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Neumann CJ, Pausan MR, Haid V, Weiss EC, Kolovetsiou-Kreiner V, Amtmann B, Winkler P, Mahnert A, Jantscher-Krenn E, Moissl-Eichinger C. The dynamics of the female microbiome: unveiling abrupt changes of microbial domains across body sites from prepartum to postpartum phases. Microbiol Spectr 2024:e0014724. [PMID: 38917430 DOI: 10.1128/spectrum.00147-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The microbial ecosystem of women undergoes enormous changes during pregnancy and the perinatal period. Little is known about the extent of changes in the maternal microbiome beyond the vaginal cavity and its recovery after birth. In this study, we followed pregnant women [maternal prepartum (mpre), n = 30] into the postpartum period [1 month postpartum, maternal postpartum (mpost), n = 30]. We profiled their oral, urinary, and vaginal microbiome; archaeome; mycobiome; and urinary metabolome and compared them with those of nonpregnant (np) women (n = 29). Overall, pregnancy status (np, mpre, and mpost) had a smaller effect on the microbiomes than body site, but massive transitions were observed for the oral and urogenital (vaginal and urinary) microbiomes. While the oral microbiome fluctuates during pregnancy but stabilizes rapidly within the first month postpartum, the urogenital microbiome is characterized by a major remodeling caused by a massive loss of Lactobacillus and thus a shift from Vaginal Community State Type (CST) I (40% of women) to CST IV (85% of women). The urinary metabolome rapidly reached an np-like composition after delivery, apart from lactose and oxaloacetic acid, which were elevated during active lactation. Fungal and archaeal profiles were indicative of pregnancy status. Methanobacterium signatures were found mainly in np women, and Methanobrevibacter showed an opposite behavior in the oral cavity (increased) and vagina (decreased) during pregnancy. Our findings suggest that the massive remodeling of the maternal microbiome and metabolome needs more attention and that potential interventions could be envisioned to optimize recovery and avoid long-term effects on maternal health and subsequent pregnancies. IMPORTANCE The perinatal microbiome is of specific interest for the health of the mother and infant. We therefore investigate the dynamics of the female microbiome from nonpregnant over prepartum to the postpartum period in urine and the oral and vaginal cavities. A specific focus of this study is put not only on the bacterial part of the microbiome but also on the underinvestigated contribution of fungi and archaea. To our knowledge, we present the first study highlighting those aspects. Our findings suggest that the massive remodeling of the maternal microbiome and metabolome needs more attention and that potential interventions could be envisioned to optimize recovery and avoid long-term effects on maternal health and subsequent pregnancies.
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Affiliation(s)
- Charlotte J Neumann
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Manuela-Raluca Pausan
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Victoria Haid
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Eva-Christine Weiss
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Styria, Austria
| | | | - Bettina Amtmann
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Styria, Austria
| | - Petra Winkler
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Styria, Austria
| | - Alexander Mahnert
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Evelyn Jantscher-Krenn
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Styria, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Graz, Styria, Austria
- BioTechMed, Graz, Styria, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Styria, Austria
- BioTechMed, Graz, Styria, Austria
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Kumari A, Suri J, Bharti R, Pandey D, Bachani S. Preoperative vaginal cleansing with chlorhexidine and cetrimide solution for reduction of postoperative infectious morbidity at a tertiary care center in North India: A prospective cohort study. Int J Gynaecol Obstet 2024; 164:708-713. [PMID: 37551118 DOI: 10.1002/ijgo.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine the effect of preoperative vaginal cleansing with chlorhexidine and cetrimide solution on postoperative infectious morbidity. METHODS This prospective cohort study was conducted over a period of 18 months in the Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Women undergoing cesarean section were alternately allotted to study and control groups. Women with chorioamnionitis, antepartum hemorrhage, rupture of membranes for more than 24 h, and fever in the preoperative period were excluded. The study group received preoperative vaginal cleansing with antiseptic solution (7.5% chlorhexidine w/v and 15% cetrimide w/v); the control group did not receive vaginal cleansing. Both groups were followed for the presence of any infectious morbidity until they were discharged from the hospital. RESULTS Age, body mass index (calculated as weight in kilograms divided by the square of height in meters), gestational age, and the parity of the women in the study and control groups were comparable (n = 760). The rate of endometritis was lower in the study group, but the difference was not statistically significant (P = 0.054). Post-cesarean febrile morbidity and wound sepsis were significantly lower in the study group (P = 0.017 and P = 0.02, respectively). On subgroup analysis, women in the study group with rupture of the membranes before cesarean delivery had lower wound sepsis and a reduced duration of hospital stay. Women in the study group with emergency cesarean delivery showed a significant reduction in wound sepsis, febrile morbidity, and length of hospital stay. CONCLUSION Preoperative vaginal cleansing with chlorhexidine and cetrimide solution before a cesarean section reduces postoperative infectious morbidity.
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Affiliation(s)
- Ankita Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Jyotsna Suri
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Rekha Bharti
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Divya Pandey
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Sumitra Bachani
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Mahdi LH, Hasoon BA, Sulaiman GM, Mohammed HA, Jawad KH, Al-Dulimi AG, Essa RH, Albukhaty S, Khan R. Anti-microbial efficacy of L-glutaminase (EC 3.5.1.2) against multidrug-resistant Pseudomonas aeruginosa infection. J Antibiot (Tokyo) 2024; 77:111-119. [PMID: 38017084 DOI: 10.1038/s41429-023-00678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/12/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023]
Abstract
The aims of this study were isolation-purification and characterization of L-glutaminase from L. gasseri BRLHM clinical isolates and investigation of its efficiency as an antimicrobial agent against multidrug-resistant P. aeruginosa. The MICs of L-glutaminase and gentamicin reference were evaluated by the well-diffusion method. The biofilm on the IUD contraceptive was visualized using atomic force microscopy (AFM) image analyses. The purified L-glutaminase possessed significant antimicrobial activity against P. aeruginosa isolates (p < 0.05), and the antibiofilm formation activity of the purified L-glutaminase was stronger than the antibiofilm activity of the referral standard drug, gentamicin (P < 0.05), which were checked by the inhibition of the biofilm formation on the IUD contraceptive device. Investigations indicated that L-glutaminase may have a crucial role in future clinical applications.
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Affiliation(s)
- Likaa H Mahdi
- Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
| | - Buthenia A Hasoon
- Division of Biotechnology, Department of Applied Sciences, University of Technology, Baghdad, Iraq
| | - Ghassan M Sulaiman
- Division of Biotechnology, Department of Applied Sciences, University of Technology, Baghdad, Iraq.
| | - Hamdoon A Mohammed
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, Qassim University, Qassim, 51452, Saudi Arabia.
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt.
| | - Kareem H Jawad
- Department of LASER and Optoelectronic Engineering, University of Technology, Baghdad, Iraq
| | - Ali G Al-Dulimi
- Department of Dentistry, Bilad Alrafidain University College, Diyala, 32001, Iraq
| | - Rajwa H Essa
- Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
| | - Salim Albukhaty
- Department of Chemistry, College of Science, University of Misan, Maysan, 62001, Iraq
- College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq
| | - Riaz Khan
- Manav Rachna International Institute of Research and Study (MRIIRS), Faridabad, HR, 121 001, India.
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Lambert KA, Honart AW, Hughes BL, Kuller JA, Dotters-Katz SK. Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation. Obstet Gynecol Surv 2023; 78:438-444. [PMID: 37480294 DOI: 10.1097/ogx.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Importance Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care. Objective To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario. Evidence Acquisition Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed. Results These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens. Conclusions Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV. Relevance Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation.
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Affiliation(s)
| | | | | | - Jeffrey A Kuller
- Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Barinov SV, Di Renzo GC, Tsibizova VI, Shifman EМ, Leont'eva NN, Arbuzov AB. Detoxification treatment in Gynecology using a modified molded sorbent. Best Pract Res Clin Obstet Gynaecol 2023:102346. [PMID: 37225639 DOI: 10.1016/j.bpobgyn.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
Postpartum endometritis is a common complication of cesarean section, the progression of which often leads to the loss of the uterus and the patient's fertility. We evaluated a detoxification therapy for treating patients with postpartum endometritis using an intrauterine application of a modified molded sorbent containing polyvinylpyrrolidone. A retrospective, controlled study included 124 patients with postpartum endometritis. The study group, n = 63, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial therapy in combination with the intrauterine application of a molded modified sorbent containing polyvinylpyrrolidone (FSMP) for 24 h daily for 5 days. The control group, n = 61, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial treatment only. The uterine cavity was infected by coccal flora (Enterococcus faecalis (26.6%), Staphylococcus spp. (21.3%), E. faecium (14.3%), and Gram-negative Escherichia coli (9.6%). A combination of these microorganisms was present in 40.5% of crops. Antibiotic resistance was detected in 53.6%-68.3% of the cases. In the study group, we observed: a faster and higher decrease in neutrophils (p < 0.05); a lower uterine concentration of pro-inflammatory cytokines: interleukin-1 beta (IL-1β) and tumor necrosis factor α (TNFα) - 4.0 and 3.2 times, respectively, compared with the control group (p < 0.05); and a significant decrease in the uterus volume and cavity (M-echo). Using a newly modified sorbent associated with antibiotic treatment in patients with postpartum endometritis, compared with antibiotics alone, we showed a sharp reduction of inflammatory parameters, residual microorganism growth, and faster uterine volume involution. Moreover, the frequency of hysterectomy decreased by 14.4 times.
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russian Federation.
| | - G C Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Wayne State University Medical School and Perinatal Research Branch, NIH-NICHD, Detroit, MI, 48201, USA; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy; Department of Obstetrics, Gynecology and Perinatal Medicine of the Clinical Institute of Children's Health Named After N.F. Filatov, I.M. Sechenov First State Medical University Under Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - V I Tsibizova
- Institute of Perinatology and Pediatrics, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.
| | - E М Shifman
- Department of Anesthesiology and Сritical Care of Moscow Regional M.V. Vladimirsky Moscow`s Regional Research Clinical Institute, Moscow, Russian Federation.
| | - N N Leont'eva
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
| | - A B Arbuzov
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
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Odogwu NM. Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1082199. [PMID: 36685092 PMCID: PMC9845938 DOI: 10.3389/frph.2022.1082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.
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Affiliation(s)
- Nkechi Martina Odogwu
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States,School of Public Health, University of Minnesota, Minneapolis, MN, United States,Correspondence: Nkechi Martina Odogwu ,
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Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdú-Soriano J. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. J Wound Care 2021; 29:S1-S48. [PMID: 33170077 DOI: 10.12968/jowc.2020.29.sup11a.s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Charmaine Childs
- Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow/Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia; Director, Skin Integrity Research Unit, University of Western Australia, Perth, Australia
| | - Carole Broad
- Clinical Specialist Physiotherapist in Pelvic Health, Department of Physiotherapy, Cardiff and Vale UHB, Cardiff, Wales, UK
| | - Rose Cooper
- Former Professor of Microbiology at Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Margarita Manresa
- Maternal and Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Verdú-Soriano
- Professor of Community Nursing and Wound Care, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Dellapiana G, Levian C, Gubernick L, Burwick RM. Prophylactic postoperative antibiotics after emergent cesarean delivery and risk of postpartum infection or wound complication. J Matern Fetal Neonatal Med 2021; 35:6830-6835. [PMID: 34008468 DOI: 10.1080/14767058.2021.1926449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emergent cesarean delivery (CD) carries a high risk for postpartum infection. In cases with a "splash" povidone-iodine (PI) skin preparation, prophylactic postoperative antibiotics (PP-Abx) are sometimes utilized, but the benefit is unclear. OBJECTIVE To evaluate if the use of PP-Abx decreases postpartum infection after emergent CD with "splash" PI skin preparation. STUDY DESIGN Cohort study of patients undergoing emergent CD with PI skin preparation from July 2012 to April 2020 at a single institution. Cases were identified using a natural language search engine, DEEP-6, with key terms "emergent" and "cesarean delivery." Patients with chorioamnionitis or non-PI skin preparation (e.g. chlorhexidine) were excluded. The primary exposure was use of PP-Abx. The primary outcome was postpartum infection or wound complication, defined as a composite: endometritis, wound infection, cellulitis, seroma, hematoma, or intra-abdominal abscess. Rates of postpartum infection or wound complication were stratified by use of PP-Abx. Demographic and labor characteristics were evaluated as confounders. Statistics by χ2, t-test, and logistic regression (α = 0.05). RESULTS In total, 481 patients underwent emergent CD; of those, 370 had PI skin preparation and were included. PP-Abx were given in 43% (160/370) of cases, including: cefazolin (n = 137), gentamicin/clindamycin (n = 18), azithromycin (n = 3), and vancomycin (n = 2). Those receiving PP-Abx were similar to those who did not, except the PP-Abx group was younger with longer CD duration. The rate of postpartum infection or wound complication was no different in patients who received PP-Abx compared to those who did not (12.6% vs. 9.5%, p = .34). This finding remained unchanged after multivariable adjustment (aOR 1.2, CI 0.61-2.4, p = .60). Moreover, the rate of postpartum infection or wound complication did not vary by antibiotic choice. CONCLUSIONS After emergent CD with PI skin preparation, routine use of prophylactic postoperative antibiotics does not appear to reduce the rate of postpartum infection or wound complication, which is important as we consider antibiotic stewardship. More studies are needed to identify treatments that decrease infectious morbidity with emergent CD.
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Affiliation(s)
- Gabriela Dellapiana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Candace Levian
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lindsay Gubernick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard M Burwick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Patel S, Suz P, Powers BD, Anaya DA. Epidural analgesia for hepatopancreatobiliary operations and postoperative urinary tract infections: an unrecognized association of "best-practices" and adverse outcomes. HPB (Oxford) 2021; 23:71-79. [PMID: 32414659 DOI: 10.1016/j.hpb.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/03/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thoracic epidural analgesia (TEA) is considered "best-practices" for pain-control following HPB operations. It is unknown if TEA increases the risk of UTI. We sought to examine the association of TEA and UTI following HPB operations. METHODS A retrospective cohort study of patients undergoing elective HPB operations was performed (ACS-NSQIP [2014-2016]). Patients were categorized by TEA utilization. The primary outcome was UTI. Multivariable logistic regression models were created to examine the association of TEA with UTI; including sensitivity and interaction analyses for age and gender. RESULTS Among 28,571 patients included, 5764 (20.2%) had TEA. UTI occurred more frequently with TEA (3.5% vs. 2.2%, p < 0.01). After multivariable analysis, TEA was associated with increased risk of UTI (1.59 [1.34-1.89]); when stratified by age and gender, the association persisted with an incremental increased risk observed in males over 70 years (1.91 [1.41-2.59]). UTI was associated with increased risk of sepsis (16.8% vs. 5.6%, P < 0.001), LOS (9 versus 6 days, P < 0.001) and readmission rates (21.4% vs. 12.3%, P < 0.001). CONCLUSION Despite TEA recommended as a best-practice standard for HPB operations, the increased risk of UTI calls for evaluation of current practices and consideration of alternative strategies for high-risk vulnerable populations - elderly males.
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Affiliation(s)
- Sephalie Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Pilar Suz
- Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Benjamin D Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Gonzalo-Carballes M, Ríos-Vives MÁ, Fierro EC, Azogue XG, Herrero SG, Rodríguez AE, Rus MN, Planes-Conangla M, Escudero-Fernandez JM, Coscojuela P. A Pictorial Review of Postpartum Complications. Radiographics 2020; 40:2117-2141. [PMID: 33095681 DOI: 10.1148/rg.2020200031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The postpartum period, also known as the puerperium, begins immediately after delivery of the neonate and placenta and ends 6-8 weeks after delivery. The appearance of physiologic uterine changes during puerperium can overlap with that of postpartum complications, which makes imaging interpretation and diagnosis difficult. Obstetric and nonobstetric postpartum complications are a considerable source of morbidity and mortality in women of reproductive age, and the radiologist plays an important role in the assessment of these entities, which often require a multimodality imaging approach. US and contrast material-enhanced CT are the techniques of choice in the emergency department, and they can show characteristic radiologic findings that enable differentiation between normal and abnormal features to help radiologists and emergency department practitioners to reach a correct diagnosis and provide timely treatment. The spectrum of postpartum complications ranges from relatively self-limiting to life-threatening conditions that can be divided into six categories: infectious conditions (endometritis), thrombotic complications (eg, deep vein thrombosis, ovarian vein thrombophlebitis, HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome, or cerebral sinus thrombosis), hemorrhagic conditions (eg, uterine atony, trauma of the lower portion of the genital tract, retained products of conception, uterine artery arteriovenous malformations, or uterine artery pseudoaneurysm), cesarean delivery-related complications (eg, bladder flap hematoma, subfascial hematoma, rectus sheath hematoma, abscess formation, uterine dehiscence, uterine rupture, vesicovaginal fistula, or abdominal wall endometriosis), iatrogenic conditions (eg, uterine perforation), and nonobstetric complications (eg, acute cholecystitis, acute appendicitis, uterine fibroid degeneration, renal cortical necrosis, pyelonephritis, posterior reversible encephalopathy syndrome, or pituitary gland apoplexy). The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Marta Gonzalo-Carballes
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Miguel Ángel Ríos-Vives
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Eva Castellà Fierro
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Xavier Gurí Azogue
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Susana Gispert Herrero
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alberto Escudero Rodríguez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - María Neus Rus
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Marina Planes-Conangla
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Miguel Escudero-Fernandez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pilar Coscojuela
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Riad M, Thottacherry E, Crawley C, Phillip-Abraham N, Ibrahim F. Invasive Group A streptococcal postpartum endometritis associated with multi-organ infarctions: an uncommon case presentation and literature review. Postgrad Med 2020; 132:526-531. [PMID: 32379557 DOI: 10.1080/00325481.2020.1760031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Streptococcal Toxic Shock Syndrome (STSS) is a serious condition that can arise from streptococcal postpartum endometritis. It is associated with a substantial increase in mortality rate and can rarely result in multiorgan infarction. Early recognition plays a vital role in patients' outcome. Objective: To report a case of complicated STSS and review the literature for previous case reports of streptococcal postpartum endometritis to determine if STSS diagnostic criteria (published by the Centers for Disease Control and Prevention) were fulfilled. Case presentation: This is a 41-year-old woman who presented 5 days after an uncomplicated vaginal delivery with endometritis complicated by invasive group A β-hemolytic streptococcus (GAS) infection and confirmed toxic shock syndrome. The patient was initially admitted to the critical care unit due to hemodynamic compromise requiring intravenous (IV) fluids, IV antibiotic therapy with penicillin and clindamycin, and IV immunoglobulin therapy. The patient subsequently developed multi-organ infarctions, acute respiratory distress syndrome requiring noninvasive respiratory support, and severe reactive arthritis. Literature review revealed 15 case reports of GAS postpartum endometritis, five met criteria for confirmed STSS. One patient died from severe septic shock leading to cardiopulmonary arrest. Thirteen out of 15 cases of postpartum endometritis occurred after uncomplicated vaginal delivery. Conclusion: STSS is a serious and possibly fatal medical condition that requires early diagnosis and treatment to prevent poor patient outcomes and death. Careful consideration to the patient's postpartum clinical presentation with the implementation of an intradisciplinary approach should be utilized.
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Affiliation(s)
- Mariam Riad
- Department of Internal Medicine, University of Alabama Huntsville Regional Campus , Huntsville, AL, USA
| | - Elizabeth Thottacherry
- Department of Internal Medicine, University of Alabama Huntsville Regional Campus , Huntsville, AL, USA
| | | | - Nessy Phillip-Abraham
- Department of Internal Medicine, University of Alabama Huntsville Regional Campus , Huntsville, AL, USA
| | - Farrah Ibrahim
- Department of Internal Medicine, University of Alabama Huntsville Regional Campus , Huntsville, AL, USA
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Kacerovsky M, Pliskova L, Bolehovska R, Gerychova R, Janku P, Matlak P, Simetka O, Faist T, Mls J, Vescicik P, Zemlickova H, Jacobsson B, Musilova I. Lactobacilli-dominated cervical microbiota in women with preterm prelabor rupture of membranes. Pediatr Res 2020; 87:952-960. [PMID: 31791041 DOI: 10.1038/s41390-019-0692-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the association between microbial invasion of the amniotic cavity (MIAC) and the presence of Lactobacillus crispatus- or Lactobacillus iners-dominated cervical microbiota in pregnancies with preterm prelabor rupture of membrane. Next, to assess the relationship between the presence of L. crispatus- or L. iners-dominated cervical microbiota and short-term neonatal morbidity. METHOD A total of 311 women were included. Cervical samples were obtained using a Dacron polyester swab and amniotic fluid samples were obtained by transabdominal amniocentesis. Bacterial DNA, L. crispatus, and L. iners in the cervical samples were assessed by PCR. Cervical microbiota was assigned as L. crispatus- or L. iners-dominated when the relative abundance of L. crispatus or L. iners was ≥50% of the whole cervical microbiota, respectively. RESULTS Women with MIAC showed a lower rate of L. crispatus-dominated cervical microbiota (21% vs. 39%; p = 0.003) than those without MIAC. Lactobacillus crispatus-dominated cervical microbiota was associated with a lower rate of early-onset sepsis (0% vs. 5%; p = 0.02). CONCLUSIONS The presence of L. crispatus-dominated cervical microbiota in women with preterm prelabor rupture of membrane was associated with a lower risk of intra-amniotic complications and subsequent development of early-onset sepsis of newborns.
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Affiliation(s)
- Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic. .,Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Radka Bolehovska
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Romana Gerychova
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Petr Matlak
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondrej Simetka
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomas Faist
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Mls
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Vescicik
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Helena Zemlickova
- Institute of Clinical Microbiology, University Hospital in Hradec Kralove, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Ivana Musilova
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
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13
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Das S, Job M, Kodiatte T, Iyadurai R. Atypical presentation of intrahepatic cholangiocarcinoma---Fever and ascites in a postpartum lady. J Family Med Prim Care 2019; 8:3748-3751. [PMID: 31803685 PMCID: PMC6881913 DOI: 10.4103/jfmpc.jfmpc_748_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 11/04/2022] Open
Abstract
Intrahepatic cholangiocarcinoma is an uncommon malignancy which usually occurs in the 7th decade. Here we present a postpartum patient with fever, hepatomegaly, and ascites, who was diagnosed to have metastatic intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Sohini Das
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
| | - Manoj Job
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
| | - Thomas Kodiatte
- Department of General Pathology, Christian Medical College and Hospital, Vellore, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
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14
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Jyothi MS, Kalra JK, Arora A, Patil A, Suri V, Jain V, Shafiq N, Saini SS, Gautam V. Randomized controlled trial of cefazolin monotherapy versus cefazolin plus azithromycin single dose prophylaxis for cesarean deliveries: A developing country's perspective. J Family Med Prim Care 2019; 8:3015-3021. [PMID: 31681684 PMCID: PMC6820430 DOI: 10.4103/jfmpc.jfmpc_593_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
AIM To compare the efficacy of pre-incision intravenous single doses of cefazolin versus cefazolin plus azithromycin as an antibiotic prophylaxis in cesarean delivery (CD). METHODS This was a single-center, double blind, randomized controlled trial conducted in the PGIMER, Chandigarh. 200 women undergoing elective/emergency cesarean section were randomized. Group A received single dose of cefazolin plus placebo while Group B received single dose of cefazolin plus azithromycin. Primary outcome evaluated was occurrence of surgical site infections (SSI); secondary outcomes included incidence of febrile morbidity, UTI, endometritis, neonatal outcome, total cost of antibiotics, and duration of hospital stay in both the study arms. Descriptive statistics and χ2 tests were used for analysis of the data. RESULT There was an overall significant reduction in the incidence of SSI (15% vs 3%; P = 0.03), endometritis (8% vs 2%; P = 0.048), and post-operative febrile morbidity (17% vs 3%; P = 0.001) with the addition of azithromycin to cefazolin. Duration of hospital stay was almost two days lesser for the cefazolin plus azithromycin group. Subgroup analysis of patients with SSI showed the age, duration of ruptured membranes, and type of anesthesia as important predictors of infection rate. Study observed statistically significant reduction in requirement of additional post operative antibiotics, phototherapy for neonates, hospital stay and cost of therapy in cefazolin plus azithromycin group (P < 0.05). CONCLUSION Tertiary care hospitals in developing countries such as India can opt for the cefazolin plus azithromycin as antimicrobial prophylaxis during CD to maximize the efficacy as well as for decreasing the cost burden of postoperative infections.
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Affiliation(s)
- Manjeera S. Jyothi
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasvinder K. Kalra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amol Patil
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv S. Saini
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gautam
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Short-Term Postoperative Outcomes between 4% Icodextrin Solution and Hyaluronic Acid- Carboxymethyl Cellulose Membrane during Emergency Cesarean Section. J Clin Med 2019; 8:jcm8081249. [PMID: 31426585 PMCID: PMC6723814 DOI: 10.3390/jcm8081249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022] Open
Abstract
Emergency cesarean sections are associated with more postoperative complications than with elective cesarean sections. Seprafilm and Adept are commonly used adhesion reduction devices and have been applied in abdominal or pelvic surgery for a long time. This study focuses on comparing the short-term postoperative outcomes of emergency cesarean sections between two groups. We performed a retrospective study that included all patients who received emergency caesarean sections from the same surgeon at MacKay Memorial Hospital between August 2014 and November 2017, We analyzed the overall cases and conducted a subgroup analysis of cases with contaminated or dirty/infected wounds in regard to the rates of surgical-site infection (SSI), bandemia, delayed flatus passage, and length of hospital stay. The two groups were similar with respect to the rates of SSI, bandemia, and length of hospital stay. However, Seprafilm was associated with higher risk of delayed flatus passage over 48 h (OR: 2.67, 95% CI = 2.16–7.64, p = 0.001). It also needs less time for recovery of the digestive system and less medical management postoperatively. In cases of contaminated or dirty/infected wounds, Adept user also had significantly lower rates (10.3% vs. 32%, p= 0.048, OR: 4.12, CI = 1.09–15.61) of postcesarean metritis.
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16
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McLain SK. A Project to Increase Nurses' Comfort in Offering Bedpans to Women Laboring With Epidural Analgesia. Nurs Womens Health 2019; 23:200-216. [PMID: 31171242 DOI: 10.1016/j.nwh.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To improve nurses' comfort in helping laboring woman void on a bedpan after initiation of epidural analgesia, to increase the frequency of bedpan use in the labor and birth unit, and to decrease the use of continuous indwelling Foley catheters during the intrapartum period. DESIGN Quality improvement project. SETTING A single large, midwestern U.S. hospital (>3,000 births annually), where bedpans are infrequently used after epidural placement. PARTICIPANTS Registered nurses on a labor and birth unit. INTERVENTION/MEASUREMENTS A 20-minute educational presentation that included current urinary catheter evidence-based practice, preferential use of bedpans, and methods to help women void successfully was taught to all registered nurses in the author's labor unit. Nurses rated on a scale of 0 (not comfortable at all) to 10 (extremely comfortable) their comfort level at helping a woman with a bedpan. Primary data were collected through a convenience sample of anonymous surveys (n = 52) completed by registered nurses regarding their experience with bedpan and catheter use during labor and their comfort level helping women be successful with voiding. This was followed by a retrospective chart audit for women with term, singleton pregnancies who labored with epidural analgesia. RESULTS Nurses' comfort levels increased from an average of 5.7 to 7.2 (p = .067). Postepidural bedpan use increased from 5.5% (n = 12) to 19% overall (n = 20; p < .001), with five women using bedpans exclusively. When assisted with bedpan use, 38% (n = 12) of women were able to void 34 of the 53 times it was offered (64%). Use of continuous indwelling Foley catheters decreased from 61.7% (n = 137) to 54.7% (n = 58), and use of intermittent catheterization increased from 30.6% (n = 68) to 37.7% (n = 40). CONCLUSION When assisted by nurses educated in and comfortable with different voiding techniques, women may be able to avoid medically unnecessary use of urinary catheters during labor.
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17
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Priputnevich T, Lyubasovskaya L, Muravieva V, Kondrakhin A, Ignateva A, Gordeev A, Shmakov R, Sukhikh G, Yarotskaya E. Postpartum endometritis and obstetrical sepsis associated with Eggerthella lenta. Case report and review of the literature. J Matern Fetal Neonatal Med 2019; 34:313-317. [PMID: 30975002 DOI: 10.1080/14767058.2019.1602602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Sepsis, associated with Eggerthella lenta is rarely reported, despite current possibilities for microorganisms isolation and identification. About 100 cases of bacteriemia associated with this pathogen have been reported so far. Postpartum infectious complications are mostly associated with bacterial inhabitants of gastrointestinal tract and vagina, including obligatory anaerobes. This case report highlights E. lenta-associated severe endometritis complicated by abdominal sepsis in a young healthy woman, and the challenges of antibacterial therapy.
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Affiliation(s)
- Tatiana Priputnevich
- Microbiology and Clinical Pharmacology Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Lyudmila Lyubasovskaya
- Clinical Pharmacology Unit, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Vera Muravieva
- Laboratory of Microbiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andrey Kondrakhin
- Clinical Pharmacology Unit, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alla Ignateva
- IInd Midwifery Physiological Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexey Gordeev
- Laboratory of Microbiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Roman Shmakov
- National Medical Research Center for Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Gennady Sukhikh
- National Medical Research Center for Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Ekaterina Yarotskaya
- International Cooperation Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia
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18
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Betts KS, Kisely S, Alati R. Predicting common maternal postpartum complications: leveraging health administrative data and machine learning. BJOG 2019; 126:702-709. [DOI: 10.1111/1471-0528.15607] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2018] [Indexed: 12/29/2022]
Affiliation(s)
- KS Betts
- School of Public Health Curtin University Bentley WA Australia
| | - S Kisely
- School of Medicine University of Queensland Brisbane QLD Australia
| | - R Alati
- School of Public Health Curtin University Bentley WA Australia
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Rule C, Ashley L, Bergin C. Sonographic findings in acute puerperal endometritis. Australas J Ultrasound Med 2018; 21:234-240. [PMID: 34760528 PMCID: PMC8409861 DOI: 10.1002/ajum.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the reliability of the sonographic subserosal hypoechoic rim sign and endomyometrial junction indistinctness in distinguishing patients with acute puerperal endometritis from other common postpartum complications, particularly those with retained products of conception. METHODS Radiographic coding identified all patients presenting to Auckland City Hospital over a 12-month period between 1 March 2016 and 28 February 2017 who had pelvic ultrasound scans to assess for postpartum complications. Clinical notes were reviewed to identify those patients with a clinical diagnosis of acute endometritis. After exclusion criteria were applied, the ultrasound images of 31 patients with acute endometritis and 31 randomly selected controls from the remaining pool of postpartum patients were randomised and anonymised. Ultrasound images were retrospectively reviewed by two independent radiologists to identify the presence or absence of the hypoechoic subserosal rim and endomyometrial junction indistinctness signs. RESULTS The average sensitivity and specificity for readers identifying the subserosal hypoechoic rim sign in full-term postpartum patients with acute endometritis were 76.9% and 92.1%, respectively. Interobserver reliability was moderate with a kappa value of 0.5. The average sensitivity and specificity for endomyometrial junction indistinctness were 89.0% and 95.2%, respectively, with substantial inter-observer agreement, Kappa 0.7. These signs remained specific but were less frequently observed in postpartum patients scanned during early pregnancy. CONCLUSION We have shown that identifying the subserosal hypoechoic rim and endomyometrial junction indistinctness on ultrasound scans can reliably help to distinguish patients with acute postpartum endometritis from other complications, particularly in full-term postpartum patients.
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Affiliation(s)
- Catherine Rule
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
| | - Linda Ashley
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
| | - Colleen Bergin
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
- Faculty of Medicine and Health Sciences University of Auckland 85 Park Rd Grafton, Auckland 1142 New Zealand
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