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[Ischaemic stroke due to basilar artery occlusion in a puerperal patient with SARS-CoV-2 infection].Revista de Neurologia Aug 2022Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute...
INTRODUCTION
Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant.
CASE REPORT
We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem.
CONCLUSION
Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.
Topics: Adult; Basilar Artery; Brain Ischemia; COVID-19; Cesarean Section; Female; Humans; Ischemic Stroke; Postpartum Period; Pregnancy; SARS-CoV-2; Stroke; Thrombosis
PubMed: 35866535
DOI: 10.33588/rn.7504.2021373 -
IDCases 2022Obstetric tetanus is defined as a infection that occurs during pregnancy or within six weeks of delivery. In Peru, there are no reports of obstetric tetanus cases. Here...
Obstetric tetanus is defined as a infection that occurs during pregnancy or within six weeks of delivery. In Peru, there are no reports of obstetric tetanus cases. Here we report a sixth case of obstetric tetanus in a puerperal woman who underwent curettage for postpartum hemorrhage, despite immunization against tetanus.
PubMed: 35855941
DOI: 10.1016/j.idcr.2022.e01568 -
Acta Obstetricia Et Gynecologica... Sep 2022Rates of delivery by cesarean section have gradually risen in many parts of the world, and it is regarded as a safe surgical procedure with expanded indications. We...
Planned cesarean section vs planned vaginal delivery among women without formal medical indication for planned cesarean section: A retrospective cohort study of maternal short-term complications.
INTRODUCTION
Rates of delivery by cesarean section have gradually risen in many parts of the world, and it is regarded as a safe surgical procedure with expanded indications. We assessed maternal complications within 6 weeks postpartum after planned cesarean section and after planned vaginal delivery among patients without medical indication for cesarean section.
MATERIAL AND METHODS
This was a retrospective cohort study based on Swedish national registers and included 714 326 deliveries from 2008 to 2017. The study group consisted of cephalic, singleton, term pregnancies and excluded those with previous cesarean or pregnancy conditions that would qualify for cesarean section. We compared the risks of short-term complications between planned cesarean section and planned vaginal delivery. We obtained adjusted risk ratios (ARRs) using modified Poisson regression models adjusting for maternal age, parity, body mass index, smoking, country of birth, and county.
RESULTS
The outcomes studied were infections and thromboembolism. In the planned cesarean section group (n = 22 855), 15% had a postpartum infection compared with 10% in the planned vaginal group (n = 691 471) (ARR 1.6; 95% confidence interval [CI] 1.5-1.6), and 0.08% vs 0.05% had a postpartum pulmonary embolism (ARR 1.7; 95% CI 1.0-2.6). The obtained risk estimates corresponded to "number needed to harm" estimates of 17 and 3448, respectively. When dividing the infections into subgroups, the risk of endometritis (ARR 1.2; 95% CI 1.1-1.3), wound infection (ARR 2.7; 95% CI 2.4-3.0), urinary tract infection (ARR 1.5; 95% CI 1.3-1.7), and mastitis (ARR 2.0; 1.9-2.2) was higher after planned cesarean section.
CONCLUSIONS
Among patients without medical indication for planned cesarean section, the risks of short-term maternal complications were higher with planned cesarean section than with planned vaginal delivery.
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Maternal Age; Parturition; Pregnancy; Retrospective Studies
PubMed: 35841162
DOI: 10.1111/aogs.14408 -
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 -
Psychiatria Danubina 2022Here we present the results of a psychometric investigation on current fear of COVID-19 infection aggravated by the earthquake-induced stress in the group of puerperal...
BACKGROUND
Here we present the results of a psychometric investigation on current fear of COVID-19 infection aggravated by the earthquake-induced stress in the group of puerperal women.
SUBJECTS AND METHODS
A group of 16 hospitalized puerperal women that gave birth at Clinical Hospital Sveti Duh in Zagreb, Department of Obstetrics and Gynecology were enrolled in retrospective clinical investigation. All the patients delivered during COVID-19 pandemic and experienced devastating earthquake on March 22nd. The women were interviewed on the exact day of the earthquake, 4 hours after the main hit and 6 months after that during second pandemic wave on October of the same year. Women were also questioned about the breastfeeding. The participants provided written informed consent and were interviewed using Generalized Anxiety Disorder 7-item (GAD-7) scale for evaluation of generalized anxiety disorder.
RESULTS
Minimal level of anxiety after the earthquake was shown for 10 mothers with 6 of them having the highest level 4. Mild anxiety was proven for 3 patients, 2 exhibited moderate anxiety with one puerperal women with severe anxiety. One could say that 37.5% of enrolled patients exhibited some degree of anxiety after the earthquake (scoring >5). At second time point during COVID-19 pandemic 13 participants had minimal anxiety score, 2 had mild, while 1 participant had moderate score evaluated by GAD-7 scale (18.8%). At the time of the earthquake 13 participants were breastfeeding (81.3%), while 3 were not due to the personal reasons. 6 months after the earthquake only 7 mothers were breastfeeding (43.8%), while 9 of the participants were feeding their children with adapted milk (56%). Main reason for breastfeeding discontinuation was the stop of milk secretion in the 6 months period after the delivery.
CONCLUSIONS
To our knowledge, our study is the only national study dealing with mental health problems in a population of puerperal and breastfeeding mothers in a challenging time of COVID-19 pandemic aggravated by devastating earthquake.
Topics: Anxiety; COVID-19; Child; Earthquakes; Fear; Female; Humans; Mothers; Pandemics; Pregnancy; Retrospective Studies
PubMed: 35772160
DOI: 10.24869/psyd.2022.370 -
American Journal of Obstetrics &... Sep 2022Women with obesity are at increased risk of complications during and after labor and delivery, including puerperal infection and cesarean delivery. As labor induction... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Women with obesity are at increased risk of complications during and after labor and delivery, including puerperal infection and cesarean delivery. As labor induction has become increasingly common, it is crucial to find ways to decrease complication rates in this high-risk population.
OBJECTIVE
This study aimed to explore the effect of prophylactic antibiotics during labor induction of nulliparous women with obesity on the rates of cesarean delivery and puerperal infection and to estimate the parameters needed to calculate the sample size for a larger, multicenter trial.
STUDY DESIGN
In this randomized, placebo-controlled pilot trial, nulliparous patients with a body mass index of ≥30 kg/m were randomized to either prophylactic antibiotics (500 mg azithromycin for 1 dose and 2 g cefazolin every 8 hours for up to 3 doses) or placebo, administered starting at the beginning of labor induction. The exclusion criteria were known fetal anomaly, fetal demise, multifetal gestation, ruptured membranes >12 hours, infection requiring antibiotics at the start of labor induction, and/or allergy to azithromycin or beta-lactam antibiotics. The co-primary outcomes were rates of puerperal infection (composite of chorioamnionitis, endometritis, and/or cesarean delivery wound infection) and cesarean delivery. Participants were followed up for 30 days after delivery, and maternal and neonatal demographic and outcome data were collected. Proportions and 95% confidence limits were calculated for each of these outcomes.
RESULTS
From January 2019 to May 2021, 101 patients were randomized in the class III stratum (1 patient who was randomized ultimately did not undergo labor induction). From February 2020 to May 2021, 38 and 47 patients were randomized to class I and II strata, respectively (to assess the effect of obesity class on the outcomes expected to be influenced by antibiotic prophylaxis). In the antibiotics and placebo groups, the rates of cesarean delivery were 29.0% (95% confidence interval, 19.8-38.3) and 39.8% (95% confidence interval, 29.8-49.7), respectively, and puerperal infection occurred in 8.6% (95% confidence interval, 2.9-14.3) and 9.7% (95% confidence interval, 3.7-15.7), respectively. In the subgroup with class III obesity, in the antibiotics and placebo groups, the rates of cesarean delivery were 33.3% (95% confidence interval, 20.4-47.9) and 46.0% (95% confidence interval, 32.2-59.8), respectively, and puerperal infection occurred in 7.8% (95% confidence interval, 0.5-15.2) and 10.0% (95% confidence interval, 1.7-18.3), respectively. Note that this pilot study was not powered to detect differences of this magnitude but rather to estimate parameters.
CONCLUSION
The administration of prophylactic antibiotics during labor induction of nulliparous patients with obesity resulted in a 27% lower cesarean delivery rate overall and a 28% lower rate in patients with class III obesity. A larger trial is warranted to evaluate these differences.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Female; Humans; Infant, Newborn; Obesity; Pilot Projects; Pregnancy; Puerperal Infection
PubMed: 35728781
DOI: 10.1016/j.ajogmf.2022.100681 -
International Urogynecology Journal Aug 2022Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects.... (Observational Study)
Observational Study
INTRODUCTION AND HYPOTHESIS
Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum.
METHODS
We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined.
RESULTS
A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups.
CONCLUSIONS
We have found a few significant obstetrical-pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.
Topics: Adult; Cesarean Section; Child; Delivery, Obstetric; Female; Humans; Infant, Newborn; Postpartum Period; Pregnancy; Puerperal Disorders; Quality of Life; Risk Factors; Urinary Retention
PubMed: 35716199
DOI: 10.1007/s00192-022-05278-3 -
Women's Health (London, England) 2022Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis. Evidence suggests that single-dose antibiotic prophylaxis has comparable efficacy to multiple-dose antibiotic prophylaxis, but with a lower cost and risk of antibiotic resistance. However, single-dose antibiotic prophylaxis after caesarean section is not generally used in many centres in sub-Saharan Africa.
OBJECTIVE
This study aimed to compare the effectiveness of single- versus multiple-dose antibiotic prophylaxis to prevent post-caesarean section infections.
METHODOLOGY
This open-label, randomized controlled trial involved 162 consenting patients admitted for caesarean section (elective or emergency) at the Federal Medical Centre Keffi. They were distributed randomly into treatment arm A or B. Subjects in both arms received intravenous ceftriaxone (1 g) and metronidazole (500 mg) 30-60 min before incision; subjects in arm B received additional parenteral doses for 48 h and then cefuroxime 500 mg tablets every 12 h and metronidazole 400 mg tablets every 8 h for 5 days. The patients were monitored for 2 weeks for evidence of wound infection, febrile morbidity and clinical endometritis.
RESULT
There was no statistical difference in the incidence of wound infection (6.6% versus 7.4%; = .882) and febrile morbidity (11.8% versus 11.1%, = .807). However, clinical endometritis (0.0% versus 6.1%, = .028) was statistically significant with none reported in the single-dose arm.
CONCLUSION
Single-dose ceftriaxone and metronidazole is as effective as multiple doses for antibiotic prophylaxis to prevent post-caesarean section infections. Adoption of this approach in low-risk patients would reduce the cost of prophylactic antibiotics, workload for staff and antibiotic resistance.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Cesarean Section; Endometritis; Female; Humans; Metronidazole; Postpartum Period; Pregnancy; Puerperal Infection; Surgical Wound Infection
PubMed: 35670414
DOI: 10.1177/17455057221101071 -
Revista Da Associacao Medica Brasileira... Apr 2022The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor.
OBJECTIVE
The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor.
METHODS
This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention.
RESULTS
Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II.
CONCLUSIONS
In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.
Topics: Adult; Cesarean Section; Female; Hospitals, University; Humans; Infant, Newborn; Labor, Obstetric; Oxygen; Pregnancy; Pregnancy Complications; Prospective Studies
PubMed: 35649079
DOI: 10.1590/1806-9282.20211358 -
BMC Pregnancy and Childbirth May 2022To investigate the epidemiological, clinical characteristics and outcomes of diabetes in pregnancy (DIP).
BACKGROUND
To investigate the epidemiological, clinical characteristics and outcomes of diabetes in pregnancy (DIP).
METHODS
This single-center, retrospective study included 16,974 pregnant women hospitalized during 2018-2019. Among them, 2860 DIP patients were grouped according to diabetes type, glycemic status, and insulin use. Multivariate logistic regression analysis was conducted.
RESULTS
The incidence of DIP [17.10%; pregestational diabetes mellitus (PGDM), 2.00% (type I, 0.08%; type 2, 1.92%); gestational diabetes mellitus (GDM), 14.85% (GDM A1, 13.58%; GDM A2, 1.27%)] increased annually. Premature birth, congenital anomalies, large for gestational age (LGA), neonatal asphyxia, neonatal intensive care unit transfer, hypertension, and puerperal infection were more common in DIP than in healthy pregnancies. The most common comorbidities/complications were hypertension, thyroid dysfunction, cervical incompetence, intrahepatic cholestasis, premature membrane rupture, oligo/polyhydramnios, and fetal distress. GDM incidence at ages ≥35 and ≥ 45 years was 1.91 and 3.26 times that at age < 35 years, respectively. If only women with high-risk factors were screened, 34.8% GDM cases would be missed. The proportion of insulin use was 14.06% (PGDM, 55%; GDM, 8.53%). Mean gestational age at peak insulin dose in DIP was 32.87 ± 5.46 weeks. Peak insulin doses in PGDM and GDM were 3.67 and 2 times the initial doses, respectively. The risks of LGA, premature birth, cesarean section, and neonatal hypoglycemia in PGDM were 1.845, 1.533, 1.797, and 1.368 times of those in GDM, respectively. The risks of premature birth and neonatal hypoglycemia in women with poor glycemic control were 1.504 and 1.558 times of those in women with good control, respectively.
CONCLUSIONS
The incidence of adverse outcomes in DIP is high.
Topics: Adult; Cesarean Section; Diabetes, Gestational; Female; Humans; Hypertension; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Middle Aged; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy in Diabetics; Premature Birth; Retrospective Studies; Weight Gain
PubMed: 35585514
DOI: 10.1186/s12884-022-04712-0