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Postpartum Endometritis

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81. Postpartum Dyspareunia Resulting From Vaginal Atrophy

for their postpartum visit Criteria Inclusion Criteria: Healthy, puerperal women who will be willing to participate, over 18 years old. Exclusion Criteria: Patients with puerperal complications such as: bleeding, fever, endometritis. Patients with significant systemic diseases. Patients who conceive again during the study. Patients who are not willing to participate Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact (...) to Publications: Layout table for additonal information Responsible Party: Meir Medical Center ClinicalTrials.gov Identifier: Other Study ID Numbers: MMC11030-2011kCTIL First Posted: March 22, 2011 Last Update Posted: April 8, 2015 Last Verified: April 2012 Keywords provided by Meir Medical Center: Postpartum dyspareunia Vaginal atrophy Additional relevant MeSH terms: Layout table for MeSH terms Atrophy Dyspareunia Pathological Conditions, Anatomical Sexual Dysfunction, Physiological Genital Diseases, Male

2011 Clinical Trials

82. Prevention of Early-Onset Group B Streptococcal Disease in Newborns

intravenous intrapartum antibiotic pro- phylaxis has demonstrated efficacy for prevention of GBS early-onset disease (EOD) in neonates born to women with positive antepartum GBS cultures and women who have other risk factors for intrapartum GBS colonization. Neither antepartum nor intra- partum oral or intramuscular regimens have been shown to be comparably effective in reducing GBS EOD. VOL. 135, NO. 2, FEBRUARY 2020 OBSTETRICS & GYNECOLOGY e51c Regardless of planned mode of birth, all pregnant women (...) specifically. c If a woman presents in labor at term with unknown GBS colonization status and does not have risk fac- tors that are an indication for intrapartum antibiotic prophylaxis but reports a known history of GBS colonization in a previous pregnancy, the risk of GBS EOD in the neonate is likely to be increased. With this increased risk, it is reasonable to offer intra- partum antibiotic prophylaxis based on the woman’s history of colonization. Health care providers also may consider discussing

2020 American College of Obstetricians and Gynecologists

83. Mechanical dilatation of the cervix during elective caeserean section before the onset of labour for reducing postoperative morbidity. Full Text available with Trip Pro

), or amount of haemoglobin drop (MD -0.01 g/dL, 95% -0.14 to 0.13; three studies, 796 women); the incidence of secondary postpartum haemorrhage within six weeks (RR 1.18, 95% CI 0.07 to 18.76; one study, 447 women); febrile morbidity (RR 1.18, 95% CI 0.76 to 1.85; seven studies, 2126 women); endometritis (RR 0.94, 95% CI 0.35 to 2.52; four studies, 1536 women); or uterine subinvolution (RR 0.34, 95% CI 0.08 to 1.36; two studies, 654 women); the results crossed the line of no effect for all of the outcomes (...) underwent intraoperative cervical dilatation with a double-gloved index finger or Hegar dilator inserted into the cervical canal to dilate, and 1130 did not undergo intraoperative cervical dilatation. Six of the eight included trials had high risk of bias for some of the risk of bias domains.Very low-quality evidence suggested it was unclear whether cervical dilatation had any impact on postpartum haemorrhage (estimated blood loss greater than 1000 mL; risk ratio (RR) 1.97, 95% confidence interval (CI

2018 Cochrane

84. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Full Text available with Trip Pro

benzalkonium chloride) on post-cesarean infectious morbidity. Additionally, some trials used vaginal preparations using sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (eight trials) or the use of a saline vaginal preparation (three trials). The risk of bias in the studies reduced our confidence in the results for endometritis outcomes.Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence (...) of post-cesarean endometritis from 8.7% in control groups to 3.8% in vaginal cleansing groups (average risk ratio (RR) 0.36, 95% confidence interval (CI) 0.20 to 0.63, 10 trials, 3283 women, moderate quality of evidence). Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used. Risks of postoperative fever and postoperative wound infection may be slightly lowered by antiseptic

2018 Cochrane

85. Management of Cardiovascular Diseases during Pregnancy Full Text available with Trip Pro

Haemodynamic monitoring during delivery 3180 3.8.7 Anaesthesia/analgesia 3180 3.8.8 Labour 3180 3.8.9 Perimortem caesarean section 3180 3.8.10 Post-partum care 3180 3.8.11 Breastfeeding 3180 3.9 Infective endocarditis 3180 3.9.1 Prophylaxis 3180 3.9.2 Diagnosis and risk assessment 3180 3.9.3 Treatment 3180 3.10 Methods of contraception and termination of pregnancy, and in vitro fertilization 3181 3.10.1 Methods of contraception 3181 3.10.2 Sterilization 3181 3.10.3 Methods of termination of pregnancy 3181 (...) Prevention of hypertension and pre-eclampsia 3207 10.4 Management of hypertension in pregnancy 3208 10.4.1 Background 3208 10.4.2 Non-pharmacological management 3208 10.4.3 Pharmacological management 3208 10.5 Delivery 3208 10.6 Prognosis after pregnancy 3209 10.6.1 Blood pressure post-partum 3209 10.6.2 Hypertension and lactation 3209 10.6.3 Risk of recurrence of hypertensive disorders in a subsequent pregnancy 3209 10.6.4 Long-term cardiovascular consequences of gestational hypertension 3209 10.6.5

2018 European Society of Cardiology

86. Placenta Praevia and Placenta Accreta: Diagnosis and Management Full Text available with Trip Pro

is not exclusively a consequence of caesarean delivery. Other surgical trauma to the integrity of the uterine endometrium and/or superficial myometrium, such as those following uterine curettage, manual removal of the placenta, postpartum endometritis or myomectomy, has been associated with accreta placentation in subsequent pregnancies. , , Overall, the aOR for placenta accreta spectrum after previous uterine surgery is 3.40 (95% CI 1.30–8.91). Evidence level 2+ The development of placenta accreta spectrum has (...) the placental edge is less than 20 mm from the internal os, and as normal when the placental edge is 20 mm or more from the internal os on TAS or TVS. This new classification could better define the risks of perinatal complications, such as antepartum haemorrhage and major postpartum haemorrhage (PPH), , and has the potential of improving the obstetric management of placenta praevia. Recent articles reviewed in this guideline refer to the AIUM classification. The estimated incidence of placenta praevia

2018 Royal College of Obstetricians and Gynaecologists

87. Intrapartum fever

prøver fra fosterhinder og placenta, optimalt som vævsprøver i spidsglas, som minimum som podning til D+R. o U-stix. Ved leukocytter og/eller nitrit suppl. med dyrkning. o Cervixpodning og amnionvæske (intrauterint kateter/ved sectio) til D+R kan overvejes. o Samtlig mikrobiologi kan have værdi postpartum, men kun U-stix har relevans i den akutte fase. o Infektionstal kan overvejes. Har begrænset diagnostisk værdi i den akutte fase, men kan evt. bruges i relation til forløbet post partum D Øget (...) urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. D Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine tenderness The individual signs have low predictive value. B Continuous CTG

2019 Nordic Federation of Societies of Obstetrics and Gynecology

88. Obstetric anal sphincter injury (OASIS)

be assessed clinically 10-15 days postpartum. The visit should include inspection of the wound to diagnose wound ruptures requiring re-suturing. C Review can be by a trained midwife or nurse, an experienced obstetrician or a uro- gynecologist. v Women who have undergone obstetric anal sphincter repair should be advised to contact the hospital in case of rupture of the wound, infection, fecal incontinence or profound fecal urgency within three weeks of delivery. v Women who have undergone obstetric anal (...) anal sphincter repair should be assessed clinically 10-15 days postpartum. The visit should include inspection of the wound to diagnose wound ruptures requiring re-suturing. C 7 Review can be by a trained midwife or nurse, an experienced obstetrician or a uro- gynecologist. v Women who have undergone obstetric anal sphincter repair should be advised to contact the hospital in case of rupture of the wound, infection, fecal incontinence or profound fecal urgency within three weeks of delivery. v

2019 Nordic Federation of Societies of Obstetrics and Gynecology

89. The Irish Maternity Early Warning System (IMEWS) National Clinical Guideline

for pregnant and postpartum women (up to 42 days postpartum). 2.5 Guideline scope This NCG applies to women with a confirmed clinical pregnancy and for up to 42 days in the postnatal period, irrespective of age or reason for presentation. Exclusions are women in labour, high dependency, recovery and critical care settings. This NCG is relevant to all clinical staff in hospitals providing care to those women. The IMEWS is designed to guide clinical judgement but not replace it. In individual cases (...) Clinical Guideline This NCG applies to women with a confirmed clinical pregnancy and for up to 42 days in the postnatal period, irrespective of age or reason for presentation. Exclusions are women in labour, high dependency, recovery and critical care settings. This NCG is relevant to all clinical staff in hospitals providing care to those women. NCEC NCG No. 4 IMEWS V2 supersedes all previous versions. Disclaimer NCEC NCGs do not replace professional judgment in particular cases, whereby the clinician

2019 HIQA Guidelines

90. ShortGUIDE: Term prelabour rupture of membranes (PROM)

Caesarean section (RR 0.84; 95% CI 0.69 to 1.04; 23 trials, n=8576) No significant difference Maternal length of stay (MD -0.79 days; 95% CI -1.20 to -0.38; 2 trials, n=748) Decreased Positive maternal experience 19,20 Mixed reports Admission to neonatal/special care (RR 0.75; 95% CI 0.66 to 0.85; 8 trials n= 6179,) Decreased Neonatal sepsis (definite or probable) (RR 0.73; 95% CI 0.58 to 0.92; 16 trials, n=7314) Decreased Postpartum antibiotic use, pyrexia, endometritis, operative vaginal birth (...) , primary postpartum haemorrhage, caesarean section for fetal distress, uterine rupture, epidural analgesia, cord prolapse, stillbirth, Apgar 24 hours o Change in fetal movements o Signs of infection o Change in vaginal loss · Offer information that risk of infection: o Increased with vaginal intercourse o Not affected by showering or bathing · Recommend IOL if: o Woman requests o Concern for maternal or fetal wellbeing Expectant care at home? Recommend expectant care in hospital Indications for active

2019 Queensland Health

91. Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity. Full Text available with Trip Pro

of the evidence for application in practice, particularly in settings where women may be at higher risk of developing endometritis. The use of antibiotics did not reduce the incidence of urinary tract infections, wound infection or the length of maternal hospital stay. Antibiotics are not a substitute for infection prevention and control measures around the time of childbirth and the postpartum period. The decision to routinely administer prophylactic antibiotics after normal vaginal births needs (...) administration of prophylactic antibiotics to women after normal (uncomplicated) vaginal birth, compared with placebo or no antibiotic prophylaxis, reduces postpartum maternal infectious morbidities and improves outcomes.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2017), LILACS, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (22 August 2017) and reference lists of retrieved studies.We planned to include randomised or quasi

2017 Cochrane

92. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Full Text available with Trip Pro

Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Genital Chlamydia trachomatis (C.trachomatis) infection may lead to pregnancy complications such as miscarriage, preterm labour, low birthweight, preterm rupture of membranes, increased perinatal mortality, postpartum endometritis, chlamydial conjunctivitis and C.trachomatis pneumonia.This review supersedes a previous review on this topic.To establish the most efficacious and best-tolerated therapy for treatment

2017 Cochrane

93. Antibiotic prophylaxis for operative vaginal delivery. Full Text available with Trip Pro

Antibiotic prophylaxis for operative vaginal delivery. Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.To assess the effectiveness and safety of antibiotic prophylaxis in reducing (...) endometritis and maternal length of stay.One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing

2017 Cochrane

94. Antibiotic prophylaxis for episiotomy repair following vaginal birth. Full Text available with Trip Pro

(e.g. endometritis) were reported in either the antibiotic or control group.The trial did not report on any of the secondary outcomes of interest for this review, including severe maternal infectious morbidity, discomfort or pain at the episiotomy wound site, sexual function postpartum, adverse effects of antibiotics, costs of care, women's satisfaction with care, and individual antimicrobial resistance.There was insufficient evidence to assess the clinical benefits or harms of routine antibiotic (...) Antibiotic prophylaxis for episiotomy repair following vaginal birth. Bacterial infections occurring during labour, childbirth, and the puerperium may be associated with considerable maternal and perinatal morbidity and mortality. Antibiotic prophylaxis might reduce wound infection incidence after an episiotomy, particularly in situations associated with a higher risk of postpartum perineal infection, such as midline episiotomy, extension of the incision, or in settings where the baseline risk

2017 Cochrane

95. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Full Text available with Trip Pro

, 5691 infants). Women in the planned early birth group had more positive experiences compared with women in the expectant management group.No clear differences between groups were observed for endometritis; postpartum pyrexia; postpartum antibiotic usage; caesarean for fetal distress; operative vaginal birth; uterine rupture; epidural analgesia; postpartum haemorrhage; adverse effects; cord prolapse; stillbirth; neonatal mortality; pneumonia; Apgar score less than seven at five minutes; use (...) the other 20 were at unclear or high risk of bias.Primary outcomes: women who had planned early birth were at a reduced risk of maternal infectious morbidity (chorioamnionitis and/or endometritis) than women who had expectant management following term prelabour rupture of membranes (average risk ratio (RR) 0.49; 95% confidence interval (CI) 0.33 to 0.72; eight trials, 6864 women; Tau² = 0.19; I² = 72%; low-quality evidence), and their neonates were less likely to have definite or probable early-onset

2017 Cochrane

96. Cerclage and Cerclage (Arabin)-pessary

uterine fibroids; IVF og flerfoldsgraviditet 178 singleton, 25 flerfold I:82 pessar, II:71 cerclage, III: 50 intet. Alle + progesteron Graviditets forløb Gestationsalder ved fødsel Fødselsmåde Post partum forløb Neonatal outcome Fødsel < 37 I: 11.3%, II: 17.4%, III 26.5% Fødsel < 34 I:5%, II:8,7%, III:16.3% Interpartum blødning I:2,5% II: 17,4% III: 24.4% Nicolaides N Engl J Med 2016 Singletons CL<25mm ved GA20- 24+6 (hvis CL<15mm tilføjedes progesteron) N = 465 + 467 PTB<34u Perinatal død Composite (...) hospitaler i UK, Spanien, Tyskland, Australien, Slovenien, Portugal, Italien, Belgien, Albanien, Kina, Brasilien og Chile. 588 kvinder fik pessar uge 20-24+6 uanset cervix længde 589 ingen intervention Post hoc ananlyse af 214 kvinder med cervix =25 mm 4,5 % havde født prætermt tidligere Primære outcoome: Præterm fødsel <34 uger Sekundære outcome: Perinatal død, neonatal morbiditet+++ og neonatal behandling.++++ Ingen effekt af pessar i forhold til fødsel før uge 34. Ingen effekt af pessar i forhold til

2018 Nordic Federation of Societies of Obstetrics and Gynecology

97. Fever during labor

should be considered. D o All microbiotic tests may be valuable postpartum, but only urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine (...) har relevans i den akutte fase. o Infektionstal kan overvejes. Har begrænset diagnostisk værdi i den akutte fase, men kan evt. bruges i relation til forløbet post partum D Øget mistanke om intrauterin infektion ved intrapartum feber og mindst et af følgende: Føtal takykardi>160 slag/min Ildelugtende eller purulent fluor Ømhed/irritation af uterus De enkelte tegn har lav prædiktiv værdi B Kontinuerlig CTG anbefales ved feber under fødslen. D Skalp pH og caput-elektrode skal bruges på vanlige

2018 Nordic Federation of Societies of Obstetrics and Gynecology

98. WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections

-scale programme evaluations of interventions • Pre-post studies of health-system changes relevant to interventions • Country case studies of relevant interventions • Overviews of reviews of health system implementation, care delivery arrangements and financial strategies Not assessed 2. Methods18 WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections 2.9 Evidence identification and retrieval Three main types of evidence were considered. a. Evidence on effectiveness

2018 World Health Organisation Guidelines

99. WHO recommendations: intrapartum care for a positive childbirth experience

resuscitation. d Integrated from WHO Recommendations for management of common childhood conditions: evidence for technical update of pocket book recommendations. e Integrated from WHO recommendations on newborn health. f Integrated from WHO recommendations on postnatal care of the mother and newborn.7 EXECUTIVE SUMMARY Care option Recommendation Category of recommendation Care of the woman after birth Uterine tonus assessment 52. Postpartum abdominal uterine tonus assessment for early identification (...) in the facility for at least 24 hours after birth. c,d Recommended a Integrated from WHO recommendations for the prevention and treatment of postpartum haemorrhage. b Integrated from WHO recommendations for prevention and treatment of maternal peripartum infections. c Integrated from WHO recommendations on postnatal care of the mother and newborn. d For the newborn, this includes an immediate assessment at birth, a full clinical examination around one hour after birth and before discharge.WHO RECOMMENDATIONS

2018 World Health Organisation Guidelines

100. CRACKCast E180 – Labor & Delivery

with or without tazobactam, and ampicillin and sulbactam. Most patients with postpartum endometritis require admission. 19) List 5 RFs for post-partum depression Previously diagnosed depression, inadequate spousal support, adverse socioeconomic factors, life stressors, and emergency delivery. Symptoms peak at 10 to 12 weeks postpartum, although some cases are diagnosed up to 1 year after delivery. When postpartum depression is unrecognized, these women are at high risk for suicide and may come to the ED (...) reliable sign of fetal extrusion. ACOG guidelines for uterine rupture identify a 30-minute window of opportunity to get the mother to C-section to maximize the baby’s chance of a good outcome. 18) List 4 RFs and 5 clinical features of post-partum endometritis. What is the management? Operative delivery, Prolonged rupture of membranes, Lack of prenatal care, Prolonged stage 2 labor, Use of intrauterine monitoring, and Frequent vaginal examinations have been linked to these ascending gynecologic

2018 CandiEM

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