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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
Puerperal fever is usually accompanied by abdominopelvic pain and purulent or foul-smelling lochia. Additional findings observed in some women are chills, headache, malaise, and/or anorexia. Uterine involution can be delayed in the case of endometritis, particularly if the myometrium is involved (endomyometritis), and excessive bleeding can occur.
Toxic Shock Syndrome and Other Related Severe Infections
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
S. pyogenes, also known as group A Streptococcus (GAS), is a potentially lethal microorganism that is rarely encountered in obstetrics and gynecology. GAS was first reported by Ignaz Semmelweis in 1847, an obstetrician practicing in Vienna, Austria [116]. He described how the failure of obstetricians to wash their hands prior to operating resulted in a surge of deaths secondary to GAS. By encouraging handwashing techniques, the cases of fatal puerperal fever decreased from 12% to 2% [116]. When encountered, however, this microorganism can quickly progress to sepsis, necrotizing soft tissue infections, TSS, and death. The overall case fatality rate is approximately 20%, with more than half of patients dying if septic shock develops [117]. The CDC estimates that approximately 11,500 cases (3.5 per 100,000 people) of invasive GAS disease occur annually in the United States. Bacteremia without a source (29%), pneumonia (15%), necrotizing fasciitis (7%), and streptococcal TSS (6%) represent the most common causes of invasive GAS infections [117].
Unexplained Fever in Obstetrics
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Less frequent causes of puerperal fever include tuberculosis, 47toxic shock syndrome, 48mycoplasma, 49 and chlamydial infections. As is the case during pregnancy, virtually any febrile disease may appear during the puerperium. The main task of the clinician is to be aware of this fact and to differentiate the features of any of these diseases from the physiological events that may take place during the postpartum period.
Maternal morbidity and mortality associated with mode of delivery in sickle cell disease
Published in Journal of Obstetrics and Gynaecology, 2022
Tracey Martinborough, Wendy Allen-Davis, Tiffany Hunter-Greaves, Minerva Thame, Marvin Reid, Donnette Simms-Stewart
The caesarean section rate for women with HbSS in this study was 41%, 1.5 times higher than that of the HbAA group (27%) and higher than a caesarean delivery rate (33%) reported in another Jamaican cohort (Lewis et al.2021). As our maternity unit is a referral centre for critically ill and high risk pregnancies across the island, the increased abdominal delivery rate likely reflects the clinical status of patients rather than the overall secular rise. Caesarean delivery in primiparous women with HbSS was associated with more puerperal fever, endometritis, preeclampsia and blood transfusions although there was no significant difference in blood loss or rates of venous thromboembolic events compared to the HbAA group. At our institution, postpartum VTE prophylaxis is routinely employed, and deliveries of high risk women are conducted by experienced, senior obstetricians, likely resulting in these findings. Nonetheless, emergency indications for caesarean deliveries (foetal distress and failure to progress) are associated with increased rates of peri-operative infections and likely contributed to the higher rates of endometritis and puerperal fever rates seen in the primiparous HbSS group (Darnal and Dangal 2020). Caesarean delivery in women with HbSS was associated with more preterm birth and low birth weight infants than those with HbAA. Additionally, caesarean section was not associated with any stillbirths and the frequency of neonatal deaths was less than that seen in the HbSS vaginal group.
Incidence and sites of pelvic adhesions in women with post-caesarean infertility
Published in Journal of Obstetrics and Gynaecology, 2018
Ayman Shehata Dawood, Adel Elshahat Elgergawy
The mean age of the studied patients was 29.6 ± 3.4 years, the mean parity was 1.6 ± 0.5, the number of previous caesarean deliveries range was 1–3 with mean of 2.1 ± 0.6, and the mean duration of infertility was 4.3 ± 1.7 years. Most patients had a history of general hospital delivery (63.43%) and most of the patients had emergency caesarean deliveries (53.79%). A history of complications in their last caesarean delivery was present in 41 cases (31.06%) of patients where wound complications represented 15.15% and a puerperal fever represented 10.61%, the most frequent complications. A higher incidence of adhesions was found in the patients whose delivery had commenced in general hospitals, meaning stronger attention to more strict antiseptic measures should be applied and there was a shortage of resources in these hospitals. The demographic data of the studied patients are described in Table 1.
Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage
Published in Journal of Obstetrics and Gynaecology, 2022
Maria-Jesús Puente-Luján, Maria-Pilar Andrés-Orós, Leticia Álvarez-Sarrado, Andrea Agustín-Oliva, Isabel González-Ballano, Belén Rodríguez-Solanilla, Sergio Castán-Mateo
Regarding the complications, a balloon expulsion occurred in 10 cases (6.8%). In 8 out of 10 cases, Bakri Balloon was found in the upper third of the vagina after removing the surgical compresses and in 2 cases the expulsion occurred in spite of the manual introduction inside the uterus and an embolisation was required in both cases. 5 patients had a puerperal fever (3.4%) and there were 3 surgical wound infections (2.0%). No uterine dehiscence was observed after a Bakri Balloon placement during a caesarean section (Figure 1).