Puerperal Group Research Articles

Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review.

Group A streptococcus (Streptococcus pyogenes) is one of the most lethal bacterial pathogens of humans, with increased risk of progression to septic shock and multiorgan failure in the pregnant population. The objective of this study is to systematically review the outcomes and management strategies for pregnancy and puerperal group A streptococcus infections in an effort to provide further guidance for prevention and treatment of a rare but lethal infection worldwide. A comprehensive search using puerperium and streptococcus pyogenes terms was completed across several registered databases. A total of 902 articles investigating pregnancy and puerperal group A streptococcus infection were identified, with 40 studies fulfilling inclusion criteria of original research articles in humans published from 1990 onwards reporting four or more unique cases of group A streptococcus in pregnancy or postpartum. This study was registered in PROSPERO: CRD42020198983. A total of 1160 patients with pregnancy and puerperal group A streptococcus infection were identified. Most infections occurred postpartum (91.9%), with 4.7% reported antepartum and 0.6% intrapartum. Bacteremia was present in 49.0% of patients and endometritis in 45.9%. Puerperal sepsis was described in 28.2% of cases and progressed to streptococcal toxic shock syndrome in one-third of such cases. Overall, the case fatality ratio was 2.0%, with one-third of the deaths from antenatal cases including 3/22 (13.6%) cases of septic abortion and 10/46 (21.7%) antenatal cases of group A streptococcus infection. Group A streptococcus infection remains an important contributor to pregnancy and puerperal morbidity and mortality. Early recognition, diagnosis and aggressive management are important for favorable outcomes given the serious risk of sepsis and streptococcal toxic shock syndrome.

Control of Puerperium in a Dairy Farm using an Intrauterine Suspension

The purpose of this research was to evaluate a product developed at the Faculty of Veterinary Medicine of Cluj Napoca and his efficiency in the control of the puerperium at cows. The study was carried out between January 2017 to December 2018 in a dairy farm from Mures county, Romania. In this study were enclosed 60 cows, randomly divided in 3 groups: Puerperal group (group 1), Puerperal and Estrumate group (group 2), and control group (group 3). For each group the treatment applied for the control of puerperium was different. For each group were followed: the evolution of puerperium, the appearance of the first postpartum estrous cycle, the interval of service period and the number of artificial inseminations necessary for one gestation. For the puerperium control and to avoid the postpartum complications Puerperal intrauterine suspension it’s a good option.

450 Obstetrically related group a streptococcal infection and predictors for severity - retrospective 12-year cohort study

To identify the clinical characteristics related with invasive puerperal group A streptococcus (GAS) infection and to discover novel predictors for admissions to the intensive care unit (ICU) A retrospective cohort study of culture-proven pregnancy-related GAS infection was performed at a tertiary university hospital between January 2008 and July 2020 1. Of 66 women diagnosed with GAS infection, 57 presented postpartum and 9 had septic abortions. 2. The most common presenting signs and symptoms were postpartum pyrexia (72%), abdominal pain and or tenderness (33%) and tachycardia (22%). 3. 11% of infections were proven to be acquired via hospital staff involved in patient admission or delivery. 4.The prevalence of strep-agalactia carriers, in which antibiotic prophylaxis was uniformly provided, in the study group was remarkably low (0.6%) in compere to its rate in the overall pregnant population (12%). Suggesting antibiotic prophylaxis as a protective factor against puerperal GAS infection. 5.13 women (19.6%) developed streptococcal toxic shock syndrome (STSS) and transferred to the intensive care unit (ICU), 10 of whom delivered vaginally, 2 had cesarean delivery and one of whom had a septic abortion. 6.Predictors for STSS and ICU admission were as following: antibiotics administration more than 24 hours from presentation (OR 5.5, CI 1.90-41) Postpartum, tachycardia (OR 4.19, CI 1.12-15.84) and CRP measurement above 202 (OR 3.25, CI 0.57-26.18). 7.The most common Emm-type isolated were: 14.3 (3), 22 (3), 75 (4) and 11 (3, all recovered from women admitted to ICU). 8.During the study period, no cases of maternal deaths occurred. Pregnancy related GAS infection is associated with a significant morbidity. Deferral in medical intervention of more than 24 hours from first abnormal signs registered, had the most important impact on maternal deterioration. Since vital signs have been demonstrated to be of utmost clinical importance with regard infection prediction in cases with delay, the implementation of wearable technology and continuous monitoring should be considered.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Out-of-season increase of puerperal fever with group A Streptococcus infection: a case-control study, Netherlands, July to August 2018.

We observed an increase in notifications of puerperal group A Streptococcus (GAS) infections in July and August 2018 throughout the Netherlands without evidence for common sources. General practitioners reported a simultaneous increase in impetigo. We hypothesised that the outbreak of puerperal GAS infections resulted from increased exposure via impetigo in the community.We conducted a case–control study to assess peripartum exposure to possible, non-invasive GAS infections using an online questionnaire. Confirmed cases were recruited through public health services while probable cases and controls were recruited through social media. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) with logistic regression analysis.We enrolled 22 confirmed and 23 probable cases, and 2,400 controls. Contact with persons with impetigo were reported by 8% of cases and 2% of controls (OR: 3.26, 95% CI: 0.98–10.88) and contact with possible GAS infections (impetigo, pharyngitis or scarlet fever) by 28% and 9%, respectively (OR: 4.12, 95% CI: 1.95–8.68). In multivariable analysis, contact with possible GAS infections remained an independent risk factor (aOR: 4.28, 95% CI: 2.02–9.09).We found an increased risk of puerperal fever after community contact with possible non-invasive GAS infections. Further study of this association is warranted.

Clinical Variables Associated With Adverse Maternal Outcomes in Puerperal Group A Streptococci Infection.

To identify clinical variables associated with increased risk of composite adverse outcome in a cohort of women with puerperal group A streptococci infection. Our prospective case registry enrolled patients between 1991 and 2017. Chart abstraction was conducted for admission demographic and clinical data in patients with culture-proven puerperal group A streptococci infection. We created a composite variable of signs of capillary leakage including pulmonary edema, pleural effusion, ascites, and abdominal distention. The composite adverse outcome included death, hysterectomy, intensive care unit admission, mechanical ventilation, and blood transfusion. Clinical characteristics were compared between those with a composite adverse outcome and those without. We fit unadjusted log-linear models with robust error variance to measure the relative risk of a composite adverse outcome associated with clinical and demographic variables among patients with group A streptococci. Thirty-five of 71 (49%) patients had an adverse outcome. Women who had adverse outcomes had higher admission heart rates (126±19 vs 112±22 beats per minute, P=.008) and respiratory rates (26±10 vs 20±5 breaths per minute, P=.01), lower systolic blood pressure (98±24 vs 114±19 mm Hg, P=.004), and were more likely to have signs of capillary leakage (77% vs 20%, P<.001) and symptoms of capillary leakage (dyspnea, cough, shoulder pain, abdominal bloating, and chest pain) (40% vs 17%, P=.03) compared with those without adverse outcomes. Log-linear models indicated that these clinical variables were individually associated with increased risk of a composite adverse outcome. The relative risk of an adverse outcome was 3.5 times higher among women with signs of capillary leakage (relative risk 3.67, 95% CI 1.94-6.94, P<.001). Vital sign parameters consistent with severe infection correlate with adverse outcomes in women with puerperal group A streptococci infection. Signs of capillary leakage are most strongly associated with a composite adverse outcome. These clinical characteristics, particularly signs of capillary leakage, are potentially useful to guide clinical care.

Predicting adverse outcomes in puerperal Group A streptococcus infection

Predicting adverse outcomes in puerperal Group A streptococcus infection

ANÁLISE COMPARATIVA DA FORÇA MUSCULAR RESPIRATÓRIA DE PRIMIGESTAS NO PUERPÉRIO IMEDIATO DE PARTO NORMAL E DE NULIGESTAS

This paper aims to analyze the respiratory muscle strength (RMS) of primiparous women of normal delivery and nulliparous. It is a case-control study that assess 59 women allocated to the Puerperal Group (PG) (primiparous, n= 29) and Control Group (CG) (niligestas, n= 30). Anthropometric and RMS characteristics were assessed (MIP and MEP) through digital manovacuometer. The Student’s t-test compared anthropometric and RMS data between groups. The Pearson correlation (p

751: Predicting need for hysterectomy in puerperal group a strep infection

751: Predicting need for hysterectomy in puerperal group a strep infection

Puerperal Group A Streptococcal Infections: A Case Series and Discussion

Puerperal group A streptococcal infections, a major postpartum killer during the late 19th and early 20th centuries, have become (fortunately) rare. We describe a cluster of 4 serious peripartum group A streptococcal infections occurring within the past five years at a single medical center. These cases were not epidemiologically linked and serve to illustrate the continuing risk of these potentially fulminant infections.

The association of innate immune response gene polymorphisms and puerperal group A streptococcal sepsis

The objective of the study was to determine whether single-nucleotide polymorphisms (SNPs) that influence the maternal innate immune response are associated with puerperal group A streptococcal sepsis. Subjects with confirmed puerperal group A streptococal infection were prospectively identified in 2 tertiary care hospitals over 18 years. Controls were racially matched subjects with term, uncomplicated deliveries. Thirty-eight polymorphisms associated with the innate immune response to bacterial infection were analyzed. Allele and genotype frequencies for subjects and controls were compared. Forty-eight women with puerperal group A streptococcal infection were identified. DNA was obtained for 28 subjects and 54 controls. Allele frequencies were significantly different between subjects and controls for polymorphisms in Toll-like receptor (TLR) 9-1486 (P = .03) and heat shock protein (HSP) 70-2 1267 (P = .003). Genotype frequencies were significantly different between subjects and controls for TLR9-1486 (P = .025), HSP70-2 1267 (P = .02), and interleukin (IL)-1beta-511 (P = .016). Puerperal group A streptococcal sepsis may be associated with innate immune response gene polymorphisms in TLR9, HSP70-2, and IL1beta.

Puerperal group A streptococci (GAS) infection: Re-emergence of a dreaded disease - A case series

Puerperal group A streptococci (GAS) infection: Re-emergence of a dreaded disease - A case series

Etiology and outcome of acute renal failure in pregnancy.

To determine the etiology and outcome of Acute Renal Failure (ARF) in pregnancy. A case series. Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria (urine output <400 ml/day) and mounting azotemia (serum creatinine > 2 mg%) were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients (83.7%). Haemorrhage was the etiology for ARF in 25 (58.1%), antepartum haemorrhage APH in 8 (18.6%) and postpartum haemorrhage PPH in 16 (37.2%) of patients. In 12 (27.9%), puerperal sepsis was the etiological factor, while 4 (9.3%) patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 (11.6%). While 1 (2.3%) was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% (n=7). Of the 36 (83.7%) surviving patients, 18 (41.4%) had complete recovery of renal function; 12 (27.9%) had partial recovery; and 6 (13.9%) required chronic dialysis. Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy.

A comparison of clinical response to electroconvulsive therapy in puerperal and non-puerperal psychoses

Background: There is a widespread belief that puerperal psychosis is particularly responsive to electroconvulsive therapy (ECT), but research evidence for this is lacking. Method: We have conducted a retrospective case-note study of clinical improvement following ECT in puerperal and non-puerperal psychosis. The main outcome measure was improvement in mental state at the end of a course of ECT, rated by a blind rater on a simple four-point scale. Additional indicators of responsiveness to ECT were improvement in mental state 4 weeks after stopping ECT, duration of in-patient stay following ECT and number of ECT received. Results: Women with puerperal psychosis showed greater clinical improvement than women with non-puerperal psychosis. The results were not explained by the greater preponderance of depressive illness in the puerperal group, as the same results were also found when the analysis was confined to women with a clinical diagnosis of depressive illness. Conclusion: These findings are the first evidence of a particular sensitivity of ECT in puerperal psychosis. However, they are preliminary and a number of explanations are possible, including good responsiveness to treatment in general. A prospective study using standardised clinical ratings and definitions of key variables is now required. Clinical implications: Clinicians treating severe postpartum illness should continue to regard ECT as a treatment option. Limitations of the study: The study is limited by its reliance on retrospective examination of information recorded in case notes. Ratings of clinical improvement were not standardised.

Puerperal and Intrapartum Group A Streptococcal Infection

Objective: To determine the demographic and clinical variables characteristic of non‐epidemic intrapartum or puerperal group A streptococcal (GAS) infection.Methods: The records of 47 patients diagnosed with intrapartum or puerperal GAS infection over a 6 1/2 year period at Hadassah‐University Hospital‐Mt. Scopus, Jerusalem were reviewed. Data regarding 25,811 women, the general population of women that delivered during that period, were obtained from their computerized medical records. Frequency distributions, t‐test, chi‐square, and Spearman′s Rank Correlation were used, as appropriate, to analyze and compare demographic and clinical variables associated with development of GAS infection, its clinical course and subsequent development of septic shock.Results: Mean age of mothers with GAS infection was higher than that of our general pregnant population (30.4 versus 27.4 years, P = 0.0019), and a higher proportion of GAS infected patients (30% versus 12%, P &lt; 0.005) experienced PROM. Thirty‐one (66%) women had fever as their sole presenting symptom, eight (17%) had fever and abdominal pain, seven (15%) had fever and abnormal vaginal bleeding, and one patient (2%) presented with a rash. Three patients (6%) developed a septic shock. Two of these patients presented with symptoms more than 14 days after delivery.Conclusions: We describe the characteristics of non‐epidemic intrapartum or puerperal GAS infection. Data from our study and review of the literature suggest that some patients who develop septic shock may present later in the puerperium than patients with an uncomplicated GAS infection. Infect. Dis. Obstet. Gynecol. 7:276–282; 1999.

Psychological sequelae in women following either parturition or non-gynaecological surgery

Childbirth, in 10% of cases, is followed by an affective disorder. However, whether this is specifically due to parturition or reflects a generalized stress response is unclear. This prospective study uses the Profile of Mood States to assess mood in 96 women before and after parturition and, unlike previous studies, compares the results with those from women undergoing non-gynaecological surgery (n = 33) and a control group (n = 44). Results indicated that women in the puerperal group experienced significantly more positive mood on average than either the surgical group or the control group. In addition criterion analysis indicated that the prevalence of depressive symptomatology was similar across all three groups. Hence, these findings question the notion of an affective disorder which is specific to the post-partum.

O-7-8 - A review of the nosological status and aetiological theories of postpartum psychosis

Background: There is a widespread belief that puerperal psychosis is particularly responsive to electroconvulsive therapy (ECT), but research evidence for this is lacking. Method: We have conducted a retrospective case-note study of clinical improvement following ECT in puerperal and non-puerperal psychosis. The main outcome measure was improvement in mental state at the end of a course of ECT, rated by a blind rater on a simple four-point scale. Additional indicators of responsiveness to ECT were improvement in mental state 4 weeks after stopping ECT, duration of in-patient stay following ECT and number of ECT received. Results: Women with puerperal psychosis showed greater clinical improvement than women with non-puerperal psychosis. The results were not explained by the greater preponderance of depressive illness in the puerperal group, as the same results were also found when the analysis was confined to women with a clinical diagnosis of depressive illness. Conclusion: These findings are the first evidence of a particular sensitivity of ECT in puerperal psychosis. However, they are preliminary and a number of explanations are possible, including good responsiveness to treatment in general. A prospective study using standardised clinical ratings and definitions of key variables is now required. Clinical implications: Clinicians treating severe postpartum illness should continue to regard ECT as a treatment option. Limitations of the study: The study is limited by its reliance on retrospective examination of information recorded in case notes. Ratings of clinical improvement were not standardised.

A severe puerperal group A streptococcal infection causing a toxic shock-like syndrome

Toxic shock syndrome (TSS) is classically associated with vaginal recovery of Staphylococcus aureus during menses. In this case a patient presented with fever, rash, abdominal pain and signs of shock, 6 days postpartum. Blood cultures were negative but endometrial cultures were positive for Group A β-hemolytic streptococcus. This case presents a toxic shock-like syndrome due to streptococcus, (toxic streptococcus syndrome) and points out the importance of culturing these patients for organisms other than Staphylococcus aureus.

Is puerperal psychosis the same as bipolar manic-depressive disorder? A family study.

The first degree relatives of three groups of women were interviewed; 51 women who had had an illness within two weeks of childbirth and no non-puerperal episodes (the puerperal group), 33 who had puerperal and non-puerperal episodes (the mixed group), and 19 women with bipolar manic-depressive disorder who had non-puerperal episodes only (the manic-depressive group). Over 60% of the affected relatives in all three groups had affective illnesses; in the main these were not puerperal. There were significantly more first degree relatives who had had general practitioner or hospital treatment for psychiatric illness in the puerperal group and in the mixed group than in the manic-depressive group. The puerperal patients had a better prognosis in terms of their illness (number of relapses and time on medication), work functioning and social functioning than the manic-depressive group and the mixed group. The mixed group had an earlier age of onset than the manic-depressive group and the puerperal group. The hypothesis that puerperal psychosis is the same as bipolar manic-depressive disorder was not upheld. The mixed group and the puerperal group were similar with respect to the risk in first degree relatives but differed in terms of prognosis. There were no significant differences between the groups with respect to puerperal episodes in first-degree relatives, although the rate of puerperal psychosis in the first-degree relatives of the puerperal patients was significantly greater than in the general population. The hypothesis that there is a specific genetically determined puerperal psychosis was not supported. Women who had had an illness with an onset within two weeks of childbirth (mixed and puerperal) subsequently had an illness following 36% of their childbirths. In women who had had puerperal and non-puerperal episodes (mixed) the risk was higher; over 50% of deliveries in these women were followed by psychiatric illness.

Puerperal psychosis in America--1847.

<h3>To the Editor.</h3> —I would like to comment on the article "Puerperal Psychosis: Phenomena and Diagnosis" by Brockington et al (Archives1981; 38:829-833). In their study of this disorder, the authors found an "excess of manic symptoms in the puerperal group" as compared with a control group of nonpuerperal psychotic women. Brockington et al note that "in the Victorian literature, reports of 'mania' were frequent; however, they were written before the distinction between dementia praecox and manic-depressive insanity was drawn." The majority of the references from this period cited by Brockington and colleagues are of European origin, with only one American study from 1859 noted.¹I have recently come across an earlier study on this subject published in the American psychiatric literature in 1847 in which MacDonald²reports on a group of 66 women with puerperal insanity. I should like to point out the "highlights" of this report

Observations on expulsion of the IUCD in puerperal and nonpuerperal insertions

The expulsion rates of puerperally and nonpuerperally inserted Lippes loops of different sizes have been compared. Although puerperal insertions show a high expulsion rate in the initial 3 month period, the subsequent expulsion rate is much less. The results are statistically significant. Both in puerperal as well as nonpuerperal women lower expulsion rates are seen with the larger loops. These results are statistically significant in the nonpuerperal groups. The same trend is observed in the puerperal group, though it is not statistically significant.