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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.
, 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
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
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.
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 postpartumendometritis. 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.
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
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
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
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.
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.
, in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were identified from electronic records and confirmed by chart review by a child neurologist, and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities (n = 109). Controls (n = 218) were randomly selected from the study population.Association between clinical (...) chorioamnionitis and increased risk of CP in term and near-term infants.Most CP cases had hemiparesis (40%) or quadriparesis (38%); 87% had been diagnosed by a neurologist and 83% had undergone neuroimaging. Chorioamnionitis, considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinically, was noted in 14% of cases and 4% of controls (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5-10.1; P =.001). Independent risk factors identified in multiple logistic
. 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
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
disadvantage. Women pregnant in their teens are more likely to suffer anaemia, eclampsia, puerperal endometritis and postnatal depression. [ ] The fetus is at risk of higher rates of perinatal mortality, low birth weight, sudden infant death syndrome and substance dependence. [ ] Pregnancy risk factors Rates of teenage pregnancy vary widely within the UK with much higher rates in areas of social deprivation. Teenage girls particularly at risk are those who: [ ] Have been, or are in care. Are homeless
: 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 (...) acidity of the vagina (pH 4.5 or above) and vulvovaginal candidiasis (pH <4.5). [ ] It cannot, however, be used to differentiate between BV and T. vaginalis . NB : a high vaginal swab (HVS) is only worthwhile where there are recurrent symptoms, treatment failure or in pregnancy, postpartum, post-abortion or post-instrumentation. [ ] Management Take history with particular care to elicit clues suggestive of the presence of an STI. If there are suggestions that there might be an STI or for recurrent
Apr120(5):621-7. doi: 10.1111/1471-0528.12120. Epub 2013 Jan 23. ; Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008 Dec22(6):999-1012. doi: 10.1016/j.bpobgyn.2008.08.004. Epub 2008 Sep 25. ; NICE Clinical Guideline (Dec 2014) ; Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun107(6):1226-32. ; Recombinant Factor VIIa in Post-partum Hemorrhage: A New Weapon in Obstetrician's Armamentarium. N Am J Med (...) 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
in the placenta were characterized by severe necrosis of the decidua basalis and the labyrinth, fibrinoid degeneration of decidual vessels, and microthrombosis. Pyometra and endometritis at the sites of previous placental attachment, characterized by ulceration, central necrosis, and moderate cellular infiltration consisting of neutrophils and macrophages, were observed postpartum. Pups sacrificed at the age of 9 days exhibited interstitial pneumonia with few granulomas and granulomatous hepatitis
group (24 patients) of those receiving 24 hours of cephalosporin prophylaxis, and 3) a long-course group (25 patients) of those receiving 5 days of cephalosporin prophylaxis. Evaluation of postpartum outcome was based on the development of endometritis and /or wound infection and on the fever index. Based on the findings of no significant differences between the 3 treatment groups for 11 potential risk factors for postpartum morbidity, randomization was judged to have been successful. A significant (...) decrease in the rate of endometritis and/or wound infection was seen in both the short- and long-course prophylactic groups as compared to the control group (29%, 20%, and 65%, respectively). There were no significant differences in postpartum morbidity between the short- and long-course prophylactic groups. Based on fever index data and individual case evaluations, there was no evidence that antibiotic prophylaxis increased the chance of more severe infection.