is infected with invasive organisms (eg, E coli and group B Streptococcus [GBS]) as compared with low-virulence organisms (eg, Ureaplasma urealyticum

2014 eMedicine Pediatrics

322. Coccidioidomycosis (Diagnosis)

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 Pediatrics

323. 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

324. 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 (...) have a cesarean delivery have a five to 20-fold greater chance of a postpartum infection compared to those who delivery vaginally . [ ] Therefore ACOG recommends the routine administration of prophylactic antibiotics in women undergoing cesarean section. [ ] In a large Cochrane review of 95 studies including over 15,000 women who had cesarean deliveries, there was a 60-70% reduction in postpartum complications after the use of prophylactic antibiotics including wound infection and endometritis

2014 eMedicine.com

325. 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 (...) to vaginal inflammation, which could facilitate ascending infection with BV-associated organisms (eg, G vaginalis ). However evidence is unclear if detecting and treating BV reduces PID related infection. [ ] In some regions, PID may be from a granulomatous salpingitis caused by Mycobacterium tuberculosis or Schistosoma species. [ ] In a cross-sectional study of 736 women with PID, patients with Trichomonas infections demonstrated a 4-fold increase in the histologic evidence of acute endometritis

2014 eMedicine.com

326. Ultrasonography, Pelvic (Treatment)

of symptomatic first-trimester pregnancy. Ann Emerg Med . 1999 Mar. 33(3):310-20. . Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, et al. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol . 2009 May 22. . Brown DL. Pelvic ultrasound in the postabortion and postpartum patient. Ultrasound Q . 2005 Mar. 21(1):27-37. . Matijevic R, Knezevic M, Grgic O, Zlodi-Hrsak L. Diagnostic accuracy of sonographic and clinical parameters in the prediction of retained products of conception. J (...) be seen within the uterus and should not be confused with free fluid in the cul-de-sac. Endovaginal view of the ovary: Note its location adjacent to an iliac vessel. Endovaginal ultrasound scan. Endometritis with air in the endometrial cavity and bilateral tubo-ovarian abscesses are shown. Video depicts 2 findings: first, it shows an enlarged hypovascular left ovary; second, it shows flow in the healthy right ovary. A small amount of intraperitoneal fluid surrounds the left ovary. Demonstration

2014 eMedicine Emergency Medicine

327. Coccidioidomycosis (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 Emergency Medicine

328. Placenta Previa (Overview)

in cases of placenta previa as well as placenta accreta, increta, and percreta.) Higher rates of blood transfusion [ , ] Placental abruption Preterm delivery Increased incidence of postpartum endometritis [ ] Mortality rate (2-3%); in the US, the maternal mortality rate is 0.03%, the great majority of which is related to uterine bleeding and the complication of The Table, below, summarizes the relative risk of some morbidities in women with placenta previa. Table. Relative Risk of Morbidities (...) birth is highly associated with placenta previa, with 16.9% of women delivering at less than 34 weeks and 27.5% delivering between 34 and 37 weeks in a population-based study from 1989 to 1997. [ ] There is a significant increase in the risk of postpartum hemorrhage and need for emergency hysterectomy in women with placenta previa. [ ] Maternal complications of placenta previa are summarized as follows: Hemorrhage, [ ] including rebleeding (Planning delivery and control of hemorrhage is critical

2014 eMedicine Emergency Medicine

329. 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 Emergency Medicine

330. Coccidioidomycosis (Diagnosis)

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 Emergency Medicine

331. Pelvic Inflammatory Disease/Tubo-ovarian Abscess

are equivocal. [ , , ] MRI findings in acute PID include cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues. In a study by Tukeva et al, the authors compared findings from MRI with sonograms and found that MRI was more accurate than ultrasonography in the diagnosis of PID. [ ] Occasionally, CT scanning may be used as the initial diagnostic study for the investigation of nonspecific pelvic pain in a female, and PID may be found incidentally. CT scanning is very (...) . This sonogram shows a markedly heterogeneous and thickened endometrium, a finding that is compatible with endometritis. Transabdominal ultrasound scan. This image demonstrates an echogenic region within the endometrium with dirty shadowing, a finding that is compatible with air in the endometrium and endometritis. Additionally, bilateral complex masses are present; this finding is compatible with tubo-ovarian masses. Pathophysiology PID is a complex polymicrobial disease that is due to the ascending spread

2014 eMedicine Radiology

332. Uterine Fibroid Embolization

material following pneumonectomy. [ ] Newer agents include Embospheres and Embozene. [ ] Some interventional radiologists have advocated for the use of Gelfoam, a temporary embolic agent frequently used for postpartum hemorrhage control. [ , ] The desired level of occlusion (ie, proximal, distal) determines the particle size selection for each embolization procedure. Generally, using small particles results in a more distal occlusion, increasing the risk for end-organ infarction. However, the tendency (...) if the source of a PE is from the pelvic veins. Inadvertent end-organ damage (ie, uterus) can result in ischemic injury or infection, both of which may require hysterectomy for treatment. Infection or, more specifically, pyometrium with acute endometritis was one of the earliest reported complications of UFE. High fever and persistent pain led to hysterectomy in an early case report. Since then, infection has been reported in less than 1% of patients. Some infected patients have been successfully treated

2014 eMedicine Radiology

333. Placenta Previa (Treatment)

in cases of placenta previa as well as placenta accreta, increta, and percreta.) Higher rates of blood transfusion [ , ] Placental abruption Preterm delivery Increased incidence of postpartum endometritis [ ] Mortality rate (2-3%); in the US, the maternal mortality rate is 0.03%, the great majority of which is related to uterine bleeding and the complication of The Table, below, summarizes the relative risk of some morbidities in women with placenta previa. Table. Relative Risk of Morbidities (...) birth is highly associated with placenta previa, with 16.9% of women delivering at less than 34 weeks and 27.5% delivering between 34 and 37 weeks in a population-based study from 1989 to 1997. [ ] There is a significant increase in the risk of postpartum hemorrhage and need for emergency hysterectomy in women with placenta previa. [ ] Maternal complications of placenta previa are summarized as follows: Hemorrhage, [ ] including rebleeding (Planning delivery and control of hemorrhage is critical

2014 eMedicine Emergency Medicine

334. Ultrasonography, Pelvic (Follow-up)

. Role of pelvic ultrasonography in evaluation of symptomatic first-trimester pregnancy. Ann Emerg Med . 1999 Mar. 33(3):310-20. . Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, et al. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol . 2009 May 22. . Brown DL. Pelvic ultrasound in the postabortion and postpartum patient. Ultrasound Q . 2005 Mar. 21(1):27-37. . Matijevic R, Knezevic M, Grgic O, Zlodi-Hrsak L. Diagnostic accuracy of sonographic and clinical parameters (...) stripe (st) is thickened. The arcuate vessels (arc) can be seen within the uterus and should not be confused with free fluid in the cul-de-sac. Endovaginal view of the ovary: Note its location adjacent to an iliac vessel. Endovaginal ultrasound scan. Endometritis with air in the endometrial cavity and bilateral tubo-ovarian abscesses are shown. Video depicts 2 findings: first, it shows an enlarged hypovascular left ovary; second, it shows flow in the healthy right ovary. A small amount

2014 eMedicine Emergency Medicine

335. Vaginitis (Overview)

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 Emergency Medicine

336. Ultrasonography, Pelvic (Overview)

evaluation in the emergency department. Emerg Med Clin North Am . 2001 Aug. 19(3):799-816. . Moloney F, Ryan D, Twomey M, Hewitt M, Barry J. Comparison of MRI and high-resolution transvaginal sonography for the local staging of cervical cancer. J Clin Ultrasound . 2016 Feb. 44 (2):78-84. . Dart RG. Role of pelvic ultrasonography in evaluation of symptomatic first-trimester pregnancy. Ann Emerg Med . 1999 Mar. 33(3):310-20. . Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, et al. Postpartum hemorrhage (...) : Clinical and radiologic aspects. Eur J Radiol . 2009 May 22. . Brown DL. Pelvic ultrasound in the postabortion and postpartum patient. Ultrasound Q . 2005 Mar. 21(1):27-37. . Matijevic R, Knezevic M, Grgic O, Zlodi-Hrsak L. Diagnostic accuracy of sonographic and clinical parameters in the prediction of retained products of conception. J Ultrasound Med . 2009 Mar. 28(3):295-9. . Wolman I, Altman E, Fait G, Har-Toov J, Gull I, Amster R, et al. Evacuating retained products of conception in the setting

2014 eMedicine Emergency Medicine

337. Pelvic Inflammatory Disease (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 (...) to vaginal inflammation, which could facilitate ascending infection with BV-associated organisms (eg, G vaginalis ). However evidence is unclear if detecting and treating BV reduces PID related infection. [ ] In some regions, PID may be from a granulomatous salpingitis caused by Mycobacterium tuberculosis or Schistosoma species. [ ] In a cross-sectional study of 736 women with PID, patients with Trichomonas infections demonstrated a 4-fold increase in the histologic evidence of acute endometritis

2014 eMedicine Emergency Medicine

338. Effect of an injectable trace mineral supplement containing selenium, copper, zinc, and manganese on the health and production of lactating Holstein cows. (Abstract)

Effect of an injectable trace mineral supplement containing selenium, copper, zinc, and manganese on the health and production of lactating Holstein cows. The objective of this study was to evaluate the effect of a subcutaneous injection of a multimineral preparation containing 300 mg of zinc, 50mg of manganese, 25mg of selenium, and 75 mg of copper at 230 and 260 days of gestation and 35 days postpartum, on the health, milk production and reproductive performance of lactating Holstein cows (...) ); for multiparous cows, the incidence of clinical mastitis for control and TMS cows was 25.4% and 19.7%, respectively (P=0.03). Additionally, control cows had increased odds of stillbirth and endometritis (odds ratios 1.69 and 1.30, respectively). The incidence of endometritis was 34.2% and 28.6% for control and TMS cows, respectively (P=0.039) but treatment had no effect on reproductive performance, milk production or other health traits. Further research is required to confirm these findings and to establish

2013 Veterinary journal (London, England : 1997) Controlled trial quality: uncertain

339. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Full Text available with Trip Pro

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries.To (...) determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 August 2012).We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean

2013 Cochrane database of systematic reviews (Online)

340. Plasma concentrations of PGFM and uterine and ovarian responses in early lactation dairy cows fed omega-3 and omega-6 fatty acids. (Abstract)

soybeans (S), and they were fed from calving to Day 70 postpartum. Estrous cycles were synchronized and ovarian follicular development was monitored daily for an entire cycle. There were no differences among diets in the incidence of lameness, mastitis, or metritis, but the incidence of clinical endometritis was lower (P < 0.05) in cows fed S (0%) compared with cows fed C (28.2%) and L (20.5%). Uterine involution in cows fed S occurred 3.77 and 2.78 days earlier, respectively, than in those fed C and L

2013 Theriogenology Controlled trial quality: uncertain

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