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Journal of Clinical and Diagnostic... May 2017Even decades after the development of effective low-cost antibiotics, sepsis persists as the foremost cause of preventable maternal death worldwide. In developing...
INTRODUCTION
Even decades after the development of effective low-cost antibiotics, sepsis persists as the foremost cause of preventable maternal death worldwide. In developing countries like India, where the paramount impediment to intervention is poverty, maternal mortality due to sepsis is a continuing representation of maternal health inequality.
AIM
To determine the incidence, risk factors and mortality in women presenting with puerperal sepsis in a tertiary care health facility in India.
MATERIALS AND METHODS
This retrospective study was carried out in VMMC and Safdarjung Hospital, New Delhi, India, from January 2016 to June 2016 in Department of Obstetrics and Gynaecology. Case records of all eligible patients of puerperal sepsis were reviewed and data were extracted regarding demographic profile, clinical profile on admission, course in hospital, management, complications and cause of mortality (in case of death). Inclusion criteria were any patient presenting either immediately after delivery or miscarriage or within 42 days of these events with fever and any of the following: pain abdomen, malodorous lochia, abdominal distention, uterine tenderness, pelvic abscess, peritonitis, mechanical or foreign body injury, any system/organ failure or shock. Exclusion criteria consisted of patients presenting with fever during pregnancy or more than 42 days after delivery or miscarriage, or patients presenting with fever due to medical conditions, wound infection, mastitis, UTI or thrombophlebitis. Data were entered in predesigned proformas and analysed. A p-value of less than 0.05 was considered significant.
RESULTS
During the study period, a total of 33 cases met the inclusion criteria. Of these, 90% were referred cases. Anaemia, prolonged labour, delivery by an untrained person and unsafe abortion were the main identifiable risk factors. Surgical management was required in 75% cases, while 70% women succumbed to their illness, mostly due to multiorgan failure.
CONCLUSION
Maternal mortality due to maternal sepsis is very high; Lack of safe and hygienic practices for conducting delivery and abortion are important contributory factors.
PubMed: 28658852
DOI: 10.7860/JCDR/2017/23710.9815 -
Diagnostic and Interventional Radiology... 2016Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and... (Review)
Review
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
Topics: Adult; Cesarean Section; Early Diagnosis; Female; Humans; Multidetector Computed Tomography; Pelvis; Postoperative Complications
PubMed: 27756714
DOI: 10.5152/dir.2016.15593 -
Biomedica : Revista Del Instituto... Dec 2019Introduction. Trypanosoma cruzi is mainly transmitted by vectors. Other pathways such as oral and congenital transmission have become increasingly relevant. Objective....
Introduction. Trypanosoma cruzi is mainly transmitted by vectors. Other pathways such as oral and congenital transmission have become increasingly relevant. Objective. To evaluate T. cruzi infections in post-partum women and their newborns who attended the Hospital Universitario Dr. Luis Razetti (Barcelona, Anzoátegui state, Venezuela). Materials and methods. A prospective cross-sectional study was undertaken from May, 2015, to August, 2016. ELISA, MABA and IFI assays were used to determine the infection in 1,200 post-partum women. The newborns of seropositive women were then examined for T. cruzi by PCR amplification and serological tests at nine months old. The prevalence of the parasitic infection in post-partum women and their newborns was then estimated. To establish the relationship between risk factors and infection, the chi-square test (c2) and the probability ratio (OR) was applied. Results. A total of 78 women were identified as seropositive (6.50 %) (CI 95%: 5.10-7.89%), and parasitic DNA was detected in six of their newborns (9.09%). Nine months after birth eleven infants were examined, and all were found to be serologically negative. Risk factors detected were pregnancy duration (OR: 0,36; CI95%: 0,15-0,84), where the patients lived at present (OR: 0,34; CI95%: 0,24-0,62) or previously (OR: 2,50; CI95%: 1,38-4,52) and having relatives with Chagas disease (OR: 1,75; CI95%: 1,02-3,01). Conclusions. Seroprevalence for T. cruzi infection in young post-partum women in rural areas was high. The detection of parasite DNA at birth was not indicative of congenital Chagas disease.
Topics: Adolescent; Adult; Antigens, Protozoan; Chagas Disease; Cross-Sectional Studies; DNA, Protozoan; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Postpartum Period; Pregnancy; Prevalence; Prospective Studies; Risk Factors; Trypanosoma cruzi; Venezuela; Young Adult
PubMed: 31860187
DOI: 10.7705/biomedica.4606 -
American Journal of Perinatology Apr 2020Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at... (Comparative Study)
Comparative Study
OBJECTIVE
Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at readmission and (2) compare early (<6 weeks) and late (6 weeks to 9 months postpartum) maternal readmission with sepsis.
STUDY DESIGN
We identified our cohort using linked hospital discharge data and birth certificates for California deliveries from 2008 to 2011. Consistent with the 2016 sepsis classification, we defined sepsis as septicemia plus acute organ dysfunction. We compared women with early or late readmission with sepsis to women without readmission with sepsis.
RESULTS
Among 1,880,264 women, 494 (0.03%) were readmitted with sepsis, 61% after 6 weeks. Risk factors for readmission with sepsis included preterm birth, hemorrhage, obesity, government-provided insurance, and primary cesarean. For both early and late sepsis readmissions, the most common diagnoses were urinary tract infection and pyelonephritis, and the most frequently identified infecting organism was gram-negative bacteria. Women with early compared with late readmission with sepsis shared similar obstetric characteristics.
CONCLUSION
Maternal risk factors for both early and late readmission with sepsis included demographic characteristics, cesarean, hemorrhage, and preterm birth. Risks for sepsis after delivery persist beyond the traditional postpartum period of 6 weeks.
Topics: Adult; Body Mass Index; California; Cesarean Section; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Multiple Organ Failure; Patient Readmission; Postpartum Hemorrhage; Premature Birth; Puerperal Disorders; Risk Factors; Sepsis; Socioeconomic Factors; Time Factors
PubMed: 31529451
DOI: 10.1055/s-0039-1696721 -
Acta Obstetricia Et Gynecologica... Apr 2023Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection;... (Observational Study)
Observational Study
INTRODUCTION
Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS).
MATERIAL AND METHODS
Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter.
RESULTS
Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity.
CONCLUSIONS
We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.
Topics: Pregnancy; Humans; Female; Anal Canal; Delivery, Obstetric; Ultrasonography; Prospective Studies; Lacerations; Puerperal Infection; Perineum; Postpartum Period; Fecal Incontinence; Obstetric Labor Complications
PubMed: 36707852
DOI: 10.1111/aogs.14515 -
International Journal of Environmental... Jun 2022is an obligate intracellular parasite that can infect several species, including humans, and can cause severe damage to the fetus when the infection occurs during...
BACKGROUND
is an obligate intracellular parasite that can infect several species, including humans, and can cause severe damage to the fetus when the infection occurs during pregnancy. The environment and/or food contamination are critical to spreading the infection. Human milk is rich in nutrients and bioactive elements that provide growth and development of the immune system of the newborn. All isotypes of immunoglobulins are present in human colostrum and they are produced from systemic or local sources. Breastfeeding protects the infant against various pathogens, but there is no conclusive study to detect IgG subclasses in colostrum against . Therefore, the aim of this study was to detect and evaluate the presence of antibody isotypes against in paired samples of serum and colostrum.
METHODS
The study included 283 puerperal patients. ELISA (Enzyme-Linked Immunosorbent Assay) for detection of anti--specific IgM, IgA, and IgG isotypes and IgG1, IgG3, and IgG4 subclasses were conducted on paired samples of serum and colostrum.
RESULTS
It was found that 45.9%, 6.0%, and 2.1% of serum samples and 45.2%, 7.1%, and 2.1% of colostrum samples were positive for IgG, IgM, and IgA, respectively. Specific IgG1, IgG3, and IgG4 were positive, respectively, in 98.5%, 54.6%, and 44.6% of serum samples, in contrast with 56.9%, 78.5%, and 34.6% of colostrum samples. Thus, the predominant reactivity of IgG subclasses against was IgG1 in serum and IgG3 in colostrum. The higher percentage of positive samples and higher levels of anti- IgG3 antibodies were observed in colostrum, when compared to serum samples, suggesting a local production of this subclass. IgG3 and IgG1 subclasses presented different percentages of positivity in serum and colostrum. Only the IgG1 subclass showed a significant correlation between the levels of anti- in serum and colostrum, suggesting that IgG1 in breast milk comes from a systemic source. IgG4 showed a similar percentage of positivity in both sample types, but no significant correlation was observed between their levels.
CONCLUSION
Colostrum presents representative levels of IgM, IgA, IgG1, IgG3, and IgG4 antibodies specific to . The detection of these antibodies presents the potential for diagnostic application of colostrum samples to better identify the diagnostic status of infection, especially during the acute phase. In addition, breastfeeding can also be a possible source of protective antibodies for the newborn against toxoplasmosis, an anthropozoonosis maintained by environmental infection, which interferes in the public health of many countries.
Topics: Antibodies, Protozoan; Colostrum; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin Isotypes; Immunoglobulin M; Infant, Newborn; Pregnancy; Toxoplasma
PubMed: 35805611
DOI: 10.3390/ijerph19137953 -
Journal of Dairy Science Dec 2023The objective was to unravel the peripartum immune and metabolic changes associated with metritis in Holstein cows. Holstein cows (n = 128) had blood collected at -14,...
The objective was to unravel the peripartum immune and metabolic changes associated with metritis in Holstein cows. Holstein cows (n = 128) had blood collected at -14, 0, 3, and 7 d relative to parturition (DRP). Flow cytometry was used to evaluate blood leukocyte counts, proportions, and activation. Total cells, live cells, single cells, monocytes (CD172α/CD14), polymorphonuclears (CD172α/CD14/SSC), B-cells (CD21/MHCII), CD4 T-cells (CD4), CD8 T-cells (CD8), and γδ T-cells (γδTCR) were evaluated. Both CD62L and CD11b were used as markers of cell activation. Major histocompatibility complex class II was used as a marker of antigen presentation in monocytes. A Milliplex Bovine Cytokine/Chemokine 08-plex kit was used to evaluate plasma concentrations of IFN-γ, IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor-α. The body weight (BW) change prepartum was calculated as the difference between calving BW and prepartum BW divided by the number of days between measurements. Plasma fatty acids (FA) were measured at -14 and 0 DRP using untargeted gas chromatography with time-of-flight mass spectrometry. Data were analyzed by ANOVA for repeated measures. Cows that developed metritis (n = 57) had greater prepartum BW, prepartum BW loss, and greater FA concentrations at calving. Plasma FA at calving was positively correlated with IL-1β. Cows that developed metritis had persistent systemic inflammation, which was demonstrated by greater B-cell activation, greater pro-inflammatory cytokine concentrations, and greater cell damage pre- and postpartum. Postpartum, we observed greater polymorphonuclear cell activation and extravasation but lesser monocytes and CD4 T-cells activation and extravasation, which suggests postpartum immune tolerance. Greater prepartum adiposity in cows that developed metritis may lead to systemic inflammation pre- and postpartum and immune tolerance postpartum, which may lead to failure to prevent bacterial infection, and development of puerperal metritis.
Topics: Female; Cattle; Animals; CD8-Positive T-Lymphocytes; Gas Chromatography-Mass Spectrometry; Postpartum Period; Cytokines; Inflammation; Pelvic Inflammatory Disease; Cattle Diseases; Lactation
PubMed: 37641354
DOI: 10.3168/jds.2023-23289 -
Acta Obstetricia Et Gynecologica... May 2018The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We... (Review)
Review
INTRODUCTION
The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We conducted a systematic review to inform up-to-date evidence-based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related to antepartum antibiotic exposure in infants.
MATERIAL AND METHODS
Four bibliographic databases were searched for published reports of trials. Ongoing or unpublished studies were searched in Clinicaltrials.gov and the World Health Organization registry platform. Randomized controlled trials comparing antibiotic prophylaxis before and after cord clamping in cesarean section were eligible. Maternal and neonatal outcomes were assessed, and certainty of evidence graded.
RESULTS
In total, 18 randomized controlled trials met the inclusion criteria. Those women who received antibiotics preoperatively were 28% (relative risk 0.72, 95% confidence interval 0.56-0.92, nine studies, 4342 women, high quality of evidence) less likely to show infectious morbidity as compared with those who received antibiotics after cord clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (relative risk 0.57, 95% confidence interval 0.40-0.82, 13 studies, 6250 women, high quality of evidence) and the risk of wound infection by 38% (relative risk 0.62, 95% confidence interval 0.47-0.81, 14 studies, 6450 women, high quality of evidence) in those who received antibiotics preoperatively as compared to those who received antibiotics after cord clamping. For other maternal infections no significant differences were identified. The risk for neonatal outcomes, such as deaths attributed to infection, sepsis, neonatal antibiotic treatment, intensive care unit admission or antibiotic-related adverse events, was not found to be different, either clinically or statistically, when antibiotics were given before or after cord clamping (moderate to low quality of evidence).
CONCLUSIONS
The evidence in favor of prophylactic antibiotic administration before, in comparison with after, cord clamping for major maternal infections was of high quality, meaning that further research would be unlikely to change the confidence in these findings. However, we recommend additional research reflecting the precision of the effect estimates for neonatal outcomes.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cesarean Section; Constriction; Drug Administration Schedule; Female; Humans; Perinatal Care; Pregnancy; Preoperative Care; Puerperal Infection; Surgical Wound Infection; Umbilical Cord
PubMed: 29215155
DOI: 10.1111/aogs.13276 -
BMC Pregnancy and Childbirth Oct 2023This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.
OBJECTIVE
This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.
METHODS
We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.
RESULTS
The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016).
CONCLUSIONS
The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).
CLINICAL TRIAL REGISTRATION
Thai Clinical Trials Registry: 20220126004.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Postpartum Hemorrhage; Retrospective Studies; Delivery, Obstetric; Birth Injuries; Risk Factors
PubMed: 37884886
DOI: 10.1186/s12884-023-06080-9 -
European Journal of Epidemiology May 2022We aimed to review Semmelweis's complete work on puerperal sepsis mortality in maternity wards in relation to exposure to cadavers and chlorine handwashing and other... (Review)
Review
We aimed to review Semmelweis's complete work on puerperal sepsis mortality in maternity wards in relation to exposure to cadavers and chlorine handwashing and other factors from the perspective of modern epidemiological methods. We reviewed Semmelweis' complete work and data as published by von Györy 1905 according to current standards. We paid particular attention to Semmelweis's definition of mortality in and of itself, to concepts of modern epidemiology that were already recognizable in Semmelweis's work, and to bias sources. We did several quantitative bias analyses to address selection bias and information bias from outcome measurement error. Semmelweis addressed biases that have become known to modern epidemiology, such as confounding, selection bias and bias from outcome misclassification. Our bias analysis shows that differential loss to follow-up is an unlikely explanation for his results. Bias due to outcome misclassification would only be relevant if misclassification differed between time periods. Confounding by health status was likely but could not be quantitatively addressed. Semmelweis was aware that cause-specific mortality is a function of incidence and prognosis. He reasoned in potential outcome terms to estimate the reduced number of deaths from an intervention. He advanced a hypothesis of clinic overcrowding as a risk factor for puerperal sepsis mortality that turns out to be wrong. Semmelweis' data provide a great pool for illustrating the logic of scientific discovery by use of the numerical method. The explanatory power of his work was strong and Semmelweis was able to refute several previous causal explanations.
Topics: Causality; Female; History, 19th Century; Humans; Hungary; Male; Pregnancy; Puerperal Infection; Risk Factors; Selection Bias; Sepsis
PubMed: 35486338
DOI: 10.1007/s10654-022-00871-8