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Postpartum Endometritis

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461. 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

462. 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

463. 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

464. Antimicrobial prophylaxis in pregnancy: a randomized, placebo-controlled trial with cefetamet-pivoxil in pregnant women with a poor obstetric history. (Abstract)

randomized to receive a single oral dose of 2 gm of cefetamet-pivoxil or a placebo at a gestational age between 28 and 32 weeks. Patients were assessed at delivery and 1 week post partum for pregnancy outcome, postpartum endometritis, human immunodeficiency virus-1 and gonococcal infections.A total of 253 (79%) women gave birth at the maternity hospital, of whom 210 (83%) attended the follow-up clinic. Overall, 18.1% of these pregnant women were human immunodeficiency virus-1 seropositive, whereas 9.5 (...) % had antibodies against Treponema pallidum. There was a significant difference between cefetamet-pivoxil- and placebo-treated women in infant birth weight (2927 gm vs 2772 gm, p = 0.03) and low birth weight (< 2500 gm) rates (18.7% vs 32.8%, p = 0.01, odds ratio 2.1, 95% confidence interval 1.2 to 3.8). The stillbirth rate was 2.2% in the cefetamet-pivoxil group and 4.2% in the placebo group (not significant). Postpartum endometritis was found in 17.3% in the intervention arm versus 31.6

1997 American journal of obstetrics and gynecology Controlled trial quality: predicted high

465. The effect of placental management at cesarean delivery on operative blood loss. (Abstract)

delivery at cesarean section. Operative blood loss was measured directly.Blood loss measured at cesarean delivery was greater in the manually delivered group (967 +/- 248 ml) than in the spontaneously delivered group (666 +/- 271 ml, p < 0.0001). The incidence of postpartum endometritis was sevenfold greater in the manual than the spontaneous group (23% vs 3%, respectively; p < 0.05).We conclude that spontaneous expulsion of the placenta at cesarean delivery results in less operative blood loss (...) and a lower incidence of postoperative endometritis.

1992 American journal of obstetrics and gynecology Controlled trial quality: uncertain

466. 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

467. 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

468. Prophylactic amnioinfusion in preganancies complicated by chorioamnionitis: a prospective randomized trial. Full Text available with Trip Pro

, placental abruption, or a nonreassuring fetal heart rate tracing. Consenting patients were randomized to receive antibiotics (ampicillin or penicillin with gentamicin) and acetaminophen with or without amnioinfusion. All patients received intrauterine pressure catheter placement. For study patients, normal saline at room temperature was infused at 10 mL/min for 60 min, then 3 mL/min until delivery. Postpartum endometritis was defined as a temperature = 100.4 degrees F accompanied by uterine tenderness (...) randomization to delivery, cesarean section rate, or umbilical cord arterial pH. The mean temperature at the time of delivery was 99.8+/-0.9 degrees F for the amnioinfusion group versus 100.5+/-1.0 degrees F for the control group (p=0.046). Three of 17 amnioinfusion patients and 3 of 17 control patients had postpartum endometritis. There was 1 neonatal infection in the treatment group and no neonatal infections among the control patients. Prophylactic amnioinfusion was associated with a decline

1998 American journal of perinatology Controlled trial quality: uncertain

469. Effects of placental delivery method and intraoperative glove changing on postcesarean febrile morbidity. (Abstract)

delivery; Group C (n = 27)--glove change with manual placental delivery; and Group D (n = 28)--glove change with expressed placental delivery. Glove change was performed by removal of a second glove after delivery of the fetal head. Variables examined included febrile morbidity, endometritis, maximums and durations of elevated temperatures, as well as other demographic, intrapartum, and postpartum variables. Febrile morbidity and endometritis rates were not significantly different between the four (...) groups. When the groups were combined so as to compare no glove change versus glove change (Groups A and B vs. C and D) and manual versus expressed placental delivery (Groups A and C vs. B and D), there were no significant differences in either febrile morbidity (relative risk: 0.7, 95% CI: 0.3-1.4 and relative risk: 1.4, 95% CI: 0.6-3.5) or endometritis (relative risk: 1.2, 95% CI: 0.5-2.8 and relative risk: 1.5, 95% CI: 0.6-3.6), respectively. There were no statistically significant differences

1998 The Journal of maternal-fetal medicine Controlled trial quality: uncertain

470. Concomitant use of glucocorticoids: a comparison of two metaanalyses on antibiotic treatment in preterm premature rupture of membranes. (Abstract)

of membranes in which glucocorticoids were used as additional treatments and compared the results with those of a previously published metaanalysis of antibiotic treatment in preterm premature rupture of membranes, which excluded studies with concomitant glucocorticoids. Primary outcomes included chorioamnionitis, postpartum endometritis, neonatal sepsis, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality. A logistic regression analysis (...) was performed to test whether glucocorticoids significantly influenced the effect of antibiotic treatment.Among the 509 patients from five trials on antibiotic and glucocorticoid treatment published between 1986 and 1993 antibiotic therapy did not show any significant effect on any of the outcomes analyzed. In contrast, antibiotic therapy without concomitant use of glucocorticoids significantly reduced the odds of chorioamnionitis, postpartum endometritis, neonatal sepsis, and intraventricular hemorrhage

1998 American journal of obstetrics and gynecology Controlled trial quality: uncertain

471. A randomized clinical trial of two surgical techniques for cesarean section. (Abstract)

morbidity was defined as a temperature > or =38 degrees C on two occasions 4 hours (hr) apart excluding the first postoperative day. Endometritis was defined as postpartum temperature > or =38 degrees C on two occasions 4 hr apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine and 150 patients were allocated to group 1 and to group 2, respectively. A shorter median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range (...) ) operative time [30 min (10-65) vs. 40 min (20-110), respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative complications, proportion of patients who required transfusion, endometritis, sepsis, febrile morbidity, and urinary tract infections. A higher rate of wound infections was found in group 2 than in group 1 [14 of 150 (9.3%) vs. 2 of 149 (1.3%), respectively, p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter opening

1998 American journal of perinatology Controlled trial quality: uncertain

472. Risk factors for neonatal sepsis in offspring of women with prelabor rupture of the membranes at 34-42 weeks. (Abstract)

latency group. All neonatal infections were classified as verified sepsis (positive culture) or clinical sepsis. The aim of the study was to compare the perinatal infectious outcome between the groups with different expectant managements in women with PROM and to study the association between demographic, intrapartum and postpartum variables and neonatal sepsis. In the short latency group one neonate had a proven sepsis while four neonates with proven sepsis were found in the early induction group (...) (OR = 27.14, 95% CI 2.38-309.16), endometritis (OR = 18.08, 95% CI 1.82-179.87), CRP over 20 mg/l in the umbilical cord (OR = 17.12, 95% CI 5.68-52.12) and Apgar score < 7 after 1, 5 or 10 minutes. In a stepwise logistic regression analysis a significant association was found between clinical sepsis and cesarean section (OR = 10.08, 95% CI = 3.26-31.20), time from ROM to delivery > 32 h (OR = 3.74, 95% CI 1.62-8.62), gestational age 34-36 weeks (OR = 3.16, 95% CI 1.11-8.96) and parous women (OR = 2.41, 95

1998 Journal of perinatal medicine Controlled trial quality: uncertain

473. Methylergometrine during the early puerperium; a prospective randomized double blind study. (Abstract)

Methylergometrine during the early puerperium; a prospective randomized double blind study. The purpose of the study was to determine the efficacy of 72-hour prophylactic oral methylergometrine in reducing postpartum hemorrhage and endometritis during the early puerperium, and the effect of methylergometrine on lochia and requests for analgesics.A prospective randomized double-blind study was undertaken; a total of 217 women received 0.2 mg methylergometrine intravenously after delivery (...) puerperium has no effect on lochia. Endometritis and postpartum hemorrhage were rare in both groups. There was no increase in requests for analgesics among women given oral methylergometrine.

1998 Acta Obstetricia et Gynecologica Scandinavica Controlled trial quality: uncertain

474. 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

475. [The efficacy of prophylactic antibiotic and tocolytic therapy for premature rupture of the membranes--a prospective randomized study]. (Abstract)

) was managed conservatively with bed rest only. At the time of admission to the study, there were no clinical signs of infection, fetal distress, or active labor in either group. All patients were delivered if the pregnancy had reached 35 weeks of gestation or later, had established labor, or developed evidence of chorioamnionitis or fetal distress. Prolongation for more than 72 hours was greater in group 1 than in group 2. There was no difference in the incidence of chorioamnionitis, postpartum (...) endometritis, or placental infection in the groups. However, the incidence of a low Apgar score (7 < at 5 min), requiring artificial ventilation, and infection was more common in group 1. It is concluded that the use of antibiotics and tocolytics might make the management of PROM more complicated.

1993 Nihon Sanka Fujinka Gakkai zasshi Controlled trial quality: uncertain

476. 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

477. Pregnancy after classic cesarean delivery. (Abstract)

weeks without preterm labor and resulted in fetal death. The prevalence of asymptomatic dehiscence was 9% (95% confidence interval 5, 15). There was no significant difference between patients with uterine dehiscence (n = 15) and patients with intact uteri (n = 141) with regard to maternal demographics, duration of labor, cervical dilatation at time of surgery, transfusion of packed red cells, bowel injury, postpartum endometritis, wound breakdown, thrombophlebitis, or umbilical arterial pH less than

2002 Obstetrics and Gynecology

478. Short- versus long-course prophylactic antibiotic treatment in Cesarean section patients. (Abstract)

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.

1980 Obstetrics and Gynecology Controlled trial quality: uncertain

479. 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

480. 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

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