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PloS One 2021We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed... (Randomized Controlled Trial)
Randomized Controlled Trial
Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade.
OBJECTIVE
We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women's opinions on their overall experience of PPH care.
METHODS
This prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0-10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported.
RESULTS
Among women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45-3.35). A high postpartum pain score of 8-10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30-10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable.
CONCLUSION
UBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women's satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.
Topics: Adolescent; Adult; Africa; Aftercare; Catheters; Cohort Studies; Female; Follow-Up Studies; Humans; Middle Aged; Pain; Patient Discharge; Postpartum Hemorrhage; Puerperal Infection; Uterine Balloon Tamponade; Young Adult
PubMed: 33556104
DOI: 10.1371/journal.pone.0245988 -
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 -
Journal of the Turkish German... Dec 2020To compare maternal and perinatal outcomes between day-time and evening/night-time births in a low-risk population.
OBJECTIVE
To compare maternal and perinatal outcomes between day-time and evening/night-time births in a low-risk population.
MATERIAL AND METHODS
The present study had a retrospective and cross-sectional design. The study recruited 421 pregnant women admitted for spontaneous or induced labor, with singleton, full-term pregnancy, without comorbidities, and with birthweight between 2,500 and 4,499 g. Maternal data, including severe bleeding, need for blood transfusion, puerperal infection, and admission to the intensive care unit, and neonatal data including birthweight, Apgar scores at first and fifth minute, oxygen administration, resuscitation, admission to the neonatal care unit, infection, and blood transfusion, were evaluated. Univariate and multivariate analysis and calculation of the prevalence ratio (PR) were performed with a 95% confidence interval (CI).
RESULTS
There were no differences in factors of maternal morbidity between delivery times. Newborns delivered during the evening/night-time had a higher prevalence of infection (15.3% vs 7.9%, p=0.019, PR: 2.11, CI 95% 1.13-3.93) and hospitalization in the neonatal care unit (25.8% vs 10.4%, p<0.001, PR: 2.99, CI 95% 1.76-5.10). There was no difference in other perinatal morbidities examined.
CONCLUSION
Evening/night-time births were associated with a higher prevalence of infection and the need for admission to an intensive care unit.
PubMed: 33273519
DOI: 10.4274/jtgga.galenos.2020.2020.0081 -
Journal of Public Health in Africa Mar 2011Genital mycoplasmas are implicated in pelvic inflammatory diseases, puerperal infection, septic abortions, low birth weight, nongonococcal urethritis and prostatitis as... (Review)
Review
Genital mycoplasmas are implicated in pelvic inflammatory diseases, puerperal infection, septic abortions, low birth weight, nongonococcal urethritis and prostatitis as well as spontaneous abortion and infertility in women. There is paucity of data on colonisation of genital mycoplasma in women and their drug sensitivity patterns. The aim of our study was to determine the prevalence of genital mycoplasmas ( and ) infection and their drug sensitivity patterns in women. A mycofast kit was used for biochemical determination of mycoplasma infection in 100 randomly selected female patients aged 19-57 years, attending the University of Yaoundé Teaching Hospital (UYTH) from March to June 2010. Informed consent was sought and gained before samples were collected. Genital mycoplasmas were found in 65 patients (65%) [95% CI=55.7-74.3%] and distributed as 41 (41%) [95% CI=31.4-50.6%] for and 4 (4%) [95% CI=0.20- 7.8%] for while there was co-infection in 20 women (20%) [95% CI=12.16-27.84%]. In our study, 57 (57%) [95% CI=47.3-67%] had other organisms, which included (19 [19%]), (35 [35%]) and (3 [3%]). Among the 65 women with genital mycoplasma, the highest co-infection was with (33.8%). Pristinamycine was the most effective antibiotic (92%) and sulfamethoxazole the most resistant (8%) antibiotic to genital mycoplasmas. We conclude that genital mycoplasma is a problem in Cameroon and infected women should be treated together with their partners.
PubMed: 28299057
DOI: 10.4081/jphia.2011.e16 -
Wiener Medizinische Wochenschrift (1946) Sep 2020Ignaz Semmelweis' (1818-1865) discovery of the endemic causes of febris puerperalis is a striking example of the role of pathology in medicine. Transdisciplinarity...
Ignaz Semmelweis' (1818-1865) discovery of the endemic causes of febris puerperalis is a striking example of the role of pathology in medicine. Transdisciplinarity encounters Semmelweis' biography, which is neither linear nor totally focused on medicine. He completed the philosophicum (artisterium), studying the septem artes liberales (1835-1837) in Pest, comprising humanities and natural science. After moving to Vienna, he began to study law, but turned to medicine as early as 1838. In 1844, he graduated with a botanical doctoral thesis composed in Neo-Latin, showing linguistic and stylistic talent and a broad knowledge of gynecology and obstetrics. The style and topoi demonstrate the interchangeability of what he learnt during his propaedeuticum. Nowadays, hardly anyone is familiar with this booklet, for two main reasons: the language choice and the life-saving impact of the physician's opus magnum on the reasons for puerperal fever (Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers). In later life, he became convinced that he had no talent as a (scientific) author-a fatal error that led him to become a victim of what we now call "publish or perish." Semmelweis had felt rejected for years. This negative feeling was the reason for his decision not to publish his great book for 14 years. When it finally went to the printer in 1861, the scientific community did not accept it. This experience caused psychosomatic symptoms owing to his long-standing and deeply felt disappointment. Bad conscience tortured him. This permanent stress destroyed his health: in 1865, his relatives (including his wife) and friends took him from Budapest to Vienna. He thought he was going to spend some time relaxing, but in fact was led into a newly built asylum for the mentally ill, the Niederösterreichische Landesirrenanstalt. When he realized what was happening, he tried to escape. Badly abused, he died from sepsis caused by open wounds and a dirty straightjacket 2 weeks later. This article will show Semmelweis to be a multilingual author of scientific literature and (open) letters; it will present him as a researcher who became a victim of harassment and what is referred to as the "Semmelweis reflex" ("Semmelweis effect"); and it will focus on his afterlife in (children's) literature, drama, and film.
Topics: Female; Fever; History, 19th Century; Humans; Obstetrics; Physicians; Pregnancy; Puerperal Infection
PubMed: 32130558
DOI: 10.1007/s10354-020-00738-1 -
Animal : An International Journal of... May 2014Up to half of dairy cows are affected by at least one of metritis, purulent vaginal discharge, endometritis or cervicitis in the postpartum period. These conditions... (Review)
Review
Up to half of dairy cows are affected by at least one of metritis, purulent vaginal discharge, endometritis or cervicitis in the postpartum period. These conditions result from inadequate immune response to bacterial infection (failure to clear pathogenic bacteria from the uterus) or persistent inflammation that impairs rather than enhances reproductive function. The degree of mobilization of fat and how effectively it is used as a metabolic fuel is well recognized as a risk factor for metabolic and infectious disease. Release of non-esterified fatty acids has direct effects on liver and immune function but also produces pro-inflammatory cytokines (tumor necrosis factor α and interleukin-6), which contribute to systemic inflammation and to insulin resistance. Therefore, reproductive tract inflammatory disease may be a function of both local and systemic inflammatory stimuli and regulation as well as regulation of fat metabolism. Better understanding of variables associated with insulin resistance and inflammatory regulation in the liver and adipose tissue may lead to improvement of reproductive tract health. This paper reviews factors that may contribute to postpartum reproductive tract inflammatory diseases in dairy cows and their inter-relationships, impacts and treatment.
Topics: Animal Husbandry; Animals; Bacterial Infections; Cattle; Cattle Diseases; Dairying; Endometritis; Female; Postpartum Period; Puerperal Disorders
PubMed: 24679404
DOI: 10.1017/S1751731114000524 -
California Medicine Dec 1951Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal...
Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal failure. The clinical situations in which hemorrhage is liable to occur must be better known, so that anticipatory and preventive measures can be taken. Recent knowledge about defibrinated blood in women with degenerative changes at the placental site must be incorporated in the thinking and practice of physicians dealing with obstetrical cases. The indications, limitations, and hazards of the various anesthetic methods available for parturient women should be carefully considered in the circumstances of each case.
Topics: Female; Hemorrhage; Humans; Maternal Mortality; Postpartum Hemorrhage; Postpartum Period; Pregnancy
PubMed: 14886749
DOI: No ID Found -
BMC Pregnancy and Childbirth Mar 2024This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection... (Meta-Analysis)
Meta-Analysis
Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns.
DATA SOURCES
We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024.
METHODS
We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity.
RESULTS
The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55-0.77; I, 0%; P < .00001); 0.62 for endometritis (95% CI, 0.52-0.74; I, 2%; P < .00001); and 0.43 for maternal wound or surgical site infection (95% CI, 0.24-0.78; P < .005); however, there was great heterogeneity among the studies (I, 75%). The pooled OR for pyelonephritis and urinary tract infections was 0.3 (95% CI, 0.17-0.52; I, 0%; P < .0001), and that for neonatal skin infections was 0.48 (95% CI, 0.35-0.65; I, 0%, P < .00001). There was no significant difference in maternal all-cause mortality or incidence of chorioamnionitis between the two groups. No significant differences were observed in the incidence of neonatal sepsis or suspected sepsis, all-cause mortality, or infections of the eyes or ears.
CONCLUSION
In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections. These findings indicate that azithromycin may be potentially beneficial for maternal postpartum infections, but its effect on neonatal prognosis remains unclear. Azithromycin should be used antenatally only if the clinical indication is clear and the potential benefits outweigh the harms.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Azithromycin; Neonatal Sepsis; Cesarean Section; Chorioamnionitis; Endometritis; Incidence; Randomized Controlled Trials as Topic; Sepsis; Puerperal Infection; Surgical Wound Infection; Urinary Tract Infections
PubMed: 38486177
DOI: 10.1186/s12884-024-06390-6 -
The Journal of Reproduction and... Oct 2021A certain level of endometrial bacterial infection and inflammation is involved in bovine uterine involution during the puerperal period. Factors that hamper normal...
A certain level of endometrial bacterial infection and inflammation is involved in bovine uterine involution during the puerperal period. Factors that hamper normal uterine involution expose the uterine environment to pathological conditions, causing different endometritis levels. The lack of proper diagnostic tools extends the time to conception. Efforts have been made to elucidate the postpartum uterine environment, including bacterial flora, changes in transient endometrial inflammation, and the pathophysiology of endometritis, to improve bovine reproductive performance. E. coli and Trueperella pyogenes in the uterus are likely to cause persistent infection, and Mycoplasma bovigenitalium infection is associated with dystocia and cytological endometritis in postpartum dairy cows. Due to the widespread use of cytobrush as a diagnostic tool for bovine subclinical endometritis (SE) that enables quantification of the degree of inflammation, we found that endometritis at week 5 postpartum was associated with delayed first ovulation. Approximately 30% of open cows have SE during the postpartum period, and cows with low blood glucose during prepartum have a high risk of developing SE. Additionally, cows with purulent vaginal discharge do not always have endometritis but only vaginitis and/or cervicitis. Intrauterine infusion of polyvinylpyrrolidone-iodine (PVP-I) improves fertility and promotes endometrial epithelial cell regeneration after inducing transient uterine inflammation, suggesting that PVP-I could be a good alternative to antibiotics. In conclusion, prepartum management to prevent glucose deficiency, prompt diagnosis to identify causative agents and intrauterine inflammation levels, and appropriate treatment to minimize antimicrobial resistance is beneficial for tackling endometritis and improving reproductive performance in bovine herds.
Topics: Animals; Cattle; Cattle Diseases; Endometritis; Female; Puerperal Disorders
PubMed: 34511538
DOI: 10.1262/jrd.2021-052 -
The Milbank Quarterly Sep 2015
Topics: Hand Disinfection; Hand Hygiene; History, 19th Century; Humans; Puerperal Infection
PubMed: 26350921
DOI: 10.1111/1468-0009.12128