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Postpartum Endometritis

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521. 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

522. 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

523. Duration of antibiotic therapy after preterm premature rupture of fetal membranes. (Abstract)

rates of chorioamnionitis, postpartum endometritis, and neonatal morbidity and mortality.Forty-eight patients were randomly selected. There was no statistically significant difference in the ability to achieve a 7-day latency (relative risk 0.83, 95% CI 0.51-1.38). In addition, there was no statistically significant difference in the rates of chorioamnionitis, endometritis, and our composite neonatal morbidity.In patients with PPROM, length of antibiotic therapy does not change the rate of a 7-day (...) latency or affect the rate of chorioamnionitis, postpartum endometritis, or neonatal morbidity.

2003 American journal of obstetrics and gynecology Controlled trial quality: predicted high

524. Magnesium sulfate in women with mild preeclampsia: a randomized controlled trial. (Abstract)

preeclampsia after randomization (relative risk = 0.8, 95% confidence interval 0.4, 1.5, P =.41). None in either group developed eclampsia or thrombocytopenia. Women assigned magnesium had similar rates of cesarean delivery (30% versus 25%), chorioamnionitis (3% versus 2.7%), endometritis (5.3% versus 4.3%), and postpartum hemorrhage (1% versus 0.9%), compared to those assigned placebo. Neonates born to women assigned magnesium had similar mean Apgar scores at 1 and 5 minutes as those born to women

2003 Obstetrics and Gynecology Controlled trial quality: predicted high

525. A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. (Abstract)

cefoxitin or placebo administration after umbilical cord clamping. Postpartum complications including febrile morbidity, wound infection, endometritis, urinary tract infection, pneumonia and transient postpartum fever were recorded, as were the duration of hospital stay and the need for therapeutic antibiotics.Wound infection was the most common complication occurring in 13.3% and 12.5% of women in the placebo and cefoxitin groups, respectively. Prophylactic antibiotics did not decrease febrile (...) morbidity, wound infection, endometritis, urinary tract infection and pneumonia. Women who received cefoxitin stayed on average a day less in hospital than those who received placebo (6.9 vs 7.8 days, risk difference 0.94 CI 1.57 - 0.31 days). Eleven women (4.6%) in the placebo group and eight (3.4%) in the cefoxitin group had microbiological evidence of wound infection. Staphylococcus aureus was the most common pathogen (43%) isolated. Similar proportions in both groups (6.3% placebo and 5.1% cefoxitin

2001 BJOG Controlled trial quality: predicted high

526. Vaginal preparation with povidone iodine and postcesarean infectious morbidity: a randomized controlled trial. (Abstract)

Vaginal preparation with povidone iodine and postcesarean infectious morbidity: a randomized controlled trial. To determine whether vaginal preparation with povidone iodine before cesarean decreased the incidence of postpartum infectious morbidity.Participants were randomly assigned to vaginal preparation with povidone iodine (n = 247) or no preparation (n = 251). Postpartum infectious morbidity included fever, defined as temperature of 38C or greater after the day of surgery; endometritis (...) , defined as fever with abdominal or uterine tenderness and initiation of intravenous antibiotics; and wound separation, defined as disruption of the abdominal incision that required wound care. We calculated overall rates of postpartum infectious morbidity, relative risks (RR), and 95% confidence intervals (CI) for the effect of vaginal preparation. As designed and reported, the trial had at least 80% power to detect a 10% or greater absolute difference in rates of overall infectious morbidity, fever

2001 Obstetrics and Gynecology Controlled trial quality: predicted high

527. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. (Abstract)

endometritis, postpartum sepsis, postcesarean wound infection, or episiotomy wound infection, necessitating antimicrobial therapy. According to the power analysis, 180 patients were needed for both treatment arms to show a three-fold difference in the rates of preterm births.The overall prevalence of BV was 10.4%. Of all BV-positive women, 375 (66%) were randomized to the treatment arms. The primary cure rate was 66% in the clindamycin group; in the placebo group, 34% spontaneously cleared BV (odds ratio (...) pregnancies during the first antenatal clinic visit at 10--17 weeks' gestation. Bacterial vaginosis-positive women with no past history of preterm delivery were randomized to a single course of treatment with either 2% vaginal clindamycin cream or identical placebo cream for 7 days. Repeat Gram stains were taken 1 week after treatment and at 30--36 weeks' gestation. Preterm delivery was defined as spontaneous delivery before 37 gestational weeks. Peripartum infectious morbidity was defined as postpartum

2001 Obstetrics and Gynecology Controlled trial quality: predicted high

528. Prophylactic amnioinfusion in preganancies complicated by chorioamnionitis: a prospective randomized trial. (Abstract)

, 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

529. The effect of antenatal corticosteroid therapy on pregnancies complicated by premature rupture of membranes. (Abstract)

subgroups 31-32 and 33-34 weeks (p<0.04), and in all birth weight subgroups (p<0.03). RDS was statistically a significant factor which resulted in increased perinatal mortality in the control group (p=0.02). Regarding the occurrence of postpartum endometritis there was a statistically significant increase among the corticosteroid treated group compared with the controls (p<0.04).Antenatal corticosteroid therapy in pregnancies complicated by PROMs has a positive influencing effect on premature infants

2001 Clinical and experimental obstetrics & gynecology Controlled trial quality: uncertain

530. 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

531. Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality. (Abstract)

administration in the second or third trimester on pregnancy outcomes. Antibiotic prophylaxis in unselected pregnant women reduced the risk of prelabour rupture of membranes (Peto odds ratio (OR) 0.32, 95% confidence interval (CI) 0.14 to 0.73). In women with a previous preterm birth there was a risk reduction in low birth weight (OR 0.48, 95% CI 0.27 to 0.84) and postpartum endometritis (OR 0.46, 95% CI 0.24 to 0.89). There was a risk reduction in preterm delivery (OR 0.48, 95% CI 0.28 to 0.81) in pregnant (...) trimester of pregnancy reduces the risk of prelabour rupture of the membranes when given routinely to pregnant women. Beneficial effects on birth weight and the risk of postpartum endometritis were seen for high risk women.

2002 Cochrane database of systematic reviews (Online)

532. Intrapartum amnioinfusion for meconium-stained fluid: meta-analysis of prospective clinical trials. (Abstract)

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 postpartum endometritis. 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 postpartum endometritis rate.

2000 Obstetrics and Gynecology

533. Screening for bacterial vaginosis in pregnancy. (Abstract)

details, risk factors for preterm delivery such as previous preterm delivery, compliance, rates of spontaneous and total preterm delivery less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2500 grams, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group

2001 American journal of preventive medicine

534. Antibiotic regimens for management of intraamniotic infection. (Full text)

). 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 (...) 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

2002 Cochrane database of systematic reviews (Online) PubMed abstract

535. 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

536. Prophylactic amnioinfusion for intrapartum oligohydramnios: a meta-analysis of randomized controlled trials. (Abstract)

), and Apgar scores under 7 at 5 minutes (OR 0.52; 95% CI 0.29, 0.91). Postpartum endometritis rates were similar among the study groups.In the presence of oligohydramnios, prophylactic intrapartum amnioinfusion significantly improves neonatal outcome and lessens the rate of cesarean delivery, without increasing the rate of postpartum endometritis. (...) heart rate (FHR) abnormalities, overall cesarean rates, acidemia at birth, intrapartum fetal heart rate abnormalities, Apgar scores under 7 at 5 minutes, and postpartum endometritis.Thirty-five studies were identified, of which 14 met the inclusion criteria for this systematic review. They included 1533 patients, 793 in the amnioinfusion group, and 740 controls. Odds ratios (OR) with their 95% confidence intervals (CI) for each outcome were calculated. We calculated an estimate of the OR and risk

2000 Obstetrics and Gynecology

537. Antibiotic regimens for endometritis after delivery. (Abstract)

Antibiotic regimens for endometritis after delivery. Postpartum endometritis, which is more common after cesarean section, occurs when vaginal organisms invade the endometrial cavity during labor and birth. Antibiotic treatment is warranted.The effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed.We searched the Cochrane Pregnancy and Childbirth Group's trials register (30 January 2004 (...) ).Randomized trials of different antibiotic regimens for postpartum endometritis, after cesarean section or vaginal birth, where outcomes of treatment failure or complications were reported were selected.We abstracted data independently and made comparisons between different types of antibiotic regimen based on type of antibiotic and duration and route of administration. Summary relative risks were calculated.Thirty-eight trials with 3983 participants were included. Fifteen studies comparing clindamycin

2004 Cochrane

538. Antibiotic regimens for endometritis after delivery. (Abstract)

Antibiotic regimens for endometritis after delivery. Post-partum endometritis, which is more common after cesarean section, occurs when vaginal organisms invade the endometrial cavity during labour and delivery. Antibiotic treatment is warranted.The effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed.We searched the Cochrane Pregnancy and Childbirth Group's trials register and the Cochrane (...) Controlled Trials Register. Date of last search: August 1999.Randomised trials of different antibiotic regimens for postpartum endometritis, after cesarean section or vaginal delivery, where outcomes of treatment failure or complications were reported were selected.Data were abstracted independently by the reviewers. Comparisons were made between different types of antibiotic regimen, based on type of antibiotic and duration and route of administration. Summary relative risks were calculated.Forty-one

2000 Cochrane

539. Prophylactic antibiotics for the prevention of postpartum infectious morbidity in women infected with human immunodeficiency virus: a randomized controlled trial. (Abstract)

of postpartum endometritis in the cefoxitin group (95% confidence interval, 0.24-0.9).The use of prophylactic intrapartum cefoxitin in HIV-infected women reduces the risk of postpartum endometritis. (...) Prophylactic antibiotics for the prevention of postpartum infectious morbidity in women infected with human immunodeficiency virus: a randomized controlled trial. The purpose of this study was to determine the effect of intrapartum prophylactic antibiotics in the prevention of postpartum sepsis in laboring women who were infected with HIV.In a double-blind, randomized trial that was conducted in Durban (South Africa), pregnant women who were infected with HIV in whom vaginal delivery

2008 American journal of obstetrics and gynecology Controlled trial quality: predicted high

540. Postpartum Haemorrhage

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 postpartum endometritis 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

2008 Mentor

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