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Postpartum Endometritis

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101. CRACKCast E177 – Acute Complications of Pregnancy

. In general, the tetracyclines and quinolones are contraindicated in pregnant patients. Treatment of genital tract infections may be important in preventing preterm labor and decreasing transmission to the infant. Complications: Salpingitis in pregnancy Disseminated gonorrhea in pregnancy Gonococcal arthritis Preterm labour Postpartum endometritis Infant: Conjunctivitis Pneumonitis Neonatal gonococcal ophthalmia Sepsis Chlamydia: Treatment during pregnancy or breast-feeding is azithromycin (single 1-g (...) Uterine rupture Retained products Endometritis Fibroid degeneration Non-uterine pregnancy related Preeclampsia with liver distension Acute fatty liver Breastfeeding uterine contractions Non-pregnancy Anything as in a regular adult! GI Ovarian Renal / GU Vascular Splenic rupture This post was uploaded and copyedited by Colin Sedgwick ( ) (Visited 1,190 times, 1 visits today) Adam Thomas CRACKCast Co-founder and newly minted FRCPC emergency physician from the University of British Columbia. Currently

2018 CandiEM

103. Insertion of a double balloon catheter for induction of labour in pregnant women without previous caesarean section

canal injury was reported in 1 woman and 5 women respectively in the DBC and prostaglandin gel groups (p=0.10) in the RCT of 126 pregnant women. 5.7 Intrapartum fever was reported in 8 and 2 women respectively in the DBC and SBC groups (p=0.10) in the RCT of 302 pregnant women comparing DBC (n=148) against SBC (n=145). 5.8 Postpartum endometritis after caesarean section occurred in 1 woman in the DBC plus oral misoprostol group (n=59) and in no women in the oral misoprostol alone group (n=63 (...) disorders, diabetes, post-term pregnancy, thrombophilia, intrauterine fetal growth restriction, oligohydramnios, non-reassuring fetal status and fetal death. 2.2 Various methods are used to ripen and dilate the cervix and successfully induce labour in women when the cervix is unfavourable for induction. These include pharmacological methods (prostaglandins in the form of vaginal gels or tablets, or pessaries, and oxytocin as a slow intravenous infusion), surgical methods (amniotomy, alone

2015 National Institute for Health and Clinical Excellence - Interventional Procedures

104. Management of Uterine Fibroids

women and included a total of 316 participants. The MRgFUS pilot study was fair quality and the other studies were poor quality. Effects of HIFU for Fibroid Ablation on Fibroid Characteristics Four studies reported fibroid volume following HIFU (Table 22). 53,58,60,156 The magnitude of fibroid volume reduction was greater at 12 months 53 after HIFU than at 1 month post- treatment. 58 Table 22. Change in uterine fibroid volume following HIFU by study arm a Author (Year) Intervention N Followup

2017 Effective Health Care Program (AHRQ)

105. Early pregnancy loss

Queensland Clinical Guidelines, Queensland Health and abide by the licence terms. You may not alter or adapt the work in any way. To view a copy of this licence, visit For further information, contact Queensland Clinical Guidelines, RBWH Post Office, Herston Qld 4029, email, phone (07) 3131 6777. For permissions beyond the scope of this licence, contact: Intellectual Property Officer, Queensland Health, GPO Box 48 (...) Laparoscopy too difficult Follow-up • GP 14 days post-surgery • If salpingo(s)tomy, weekly ß-hCG until negative • If salpingectomy, urinary ß-hCG 3 weeks after surgery • USS if clinically indicated • Optimal conception interval unknown (0–3 months common) Indicated only if: • Haemodynamically stable • No evidence of rupture • Low and falling serum ß-hCG ( : greater than, 90% over 7 days Indications • Woman’s preference • Missed/incomplete miscarriage Contraindications • Haemodynamic instability

2017 Queensland Health

106. Vaginal cleansing before caesarean delivery reduces risk of infections

views on the research. Why was this study needed? A womb infection (postpartum endometritis) occurs after about 27% of caesarean deliveries. This is five to 20 times more common than after vaginal delivery. There are about 167,000 planned and emergency caesarean deliveries each year in English NHS hospitals. Womb infections are often caused by vaginal bacteria that migrate to the womb. These infections need prompt antibiotic treatment to avoid sepsis, complications of the reproductive system (...) Excellence; 2011 (updated 2012). Patient. . Leeds: Patient; 2017. The Maternal, Newborn and Infant Clinical Outcome Review Programme. . Oxford: The Maternal, Newborn and Infant Clinical Outcome Review Programme; 2016. WHO. . Geneva: World Health Organization; 2015. Why was this study needed? A womb infection (postpartum endometritis) occurs after about 27% of caesarean deliveries. This is five to 20 times more common than after vaginal delivery. There are about 167,000 planned and emergency caesarean

2019 NIHR Dissemination Centre

107. WHO recommendations on maternal health

14 Augmentation of labour 15 6. Prevention of postpartum haemorrhage 15 7. Postnatal care 16 8 . Health promotion for maternal and newborn health 19 Management of maternal conditions 22 9. Postpartum haemorrhage 22 10. Pre-eclampsia and eclampsia 23 11. Peripartum infections 24 12. HIV infection 24 13. Malaria 27 14. Tuberculosis 27iv Abbreviations AIDS acquired immunodeficiency syndrome ANC antenatal care ART antiretroviral therapy ARV antiretroviral AZT zidovudine CCT controlled cord traction (...) and low quality evidence for mothers. Source17 PROMOTE, PREVENT AND PROTECT MATERNAL AND PERINATAL HEALTH Home visits for postnatal care ¦ ¦ Home visits in the first week after birth are recommended for care of the mother and newborn. (Strong recommendation, low to moderate quality evidence). Source Content of postnatal care for the mother Assessment of the mother First 24 hours after birth All postpartum women should have regular assessment of vaginal bleeding, uterine contraction, fundal height

2017 World Health Organisation Guidelines

108. Tiny Tips: Approach to Abnormal Uterine Bleeding

infections (PID, endometritis, salpingitis) S evere menorrhagia E ctopic pregnancy S pontaneous abortion O varian cyst rupture F ibroid (Leiomyoma) b … L ocation of placenta- placenta previa O varian torsion O nset after delivery – Post-Partum Hemorrhage D rugs – anticoagulants, antipsychotics, corticosteroids, hormone replacement This post was copyedited by Dat Nguyen-Dinh (@dat_nd). Reviewing with the Staff The above mnemonic provides a reasonable, but not comprehensive, differential for abnormal (...) Tiny Tips: Approach to Abnormal Uterine Bleeding Tiny Tips: Approach to Abnormal Uterine Bleeding - CanadiEM Tiny Tips: Approach to Abnormal Uterine Bleeding In , by Zoe Polsky July 14, 2017 Whether the patient is an expecting mother, a post-menopausal woman, or a young adolescent, abnormal uterine bleeding is distressing for the patient, and often overwhelming for learners. Consider the ‘ CAUSES OF bLOOD ’ to better tailor your investigations and management. C ancer A bruption U rogenital

2017 CandiEM

109. Postplacental insertion of intrauterine devices

because it does not requireaseparatepostpartumvisit.TheAmericanCollegeof Obstetricians and Gynecologists (ACOG) strongly encour- ages the practice of immediate postpartum provision of long-acting reversible contraception (LARC) [1]. To in- creaseaccesstopostpartumLARC,27statesandtheDistrict ofColumbiahavepublishedproposedorfinalguidelinesfor Medicaid reimbursement for in-hospital provision of post- partum LARC, including IUDs [2]. In the United States, the rate of postpartum IUD insertion prior (...) deviceplacementduringcesareandeliveryandcontinueduse6months postpartum: a randomized controlled trial. Obstet Gynecol 2015;126(5):5–11 [Evidence Grade: I]. [32] WelkovicS, Costa LO, FaundesA, de AlencarXimenesR, CostaCF. Post-partum bleeding and infection after post-placental IUD insertion. Contraception 2001;63(3):155–8 [Evidence Grade: II-2]. [33] ElsedeekMS.Puerperalandmenstrualbleedingpatternswithdifferent types of contraceptive device fitted during elective cesarean delivery. Int J Gynaecol Obstet 2012;116(1):31–4 [Evidence Grade: II-2]. [34

2017 Society of Family Planning

110. Approaches to Limit Intervention During Labor and Birth

hours; 95% had delivered by 94–107 hours after rupture of membranes ( ). A 2017 Cochrane review that compared immediate induction with expectant management did not find a difference in cesarean delivery or definite early-onset neonatal sepsis, but did find a decreased risk of chorioamnionitis or endometritis, or both (relative risk [RR], 0.49; 95% CI, 0.33–0.72), decreased risk of definite or probable early-onset neonatal sepsis (RR, 0.73; 95% CI, 0.58–0.92), and a decreased risk of neonatal (...) was restricted to high quality RCTs (RR, 1.07; 95% CI, 0.98–1.16.) (55). However, a recent large retrospective analysis found that delaying pushing by 60 minutes or more was associated with modest increases in cesarean delivery (adjusted odds ratio [AOR], 1.86; 95% CI, 1.63–2.12) and operative vaginal delivery (AOR, 1.26; 95% CI, 1.14–1.40), postpartum hemorrhage (AOR, 1.43; 95% CI, 1.05–1.95), and transfusion (AOR, 1.51; 95% CI, 1.04–2.17), but no increase in adverse neonatal outcomes ( ). The study design

2017 American College of Obstetricians and Gynecologists

111. Long-Acting Reversible Contraception: Implants and Intrauterine Devices

Category 1 (47). Immediate postpartum insertion is contraindicated for women in whom uterine infection (ie, peripartum chorioamnionitis, endometritis, or puerperal sepsis) or ongoing postpartum hemorrhage are diagnosed (US MEC Category 4) (47). Expulsion rates for immediate postpartum IUD insertion are higher than for interval or postabortion insertion, vary by study, and may be as high as 10–27% ( ). Differences in expulsion rates are similar with manual insertion versus use of ring forceps, but may (...) these contraceptive methods are made readily available (51). Adolescents aged 14–17 years who chose a LARC method were more likely to use the contraceptive implant (51). Contraceptive acceptability and continuation rates were studied in a group of 137 postpartum adolescents ( ). At 24 months, continuation rates were higher in contraceptive implant users compared with contraceptive injection and combined contraceptive pill users ( P <.001) (64). In another study of 116 adolescents, continuation rates

2017 American College of Obstetricians and Gynecologists

112. Intrapartum Management of Intraamniotic Infection

and managed by obstetrician–gynecologists or other obstetric care providers will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome (...) –3.84) (13). It is nonetheless important to acknowledge that the overall absolute risk of cerebral palsy remains quite low (approximately 2 per 1,000 live births) ( ). Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death ( , ). Obstetric risk factors for intraamniotic infection

2017 American College of Obstetricians and Gynecologists

113. Antenatal Corticosteroid Therapy for Fetal Maturation

, 0.53–0.84; P <.001). There were also significant decreases in the rates of transient tachypnea of the newborn; bronchopulmonary dysplasia; a composite of respiratory distress syndrome (RDS), transient tachypnea of the newborn and RDS; and the need for postnatal surfactant. Infants exposed to betamethasone were less likely to require immediate postnatal resuscitation. There was no increase in proven neonatal sepsis, chorioamnionitis, or endometritis with late preterm betamethasone. Hypoglycemia (...) Institute of Child Health and Human Development. J Pediatr 2009;155:612–7. [ ] [ ] Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Committee on Fetus and Newborn. Pediatrics 2011;127:575–9. [ ] [ ] Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Am J Obstet Gynecol 2016; DOI: 10.1016/j.ajog.2016.03.013. [ ] [ ] Wapner RJ, Sorokin Y

2017 American College of Obstetricians and Gynecologists

114. Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection

; 95% CI 0.61 to 0.85; four trials, 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 (...) was better at reducing the risk of maternal infection in the lining of the uterus (endometritis) and/or the fetal membranes (chorioamnionitis) or the need for caesarean section. Researchers also looked for stillbirths or complications for the baby recorded in the trials. For some outcomes, the quality of the evidence was downgraded to low due to a high risk of bias and large differences between the studies. However, the maternal infection and caesarean section outcomes are objective so we are moderately

2019 NIHR Dissemination Centre

115. Techniques for assisting difficult delivery at caesarean section. (Abstract)

, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies.All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate (...) section Four randomised trials involving 357 women were identified and included in the review. The primary outcome of birth trauma was reported by three trials and there was no difference between reverse breech extraction and head push for this rare outcome (three studies, 239 women, risk ratio (RR) 1.55, 95% confidence interval (CI) 0.42 to 5.73). Secondary outcomes including endometritis rate (three studies, 285 women, average RR 0.52, 95% CI 0.26 to 1.05, Tau I² = 0.22, I² = 56%), extension

2016 Cochrane

116. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. (Abstract)

of this review's primary or secondary outcomes.There was no clear difference between irrigation and intravenous antibiotic prophylaxis in reducing the risk of post-caesarean endometritis. For other outcomes, there is insufficient evidence regarding which route of administration of prophylactic antibiotics is most effective at preventing post-caesarean infections. The quality of evidence was very low to low, mainly due to limitations in study design and imprecision. Furthermore, most of the included studies (...) Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. Post-caesarean section infection is a cause of maternal morbidity and mortality. Administration of antibiotic prophylaxis is recommended for preventing infection after caesarean delivery. The route of administration of antibiotic prophylaxis should be effective, safe and convenient. Currently, there is a lack of synthesised evidence regarding the benefits and harms of different routes

2016 Cochrane

117. Amnioinfusion for chorioamnionitis. Full Text available with Trip Pro

pressure catheter, acetaminophen and antibiotics (ampicillin or, if receiving Group B beta streptococcal prophylaxis, penicillin and gentamycin). We did not identify any trials that used transabdominal amnioinfusion.Compared to no amnioinfusion, transcervical amnioinfusion had no clear effect on the incidence of postpartum endometritis (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.29 to 7.87; absolute risk 176/1000 (95% CI 34 to 96) versus 118/1000;low-quality evidence). Nor was there a clear (...) amnioinfusion. The evidence in this review can neither support nor refute the use of transcervical amnioinfusion outside of clinical trials. We included one small study that reported on a limited number of outcomes of interest in this review. The numbers included in this review are too small for meaningful assessment of substantive outcomes, where reported. For those outcomes we assessed using GRADE (postpartum endometritis, neonatal infection, and caesarean section), we downgraded the quality

2016 Cochrane

118. Antibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity. (Abstract)

pregnancy (RR 0.64; 95% CI 0.47 to 0.88 (one trial, 258 women)), but there was no reduction in the subgroup of pregnant women with previous preterm birth without BV during the pregnancy (RR 1.08; 95% CI 0.66 to 1.77 (two trials, 500 women)). A reduction in the risk of postpartum endometritis (RR 0.55; 95% CI 0.33 to 0.92 (one trial, 196 women)) was observed in high-risk pregnant women (women with a history of preterm birth, low birthweight, stillbirth or early perinatal death) and in all women (RR 0.53 (...) of bias was low, except that incomplete outcome data produced high risk of bias in some studies. The quality of the evidence using GRADE was assessed as low for preterm prelabour rupture of membranes, high for preterm delivery, moderate for postpartum endometritis, low for prelabour rupture of membranes, and very low for chorioamnionitis. Intrapartum fever needing treatment with antibiotics was not reported in any of the included studies.Antibiotic prophylaxis did not reduce the risk of preterm

2015 Cochrane

119. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

stewardship consultants in the hospital. FTE antimicrobial stewardship refers to the dedicated time of a consultant (or pharmacist) employed by the hospital and specifically paid for antimicrobial stewardship tasks (e.g. antimicrobial stewardship activities mentioned as part of his/her job description), not the time spent by treating physicians on antimicrobial stewardship activities (e.g. post-prescription review) as part of their daily practice. Deduct FTE from FTE infection control doctor if same

2016 European Centre for Disease Prevention and Control - Technical Guidance

120. Birth after Previous Caesarean Birth

of findings (most often abnormal CTG and abdominal pain). 20,23,120 The diagnosis is made at emergency caesarean delivery or postpartum laparotomy. Most uterine ruptures (more than 90%) occur during labour (the peak incidence being at 4–5 cm cervical dilatation), with around 18% occurring in the second stage of labour and 8% being identified post vaginal delivery. 23 The clinical features associated with uterine scar rupture include: l abnormal CTG l severe abdominal pain, especially if persisting between (...) and efficacy of planned VBAC in pregnancies complicated by post-dates, twin gestation, fetal macrosomia, antepartum stillbirth or maternal age of 40 years or more. Hence, a cautious approach is advised if VBAC is being considered in such circumstances. Women who are preterm and considering the options for birth after a previous caesarean delivery should be informed that planned preterm VBAC has similar success rates to planned term VBAC but with a lower risk of uterine rupture. 1. Purpose and scope

2015 Royal College of Obstetricians and Gynaecologists

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