Incidence Of Postpartum Endometritis Research Articles

Эффективность карбетоцина для коррекции репродуктивной функции у свиноматок

The article shows the efficiency of the preparation carbetocin during the postpartum period in highly productive sows. The use of a prolonged form of oxytocin in postpartum animals activates the contractile activity of smooth muscle structures of the myometrium. Against this background, we record a 2.57-fold decrease in the incidence of postpartum endometritis and postpartum dysgalactia of sows. The young animals have then high viability and growth energy values. After weaning of piglets, the breeding stock quickly restores the sexual cycle. The efficiency of insemination is comparatively high.

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ПОСЛЕРОДОВОМ ЭНДОМЕТРИТЕ (ОБЗОР ЛИТЕРАТУРЫ)

The review is based on the databases https://cyberleninka.ru/, PubMed, MedArt, and CNMB. Postpartum endometritis is the leading infectious and inflammatory disease of the postpartum period and one of the stable leading causes of maternal mortality. In Russia, the incidence of postpartum endometritis in the population is 3-8%, in pathological deliveries it is 10-20%, and in women with a high infection risk it is 13.3-54.3%. Infection occurs predominantly by the ascending route, as a rule, with active participation in associations of opportunistic pathogenic flora. The leading position among the risk factors of postpartum endometritis is taken by surgical delivery and, primarily, by cesarean section. Immune disorders play one of the key roles in the pathogenesis of this disease according to modern researchers. In case of insufficient effectiveness of empirical antibacterial therapy, the choice of antibacterial drugs must be made on the basis of blood cultures. The second local component of treatment of patients with postpartum endometritis is the evacuation of uterine cavity contents. Careful emptying is one of the most important criteria for choosing the method of evacuation. An immunomodulatory component should be included in the treatment to increase its effectiveness. Thus, postpartum endometritis is a serious obstetric problem, in the treatment of which gentle evacuation of the uterine cavity contents in combination with local use of immunomodulatory drugs is promising.

EFFICACY OF ANTIMETRIMAST APPLICATION FOR PREVENTION OF POSTPARTUM ENDOMETRITIS IN COWS

The article presents the results of the efficacy of using the drug antimetrimast for the prevention of postpartum endometritis in cows. Administration of antimetrimast on three occasions, starting on the first day after calving, with a 24-hour interval at a dose of 10 ml/animal, provides a 3.3-fold decrease in the incidence of postpartum endometritis in cows, a 2.0-fold increase in prophylactic efficacy, and an increase by 42.7% in the number of fertilized animals. The application of antimetrimast for prophylactic purposes helps reduce the inflammatory reaction in the uterus and activate the humoral and cellular elements of the general nonspecific resistance of bovine organism.

PREVALENCE OF POSTPARTUM ENDOMETRITIS AND ANTIMICROBIAL RESISTANCE OF RESPONSIBLE PATHOGENS IN UKRAINE: RESULTS A MULTICENTER STUDY (2015-2017)

The aim: To obtain the prevalence of postpartum endometritis women and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study. The study population consisted of all women who had a vaginal delivery or cesarean section in 14 Regional Women's Hospitals of Ukraine. Results: Total 2460 of 25,344 patients were found to have postpartum endometritis, for an overall infection rate of 9.7%. The postpartum endometritis rates were 7.6% after vaginal delivery and 16.4% after cesarean section. Incidence of postpartum endometritis after cesarean section is affected mainly by the mode of delivery (scheduled caesarean deliveries (done before labor starts) - 13.8% and unscheduled caesarean deliveries (done after labor starts) - 22.5%. The predominant pathogens were: Escherichia coli (32.7%), Enterococcus faecalis (13.0%), Streptococcus spp. (12.1%), Klebsiella spp. (10.4%) and Enterobacter spp. (10%). Among the antimicrobial agents tested, the ertapenem, piperacillin/tazobactam, and cefotaxim were the most consistently active in vitro against Enterobacteriaceae in both vaginal deliveries and after cesarean section infections. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 22.8% and of methicillin-resistance in Staphylococcus aureus (MRSA) 15.4%. Conclusions: Postpartum endometritis and antimicrobial resistance of responsible pathogens presents a significant burden to the hospital system. Postpartum infections surveillance is required in all women's hospitals. This knowledge is essential to develop targeted strategies to reduce the incidence of postpartum infections.

Analysis of Long-Term Dynamics of Incidence of Healthcare-Associated Infections in the Irkutsk Region

Introduction.Healthcare-associated infections incidence is one of the most pressing issues in modern healthcare due to their high abundance as well as economic loss they cause.The aimis to study regional features of the incidence of healthcare-associated infections.Methods.We conducted a retrospective epidemiological analysis of nosocomial morbidity in hospitals of the Irkutsk region within 2006-2017 years. We used data, presented in the following state reports: “On the state of sanitary and epidemiological welfare of the population in the Russian Federation”, “On the state of sanitary and epidemiological welfare of the population in the Irkutsk region”.Results and discussion.According to the results of the conducted analysis, it was shown that the average long-term prevalence of healthcare-associated infections in the Irkutsk region was 41.94 ± 2.040/00000 (Russian Federation – 17.49) with a tendency to stabilization in recent years. The therapeutic and prophylactic organizations of the surgical profile have the highest epidemiological significance (over 51 %). At the same time, the share of postoperative complications during the study period decreased by 1.5 times. We have noted a rising trend line with a positive rate of increase in the incidence of nosocomial pneumonia, which in the last two years has taken a leading position in the structure of healthcare-associated infections. The incidence of infections in newborns in the Irkutsk region ranks the third, with a specific weight of 11.54 %. Moreover, if before 2013 purulent-septic diseases of the newborns were the predominant nosological form, in recent years pneumonia has firmly taken over the leadership. During the study period we revealed an increase in the incidence of postpartum endometritis in puerperas. It has been shown that the registration of sepsis, urinary tract infections in the region is low.

Antibiotic prophylaxis in ragged placental membranes: a prospective, multicentre, randomized trial

BackgroundRagged placental membranes is a distinct entity from retained placenta and not uncommonly reported in midwifery texts. Although the incidence of postpartum endometritis is merely 1–5% after vaginal births, it remains the most common source of puerperal sepsis, contributing up to 15% of maternal mortality in low income countries. Geographically-remote centres in Malaysia prophylactically administer antibiotics for women with ragged placental membranes after vaginal birth, extrapolating evidence from retained placenta. We sought to clarify the rationale in continuing such practices.MethodsThis was an open-label, prospective, multicentre, randomized trial. Three hospitals where the current protocol was to administer prophylactic amoxycillin-clavulanic acid served as the sites of recruitment. Women who delivered vaginally beyond 24+ 0 weeks of gestation with ragged membranes were invited to participate in the trial and randomized into prophylaxis or expectant management with medical advice by blocks of 10, at a 1:1 ratio. A medication adherence diary was provided and patients followed up at 2 weeks and 6 weeks postpartum.ResultsA total of 6569 women gave birth vaginally in three centres during the trial period, of which 10.9% had ragged membranes. The incidence of endometritis was not significantly raised in women with or without prophylaxis (0.90% vs 0.29%; p = 0.60). All cases of endometritis presented within the first 2 weeks and preventive use of antibiotics did not ameliorate the severity of endometritis since rates of ICU admission, surgical evacuation and transfusion were comparable.ConclusionPreventive use of antibiotics after vaginal delivery in women with ragged placental membranes did not result in a reduction of endometritis. Educating women on the signs and symptoms of endometritis would suffice. Based on the reported incidence of ragged membranes, a change in practice would result in 1500 less prescriptions of antibiotics per annum in these three centres.Trial registrationNCT 03459599 (Retrospectively registered on 9 March 2018).

Amnioinfusion for chorioamnionitis.

Amnioinfusion for chorioamnionitis.

Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis.

ObjectiveTo compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery.MethodsWe conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool.ResultsFour hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed.ConclusionFor elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up.Trial RegistrationChinese Clinical Trial Registry ChiCTR-TRC-11001853

A Retrospective Study on the Risk Factors and the Effect of Higher Somatic Cell Count in Milk on Reproductive Performance in Dairy Cows

This retrospective study evaluated the effect of somatic cell count (SCC) in milk during early lactation on reproductive performance in dairy cows. Data were collected on 774 cows from six dairy farms, including cow parity, dates of previous calving, artificial insemination, pregnancy diagnosis, incidence of postpartum endometritis, reproductive performance (the intervals from calving to first insemination and conception), milk production and SCC. Data on 774 lactations were grouped based on the average first 3 months postpartum linear somatic cell score (SCS) as T1 ( 0.05). The hazard of pregnancy by 365 DIM in the T3 group was lower (HR: 0.75, p < 0.05 respectively) than in the T1 and T2 groups. The SCS during 4 to 7 months postpartum differed (p < 0.0001) among the 3 groups. Farm and cow parity were important risk factors for higher SCS (≥ 4.0). Multiparous cows were more likely to have a higher SCS (OR: 2.26, p = 0.0005) compared with primiparous cows. In conclusion, higher SCS (≥ 4.0) during early lactation was associated with decreased reproductive performance of dairy cows.

Antibiotic regimens for management of intraamniotic infection.

Intraamniotic infection is associated with maternal morbidity and neonatal sepsis, pneumonia and death. Although antibiotic treatment is accepted as the standard of care, few studies have been conducted to examine the effectiveness of different antibiotic regimens for this infection and whether to administer antibiotics intrapartum or postpartum. To study the effects of different maternal antibiotic regimens for intraamniotic infection on maternal and perinatal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002). Trials where there was a randomized comparison of different antibiotic regimens to treat women with a diagnosis of intraamniotic infection were included. The primary outcome was perinatal morbidity. Data were extracted from each publication independently by the authors. Two eligible trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone, but this did not reach statistical significance (RR 0.54; CI 0.19, 1.49). The conclusions that can be drawn from this meta-analysis are limited due to the small number of studies. For none of the outcomes was a statistically significant difference seen between the different interventions. Current consensus is for the intrapartum administration of antibiotics when the diagnosis of intraamniotic infection is made; however, the results of this review neither support nor refute this although there was a trend towards improved neonatal outcomes when antibiotics were administered intrapartum. No recommendations can be made on the most appropriate antimicrobial regimen to choose to treat intraamniotic infection.

Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, doubleblind trial of ampicillin-sulbactam prophylaxis

To evaluate the efficacy of intrapartum prophylactic administration of ampicillin-sulbactam in reducing intraamniotic infection and postpartum endometritis in patients with meconium-stained amniotic fluid (AF). Patients with intrapartum meconium-stained AF were randomized to receive either ampicillin-sulbactam or normal saline (placebo) intravenously at the time of diagnosis of meconium and every 6 hours until delivery. The outcomes of the two groups were compared with respect to intra-amniotic infection and postpartum endometritis. During the study period, 332 patients with meconium-stained AF were approached for participation, and 120 patients met inclusion criteria and were enrolled. Patient demographics, labor, and delivery characteristics were similar. Ampicillin-sulbactam reduced the incidence of intra-amniotic infection from 23.3 to 6.7%, (P = .02; relative risk [RR] 0.48, 95% confidence interval [CI] 0.22-0.98). The incidence of postpartum endometritis was also reduced, but the difference was statistically nonsignificant (8.3 versus 16.7%, P = .16; RR 0.64, 95% CI 0.30-1.33). Prophylactic intravenous ampicillin-sulbactam significantly reduces intra-amniotic infection in patients with meconium-stained AF.

Effect of Amnioinfusion on the Incidence of Postpartum Endometritis in Patients Undergoing Cesarean Delivery

We reviewed records from 251 consecutive cesarean deliveries performed over a six-month period to evaluate the effect of amnioinfusion during labor on the incidence of postpartum endometritis in patients who delivered by cesarean section. One hundred fifty-four patients were excluded because they were not in labor, were at less than 35 weeks' gestation or received antibiotics during labor. Twenty-three of the remaining 97 patients received amnioinfusion during labor and represented the study group. Seventy-four patients did not receive amnioinfusion during labor and were used as controls. The incidence of postpartum endometritis in the amnioinfusion group was 13%, while the incidence in the group not receiving amnioinfusion was 38% (relative risk, 0.34; 95% confidence interval, 0.13-0.88; P = .026). Amnioinfusion during labor appears to significantly decrease the incidence of postpartum endometritis in patients subsequently undergoing cesarean delivery.

The effect of placental management at cesarean delivery on operative blood loss

OBJECTIVES: The effect of alternative methods of placental delivery at cesarean section on blood loss has not been reported. The hypothesis of this study was that spontaneous expulsion of the placenta would reduce operative blood loss, compared with that of manual extraction during cesarean delivery. STUDY DESIGN: We prospectively randomized and compared outcomes of 62 gravid women with manual ( n = 31) or spontaneous ( n = 31) placental delivery at cesarean section. Operative blood loss was measured directly. RESULTS: Blood loss measured at cesarean delivery was greater in the manually delivered group (967 ± 248 ml) than in the spontaneously delivered group (666 ± 271 ml, p < 0.0001 ). The incidence of postpartum endometritis was sevenfold greater in the manual than the spontaneous group (23% vs 3%, respectively; p < 0.05). CONCLUSIONS: We conclude that spontaneous expulsion of the placenta at cesarean delivery results in less operative blood loss and a lower incidence of postoperative endometritis.