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Prelabor rupture of the membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Lami Yeo, Francesca Gotsch, Eleazar Soto, Sonia S. Hassan, Juan Pedro Kusanovic, Ray Bahado-Singh
Clinical investigators have compared expectant management with steroid administration for 48 hours followed by delivery. However, induction of delivery immediately after steroid administration is associated with an increased risk of RDS and, therefore, is best avoided (261). The 1994 National Institutes of Health Consensus Conference recommended the use of corticosteroids in pregnancies complicated by preterm PROM with expected delivery between 24 and 30 to 32 weeks of gestation (234). This recommendation was based largely on data suggesting that the incidence of IVH was lower in neonates exposed to corticosteroids (234). The modest increased risk of puerperal infection is considered easy to manage. A meta-analysis comparing the outcome of treatment with antibiotics and steroids versus antibiotics without steroids found that steroid administration diminished the beneficial effects of antibiotics in reducing the rate of chorioamnionitis, endometritis, neonatal sepsis, and IVH (262).
The puerperium
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
A mixed flora with low virulence normally colonizes the vagina. Puerperal infection is usually polymicrobial and involves contaminants from the bowel that colonize the perineum and lower genital tract. The organisms most commonly associated with puerperal genital infection are listed in the box below. Following delivery, natural barriers to infection are temporarily removed and therefore organisms with a pathogenic potential can ascend from the lower genital tract into the uterine cavity. Placental separation exposes a large raw area equivalent to an open wound, and retained products of conception and blood clots within the uterus can provide an excellent culture medium for infection. Furthermore, vaginal delivery is almost invariably associated with lacerations of the genital tract (uterus, cervix and vagina). Although these lacerations may not need surgical repair, they can become a focus for infection similar to iatrogenic wounds, such as caesarean section and episiotomy.
Postpartum pyrexia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Following delivery, pyrexia is common, with fever secondary to disorders of the breast occurring in approximately 18 percent of healthy mothers.2,3 Benign fever with resolution in the first 24 hours occurs with an incidence of 3 percent.4 Fever associated with infection is also common, with urinary tract infection (UTI) occurring in 2–4 percent of women following delivery and endometritis in 1.6 percent. Infections of the lower genital tract are uncommon and account for only approximately 1 percent of cases of puerperal infection.5
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
Globally, there has been an upsurge in rates of caesarean deliveries despite its link to a 2.84-fold increase in maternal mortality and perinatal respiratory morbidity (Deneux-Tharaux et al.2006). Even after adjusting for confounders, women with normal haemoglobin have an increase in postpartum venous thromboembolic events and puerperal infection when delivered via caesarean vs. vaginally (Mahadik 2019). Women with sickle cell disease (SCD) have a higher likelihood of experiencing these complications as they have higher rates of operative delivery for foetal indications (Galiba Atipo Tsiba et al.2020). Additionally, SCD remains a leading cause in indirect maternal deaths, contributing significantly to late maternal deaths in Afro-Caribbean populations (McCaw-Binns et al.2018). Increased risk of puerperal infection, sickle crises and mortality are linked to increased rates of caesarean deliveries in this population of women (Kuo and Caughey 2016). Nonetheless, reports in low-resource settings have shown improved pregnancy outcomes for women with SCD when there is a multidisciplinary approach to patient care (Serjeant et al.2004, Wilson et al.2012, Oppong et al.2019).
Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand
Published in Journal of Obstetrics and Gynaecology, 2019
Thanawut La-Orpipat, Chitkasaem Suwanrath
Our findings add to previously published literature, in the context of developing countries in Southeast Asia, as it demonstrates the higher rates of adverse maternal and foetal outcomes in adolescent pregnancy. Rate of maternal death was higher, with different causes of death from a previous study (Chen et al. 2007), and an increased risk of PIH in both younger (≤15 years) and older (16–19 years) adolescents. Rates of infection during pregnancy and the postpartum period, such as urinary tract infection, chorioamnionitis and puerperal infection were also increased in adolescents which were not frequently analysed in previous literature. Confirmation of earlier studies in lower rate of caesarean deliveries was reported and we also found decreased rates of diabetes mellitus, chronic hypertension, placenta praevia and CPD. Our study additionally demonstrated the effect of inadequate antenatal care for adolescents, which revealed higher rates of adverse maternal and foetal outcomes. Importantly, students were common in this group. It implies the consequences of unplanned pregnancy coupled with a limitation in accessing to health care.
A review of post-caesarean infectious morbidity: how to prevent and treat
Published in Journal of Obstetrics and Gynaecology, 2018
Rebecca C. Pierson, Nicole P. Scott, Kristin E. Briscoe, David M. Haas
Puerperal infection is a significant cause of morbidity and mortality in postpartum women worldwide (Kassebaum et al. 2014). Puerperal infection increases length of hospital stay and healthcare costs. One of the major risk factors for postpartum infection is caesarean delivery (CD). Post-caesarean infection can be separated into two sub-groups: surgical site infection (SSI) and endometritis. Surgical site infection refers to infection of the skin and subcutaneous tissue at the location of the incision. Endometritis or endomyometritis refers to infection of the uterine corpus, endometrium and myometrium. According to a large retrospective study in the United States, the cost per patient of readmission and treatment for SSI and endometritis was $3529 USD and $3956 USD, respectively (Olsen et al. 2010). In addition to healthcare costs, there is the potential for impact on initiation and continuation of breastfeeding. In 2012, approximately 22.9 million CDs were performed worldwide (Molina et al. 2015); it is imperative to understand the disease process and prevention and management strategies.