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Postpartum Endometritis

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461. Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section. Full Text available with Trip Pro

of febrile morbidity, wound infection, and endometritis were less for those treated with cefazolin (4.0, 3.2, and 0.8%, respectively) than for those treated with moxalactam (9.2, 7.7, and 1.6%, respectively). No serious adverse effects were apparent in the mother and newborn infant from short-term exposure to either drug. Although the newer, more expensive, and broader-spectrum cephalosporin, moxalactam, was associated with a low postoperative febrile morbidity rate and short postpartum hospitalization

1985 Antimicrobial agents and chemotherapy Controlled trial quality: uncertain

462. Conservative versus aggressive management of preterm rupture of membranes. A randomized trial of amniocentesis. (Abstract)

differences in these complications were demonstrated individually. No differences in antepartum hospital days, postpartum hospital days, postpartum endometritis, or sepsis were apparent between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

1984 American journal of perinatology Controlled trial quality: uncertain

463. Moxalactam versus clindamycin plus tobramycin for the treatment of puerperal infections. (Abstract)

%) of those given combination therapy. The two failures of moxalactam therapy were associated with enterococcal infection. Failures of clindamycin/tobramycin therapy were due to enterococcal infection, abscess formation, and moderately severe diarrhea. This study indicates that moxalactam is as effective and safe as the combination of clindamycin/tobramycin for the treatment of postpartum endometritis. (...) Moxalactam versus clindamycin plus tobramycin for the treatment of puerperal infections. Sixty women with the diagnosis of puerperal endometritis were randomized to receive either moxalactam (n = 29) or the combination of clindamycin and tobramycin (n = 31) as therapy for their infection. Endometrial bacteriology consisted of mixed flora, both aerobic and anaerobic gram-positive and gram-negative organisms. Clinical cure was achieved in 27 (93%) of the moxalactam-treated patients and 28 (90

1987 Southern medical journal Controlled trial quality: uncertain

464. [Effects of routine administration of methylergometrin during puerperium on involution, maternal morbidity and lactation]. (Abstract)

involution of the uterus was accelerated in the first few days following birth, but after 4 weeks there were no longer any significant differences. Post-partum pains were almost twice as intense in the treated group as in the untreated group. It proved impossible to reduce the number of cases of infection (lochiostasis, axillary temperature over 37.5 degrees C) by administering Methergin during the puerperium; following spontaneous births there were actually more cases of endometritis in the treated

1986 Geburtshilfe und Frauenheilkunde Controlled trial quality: uncertain

465. Cefonicid vs. cefoxitin for cesarean section prophylaxis. (Abstract)

postpartum. In those patients receiving cefonicid prophylaxis, endometritis incidence was 17.3% (14 of 81). This finding was not statistically significant (P less than .397) when compared to the 12.1% incidence of endometritis (7 of 58) with cefoxitin. In addition, the febrile morbidity incidence for cefonicid prophylaxis was 23.5% (19 of 81) as compared to 15.5% (9 of 58) for cefoxitin (P less than .25). Because the two drugs appear to be equally efficacious, cefonicid may be the better choice because

1987 Journal of Reproductive Medicine Controlled trial quality: uncertain

466. Results of a multicenter comparative study of single-dose cefotetan and multiple-dose cefoxitin as prophylaxis in patients undergoing cesarean section. (Abstract)

clinical response rate was achieved in 139 of 162 of the evaluable subjects given cefotetan (86 percent) and in 71 of 79 patients (90 percent) given cefoxitin. The respective satisfactory bacteriologic response rates were 91 percent (135 of 148 patients) and 93 percent (68 of 73 patients). The incidences of endometritis for cefotetan and cefoxitin (12 percent and 5 percent, respectively) and of postoperative wound infection (3 percent and 5 percent, respectively) were also not significantly different (...) . Bactericidal levels of cefotetan were maintained in plasma in the immediate postpartum period. Both drugs were well tolerated. Single-dose prophylaxis with cefotetan was comparable to multiple doses of cefoxitin in reducing infectious morbidity in women undergoing cesarean section.

1988 American journal of surgery Controlled trial quality: uncertain

467. Upper genital tract isolates at delivery as predictors of post-cesarean infections among women receiving antibiotic prophylaxis. (Abstract)

Upper genital tract isolates at delivery as predictors of post-cesarean infections among women receiving antibiotic prophylaxis. The introduction of antibiotic prophylaxis for cesarean delivery has decreased the risk of postpartum endometritis and wound infection, but factors that contribute to prophylaxis failure are not understood. To determine factors that might contribute to postpartum infections following antibiotic prophylaxis, we cultured amniotic fluid, decidua, and chorioamniotic (...) membrane specimens for anaerobic and facultative bacteria and for genital mycoplasmas at cesarean delivery. Women were assessed daily for the development of infections, and if endometritis developed, a protected endometrial culture was obtained. Postpartum endometritis developed in 16 and wound infection in four of 102 women. Infection rates were similar for women receiving cefotetan (N = 50) or cefoxitin (N = 52) for prophylaxis. The isolation of group B streptococcus (P less than .001

1991 Obstetrics and Gynecology Controlled trial quality: uncertain

468. A prospective randomized study of saline solution amnioinfusion. (Abstract)

A prospective randomized study of saline solution amnioinfusion. We performed a prospective randomized study of saline solution amnioinfusion in four types of pregnancy complications: postterm pregnancy, variable decelerations in labor, preterm labor, and oligohydramnios-suspected growth retardation. A total of 100 patients were randomized, 43 to undergo amnioinfusion and 57 to be in a control group. Patients undergoing amnioinfusion had a significantly decreased incidence of postpartum (...) endometritis (2.4% vs 19%, p = 0.01) and a lower incidence of cesarean delivery that was due to fetal distress in labor (4.7% vs 16%, p = 0.07). The use of amnioinfusion also made a significant contribution to the four-quadrant ultrasonographic estimate of amniotic fluid volume (14.7 vs 9.8 cm, p less than 0.001). All other maternal and neonatal outcome parameters were similar between the two groups. We conclude that saline solution amnioinfusion in labor may be a beneficial procedure but that further

1990 American journal of obstetrics and gynecology Controlled trial quality: uncertain

469. Antibiotic prophylaxis: is there a difference? (Abstract)

to be superior in preventing postpartum endometritis: ampicillin 2 gm (p = 0.03), cefazolin 2 gm (p = 0.005), piperacillin 4 gm (p = 0.0007), and cefotetan 1 gm (p = 0.0001). Single-dose cephalosporin antibiotic prophylaxis was found to result in approximately a twofold increase in Enterococcus faecalis colonization of the vagina (p less than 0.01). This may be significant in patients in whom postpartum endometritis develops and who have failure of initial treatment with a broad-spectrum cephalosporin, e.g (...) ., cefoxitin or cefotetan, or a combination such as clindamycin or metronidazole plus an aminoglycoside. Rupture of amniotic membranes for a half hour or more was associated with an increased risk for postpartum endometritis. The use of internal fetal monitoring was associated with an increased risk of soft tissue pelvic infection.

1990 American journal of obstetrics and gynecology Controlled trial quality: uncertain

470. Antimicrobial therapy in preterm premature rupture of membranes: results of a prospective, double-blind, placebo-controlled trial of erythromycin. (Abstract)

delivered of infants within 4 days (p = 0.02). Erythromycin treatment among women less than 28 and between 33 to 34 weeks' gestation was not associated with prolonged latency or other changes. There were no differences between erythromycin- and placebo-treated women in the occurrence of clinically recognized chorioamnionitis, postpartum endometritis, or neonatal infectious morbidity. In this double-blind, placebo-controlled trial, erythromycin treatment was well tolerated, safe, and associated

1991 American journal of obstetrics and gynecology Controlled trial quality: predicted high

471. Ampicillin/sulbactam versus ampicillin alone for cesarean section prophylaxis: a randomized double-blind trial. (Abstract)

Ampicillin/sulbactam versus ampicillin alone for cesarean section prophylaxis: a randomized double-blind trial. To study the effectiveness of anaerobic coverage in prevention of postpartum endometritis in women undergoing nonelective cesarean sections, we conducted a randomized prospective double-blind study of women undergoing cesarean sections and requiring antibiotic prophylaxis from April 1, 1989, through December 31, 1990. Ninety-four patients were enrolled in the study. Forty-five (...) patients received ampicillin alone and 46 received ampicillin in conjunction with sulbactam. All patients were evaluated prior to surgery and in the postoperative period. Ninety-one patients completed the study and their records were analyzed. Patients were divided into two groups depending on the presence or absence of ruptured membranes. Seventy-five percent of patients had ruptured membranes. Failure of prophylaxis and subsequent endometritis was documented in 8.8% of patients who received

1995 American journal of perinatology Controlled trial quality: uncertain

472. Mass antimicrobial treatment in pregnancy. A randomized, placebo-controlled trial in a population with high rates of sexually transmitted diseases. (Abstract)

) and postpartum endometritis (3.8% versus 10.4%, P = .05) in the intervention than in the placebo group. Neisseria gonorrhoeae was isolated from the cervixes of postpartum women in 1.8% of the intervention group as compared to 4.2% of the control group. These data suggest a beneficial effect of antimicrobial prophylaxis on pregnancy outcome. Larger studies should be carried out to examine the public health impact of this intervention.

1995 Journal of Reproductive Medicine Controlled trial quality: predicted high

473. Pre-induction cervical ripening: a randomized comparison of two methods. (Abstract)

cervical scores. In the group receiving hygroscopic dilators, only 28% entered the active phase of labor within 6 hours of oxytocin infusion compared with 45% (P < .001) in the PGE2 group. Thus, in this study, a change in cervical score did not directly predict induction success. There was a higher rate of postpartum endometritis (24 versus 14%; P = .007) and suspected neonatal infection (10 versus 5%; P = .03) in the dilator group.Pre-induction ripening by hygroscopic dilators and intracervical PGE2 (...) Pre-induction cervical ripening: a randomized comparison of two methods. To compare two methods of pre-induction cervical ripening in a randomized clinical trial.A single intracervical prostaglandin E2 (PGE2) gel application was compared with a single insertion of hygroscopic dilators in 441 women at term with unfavorable cervical scores. Induction success was defined as entry into active labor within 6 hours of oxytocin infusion.There was no statistical difference in pre- or post-ripening

1995 Obstetrics and Gynecology Controlled trial quality: uncertain

474. A prospective, randomized, placebo-controlled trial of penicillin in preterm premature rupture of membranes. (Abstract)

prophylactic penicillin had fewer infectious complications, including intraamniotic infection and postpartum endometritis (4 vs 11, p < 0.03), without adverse effects on the mother or fetus.Prophylactic penicillin in patients with preterm premature rupture of membranes reduces maternal infectious complications without adversely affecting the mother or newborn.

1994 American journal of obstetrics and gynecology Controlled trial quality: predicted high

475. Management of premature rupture of membranes at term: randomized trial. (Abstract)

by sterile speculum examination of the vagina. Patients randomized to expectant management were transferred to antenatal care and were not examined vaginally until they went into labor. Patients randomized to induction of labor had induction with oxytocin 8 hours after premature rupture of membranes.Two hundred sixty-two patients were randomized to the expectant management and induction of labor groups. The cesarean birth rate and the clinical diagnosis of postpartum endometritis was not significantly

1994 American journal of obstetrics and gynecology Controlled trial quality: uncertain

476. A randomised study on the impact of peroral amoxicillin in women with prelabour rupture of membranes preterm. (Abstract)

delivered within 1 week after admission. The average rupture-to-expulsion interval was 68.4 h in the placebo group and 91.7 h in the amoxicillin group, implying a significantly prolonged stay by 43% in the amoxicillin group (p = 0.03). The other outcome variables registered (birth weight, stillbirth prevalence, vaginal haemorrhage and postpartum endometritis-myometritis) did not differ significantly in the two treatment groups. There was a trend towards a longer duration of stay in the neonatal ward

1996 Gynecologic and obstetric investigation Controlled trial quality: uncertain

477. Impact of intrapartum intravenous ampicillin on pregnancy outcome in women with preterm labor: a randomised, placebo-controlled study. (Abstract)

Impact of intrapartum intravenous ampicillin on pregnancy outcome in women with preterm labor: a randomised, placebo-controlled study. The purpose of this study was to elucidate whether the use of intravenous ampicillin (vs. placebo therapy) in women in early active-phase preterm labor reduces infectious complications postpartum in mothers and their newborns. A randomised, double-blind, placebo-controlled study was carried out on 102 women with gestational age < 37 completed weeks in the active (...) 2.0-19.4) and puerperal endometritis-myometritis (OR 3.7; 95% CI 1.3-10.3). It is concluded that women in the active phase of preterm labor and their newborns benefit from treatment with intravenous ampicillin. Antibiotic treatment reduces the incidence of neonatal infectious morbidity, of puerperal endometritis and of histological chorioamnionitis.

1996 Gynecologic and obstetric investigation Controlled trial quality: predicted high

478. Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, double-blind trial of ampicillin-sulbactam prophylaxis. (Abstract)

Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, double-blind trial of ampicillin-sulbactam prophylaxis. To evaluate the efficacy of intrapartum prophylactic administration of ampicillin-sulbactam in reducing intraamniotic infection and postpartum endometritis in patients with meconium-stained amniotic fluid (AF).Patients with intrapartum meconium-stained AF were randomized to receive either ampicillin-sulbactam or normal saline (placebo) intravenously at the time (...) risk [RR] 0.48, 95% confidence interval [CI] 0.22-0.98). The incidence of postpartum endometritis was also reduced, but the difference was statistically nonsignificant (8.3 versus 16.7%, P = .16; RR 0.64, 95% CI 0.30-1.33).Prophylactic intravenous ampicillin-sulbactam significantly reduces intra-amniotic infection in patients with meconium-stained AF.

1996 Obstetrics and Gynecology Controlled trial quality: predicted high

479. Warm tub bath during labor. A study of 1385 women with prelabor rupture of the membranes after 34 weeks of gestation. (Abstract)

before labor was induced with oxytocin. Digital examinations of the cervix were avoided until onset of active labor or until the time induction was planned. For statistical analysis Fisher's exact test was used.Chorioamnionitis during labor occurred in 1.1% of the women in the bath group and in 0.2% in the reference group (p = 0.06). Postpartum endometritis was found in three cases both in the bath group (0.6%) and in the reference group (0.4%) (p = 0.68). The frequency of neonates receiving

1996 Acta Obstetricia et Gynecologica Scandinavica Controlled trial quality: uncertain

480. Group B Streptococcus and preterm premature rupture of membranes: a randomized, double-blind clinical trial of antepartum ampicillin. (Abstract)

of patients with cultures negative for group B Streptococcus who remained undelivered 7 days after preterm premature rupture of membranes 39% vs 27%; p = 0.40; relative risk, 1.4; 95% confidence interval 0.61 to 3.3). There were no differences between the treatment and placebo arms of the group B Streptococcus positive and negative cohorts in incidence of cesarean section, chorioamnionitis, postpartum endometritis, or neonatal infectious morbidity.Use of antibiotics increases the percentage of patients

1996 American journal of obstetrics and gynecology Controlled trial quality: predicted high

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