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Kogner L, Lundborg L, Liu X, Ladfors LV, Ahlberg M, Stephansson O, Sandström A. Duration of the active first stage of labour and severe perineal lacerations and maternal postpartum complications: a population-based cohort study. BJOG 2024; 131:832-842. [PMID: 37840230 DOI: 10.1111/1471-0528.17692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period. DESIGN A population-based cohort study. SETTING Regions of Stockholm and Gotland, Sweden, 2008-2020. POPULATION A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups. METHODS The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed. MAIN OUTCOME MEASURES Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures. RESULTS The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the ≥90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46-1.84) in primiparous women, 2.43 (95% CI 1.98-2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65-3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage. CONCLUSIONS Increasing active first stage duration is associated with maternal complications in the early postpartum period.
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Affiliation(s)
- Lisa Kogner
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Louise Lundborg
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Xingrong Liu
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linnea V Ladfors
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Dunk SA, Owen J, Lu MY, Kim DJ, Szychowski JM, Subramaniam A. Operative vaginal delivery as an independent risk factor for maternal postpartum infectious morbidity. Am J Obstet Gynecol MFM 2022; 4:100705. [PMID: 35931367 DOI: 10.1016/j.ajogmf.2022.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND A recent study from the United Kingdom suggested that a single dosage of adjunctive amoxicillin/clavulanic acid with operative vaginal delivery reduces maternal infectious morbidity by 40% (from 19% to 11%). However, 89% of their study population received an episiotomy. OBJECTIVE This study aimed to evaluate whether operative vaginal delivery is an independent risk factor for composite maternal postpartum infectious morbidity in a population with a low episiotomy rate. STUDY DESIGN This was a retrospective cohort study of patients with viable singleton vaginal deliveries after ≥34 weeks gestation at a single perinatal center (2013-2018). The patients were categorized by the mode of delivery: spontaneous vaginal delivery or operative vaginal delivery (forceps or vacuum-assisted). The primary outcome was a composite of maternal infectious morbidity up to 6 weeks after delivery, defined as (1) endometritis, (2) perineal wound morbidity (infection, breakdown, or dehiscence), or (3) culture-proven urinary tract infection. The patient characteristics and outcomes were compared between the groups using appropriate tests. Multivariable models were used to estimate the association between operative vaginal delivery and study outcomes compared with spontaneous vaginal delivery, with adjustment for selected confounders. RESULTS Of 14,647 deliveries meeting the inclusion criteria, 732 (5.0%) were operative vaginal deliveries: 354 (48%) forceps and 378 (52%) vacuums. Overall, 210 (1.4%) patients developed the morbidity composite. Patients having an operative vaginal delivery were more likely to be nulliparous, have labor inductions, develop intrapartum chorioamnionitis, receive an episiotomy, and sustain a third- or fourth-degree laceration. After adjusting for confounding factors, no significant association was observed between operative vaginal delivery and composite morbidity (adjusted odds ratio, 1.4 [0.8-2.4]) or any of its individual components. Administration of postpartum antibiotics and documented fever were also similar between groups. There was also no significant association between instrument (forceps vs vacuum) and the maternal infection composite. CONCLUSION In this single-center US cohort, operative vaginal delivery was not an independent risk factor for maternal composite postpartum infectious morbidity.
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Affiliation(s)
- Sarah A Dunk
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam).
| | - John Owen
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Michelle Y Lu
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Dhong-Jin Kim
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Dr Szychowski)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam); Departments of Obstetrics and Gynecology (Drs Dunk, Owen, and Lu, Mr Kim, and Drs Szychowski and Subramaniam)
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Cox CK, Bugosh MD, Fenner DE, Smith R, Swenson CW. Antibiotic use during repair of obstetrical anal sphincter injury: a quality improvement initiative. Int J Gynaecol Obstet 2021; 156:95-101. [PMID: 33507531 DOI: 10.1002/ijgo.13623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effects of a quality improvement initiative regarding the administration of antibiotics at the time of obstetric anal sphincter injury (OASIS) repair. METHODS At University of Michigan-a tertiary care center in Ann Arbor, MI, USA, we implemented a quality improvement intervention aimed at administering a single dose of broad-spectrum antibiotics at the time of OASIS repair. Best practice recommendations and reminders were presented to the department. Cefazolin plus metronidazole or clindamycin plus gentamycin were the recommended antibiotics. The effects of this intervention were assessed based on a chart review of deliveries between January 4, 2014 and February 13, 2019, which included patient data both pre-initiative and post-initiative to compare the prevalence of antibiotic use at the time of OASIS repair. RESULTS Recommended antibiotic use increased from 0.3% (1/372) pre-initiative to 75.7% (106/140) post-initiative (P < 0.001), and any antibiotic use increased from 6.5% (24/372) to 82.9% (116/140, P < 0.001). The proportion of cases complicated by wound infection/breakdown decreased by 55% after the quality improvement intervention (3.2% pre-intervention vs 1.4% post-intervention, P = 0.22). CONCLUSION Following a departmental quality improvement intervention aimed at increasing antibiotic administration at the time of OASIS repair, antibiotic use increased 13-fold. Although underpowered to detect a significant difference in wound complications, our study showed a clinically meaningful decrease in wound infection/breakdown with antibiotic administration.
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Affiliation(s)
- Caroline K Cox
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Meghan D Bugosh
- IHA Obstetrics and Gynecology, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Roger Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Daifotis HA, Smith MM, Denoble AE, Dotters-Katz SK. Risk Factors for Postpartum Maternal Infection Following Spontaneous Vaginal Delivery Complicated by Chorioamnionitis. AJP Rep 2020; 10:e159-e164. [PMID: 32426175 PMCID: PMC7228805 DOI: 10.1055/s-0040-1709983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/05/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Guidelines for the management of chorioamnionitis include intrapartum antibiotics, while postpartum antibiotics after spontaneous vaginal delivery (SVD) are reserved high-risk women. Our objective is to describe the incidence of and risk factors for postpartum infection after SVD complicated by chorioamnionitis. Study Design This is a retrospective study of SVDs with clinically diagnosed chorioamnionitis at a single center. The primary outcome was a composite of postpartum infection. Women who developed the primary outcome were compared with those who did not using bivariate statistics. Regression models were developed to estimate adjusted odds of outcomes. Results In this cohort, 346 women underwent SVD complicated by chorioamnionitis. Of these, 23 (6.6%) developed postpartum infections (endometritis n = 7, urinary tract infection/pyelonephritis n = 6, sepsis n = 4, and perineal wound infection n = 6). Receipt of antibiotics intra- or postpartum did not differ between groups, but women with postpartum infections were more likely to deliver prior to 32 weeks (17.4 vs. 4.9%, p = 0.04). When controlling for antibiotic use, delivery at < 32 weeks was associated with 3.8-fold increased (95% confidence interval: 1.07-13.7) odds of postpartum infection. Conclusion Postpartum infections occur in ∼1/15 women delivering vaginally with chorioamnionitis, with those who deliver at < 32 weeks' gestation being at increased risk.
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Affiliation(s)
| | - Megan M Smith
- Duke University School of Medicine, Durham, North Carolina
| | - Anna E Denoble
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarah K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Smith MM, Daifotis HA, DeNoble AE, Dotters-Katz SK. Using the new definition of intraamniotic infection - is there morbidity among the women left out? J Matern Fetal Neonatal Med 2020; 34:4148-4152. [PMID: 31928262 DOI: 10.1080/14767058.2020.1711723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Recently, ACOG released updated definitions for intraamniotic infection (IAI): maternal fever (≥38.0 °C) and ≥1 symptom (fetal tachycardia, maternal white blood cell count >15,000/mm3 or purulent discharge). Treatment was no longer recommended for women with fever <39.0 °C plus maternal tachycardia or fundal tenderness (previous criteria). The objective of this study was to compare postpartum infectious morbidity among women meeting previous criteria (but not the new IAI criteria) to women meeting new IAI criteria.Methods: Retrospective cohort of women delivering vaginally at a single academic center. Demographics, antepartum and intrapartum characteristics of women who met diagnostic criteria for chorioamnionitis (previous criteria) compared to those who met IAI criteria using bivariate statistics. The primary outcome was a composite of postpartum infection, including: endometritis, perineal infection, sepsis, urinary tract infection, pyelonephritis. Backward-stepwise elimination used to estimate odds of primary outcome.Results: Of 229 women who met previous IAI criteria, 51 (22.3%) did not meet new IAI criteria. Women no longer meeting IAI criteria were younger (25 versus 27 years, p = .02), more likely to have gestational hypertension (16.0 versus 3.4%, p < .01), and less likely to have third or fourth degree lacerations (2.0 versus 13.4%, p = .02). No difference in antibiotic receipt was observed. Postpartum infection occurred in 16/229 (7.0%) women overall; five (9.8%) in those not meeting new IAI criteria, and 11 (6.2%) meeting new IAI criteria. After adjusting for confounders, there was no difference in odds of postpartum infection (aOR 1.65, 95% CI 0.55-4.99).Conclusions/implications: Among women who met old ACOG criteria for IAI, but not the new criteria, postpartum infection occurred in nearly 10%. This number could be higher if these women were not treated with antibiotics.
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Affiliation(s)
- Megan M Smith
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Anna E DeNoble
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Sarah K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
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Alexander AJ, Myers C, Beres SB, Olsen RJ, Musser JM, Mangino JE. Postpartum Group A Streptococcus Case Series: Reach Out to Infection Prevention! Open Forum Infect Dis 2018; 5:ofy159. [PMID: 30038929 PMCID: PMC6051448 DOI: 10.1093/ofid/ofy159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
A series of postpartum Streptococcus pyogenes infections prompted an investigation to rule out potential transmission by a health care worker. None of the hospital staff screened were colonized. All isolates were determined to be unrelated by molecular methods, including whole-genome sequencing. Thus, nosocomial transmission was considered unlikely.
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Affiliation(s)
- Andrew J Alexander
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Carol Myers
- Department of Clinical Epidemiology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stephen B Beres
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
| | - James M Musser
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
| | - Julie E Mangino
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Clinical Epidemiology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Axelsson D, Brynhildsen J, Blomberg M. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications. J Perinat Med 2018; 46:271-278. [PMID: 28672754 DOI: 10.1515/jpm-2016-0389] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/11/2017] [Indexed: 11/15/2022]
Abstract
The purpose was to evaluate the association between maternal characteristics, obstetrical interventions/complications and postpartum wound infections (WI), urinary tract infection (UTI) and endometritis. Furthermore, this study aimed to determine the time from delivery to onset of infections after discharge from the hospital. Three large Swedish Medical Health Registers were scrutinized for the period 2005-2012. A total of 582,576 women had 795,072 deliveries. Women with diagnosis codes for WIs, UTIs or endometritis, from delivery to 8 weeks postpartum, were compared to non-infected women. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Increasing age and body mass index (BMI) were both associated with increasing prevalence of postpartum infections. WIs were most strongly associated with cesarean section (CS) (OR 17.2; 95%CI 16.1-18.3), 3rd and 4th degree tears (OR 10.7%; 95%CI 9.80-11.9) and episiotomy (OR 10.2; 95%CI 8.94-11.5). Endometritis was associated with anemia (OR 3.16; 95%CI 3.01-3.31) and manual placental removal (OR 2.72; 95%CI 2.51-2.95). UTI was associated with emergency CS (OR 3.46; 95%CI 3.07-3.89) and instrumental delivery (OR 3.70; 95%CI 3.29-4.16). For women discharged from the delivery hospital the peak occurrence of UTI was 6 days postpartum, while for WIs and endometritis it was 7 days postpartum.
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Affiliation(s)
- Daniel Axelsson
- Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Moulton LJ, Eric Jelovsek J, Lachiewicz M, Chagin K, Goje O. A model to predict risk of postpartum infection after Caesarean delivery. J Matern Fetal Neonatal Med 2017. [PMID: 28629241 DOI: 10.1080/14767058.2017.1344632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study is to build and validate a statistical model to predict infection after caesarean delivery (CD). METHODS Patient and surgical variables within 30 d of CD were collected on 2419 women. Postpartum infection included surgical site infection, urinary tract infection, endomyometritis and pneumonia. The data were split into model development and internal validation (1 January-31 August; N = 1641) and temporal validation subsets (1 September-31 December; N = 778). Logistic regression models were fit to the data with concordance index and calibration curves used to assess accuracy. Internal validation was performed with bootstrapping correcting for bias. RESULTS Postoperative infection occurred in 8% (95% CI 7.3-9.9), with 5% meeting CDC criteria for surgical site infections (SSI) (95% CI 4.1-5.8). Eight variables were predictive for infection: increasing BMI, higher number of prior Caesarean deliveries, emergent Caesarean delivery, Caesarean for failure to progress, skin closure using stainless steel staples, chorioamnionitis, maternal asthma and lower gestational age. The model discriminated between women with and without infection on internal validation (concordance index = 0.71 95% CI 0.67-0.76) and temporal validation (concordance index = 0.70, 95% CI 0.62, 0.78). CONCLUSIONS Our model accurately predicts risk of infection after CD. Identification of patients at risk for postoperative infection allows for individualized patient care and counseling.
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Affiliation(s)
- Laura J Moulton
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Desk A81 , Cleveland , OH , USA
| | - J Eric Jelovsek
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Desk A81 , Cleveland , OH , USA
| | - Mark Lachiewicz
- b Department of Gynecology and Obstetrics , Emory University , Atlanta , GA , USA
| | - Kevin Chagin
- c Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland , OH , USA
| | - Oluwatosin Goje
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Desk A81 , Cleveland , OH , USA
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Guo YN, Ma J, Wang XJ, Wang BS. Does uterine gauze packing increase the risk of puerperal morbidity in the management of postpartum hemorrhage during caesarean section: a retrospective cohort study. Int J Clin Exp Med 2015; 8:13740-13747. [PMID: 26550320 PMCID: PMC4613005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To compare the outcomes especially the puerperal morbidity of uterine gauze packing (UGP) with those of uterine balloon tamponade (UBT) in the management of postpartum hemorrhage (PPH) during caesarean section (c-section). METHODS It was considered success as no requirement for either a further therapy or hysterectomy for PPH. The postpartum infection risk was pragmatically measured as puerperal morbidity. RESULTS The identified PPH subjects were subdivided into two groups for comparison, in which UGP or UBT was used as second-line therapy for women undergoing c-sections between January 2010 and September 2014. Of the 318 c-section subjects initially treated by basic managements for expected PPH, 99 cases underwent UGP and 66 UBT as the second-line therapies to stop persistent bleeding. The success rates of the UGP and UBT groups were 90.91 and 87.88%, respectively. Only one patient in UBT group resorted to hysterectomy. The respective rates of puerperal morbidity were 10.10 and 13.64%, with risk ratio of 0.74 (95% CI: 0.32, 1.72). There were no significant differences between the two groups even after the adjustment for potential confounding factors. CONCLUSION UGP appears to be effective in treating PPH during c-section without an observed increase in the risk of potential postpartum infection when compared with UBT. UGP could be recommended as routine for patients who are not responding to conventional basic therapies in addressing PPH, along with the provision of appropriate training.
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Affiliation(s)
- Yu-Na Guo
- Department of Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of MedicineShanghai, PR China
| | - Jue Ma
- Department of Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of MedicineShanghai, PR China
| | - Xiao-Jin Wang
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine280 South Chongqing Road, Shanghai 200025, PR China
| | - Bing-Shun Wang
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine280 South Chongqing Road, Shanghai 200025, PR China
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Boie S, Krog J, Tørring S, Bor IP. Life-threatening necrotizing myometritis, due to Group A streptococcus - still a life-threatening condition. Clin Case Rep 2015; 3:291-3. [PMID: 25984307 PMCID: PMC4427370 DOI: 10.1002/ccr3.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/19/2014] [Indexed: 11/14/2022] Open
Abstract
Puerperal infection with Group A streptococcus (GAS) can present with few symptoms and rapidly progress to a life-threatening condition. Often, the infection can be treated with antibiotics. Delay in diagnosis increases risk of sepsis, multiorgan failure, and death. GAS infection is a differential diagnose for all postpartum women with unexplained symptoms.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynecology, Regional Hospital RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Jan Krog
- Department of Anesthesia, Regional Hospital of RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Sofus Tørring
- Department of Radiology, Regional Hospital of RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Isil Pinar Bor
- Department of Obstetrics and Gynecology, Regional Hospital RandersSkovlyvej 1, 8900, Randers, Denmark
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Romano AM. Deconstruction junction: how to separate the good evidence from the bad (from the ugly). J Perinat Educ 2009; 18:49-55. [PMID: 19936113 DOI: 10.1624/105812409x474717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the need to look closely at research articles to avoid being misled. Examples include new research on the effectiveness of intrapartum antibiotics for preventing early onset Group B streptococcal disease in newborns, a recent study on the incidence of infection after cesarean surgery and vaginal birth, and a new study demonstrating long-term benefits of skin-to-skin contact between the mother and infant after birth.
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Affiliation(s)
- Amy M Romano
- AMY ROMANO is a midwife, author, and advocate for mother-friendly maternity care. She has analyzed, summarized, and critiqued research for the Lamaze International community since 2004 and is currently co-authoring the second edition of Obstetric Myths Versus Research Realities with Henci Goer. Romano is also a practicing home- and hospital-based midwife in Connecticut
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