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Postpartum Endometritis

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401. Concomitant use of glucocorticoids: a comparison of two metaanalyses on antibiotic treatment in preterm premature rupture of membranes

on admission ranged from 29.2 to 30.4 weeks. Most patients remained hospitalised throughout the treatment. Outcomes assessed in the review The neonatal outcomes assessed were: neonatal death, sepsis, hyaline membrane disease, respiratory distress syndrome, intraventricular haemorrhage, and necrotising enterocolitus. The maternal outcomes included chorioamnionitis and postpartum endometritis. The secondary outcomes were mean latency periods, mean birth weights, and mean durations of maternal and neonatal (...) was not violated in any outcome included. Antibiotic treatment had no significant effect on chorioamnionitis, postpartum endometritis, or on any of the neonatal outcomes included. Secondary outcomes: a combined result for secondary outcomes was not calculated because the outcomes were either incomplete or reported inconsistently. Information regarding pregnancy prolongation was available in 4 of the 5 studies. In one study, the mean rupture-to-delivery interval was significantly longer in the antibiotics group

1998 DARE.

402. Intrapartum chemoprophylaxis of perinatal group B streptococcal infections: a critical review of randomized controlled trials

outcomes. One study observed a statistically-significant reduction in postpartum vaginal colonisation with intrapartum chemoprophylaxis in a subset of patients, and also a statistically-significant reduction of postpartum febrile morbidity. No statistically-significant reduction was found in endometritis or sepsis, but these events have a very low incidence and so the sample size is too small to detect such a reduction. Authors' conclusions The use of intrapartum chemoprophylaxis to reduce perinatal (...) . Women had to be treated with antibiotic during, but not before, labour. Outcomes assessed in the review Group B streptococci neonatal outcomes: colonisation, proved early- or late-onset infection, probable infection and proved infection due to organisms other than group B streptococci. Group B streptococci maternal outcomes: sepsis, postpartum febrile morbidity and postpartum vaginal colonisation. How were decisions on the relevance of primary studies made? Two researchers assessed the papers

1994 DARE.

403. Pumps and warmers during amnioinfusion: is either necessary?

of meconium below the vocal cords at delivery, low 5-minute Apgar score and postpartum endometritis. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the authors performed the selection. Studies in which the primary purpose was other than to compare outcomes in patients who received, or did not receive amnioinfusion, were excluded. Assessment of study quality Studies with less than 40 patients were excluded

1996 DARE.

404. Uncomplicated pregnancy: clinical pathway genesis based on the nursing process

% confidence interval, CI: 2.17 - 6.92; p<0.05). However, these admissions were not clinically significant because they were all for postpartum mastitis or endometritis, and they occurred after 48 hours of hospital discharge. There were 9 newborn hospital readmissions in the control group versus 12 in the intervention group, (p>0.05). The number of maternal unscheduled clinic visits was 123 in the control group and 237 in the intervention group, (p>0.05). The numbers of newborn unscheduled clinic visits (...) the programme. Multiparous patients were discharged within 24 hours and primiparous patients were discharged within 48 hours. Type of intervention Other: Patient care management. Economic study type Cost-effectiveness analysis. Study population The study population comprised gravidas with uncomplicated antepartum, intrapartum and postpartum courses, with a vaginal delivery of the newborn between 38 and 42 weeks' gestation with weight appropriate for gestational age by the appropriate intrauterine growth

2000 NHS Economic Evaluation Database.

405. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis (Abstract)

Timing of perioperative antibiotics for cesarean delivery: a metaanalysis The purpose of this study was to summarize the available evidence on timing of perioperative antibiotics for cesarean delivery.We searched the literature for studies that compare prophylactic antibiotics for cesarean delivery that are given before the procedure vs at cord clamping. Only randomized controlled trials were included.Preoperative administration significantly reduced the risk of postpartum endometritis (...) ). There was no significant heterogeneity between the randomized controlled trials.There is strong evidence that antibiotic prophylaxis for cesarean delivery that is given before skin incision, rather than after cord clamping, decreases the incidence of postpartum endometritis and total infectious morbidities, without affecting neonatal outcomes.

2008 EvidenceUpdates

406. High-concentration supplemental perioperative oxygen to reduce the incidence of postcesarean surgical site infection: a randomized controlled trial Full Text available with Trip Pro

inspired oxygen decreases the incidence of surgical site infection in women undergoing cesarean delivery.Using a double blind technique, 143 women undergoing cesarean delivery under regional anesthesia after the onset of labor were randomly assigned to receive low- or high-concentration inspired oxygen via nonrebreathing mask during the operation and for 2 hours after. Surgical site infection was defined clinically as administration of antibiotics for postpartum endometritis or wound infection during

2008 EvidenceUpdates Controlled trial quality: predicted high

407. Is there any evidence for using Co-Amoxiclav to treat mastitis or endometriosis in breast-feeding women?

-lactamase inhibitors with penicillins have been used in an attempt to avoid polypharmacy and its associated toxicities. In general, these alternative therapies have a cure rate of 80-90%. The most accepted among this category of drugs are cefoxitin or moxalactam.” [3] A second e-Medicine article on postpartum infections, focusing on patients presenting to emergency departments, notes: • “Postpartum endometritis treatment o Mild cases of endometritis after vaginal delivery may be treated with oral (...) antimicrobial agents (such as doxycycline or clindamycin). o Moderate-to-severe cases, including those involving cesarean deliveries, should be treated with parenteral broad-spectrum antimicrobials (cefoxitin with doxycycline or clindamycin). o A rapid response to antibiotics is the typical response in the treatment of postpartum endometritis. • Mastitis treatment o Administer dicloxacillin, penicillinase-resistant penicillin, or clindamycin, and use local measures, such as ice packs, analgesics, and breast

2007 TRIP Answers

408. Can a chlamydia swab increase the possibility of miscarriage?

states: “Complications of pregnancy: there is some evidence that genital chlamydial infection may contribute to miscarriage, premature rupture of membranes, preterm birth, stillbirth and low birth weight. It is uncertain whether microbiological cure of maternal chlamydia infection results in reduced complications. Postpartum endometritis has also been associated with chlamydial infection, although the risk of this occurring in women infected at the time of delivery is unknown” [1] And: “What happens (...) vaginal examinations and notes: “Infection in late pregnancy After the first trimester, infection of the vagina, cervix, and fetal membranes or amniotic fluid (chorioamnionitis) is a common cause of spontaneous abortion, rupture of membranes, preterm labour and stillbirth. The same vaginal, cervical and exogenous organisms (gonococci, chlamydia, bacteria associated with bacterial vaginosis, trichomonas, group B streptococci) may be involved in postabortion infection, chorioamnionitis, and postpartum

2006 TRIP Answers

409. Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV). (Abstract)

Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV). The incidence of chlorioamnionitis occurs in between 8 to 12 women for every 1000 live births and 96% of the cases of chlorioamnionitis are due to ascending infection. Following spontaneous vaginal delivery, 1% to 4% of women develop postpartum endometritis. The incidence of neonatal sepsis is 0.5% to 1% of all infants born. Maternal vaginal bacteria are the main agents (...) maternal and neonatal infections. Although the data suggest a trend in reducing postpartum endometritis, the difference was not statistically significant (relative risk 0.83; 95% confidence interval 0.61 to 1.13).There is no evidence to support the use of vaginal chlorhexidine during labour in preventing maternal and neonatal infections. There is a need for a well-designed randomized controlled trial using appropriate concentration and volume of vaginal chlorhexidine irrigation solution

2004 Cochrane database of systematic reviews (Online)

410. Vaginal Cleansing at Cesarean Delivery to Reduce Infection: A Randomized, Controlled Trial

Last Update Posted : February 8, 2010 Sponsor: Indiana University School of Medicine Information provided by: Indiana University Study Details Study Description Go to Brief Summary: The objective of the project is to find out whether cleansing the vagina before a cesarean delivery decreases the risk of complications and infections after having the baby. If this is the case, cleansing the vagina before cesarean delivery can help improve outcomes for many women and make their early postpartum (...) recovery much more pleasant, giving a healthier start for the family. Condition or disease Intervention/treatment Phase Cesarean Section Endometritis Surgical Wound Infection Procedure: Vaginal cleansing before cesarean delivery Not Applicable Detailed Description: Infectious morbidity frequently complicates cesarean delivery. Endometritis can complicate the postoperative course of a cesarean delivery 6-27% of the time. This complication, up to 10 times more frequent than after vaginal delivery, can

2006 Clinical Trials

411. The modified Misgav-Ladach versus the Pfannenstiel-Kerr technique for cesarean section: a randomized trial. (Abstract)

undergoing transverse lower uterine segment cesarean section. Patients were allocated to one of the two arms: 88 to the MML technique and 74 to the Pfannenstiel-Kerr technique. Main outcome measures were defined as the duration of surgery, analgesic requirements, and bowel restitution by the second postoperative day. Additional outcomes evaluated were febrile morbidity, postoperative antibiotic use, postpartum endometritis, and wound complications. Student's t, Mann-Whitney, and Chi-square tests were (...) used for statistical analysis of the results, and a p < 0.05 was considered as the probability level reflecting significant differences.No differences between groups were noted in the incidence of analgesic requirements, bowel restitution by the second postoperative day, febrile morbidity, antibiotic requirements, endometritis, or wound complications. The MML technique took on average 12 min less to complete (p = 0.001).The MML technique is faster to perform and similar in terms of febrile

2005 Acta Obstetricia et Gynecologica Scandinavica Controlled trial quality: uncertain

412. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. (Abstract)

for hysterectomy.Eleven viable fetuses were born with no radiation exposure. There were no maternal or fetal mortalities. Nine of 11 patients had an estimated blood loss between 500 and 2300 mL. Emergency hysterectomy was performed in two patients because of massive bleeding. The complications, including peritonitis and endometritis, occurred in another two patients after embolization.Prophylactic, intraoperative UAE before placental expulsion appears to reduce the risk of postpartum hemorrhage, decrease morbidity

2008 Fertility and Sterility

413. Clinical variability of bacterial vaginosis and trichomoniasis. (Abstract)

of such pregnancy complications as preterm delivery, preterm labor and premature rupture of the membranes; amniotic fluid infection; postpartum endometritis and surgical infections; and the role of bacterial vaginosis are discussed. Treatment modalities in both the nonpregnant and pregnant woman, as well as treatment of resistant cases of both vaginal conditions, are recommended.

2004 Journal of Reproductive Medicine

414. Puerperal pyrexia: a review. Part I. (Abstract)

Puerperal pyrexia: a review. Part I. Puerperal pyrexia and sepsis are among the leading causes of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. Most postpartum infections take place after hospital discharge, which is usually 24 hours after delivery. In the absence of postnatal follow-up, as is the case in many developing countries, many cases of puerperal infections can go undiagnosed and unreported. Besides endometritis (...) and postpartum hemorrhage. Maternal complications include septicemia, endotoxic shock, peritonitis or abscess formation leading to surgery and compromised future fertility. The transmissions of infecting organisms are typically categorized into nosocomial, exogenous, and endogenous. Nosocomial infections are acquired in hospitals or other health facilities and may come from the hospital environment or from the patient's own flora. Exogenous infections come from external contamination, especially when

2007 Obstetrical & Gynecological Survey

415. Puerperal Pyrexia: a review. Part II. (Abstract)

Puerperal Pyrexia: a review. Part II. Puerperal pyrexia and sepsis are among the leading causes of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. Most postpartum infections take place after hospital discharge, which is usually 24 hours after delivery. In the absence of postnatal follow-up, as is the case in many developing countries, many cases of puerperal infections can go undiagnosed and unreported. Besides endometritis (...) and postpartum hemorrhage. Maternal complications include septicemia, endotoxic shock, peritonitis or abscess formation leading to surgery and compromised future fertility. The transmissions of infecting organisms are typically categorized into nosocomial, exogenous, and endogenous. Nosocomial infections are acquired in hospitals or other health facilities and may come from the hospital environment or from the patient's own flora. Exogenous infections come from external contamination, especially when

2007 Obstetrical & Gynecological Survey

416. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. (Abstract)

, Montevideo, Uruguay. Adjusted odds ratios were obtained through logistic regression analysis.After an adjustment for 16 major confounding factors, adolescents aged 15 years or younger had higher risks for maternal death, early neonatal death, and anemia compared with women aged 20 to 24 years. Moreover, all age groups of adolescents had higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age

2005 American Journal of Obstetrics and Gynecology

417. False-positive 1-hour glucose challenge test and adverse perinatal outcomes. Full Text available with Trip Pro

followed by a normal 3-hour glucose tolerance test (GTT). We compared the negative GCT and false-positive GCT cohorts for a composite perinatal outcome variable that included fetal macrosomia, antenatal death, shoulder dystocia, chorioamnionitis, preeclampsia, intensive care nursery admission, and postpartum endometritis. Secondary outcomes included cesarean delivery and each component variable of the composite. Unadjusted, stratified, and multiple logistic regression analyses were used to investigate (...) outcome (odds ratio [OR] 5.96, 95% confidence interval[CI]1.47,24.16), macrosomia greater than 4500 g (OR 3.66, 95% CI 1.30, 10.32), antenatal death (OR 4.61, 95% CI 0.77, 27.48), shoulder dystocia (OR 2.85, 95% CI 1.25, 6.51), endometritis (OR 2.18, 95% CI 1.03, 4.63), and cesarean delivery (OR 1.76, 95% CI 0.99, 3.14).A false-positive GCT is an independent risk factor for adverse perinatal outcomes.

2004 Obstetrics and Gynecology

418. Maternal morbidity associated with vaginal versus cesarean delivery. Full Text available with Trip Pro

Maternal morbidity associated with vaginal versus cesarean delivery. To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies.The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery (...) in 1,733 (7.8%) women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95% CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95% CI 5.9, 17.9) than after spontaneous vaginal

2004 Obstetrics and Gynecology

419. Fulminant postcesarean Clostridium difficile pseudomembranous colitis. (Abstract)

Fulminant postcesarean Clostridium difficile pseudomembranous colitis. Pseudomembranous colitis due to Clostridium difficile infection is rarely reported in the obstetric literature. This disease process is associated with prior antibiotic exposure.A term primigravida was delivered by primary cesarean for failed vacuum extraction. She received Intravenous cefazolin after cord clamping, which was continued for 36 hours for a presumptive diagnosis of endometritis. On day 3, oral amoxicillin (...) and clavulanate was started for suspected cellulitis of the incision. She was readmitted 1 day after her discharge with severe diffuse abdominal pain and distention. Proctoscopy showed pseudomembranous colitis. Colectomy with temporary ileostomy was performed for worsening symptoms and imminent perforation.The diagnosis of pseudomembranous colitis should be considered in postpartum women who have low-grade fever, abdominal and gastrointestinal symptoms, and recent antibiotic exposure.

2007 Obstetrics and Gynecology

420. Differences between hospitals in cesarean rates for term primigravidas with cephalic presentation. Full Text available with Trip Pro

labor) were identified. A total of 174 medical records at Hospital A and 150 records at Hospital B were reviewed. Statistical analysis was performed using independent-sample t tests, chi(2), and multiple logistic regression.Indications for cesarean delivery were not different between the 2 groups, with the majority being for failure to progress in labor and nonreassuring fetal status. There were no differences between groups in rates of postpartum hemorrhage, chorioamnionitis, or endometritis

2005 Obstetrics and Gynecology

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