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Postpartum Endometritis

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101. 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

102. 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

103. 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

104. 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

105. 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

106. WHO recommendations on maternal health

PERIPARTUM INFECTIONS NEW ¦ ¦ A simple regimen such as ampicillin and once-daily gentamicin is recommended as first- line antibiotics for the treatment of chorioamnionitis. (Conditional recommendation based on very low-quality evidence). Source ¦ ¦ A combination of clindamycin and gentamicin is recommended as first-line antibiotics for the treatment of postpartum endometritis. (Conditional recommendation based on very low- quality evidence). Source 12. HIV INFECTION DURING PREGNANCY HIV diagnosis (...) 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

2017 World Health Organisation Guidelines

108. 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

2018 NIHR Dissemination Centre

109. 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

2018 NIHR Dissemination Centre

110. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. (PubMed)

studies.All of the included trials involved women undergoing caesarean section whether elective or non-elective. Intravenous antibiotics versus antibiotic irrigation (nine studies, 1274 women) Nine studies (1274 women) compared the administration of intravenous antibiotics with antibiotic irrigation. There were no clear differences between groups in terms of this review's maternal primary outcomes: endometritis (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.29; eight studies (966 women (...) ) (low-quality evidence)); wound infection (RR 0.49, 95% CI 0.17 to 1.43; seven studies (859 women) (very low-quality evidence)). The outcome of infant sepsis was not reported in the included studies.In terms of this review's maternal secondary outcomes, there were no clear differences between intravenous antibiotic or irrigation antibiotic groups in terms of postpartum febrile morbidity (RR 0.87, 95% CI 0.48 to 1.60; three studies (264 women) (very low-quality evidence)); or urinary tract infection

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2016 Cochrane

111. Techniques for assisting difficult delivery at caesarean section. (PubMed)

, 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

112. Amnioinfusion for chorioamnionitis. (PubMed)

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

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2016 Cochrane

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

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

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2015 Cochrane

115. Efficacy of homeopathic remedies as prophylaxis of bovine endometritis. (PubMed)

Efficacy of homeopathic remedies as prophylaxis of bovine endometritis. The objective of this study was to evaluate the efficacy of 2 different homeopathic prophylactic strategies for the prevention of endometritis. The drugs used were Lachesis compositum (Lachesis), Carduus compositum (Carduus), and Traumeel LT (Traumeel). Each drug contained a mixed formula of homeopathic remedies. All 929 cows received the first treatment within 24 h postpartum. The second to fourth treatments were conducted (...) at 7 to 13, 14 to 20, and 21 to 27 d in milk, respectively. In the first group, the 4 treatments were Traumeel, Lachesis, Carduus, and Carduus, respectively (n = 206). In the second group, Lachesis was administered 3 times, followed by 1 treatment with Carduus (n = 198). The control group received 4 injections of saline (n = 189). In the fourth week after calving, the prevalence of clinical endometritis, uterine involution, and ovarian activity was monitored by rectal palpation

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2009 Journal of dairy science Controlled trial quality: uncertain

116. Reduction of Endometritis After Cesarean Section With the Routine Use of Methergine

received Methergine 0.2mg po every 6 hours for two days, plus routine postpartum care. Drug: Methergine Scheduled methergine 0.2 mg PO every 6hrs for duration of postpartum stay No Intervention: No treatment No treatment group received only routine postpartum care. Outcome Measures Go to Primary Outcome Measures : Endometritis Incidence [ Time Frame: One year ] Number of participants who developed endometritis Eligibility Criteria Go to Information from the National Library of Medicine Choosing (...) Reduction of Endometritis After Cesarean Section With the Routine Use of Methergine Reduction of Endometritis After Cesarean Section With the Routine Use of Methergine - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before

2009 Clinical Trials

117. Pelvic inflammatory disease

for the management of pelvic inflammatory disease [ ] and the European guideline for the management of pelvic inflammatory disease [ ]. This CKS topic covers the management of acute pelvic inflammatory disease (PID) in primary care. This CKS topic does not cover the management of chronic PID, chronic pelvic pain, postpartum endometritis, or PID following childbirth. There are separate CKS topics on , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK (...) the endocervix causing one or more of the following: Endometritis. Salpingitis. Parametritis. Oophoritis. Tubo-ovarian abscess. Pelvic peritonitis. [ ; ] Causes and risk factors What are the causes and risk factors? Pelvic inflammatory disease (PID) is almost always a sexually transmitted infection (STI). Chlamydia trachomatis (14–35% of cases) and Neisseria gonorrhoeae (2–3% of cases) have been identified as causative organisms for PID [ ]. Mycoplasma genitalium has been associated with upper genital tract

2019 NICE Clinical Knowledge Summaries

118. Birth after Previous Caesarean Birth

encephalopathy (HIE). • < 1 per 10 000 ( < 0.01%) risk of delivery- related perinatal death or HIE. • 4 per 10 000 (0.04%) risk of delivery-related perinatal death. This is comparable to the risk for nulliparous women in labour. The estimates of risk for adverse maternal or fetal events in VBAC are based on women receiving continuous electronic monitoring during their labour. Hysterectomy and other morbidities The rates of hysterectomy, thromboembolic disease, transfusion and endometritis did not differ (...) significantly between planned VBAC and ERCS according to the AHRQ meta-analysis 9 and another meta-analysis. 74 However, the NICHD study showed unsuccessful compared with Evidence level 2+RCOG Green-top Guideline No. 45 © Royal College of Obstetricians and Gynaecologists 11 of 31 successful VBAC increased the risk of uterine rupture (2.3% versus 0.1%), hysterectomy (0.5% versus 0.1%), transfusion (3.2% versus 1.2%) and endometritis (7.7% versus 1.2%). 18 Meta- analysis has shown that hysterectomy

2015 Royal College of Obstetricians and Gynaecologists

119. Prevalence, risk factors and molecular characterization of Chlamydia trachomatis in pregnant women from Córdoba, Argentina: A prospective study. (PubMed)

Prevalence, risk factors and molecular characterization of Chlamydia trachomatis in pregnant women from Córdoba, Argentina: A prospective study. Chlamydia trachomatis causes the most prevalent bacterial Sexual Transmitted Infection. In pregnant women, untreated chlamydial infections are associated with abortions, premature rupture of membranes, postpartum endometritis, low birth weight and transmission to the newborn. In Córdoba, Argentina, there is little knowledge about the prevalence

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2019 PLoS ONE

120. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial. (PubMed)

participants (n = 1204) were instructed to wait 60 minutes.The primary outcome was spontaneous vaginal delivery. Secondary outcomes included total duration of the second stage, duration of active pushing, operative vaginal delivery, cesarean delivery, postpartum hemorrhage, chorioamnionitis, endometritis, perineal lacerations (≥second degree), and a composite outcome of neonatal morbidity that included neonatal death and 9 other adverse outcomes.Among 2414 women randomized (mean age, 26.5 years), 2404 (...)  < .001), lower rates of chorioamnionitis (6.7% vs 9.1%; between-group difference, -2.5% [95% CI, -4.6% to -0.3%], P = .005), and fewer postpartum hemorrhages (2.3% vs 4.0%; between-group difference, -1.7% [95% CI, -3.1% to -0.4%], P = .03).Among nulliparous women receiving neuraxial anesthesia, the timing of second stage pushing efforts did not affect the rate of spontaneous vaginal delivery. These findings may help inform decisions about the preferred timing of second stage pushing efforts, when

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2018 JAMA Controlled trial quality: predicted high

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