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Sepsis
Published in Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis, Crises in Childbirth Why Mothers Survive, 2018
Postpartum endometritis is caused by an infection of the decidua with extension to the myometrium and parametrial tissues, and is usually caused by a mixture of aerobic and anaerobic organisms. Risk factors for infection include chorioamnionitis, prolonged rupture of membranes, premature labour, multiple vaginal examinations, retained products of conception and Caesarean section. The frequency of endometritis in women who undergo a vaginal delivery is approximately 1–3%. However, in women who have an elective Caesarean section this figure is around 5–15%, but it can be as high as 35%, depending on the particular situation. The use of prophylactic antibiotics has been shown to reduce this rate of infection.25 With regard to the choice of antibiotic, both ampicillin and first-generation cephalosporins have been shown to have similar efficacy.26 Septic abortion is an infection following a termination of pregnancy (either spontaneous or induced). The risk of infection following an induced abortion is about 1%. Infections can range from localised infection to the formation of a pelvic abscess. Intra-amniotic infections include a spectrum of diseases such as chorioamnionitis, amnionitis and amniotic fluid infection. Intra-amniotic infections can complicate up to 10% of deliveries.27 Sepsis complicates intra-amniotic infection in 0.5–1.3% of cases.28 Septic pelvic thrombophlebitis can also be a cause of puerperal fever, and is thought to follow pelvic infection. Patients present with a fever that is unresponsive to antibiotics, and the diagnosis is confirmed clinically or radiologically. The condition responds rapidly to intravenous heparin. Wounds are also at risk of infection, and patients who are particularly susceptible include those who have had a Caesarean section, those with drains or haematomas, and those with obesity and diabetes. The most severe of these infections is necrotising fasciitis, which has a significant mortality rate.29
Reproductive health and desire for children among young female sex workers in Bangladesh brothels
Published in Health Care for Women International, 2019
Eileen A. Yam, Nargis Sultana, Tarik Hossain, Brady Zieman, Shongkour Roy, Reena Yasmin, Najmus Sadiq, Sharif M.I. Hossain
1Abortion is not legal in Bangladesh except to save a woman’s life, but menstrual regulation using manual vacuum aspiration or misoprostol medication is permitted to remove the uterine lining up to 10 weeks after a missed period. Recent policy changes permit menstrual regulation at up to 12 weeks after a missed period (Association for Prevention of Septic Abortion, Bangladesh & Guttmacher Institute, 2017).
Fluoroquinolone-resistant Salmonella typhi infection: a report of two cases in South Africa
Published in Southern African Journal of Infectious Diseases, 2018
N Schellack, E Bronkhorst, C Maluleka, L Hunt, P Srinivas, W Grootboom, D Goff, P Naicker, T Modau, O Babarinde
A primary diagnosis of septic abortion, typhoid fever, with severe epistaxis complicated by disseminated intravascular coagulopathy (DIC) and resulting kidney failure, was made. The patient was initiated on haemodialysis, and received fresh frozen plasma and platelets.
Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala General Hospital
Published in Renal Failure, 2018
Marie Patrice E. Halle, Ndjifoum Moselle Chipekam, Gérard Beyiha, Hermine Fouda, Aminata Coulibaly, Romuald Hentchoya, Folefack Francois Kaze, Namme Henry Luma, Gloria Ashuntantang
The etiology of AKI in LMIC is dependent on geographical location. A recent meta-analysis from Wasiu et al. reported that the two leading causes in SSA were infections and nephrotoxin [11]. In the present study, pre-renal AKI (61.4%) and acute tubular necrosis (28.9%) were the most frequent forms. Sepsis from bacterial infection was the main precipitating factor followed by hypovolemia mainly from dehydration and hemorrhage. Similar findings were reported in developed and developing countries [18,29–33]. The main source of infection in our study population was the urinary tract (88/310), followed by gastroenteritis (75/310) and pneumonia (64/310). These three sources have been reported in the literature but with differences in proportion [34–36]. Pneumonia was the leading cause in the study of Madav et al. in Nepal followed by gastroenteritis and urinary tract infection [35]. In contrast, gastroenteritis was the first etiology in the studies of Praskash et al. (60%) in India and Arogundade et al. (36.9%) in Nigeria [17,28]. Toxic AKI is common in SSA with a global prevalence of 18% [11]. We found that 62 (10.1%) cases of AKI were due to nephrotoxins mainly herbal remedies (20 patients). This is similar to reported findings in LIC [27,37,38]. We found 22 cases (4.10%) of obstructive AKI, similar to the reported prevalence in SSA (5%), of Singhal et al. (5%) and Nagamani et al. (4%) [11,32,39]. In SSA, the major causes of obstruction are renal stone, prostate hypertrophy and less malignancy [11]. In our study, malignancy mainly solid pelvic cancer (18 cases) was the leading cause of obstruction. This high proportion of cancer can be explained by the fact that our hospital has a referral center for oncology included in the internal medicine ward and patients are usually referred at late stage of the disease in that setting with complications [40]. The estimated prevalence of obstetric AKI in SSA is 16% mainly due to septic abortion, eclampsia and post-partum hemorrhage [11]. With the improved maternal care, the incidence has decreased. We found an incidence of obstetric AKI of 7.1% (38 patients) with eclampsia (11 patients) post-partum hemorrhage (eight cases) and sepsis (four patients) being the major causes. This is similar to other studies in SSA [30,41].