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Medicine Mar 2024Puerperal sepsis is a life-threatening condition caused by infection that can rapidly progress to multisystem infection and toxin-mediated shock. Symmetrical peripheral...
RATIONALE
Puerperal sepsis is a life-threatening condition caused by infection that can rapidly progress to multisystem infection and toxin-mediated shock. Symmetrical peripheral gangrene is defined as symmetrical distal ischemic damage in two or more sites in the absence of major vascular occlusive disease. The syndrome is devastating and rare. In this study, we introduce a case of puerperal septicemia complicated by symmetrical peripheral gangrene.
PATIENT CONCERNS
A 23-year-old woman delivered a live female infant vaginally after cervical balloon dilatation at 39 weeks of gestation. Persistent hyperthermia developed on the first postpartum day. After experiencing ventricular fibrillation, acute liver failure, and acute pulmonary edema, she developed blackened extremities on the 5th postpartum day.
DIAGNOSES
Puerperal septicemia complicated by symmetrical peripheral gangrene.
INTERVENTIONS
Upon transfer to our hospital, the patient was enrolled in the intensive care unit and underwent anti-infective and amputation surgery.
OUTCOMES
After the surgery, the patient recovered well and was successfully discharged from the hospital.
LESSONS
Early detection and timely treatment is the best way to reduce the mortality and sequelae of puerperal sepsis. Physicians should be alert to the possibility of comorbid symmetrical peripheral gangrene when sepsis patients present with hepatic impairment.
Topics: Humans; Female; Young Adult; Adult; Gangrene; Shock, Septic; Extremities; Amputation, Surgical; Postpartum Period
PubMed: 38552074
DOI: 10.1097/MD.0000000000037571 -
Scientific Reports Mar 2024Sepsis is responsible for 50% of intrahospital maternal deaths worldwide. Incidence is increasing in both low and middle-, and high-income countries. There is little...
Sepsis is responsible for 50% of intrahospital maternal deaths worldwide. Incidence is increasing in both low and middle-, and high-income countries. There is little data on incidence and clinical outcomes of obstetric infections including maternal sepsis in the Nordic countries. The aims of this study are to give estimates of the occurrence of obstetric infections and maternal sepsis in a Norwegian hospital cohort, assess the quality of management of maternal sepsis cases, and evaluate the usefulness of diagnostic codes to identify maternal sepsis retrospectively. We conducted a retrospective cohort study of pregnant, labouring, post-abortion, and postpartum women. We assessed the accuracy of the diagnostic code most frequently applied for maternal sepsis, O85. We found 7.8% (95% confidence interval 7.1-8.5) infection amongst pregnant, labouring, and postpartum women. The incidence of maternal sepsis was 0.3% (95% confidence interval 0.2-0.5), and the majority of sepsis cases were recorded in the postpartum period. Two thirds of women were given broad-spectrum antibiotics at the time sepsis was diagnosed, but only 15.4% of women with puerperal sepsis were given antimicrobials in accordance with national guidelines. When used retrospectively, obstetric infection codes are insufficient in identifying both maternal and puerperal sepsis, with only 20.3% positive predictive value for both conditions. In conclusion, obstetric infections contribute significantly to maternal morbidity in Norway's second largest maternity hospital. This study provides incidences of maternal infections for hospitalised patients in temporal relation to pregnancy, labour, abortion and the postpartum period, knowledge which is valuable for planning of health care services and allocation of resources. In addition, the study highlights areas where improvement is needed in clinical handling of maternal sepsis. There is need for studies on the management quality and use of correct diagnostic codes in this patient category.
Topics: Pregnancy; Humans; Female; Retrospective Studies; Pregnancy Complications, Infectious; Postpartum Period; Sepsis; Pre-Eclampsia; Hospitals
PubMed: 38480912
DOI: 10.1038/s41598-024-56486-4 -
Medicine Aug 2023Placental residue is a relatively common and sophisticated disease among obstetric delivery complications. A failure to detect placental residue in time may cause poor...
RATIONALE
Placental residue is a relatively common and sophisticated disease among obstetric delivery complications. A failure to detect placental residue in time may cause poor outcomes such as postpartum hemorrhage and puerperal infection.
PATIENT CONCERNS
We present the case of a 33-year-old full-term singleton parturient with placental residue. Upon precipitate labor and childbirth, the placenta and fetal membranes were examined to be intact. However, 1 day after discharge, she felt that there was discharge from the vagina and thus presented to our emergency department.
DIAGNOSES
The patient was diagnosed with residual membranes and readmitted to the hospital for uterine curettage.
INTERVENTION
Uterine curettage was performed under B-ultrasound guidance.
OUTCOME
The patient was discharged smoothly without any postoperative complications.
LESSONS
This paper can provide significant enlightenment for the prevention and early treatment of placental residue, including enhancing the risk awareness of high-risk patients, standardizing the process of clinical examination of the placenta, and early uterine contraction promotion to assist in the discharge of residual tissue, so as to reduce the occurrence of placental residue.
Topics: Pregnancy; Humans; Female; Adult; Patient Discharge; Placenta; Patient Readmission; Delivery, Obstetric; Extraembryonic Membranes
PubMed: 37565921
DOI: 10.1097/MD.0000000000034565 -
International Journal of Environmental... Mar 2024Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal...
Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal fever could reduce severe outcomes, such as maternal mortality due to puerperal sepsis. The purpose of this cross-sectional study was to determine the prevalence of and associated factors of postnatal fever among postnatal women at Kawempe National Referral Hospital. Three hundred postnatal women were recruited. Temperature measurements were conducted and a 29-item questionnaire was completed along with the extraction of health history from the medical records of the participants. The prevalence of maternal fever was 58/300 (19.3%). Multivariable analysis indicated that only four factors-HIV-positive status (AOR = 2.56; 95% CI = 1.02-6.37), labor complications (AOR = 6.53; 95% CI = 2.40-17.71), prolonged labor (AOR = 3.12; 95% CI = 1.11-8.87), and more than 24 h spent in postnatal care (AOR = 5.16; 95% CI = 2.19-12.16)-were found to be significantly associated with postnatal fever. The prevalence of postnatal maternal fever among postnatal women at Kawempe National Referral Hospital was higher than that in other reports in the literature. The factors significantly associated with maternal fever were HIV-positive status, complications during labor, prolonged labor, and more than 24 h spent in postnatal care. Health workers involved in the provision of labor and obstetric services must follow guidelines to assess fever and manage the underlying conditions causing it.
Topics: Pregnancy; Humans; Female; Uganda; Prevalence; Cross-Sectional Studies; Pregnancy Complications; Hospitals; HIV Infections; Referral and Consultation
PubMed: 38541315
DOI: 10.3390/ijerph21030316 -
International Health Jan 2024Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in...
BACKGROUND
Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in the third trimester of pregnancy and the associations between anaemia and adverse perinatal outcomes in Hebei Province, China.
METHODS
We used SPSS software to describe the incidence of anaemia in the third trimester of pregnancy in Hebei Province and analysed the clinical characteristics in anaemic patients and the relationship between anaemia and adverse pregnancy outcomes.
RESULTS
The overall prevalence of anaemia in the third trimester of pregnancy was 35.0% in Hebei Province. The prevalence of anaemia in the population with a high education level was lower than that in the population with a low education level. The incidence rate in rural areas was higher than that in urban areas. After adjustment for confounding factors, anaemia in the third trimester of pregnancy is an independent risk factor in terms of placenta previa, placental abruption, uterine atony, pre-eclampsia, gestational diabetes mellitus, heart disease, postpartum haemorrhage, premature birth, laceration of birth canal, puerperal infection, caesarean section and large for gestational age.
CONCLUSIONS
The prevalence of anaemia in the third trimester of pregnancy is associated with an increased risk of adverse perinatal outcomes. A comprehensive approach to prevent anaemia is needed to improve maternal and child health outcomes.
Topics: Child; Pregnancy; Humans; Female; Pregnancy Trimester, Third; Cesarean Section; Prevalence; Placenta; Pregnancy Outcome; Anemia
PubMed: 37093789
DOI: 10.1093/inthealth/ihad028 -
PloS One 2024The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal,...
Impact of COVID-19 pandemic in the Brazilian maternal mortality ratio: A comparative analysis of Neural Networks Autoregression, Holt-Winters exponential smoothing, and Autoregressive Integrated Moving Average models.
BACKGROUND AND OBJECTIVES
The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal, and neonates. Brazil has the highest number of maternal deaths and a distressing fatality rate of 7.2%, more than double the country's current mortality rate of 2.8%. This study investigates the impact of the COVID-19 pandemic on the Brazilian Maternal Mortality Ratio (BMMR) and forecasts the BMMR up to 2025.
METHODS
To assess the impact of the COVID-19 pandemic on the BMMR, we employed Holt-Winters, Autoregressive Integrated Moving Average (ARIMA), and Neural Networks Autoregression (NNA). We utilized a retrospective time series spanning twenty-five years (1996-2021) to forecast the BMMR under both a COVID-19 pandemic scenario and a controlled COVID-19 scenario.
RESULTS
Brazil consistently exhibited high maternal mortality values (mean BMMR [1996-2019] = 57.99 ±6.34/100,000 live births) according to World Health Organization criteria. The country experienced its highest mortality peak in the historical BMMR series in the second quarter of 2021 (197.75/100,000 live births), representing a more than 200% increase compared to the previous period. Holt-Winter and ARIMA models demonstrated better agreement with prediction results beyond the sample data, although NNA provided a better fit to previous data.
CONCLUSIONS
Our study revealed an increase in BMMR and its temporal correlation with COVID-19 incidence. Additionally, it showed that Holt-Winter and ARIMA models can be employed for BMMR forecasting with lower errors. This information can assist governments and public health agencies in making timely and informed decisions.
Topics: Humans; Infant, Newborn; Brazil; COVID-19; Forecasting; Maternal Mortality; Neural Networks, Computer; Pandemics; Retrospective Studies; Female; Pregnancy
PubMed: 38295029
DOI: 10.1371/journal.pone.0296064 -
Gynecologie, Obstetrique, Fertilite &... Apr 2024Over the 2016-2018 period, maternal mortality due to direct infectious causes accounted for 13% of maternal deaths by direct causes. The increasing trend in...
Over the 2016-2018 period, maternal mortality due to direct infectious causes accounted for 13% of maternal deaths by direct causes. The increasing trend in genital-tract infections related-deaths noted in the 2013-2015 report continues for the 2016-2018 period, but this 2010-2018 increase remains at the limit of statistical significance given the low number of cases (p 0.08). The 13 deaths from direct infectious causes for the 2016-2018 period were due to 4 cases of puerperal toxic shock syndrome (Streptococcus A beta hemolyticus or Clostridium group bacilli), 6 sepsis caused by intrauterine infection due to E. Coli and 3 cases of septic shock from intrauterine origin and no documented bacteria. In this 2016-2018 triennium, the quality of care concerning women who died of direct infections was considered non-optimal in 85% (11/13). Death was considered possibly or probably avoidable in 9/13 cases (69%), which made it one of the most avoidable causes of maternal mortality. Preventable factors related to the medical management were the most frequent (9/13), with in particular a diagnostic failure or delayed diagnosis leading to a delay in the introduction of medical treatment. The others contributory factors to these deaths were related to the organization of healthcare (delayed transfer, lack of communication between practitioners) as well as factors related to patient social and/or mental vulnerability.
Topics: Female; Humans; Maternal Mortality; Reproductive Tract Infections; Escherichia coli; Maternal Death; Delivery of Health Care; Shock, Septic; France
PubMed: 38382839
DOI: 10.1016/j.gofs.2024.02.014 -
Case Reports in Women's Health Mar 2024Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI...
Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.
PubMed: 38178842
DOI: 10.1016/j.crwh.2023.e00574