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Postpartum Endometritis

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121. 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

122. Vaginal discharge

. The woman is not postnatal or post miscarriage. The woman is not pre or post termination. This is a first episode of suspected BV, or if recurrent, a previous episode of recognizably similar symptoms was previously diagnosed to be BV following examination. The woman is not pregnant. Characteristic symptoms of vaginal candidiasis if all the following apply: The woman is at low risk of an STI. The woman does not have symptoms of other conditions causing vaginal discharge. Symptoms have not developed (...) with vaginal discharge should have a high vaginal swab taken for culture if: They are postnatal or post miscarriage. They have vaginitis without discharge. They are pre or post gynaecological surgery. They are pre or post termination of pregnancy. Symptoms are not characteristic of BV. Within 3 weeks of intrauterine contraceptive insertion. The condition is recurrent (4 cases a year or more). A previous treatment failed. Examination and investigations If necessary, what examination and investigations

2019 NICE Clinical Knowledge Summaries

123. Chlamydia - uncomplicated genital

reactive arthritis (SARA) (polyarthritis of weight-bearing joints) is more common in men than women with chlamydia. Anxiety and psychological distress has been reported in people with chlamydia. Chlamydia in pregnancy is associated with: Increased risk of premature rupture of membranes, pre-term delivery, and low birth weight in the infant. Increased risk of intra-partum pyrexia and late post partum endometritis. Infections of the eyes, lungs, nasopharynx, and genitals in the neonate, due to exposure (...) is considered uncomplicated when the infection has not ascended to the upper genital tract. Ascending chlamydial infection in women can cause pelvic inflammatory disease (PID). The National Chlamydia Screening Programme recommends annual screening for all sexually active people younger than 25 years of age, or more frequently if they change their partner. Tests for chlamydia are recommended if a sexually active person has the following symptoms and signs: In women: post-coital or intermenstrual bleeding

2019 NICE Clinical Knowledge Summaries

124. Prevalence, risk factors and molecular characterization of Chlamydia trachomatis in pregnant women from Córdoba, Argentina: A prospective study. Full Text available with Trip Pro

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

2019 PLoS ONE

125. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial. Full Text available with Trip Pro

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

2018 JAMA Controlled trial quality: predicted high

126. Institutional Protocols for Vaginal Preparation With Antiseptic Solution and Surgical Site Infection Rate in Women Undergoing Cesarean Delivery During Labor Full Text available with Trip Pro

in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits.A total of 523 women

2018 EvidenceUpdates

127. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. (Abstract)

determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (21 July 2014).We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean (...) infectious morbidity.We independently assessed eligibility and quality of the studies.Five trials randomizing 1946 women (1766 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 7.2% in control groups to 3.6% in vaginal

2014 Cochrane

128. Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV). (Abstract)

Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV). The incidence of chorioamnionitis occurs in between eight and 12 women for every 1000 live births and 96% of cases of chorioamnionitis are due to ascending infection. Following spontaneous vaginal delivery, 1% to 4% of women develop postpartum endometritis. The incidence of neonatal sepsis is 0.5% to 1% of all infants born. Maternal vaginal bacteria are the main agents (...) authors independently assessed trial eligibility and quality, extracted and interpreted the data. A third review author analyzed and interpreted the data. The fourth author also interpreted the data.We included three studies (3012 participants). There was no evidence of an effect of vaginal chlorhexidine during labour in preventing maternal and neonatal infections. Although the data suggest a trend in reducing postpartum endometritis, the difference was not statistically significant (three trials

2014 Cochrane

129. Antibiotic regimens for management of intra-amniotic infection. Full Text available with Trip Pro

placebo after vaginal delivery showed no significant differences between groups in rates of treatment failure or postpartum endometritis. No significant differences were found in rates of neonatal death and postpartum endometritis when use of antibiotics was compared with no treatment. Four trials assessing two different dosages/regimens of gentamicin or dual-agent therapy versus triple-agent therapy, or comparing antibiotics, found no significant differences in most reported neonatal or maternal (...) in nearly 20% of term births and in 50% of preterm births. Women with chorioamnionitis have a two to three times higher risk for cesarean delivery and a three to four times greater risk for endomyometritis, wound infection, pelvic abscess, bacteremia, and postpartum hemorrhage.To assess the effects of administering antibiotic regimens for intra-amniotic infection on maternal and perinatal morbidity and mortality and on infection-related complications.We searched the Cochrane Pregnancy and Childbirth

2014 Cochrane

130. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections. Full Text available with Trip Pro

) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal (...) sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis.Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess

2014 Cochrane

131. High-dose versus low-dose oxytocin infusion regimens for induction of labour at term. Full Text available with Trip Pro

0.84, 95% CI 0.23 to 3.12; two trials), postpartum haemorrhage (RR 1.08, 95% CI 0.87 to 1.34; five trials), or endometritis (RR 1.35, 95% CI 0.53 to 3.43; three trials). Removal of high bias studies reveals a significant reduction of induction to delivery interval (MD -1.94 hours, 95% CI -0.99 to -2.89 hours, 489 women). A significant increase in hyperstimulation without specifying fetal heart rate changes was found in the high-dose group (RR 1.86, 95% CI 1.55 to 2.25).No other secondary outcomes

2014 Cochrane

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

endometritis and maternal length of stay.The data were too few to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity. (...) 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

2014 Cochrane

133. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. (Abstract)

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. Retained placenta is a potentially life-threatening condition because of its association with postpartum hemorrhage. Manual removal of placenta increases the likelihood of bacterial contamination in the uterine cavity.To compare the effectiveness and side-effects of routine antibiotic use for manual removal of placenta in vaginal birth in women who received antibiotic prophylaxis and those who did (...) not and to identify the appropriate regimen of antibiotic prophylaxis for this procedure.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014).All randomized controlled trials comparing antibiotic prophylaxis and placebo or non antibiotic use to prevent endometritis after manual removal of placenta in vaginal birth.There are no included trials. In future updates, if we identify eligible trials, two review authors will independently assess trial quality and extract dataNo studies

2014 Cochrane

134. Bacterial vaginosis

. Pre-term premature rupture of membranes. Spontaneous abortion. Low birthweight baby. Postpartum endometritis. Post caesarean delivery wound infections. Post surgical infections. Subclinical PID. Diagnosis Diagnosis of bacterial vaginosis Assessment How should I assess a woman with suspected bacterial vaginosis? Take a history. Ask about the symptoms experienced (if any). Approximately 50% of women with bacterial vaginosis (BV) are asymptomatic. When symptoms are present, BV is characterized (...) is also associated with several obstetric and gynecologic complications, including late miscarriage, pre-term labour, pre-term birth, pre-term premature rupture of membranes, low birthweight, and postpartum endometritis. Approximately 50% of women with BV are asymptomatic. When symptoms are present, BV is characterized by a fishy-smelling vaginal discharge. It is not usually associated with soreness, itching, or irritation. Examination may reveal a thin, white, homogeneous discharge coating the walls

2018 NICE Clinical Knowledge Summaries

135. The golden hour of sepsis: An in-depth analysis of sepsis-related maternal mortality in middle-income country Suriname. Full Text available with Trip Pro

and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess socio-demographic characteristics, clinical aspects and substandard care.Of all 65 maternal deaths in Suriname 29 (45%) were sepsis-related. These women were mostly of low socio-economic class (n = 23, 82%), of Maroon ethnicity (n = 14, 48%) and most deaths occurred postpartum (n = 21, 72%). Underlying causes were pneumonia (n = 14, 48%), wound infections (n = 3, 10%) and endometritis

2018 PLoS ONE

136. WHO guidelines for the treatment of Chlamydia trachomatis

FOR THE TREATMENT OF CHLAMYDIA TRACHOMATIS STI Guideline Development Group (GDG): Chairpersons: Judith Wasserheit, Holger Schünemann and Patricia Garcia Members: * 8 ' @W K D WD ? H F W VO \ P S K R L G W L VVX H D Q GW U D F K R P D H \ HL Q I H F W L R Q CLINICAL PRESENTATION Genital infections due to C. trachomatis are DV \ P SW R P DW L FL QD S S U R [ L P DWH O \ RIZR P H QD Q G RIP H Q (2). Symptoms of uncomplicated chlamydial infection in women include abnormal vaginal discharge, dysuria, and post

2016 World Health Organisation Guidelines

137. WHO guidelines for the treatment of Neisseria gonorrhoeae

. Pharyngeal infections are mainly asymptomatic, but mild sore throat and pharyngitis may occur. In the majority of women with gonorrhoea, the lack of discernible symptoms results in unrecognized and untreated infections. Untreated infections usually resolve spontaneously but may lead to serious complications such as pelvic inflammatory disease, including endometritis, salpingitis and tubo-ovarian abscess, which can lead to ectopic pregnancy and infertility. Untreated urethral infection in men can lead

2016 World Health Organisation Guidelines

138. Core Competencies for Management of Labour

of a Primary Care Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 7 . Postpartum Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 8A. Obstetrical Emergencies – Cord Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 8B. Obstetrical Emergencies – Shoulder Dystocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Perinatal Services BC Copyright © 2011 - PSBC MANAGEMENT (...) are defined as those with patient units or portions of patient units that are appointed for the specified purpose of providing intrapartum and postpartum care. • An RN who w or ks in a small r ur al hospit al or set ting that does not ha v e designat ed mat er nit y services is ethically obligated to provide the best care s/he can in the absence of the primary care provider, given the circumstances and her/his level of competence. 4. One-to-one Support in Labour • A w oman in activ e phase of labour

2014 British Columbia Perinatal Health Program

140. WHO recommendations for prevention and treatment of maternal peripartum infections

, and antibiotic prophylaxis for preventing infection in infection-prone conditions and obstetric procedures (prelabour rupture of membranes, meconium- stained amniotic fluid, perineal tears, manual removal of the placenta, operative vaginal birth and caesarean section). The recommendations on treatment of maternal peripartum infections are specific to antibiotic management of chorioamnionitis and postpartum endometritis. For each recommendation, the overall quality of evidence was graded as very low, low (...) should be used in preference to other classes of antibiotics. Conditional recommendation based on very low-quality evidence Treatment of peripartum infections 19. 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 20. A combination of clindamycin and gentamicin is recommended as first-line antibiotics for the treatment of postpartum endometritis

2015 World Health Organisation Guidelines

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