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postpartum complications, including urinary tract and wound infections, endometritis, anesthesia complications, and postpartum hemorrhage were reported with less than 70% sensitivity, but at least 80% positive predictive value. Composite measures from HealthGrades and Solucient, which include these complication codes, also suffer from high false-negative rates.Third- and fourth-degree perineal lacerations are accurately reported on hospital discharge abstracts, confirming the validity of related quality (...) indicators sponsored by the Agency for Healthcare Research and Quality and JCAHO. Administrative data seem less useful for monitoring other in-hospital postpartum complications.
and analyzed using logistic regression. Women were surveyed for a large number of intraoperative complications, common perioperative morbidities, and uncommon maternal complications.There were 378 HIV-infected and 54,281 uninfected women who met criteria. Patients infected with HIV were more likely to have postpartumendometritis (11.6% compared with 5.8%, P<.001), require a postpartum blood transfusion (4.0% compared with 2.0%, P=.02), develop maternal sepsis (1.1% compared with 0.2%, P<.001), be treated (...) for pneumonia (1.3% compared with 0.3%, P=.001), and to have a maternal death (0.8% compared with 0.1%, P<.001). After controlling for potential confounders, patients with HIV infection were more likely to have one or more postpartum morbidities (odds ratio 1.6, 95% confidence interval 1.2-2.2).Women with HIV infection undergoing cesarean delivery are at increased risk for perioperative morbidity and maternal mortality.II.
Ovarian vein thrombosis: a rare cause of abdominal pain outside the peripartum period. Ovarian vein thrombosis (OVT) is a rare cause of abdominal pain that may mimic a surgical abdomen. The differential diagnosis of OVT includes acute appendicitis, endometritis, pelvic inflammatory disease, pyelonephritis, nephrolithiasis, tubo-ovarian abscess, and ovarian torsion. The complications of OVT, including sepsis and pulmonary embolism, are significant. Diagnosis relies on a careful examination (...) of the radiographic findings. This diagnosis should be considered not only in postpartum patients but also in women with pelvic inflammatory disease, recent abdominal surgery, malignancy, or known hypercoagulable state. In this report we present a case of OVT in a 29-year-old woman presenting with 3 days of sharp left-sided abdominal pain, nausea, and vomiting after bilateral salpingectomy. We then discuss the epidemiology, pathophysiology, and clinical management of OVT.
. Invasive GAS infection is defined by the isolation of GAS from a normally sterile site (e.g., blood) or by the isolation of GAS from a nonsterile site in the presence of the streptococcal toxic shock syndrome or necrotizing fasciitis. A postpartum case of invasive GAS is defined as isolation of GAS during the postpartum period, in association with a clinical postpartum infection (e.g., endometritis) or from either a sterile site or a wound infection. Because of the burden and severity of invasive GAS (...) : January 18, 2012 Sponsor: Hadassah Medical Organization Information provided by: Hadassah Medical Organization Study Details Study Description Go to Brief Summary: Group A streptococcus (GAS) causes a variety of human infections. It is also an uncommon but serious cause of postpartum infections. In contrast to group B streptococcus (GBS) infection, which causes illness and death in newborns disproportionately more often than it does in mothers, perinatal GAS infection primarily affects mothers
[ Time Frame: birth to 28days of life ] Documented sepsis within 72 hours of delivery [ Time Frame: birth to 72 hours after delivery ] Grade 3 or 4 intraventricular hemorrhage [ Time Frame: birth to 28days of life ] Stage 2 or 3 necrotizing enterocolitis [ Time Frame: birth to 28days of life ] Neonatal intensive care unit (NICU) stay [ Time Frame: birth to 28days of life ] Birth weight [ Time Frame: at birth ] Estimated gestational age (EGA) at delivery [ Time Frame: at delivery ] Postpartum (...) endometritis [ Time Frame: birth to 28days of life ] Maternal sepsis [ Time Frame: birth to 28days following delivery ] Latency [ Time Frame: labor to delivery ] Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided
was considered one day. Number of Neonates Who Required Surfactant Therapy After Birth. [ Time Frame: Birth to 28 days of life ] The Number of neonates who required surfactant therapy within the first 28 days after birth. Number of Neonates With Pneumothorax [ Time Frame: birth to 28 days of life ] Total number of neonates with pneumothorax diagnosed postpartum. Maternal Infectious Morbidity. [ Time Frame: Up to 28 days after giving birth ] Total number of Mothers having Maternal infectious morbidity (e.g (...) . endometritis & maternal sepsis) noted from birth through 28 days after birth Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible
will compare the failure rates, cesarean section rate, infections and postpartum complications, especially endometritis. Condition or disease Intervention/treatment Phase Induction of Labor Cesarean Endometritis Device: Mechanical induction of labor Device: Double Balloon Device: Foley Catheter Not Applicable Detailed Description: We will conduct a comparative study of the foley catheter vs the cervical ripening double balloon (Cook medical, GPN: G48149). We will compare the failure rates, cesarean section (...) rate, infections and postpartum complications, especially endometritis. The study will include 200 parturients, 100 primiparous and 100 multiparous women. We will randomize each group to induction with the foley catheter or the cervical ripening double balloon. We will compare the failure rates, cesarean section rate, infectious and other postpartum complications, especially endometritis. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated
Go to Brief Summary: Hypothesis: The bacterial flora of the uterus during elective Cesarean sections differs from the uterine flora during non-elective Cesarean sections. We want to study whether the uterine flora can predict post-cesarean febrile morbidity and endometritis. Condition or disease Endometritis Detailed Description: Objective: To evaluate the uterine flora at the time of elective and non-elective cesarean sections and to study the relationship to the development of postpartum fever (...) and/or endometritis. Methods: Eight-hundred women who will be delivered by cesarean section will be enrolled in this study. Cultures will be obtained during the surgery from the open uterine cavity after removal of the placenta. Data regarding postpartum morbidity would be collected. Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 600 participants Time Perspective: Prospective Official Title: Uterine Flora During Elective and Urgent Cesarean Sections and Its
of the membranes, chorioamnionitis, amniotic fluid infection, preterm labor, preterm birth, and postpartumendometritis. Several studies have documented increased postpartum complications in the newborn and infants. The etiology of BV is poorly understood but recurrence is quite common despite treatment. Documented recurrence rate of up to 30% within three months are reported. Small studies have shown that adding vaginal acidifying gel to standard antibiotic regimens may reduce recurrence rates of BV. We plan (...) by: Indiana University Study Details Study Description Go to Brief Summary: Bacterial vaginosis (BV) is a common, complex clinical syndrome characterized by alterations in the normal vaginal flora. Bacterial vaginosis has been associated with a variety of adverse health outcomes including endometritis; post-abortion endometritis; nongonococcal, nonchlamydial pelvic inflammatory disease; and an increased risk of acquiring and transmitting HIV infection. In pregnancy, BV is associated with premature rupture
and Interventions Go to Intervention Details: Device: VS Sense An applicator to diagnose pH increase above 5.2 Outcome Measures Go to Primary Outcome Measures : Does screening for BV using VS-SENSE in pregnant women with h/o preterm delivery or with premature contractions, and treatment will reduce or prevent Late miscarriage, preterm birth, preterm PROM, chorioamnionitis, and postpartumendometritis. [ Time Frame: One year ] Eligibility Criteria Go to Information from the National Library of Medicine Choosing
that will receive antibiotics immediately after clamping the umbilical cord Drug: Antibiotic Cefazolin 1gm Intravenously and Azithromycin 500mg Intravenously Outcome Measures Go to Primary Outcome Measures : Endometritis and Wound Infection [ Time Frame: Patients were followed from the time of surgery until 6 weeks postpartum. ] In non-pregnant patients having certain types of surgery with a high risk of infection, prophylactic antibiotics are routinely administered before the surgical procedure begins (...) of antibiotic prophylaxis. All patients undergoing cesarean delivery will be eligible except for the patients with the diagnosis of chorioamnionitis. One group will receive Cefazolin 1gm intravenous + Azithromycin 500mg intravenous 30-60 minutes prior to incision. The second group will receive the same antibiotics immediately after cord clamp. The primary outcomes will be endometritis, wound infection, neonatal sepsis evaluations, proven cases of neonatal infection. Secondary outcomes will be patients
Morbidity related to maternal group B streptococcal infections. Group B streptococcus is known to be a leading cause of neonatal infection, but less appreciated is the fact that it causes maternal infection also. Maternal group B streptococcal infections during pregnancy and delivery threaten not only the mother, but the child as well. Postpartum infection, such as mastitis, bacteremia, sepsis, meningitis, endometritis, and wound infections are hazards to the mother. We describe the various (...) maternal group B streptococcal infections, their characteristics, associated neonatal morbidity, and prevention and treatment strategies during pregnancy, delivery, and in the postpartum period.
. Nipple trauma and cellulitis. Usually caused by Staphylococcus spp. Postoperative infection following caesarean section : is the most important risk factor for puerperal pyrexia; there is a significantly increased risk of postpartum sepsis, wound problems, urinary tract infections and fever following LSCS. In the UK there is an 8% risk of infection following LSCS - appropriate antibiotic prophylaxis (not co-amoxiclav) before skin incision should be offered routinely. [ ] Prophylaxis reduces (...) endometritis by 66-75% and also reduces rate of wound infection. [ ] Presenting features may include: Painful, red suture line. Deep tenderness on palpation. Lochia pink/coloured. Deep venous thrombosis : [ ] A low-grade pyrexia can be caused by . Caused by venous stasis and hypercoagulability. Painful, swollen calf. Ovarian vein thrombophlebitis is a rare cause of persistent puerperal pyrexia. [ ] Other infections : Pyrexia in a recently delivered mother may also be due to causes common to all
: Natural menopause or oophorectomy. Anti-oestrogenic treatments - eg, tamoxifen, aromatase inhibitors. Radiotherapy or chemotherapy. It can also occur postpartum or with breast-feeding, due to reduced oestrogen levels. Presentation It is important to initiate discussion regarding any vaginal dryness with postmenopausal women, as many women are very reluctant to talk about it or initiate conversation about it. Women are poorly aware that vulvovaginal atrophy is a chronic condition with a significant (...) causing concern. Investigation may be needed to exclude other problems: Any postmenopausal bleeding requires investigation. If there is discharge or bleeding, an infection screen may be relevant (for vaginal infections or endometritis). Other causes of recurrent UTI. Screen for diabetes may be considered (uncontrolled diabetes can contribute to symptoms). Other possible investigations are: Vaginal pH testing (using pH paper and sampling from the mid-vagina, not the posterior fornix). The result
in those aged under 20, where it is found in almost 13%. [ ] Does not affect pregnancy outcome but mother-to-baby transmission can occur at delivery, causing ophthalmia neonatorum in 15-25% or pneumonitis in 5-15% of newborns. It may be associated with postpartumendometritis. [ ] T. vaginalis : Increasingly thought to be associated with preterm delivery and low birth weight. Vaginal discharge following miscarriage, abortion or delivery These patients should be fully investigated and empirically (...) treated whilst awaiting results of swabs. BV is associated with endometritis and PID following abortion but retained products of conception should be considered in all women, particularly in the presence of a heavy growth of coliforms. Investigations Patients who present with typical symptoms suggestive of BV or vulvovaginal candidiasis, who are at low risk of an STI , can be treated without sampling. [ ] Otherwise, STI screening and swabs should be offered: Endocervical swab in transport medium
of, for example, endometritis, manual removal of placenta, curettage. Assisted conception. Presentation It may be an incidental finding on routine anomaly ultrasound. Painless bleeding starting after the 28th week (although spotting may occur earlier) is usually the main sign: Typically, it is sudden and profuse but usually does not last for long and so is only rarely life-threatening. Women with placenta praevia are reported to be 14 times more likely to bleed in the antenatal period compared with women (...) is delivered urgently whatever its gestational age. Hysterectomy should also be considered in severe cases. If immediate delivery is not likely, maternal steroids may be indicated in order to promote fetal lung development and reduce the risk of respiratory distress syndrome and intraventricular haemorrhage [ ] . Complications Potentially fatal hypovolaemic shock resulting from severe antepartum, intrapartum or postpartum bleeding. Venous thromboembolism is associated with prolonged inpatient care
perforation. The patient may require iron supplementation if Hb has fallen. Warn of the risk of constipation. Prognosis 90% of cases of postpartumendometritis treated with antibiotics improve within 48-72 hours. [ ] If this is not the case, the patient should be re-evaluated. Did you find this information useful? Thanks for your feedback! Why not subscribe to the newsletter? Email address * We'd love to send you our articles and latest news by email, giving you the best opportunity to stay up to date (...) haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence. BJOG. 2013 Feb120(3):277-85 ; Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double-blind randomised controlled trial. BJOG. 2012 Jul119(8):975-82 ; Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. 2004 Oct 18(4):CD001067. ; Postpartum ultrasound in women with postpartumendometritis, after cesarean section and after manual evacuation
of intrapartum amnioinfusion for meconium-stained AF. In every case, group allocation was based exclusively on meconium in AF. Only published studies with clearly documented outcome data were included. The trials were evaluated for meconium below the vocal cords, meconium aspiration syndrome, fetal acidemia, cesarean delivery, and postpartumendometritis. Each trial was evaluated for the quality of its methodology, inclusion and exclusion criteria, adequacy of randomization, amnioinfusion protocols (...) . 46), of meconium below the vocal cords, and neonatal acidemia. Subjects allocated to receive amnioinfusion also had a significantly lower overall cesarean rate (OR 0.74, 95% CI 0.59, 0.93) without increased postpartum endometritis.Amnioinfusion in cases of meconium-stained fluid significantly improves neonatal outcome, lowers the cesarean delivery rate, and does not increase the postpartumendometritis rate.
trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45 (...) ). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone