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Cureus Jul 2023Breast abscesses can be a complication of infectious mastitis or the first presentation of a breast infection, presenting as pain, erythema, and a lump. Actinomycosis is...
Breast abscesses can be a complication of infectious mastitis or the first presentation of a breast infection, presenting as pain, erythema, and a lump. Actinomycosis is a rare chronic disease caused by anaerobic branched filamentous gram-positive bacteria belonging to the genus. It is usually found in the human mouth, digestive tract, and genital tract but can also cause breast abscesses. Actinomycosis affecting the breast is a rare condition that typically occurs as a secondary infection resulting from a pulmonary infection. It is primary when inoculation occurs through the nipple. This report describes the case of a 48-year-old institutionalized female with periareolar swelling in the right breast that had been evolving for approximately two months. The abscess was drained, and the aspirated material contained , a gram-positive bacterium. Actinomycosis of the breast can manifest as either a sinus tract or mass-like features that closely resemble malignancy. The clinical presentation can pose challenges in distinguishing between primary actinomycosis, mastitis, and inflammatory carcinoma. Treatment consists of drainage with needle aspiration or surgical drainage and antibiotic therapy.
PubMed: 37602065
DOI: 10.7759/cureus.42092 -
Animal : An International Journal of... May 2023This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect... (Review)
Review
This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect reproductive performance. Metritis is characterized by fetid discharge from the uterus, with or without fever. Purulent vaginal discharge describes exudate that is >50% pus that may be attributable to uterine infection or cervicitis. Endometritis is inflammation of the uterus diagnosed by endometrial cytology with a proportion of neutrophils (typically ≥5%) that is associated with impaired fertility. Metritis and PVD are associated with uterine bacterial dysbiosis: changes in the microbiota to lesser diversity and greater abundance of pathogens, especially Gram-negative anaerobic bacteria, and Trueperella pyogenes in the case of PVD. Metritis is justifiably treated with approved antibiotics but criteria for more selective treatment without loss of performance are emerging. Purulent vaginal discharge is not synonymous with clinical endometritis, and greater precision in terminology is warranted. PVD is likely under-diagnosed and represents an opportunity for improved management in many herds. Endometritis seems in many cases to reflect persistent, dysregulated inflammation, for which the inciting cause is unclear. Postpartum uterine infection and inflammation have harmful effects on oocytes, embryo development, and the endometrium for at least three months, even if the disease is apparently resolved. Emerging concepts of the resolution and regulation of inflammation are promising for the improvement of prevention and therapy of endometritis.
Topics: Female; Cattle; Animals; Endometritis; Vaginal Discharge; Postpartum Period; Fertility; Puerperal Disorders; Inflammation; Cattle Diseases
PubMed: 37567665
DOI: 10.1016/j.animal.2023.100781 -
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 -
BMC Women's Health Jul 2023The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric,...
BACKGROUND
The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications.
OBJECTIVES
This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia.
METHODS
This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul's hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05.
RESULTS
Factors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane.
CONCLUSION
Proper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.
Topics: Humans; Female; Ethiopia; Case-Control Studies; Pregnancy; Infant, Newborn; Puerperal Infection; Chorioamnionitis; Risk Factors; Adult; Fetal Membranes, Premature Rupture
PubMed: 37491270
DOI: 10.1186/s12905-023-02497-8 -
F1000Research 2022Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical equivalence of Trusynth fast and Vicryl rapide polyglactin 910 fast absorbing sutures on maternal morbidity experienced by women following episiotomy repair: a single-blind, randomized study.
Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast and Vicryl Rapide polyglactin 910 fast-absorbing sutures. : This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18-40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast (n=47) or Vicryl Rapide (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. : The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p<0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 0.35±0.56) and swelling on day 2 (8.51 28.57%) was noted between Trusynth Fast and Vicryl Rapide group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. : Trusynth Fast suture is clinically equivalent to Vicryl Rapide suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020.
Topics: Humans; Female; Pregnancy; Episiotomy; Polyglactin 910; Dyspareunia; Prospective Studies; Single-Blind Method; Sutures; Pelvic Pain
PubMed: 37388624
DOI: 10.12688/f1000research.126555.2 -
World Journal of Clinical Cases Jun 2023Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical...
BACKGROUND
Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical symptoms and signs. This paper reports two patients who developed right ovarian vein thrombosis after cesarean section and vaginal delivery, respectively.
CASE SUMMARY
Case 1 was a 32-year-old female who underwent a cesarean section in labor at 40 wk of gestation due to fetal distress. The patient was persistently febrile after the operation and escalated antibiotic treatment was ineffective. POVT was diagnosed by abdominal computed tomography (CT) and was treated by increasing the dose of low molecular weight heparin (LMWH). Case 2 was a 21-year-old female with a spontaneous vaginal delivery at 39 wk of gestation. The patient developed fever and abdominal pain 3 days after delivery. POVT was promptly identified by abdominal CT, and the condition was quickly controlled after treatment with LMWH and antibiotics.
CONCLUSION
These two cases occurred after cesarean section and vaginal delivery, respectively. The diagnosis was mainly based on imaging examination due to the unspecific clinical symptoms and signs, the CT scan provided an especially high diagnostic value. Comparing these two cases, escalating antibiotics alone did not provide significant therapeutic benefit, but the early escalation of anticoagulant dosage seemed to shorten the disease course. Therefore, early diagnosis by CT followed by aggressive anticoagulation might have a positive effect on improving the prognosis of the disease.
PubMed: 37383122
DOI: 10.12998/wjcc.v11.i16.3877 -
Frontiers in Medicine 2023Maternal sepsis is a life-threatening condition and ranks among the top five causes of maternal death in pregnancy and the postpartum period. Herein, we conducted a...
Maternal sepsis is a life-threatening condition and ranks among the top five causes of maternal death in pregnancy and the postpartum period. Herein, we conducted a retrospective study on sepsis cases to explain the related risk factors by comparing them with bloodstream infection (BSI) and control maternities. In total, 76 sepsis cases were enrolled, and 31 BSI and 57 maternal cases of the same age but with neither sepsis nor BSI were set as controls. Genital tract infection (GTI) and pneumonia were the two most common infection sources in both sepsis (22 cases, 29% and 29 cases, 38%) and BSI cases (18 cases, 58% and 8 cases, 26%). Urinary tract infection (UTI)/pyelonephritis (9 cases, 12%) and digestive infection cases (11 cases, 14%) only existed in the sepsis group. Significantly different infection sources were discovered between the sepsis-death and sepsis-cure groups. A higher proportion of pneumonia and a lower proportion of GTI cases were present in the sepsis-death group (17 cases, 45% pneumonia and 9 cases, 24% GTI) than in the sepsis-cure group (12 cases, 32% pneumonia and 13 cases, 34% GTI). In addition, although gram-negative bacteria were the dominant infectious microorganisms as previously reported, lower proportion of gram-negative bacteria infectious cases in sepsis (30 cases, 50%) and even lower in sepsis-death group (14 cases, 41%) was shown in this study than previous studies. As expected, significantly greater adverse maternal and fetal outcomes, such as higher maternal mortality (26.3% vs. 0% vs. 0%), higher fetal mortality (42.2% vs. 20.8% vs. 0%), earlier gestational age at delivery (26.4 ± 9.5 vs. 32.3 ± 8.1 vs. 37.7 ± 4.0) and lower newborn weight (1,590 ± 1287.8 vs. 2859.2 ± 966.0 vs. 3214.2 ± 506.4), were observed in the sepsis group. This study offered some potential pathogenesis and mortality risk factors for sepsis, which may inspire the treatment of sepsis in the future.
PubMed: 37261123
DOI: 10.3389/fmed.2023.1126807 -
The Journal of Maternal-fetal &... Dec 2023Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No comprehensive overview or systematic summary is currently available.
METHODS
EMBASE, PubMed, and the Cochrane Library databases were searched from inception to 1 February 2020. Studies reporting the safety of TOLAC and ERCS in pregnant women with prior cesarean delivery were included. Statistical analysis was performed using RevMan 5.3 and Stata 15.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted as the effective measures.
RESULTS
A total of 13 studies covering 676,532 cases were included in this meta-analysis. The results demonstrated that the rates of uterine rupture (OR = 3.35, 95%CI [1.57, 7.15], = 81%), neonatal asphyxia (OR = 2.32, 95%CI [1.76, 3.08], = 0%) and perinatal death (OR = 1.71, 95%CI [1.29, 2.25], = 0%) were higher in the TOLAC group compared with the ERCS group. The rates of peripartum hysterectomy (OR = 0.70, 95%CI [0.44, 1.11], = 62%), blood transfusion (OR = 1.24, 95%CI [0.72, 2.12], = 95%), and puerperal infection (OR = 1.11, 95%CI [0.77, 1.60], = 95%) showed no significant differences between the two groups.
CONCLUSION
TOLAC is associated with a higher risk of uterine rupture, neonatal asphyxia, and perinatal death compared with ERCS. Nevertheless, it should be noted that the risks of all complications were small in both groups. This information is important for healthcare providers and women choosing the delivery type.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Cesarean Section; Cesarean Section, Repeat; Trial of Labor; Perinatal Death; Uterine Rupture; Asphyxia; Vaginal Birth after Cesarean; Retrospective Studies
PubMed: 37217450
DOI: 10.1080/14767058.2023.2214831