Risk Factors For Endometritis Research Articles

Prevalence, Etiology and Risk Factors of Endometritis in Zebus Cattle Slaughtered at the Municipal Abattoir of Ngaoundere, Adamawa Region, Cameroon

Objective: Identification of pathogens and risk factors associated with bovine endometritis is helpful in treatment and management decisions. This study was aim to determine the prevalence, etiology and risk factors of endometritis at the Ngaoundere municipal abattoir. Specifically, it was a question of characterizing slaughtered cows, evaluating the prevalence of endometritis, determining the bacterial species involved in endometritis, determining the risk factors for endometritis and the correlated effect of risk factors on the bacterial species responsible for the endometritis. Methodology: Three hundred and forty-four non-pregnant zebus cows slaughtered at the abattoir of Ngaoundere were evaluated. They were characterized and their uteri were collected, cleaned and the diameters of the cervix and uterine horns were measured using an electronic caliper. The affected uteri were sampled to determine the bacterial species responsible for the endometritis. Results: Data analysis revealed a prevalence of 12.5% for endometritis (at 95% CI). The bacteria species: Citrobacter braakii, Actinomyces pyogenes, Proteus mirabilis, Enterobacter cloacae, Escherichia coli, Aeromonas hydrophila, Bulkhoderia cepacia, Provendencia stuartii and Salmonella spp with the following proportions: 41,86%; 20,93%; 11,62%; 9,30%; 4,65%; 4,65%; 2,32%; 2,32% and 2,32%, respectively, were recorded in the positive cows. The correlation between the risk factors and the bacterial species showed that; there is a direct relation between the season and Citrobacter braakii; the rainy season and Citrobacter braakii was found to have correlation coefficients of 0.86 and 1, respectively. Nevertheless, moderate correlation values were observed between the bacteria species and the BCS (body condition score); emaciated animals and bacteria species; the Red Fulani breed and Escherichia coli with correlation coefficients of 0.42; 0.44 and 0.43, respectively. Conclusion: Endometritis is present in the bovine population ofAdamawa, and the age of the animals was a principal risk factor, with the age group (5-9 years) being the highest risk group.

609: The impact of prompt diagnosis and treatment on maternal and perinatal outcome in pregnant women with influenza A (H1N1)

singleton pregnancies after exclusion of long term steroid use and anomalies. Infectious outcomes were analyzed, including endometritis, chorioamnionitis, group B streptococcus (GBS), antenatal urinary tract infections (UTI), and wound infections. Infectious neonatal data were analyzed, including neonatal fever, sepsis, and pneumonia. Relative risk (RR) analyses were performed comparing normal weight (BMI 18.50-24.49) and underweight (BMI 50.00) patients with their corresponding neonatal data. Regression analyses were performed to account for confounding factors. RESULTS: Obese patients were at increased risk for wound infections (RR 1.96, 95% CI 1.55-2.47, P 0.0001), as well as endometritis (RR 1.62, 95% CI 1.19-2.22, P 0.0021), UTIs (RR 1.33, 95% CI 1.23-1.43, P 0.0001), and GBS (RR 1.22, 95% CI 1.18-1.26, P 0.0001). Interestingly, obesity was protective against chorioamnionitis with a RR of 0.83 (95% CI .074-0.92, P 0.0003). The multivariable logistic regression analysis showed that only race, age parity, and number of vaginal exams were risk factors for chorioamnionitis. Age, parity, and diabetes were risk factors for endometritis. Maternal obesity had no correlation with infectious neonatal outcomes. CONCLUSION: In addition to the predisposition to wound infections, obesity is a risk factor for endometritis, GBS, and antenatal UTIs. After regression analysis endometritis and chorioamnionitis do not have any significant association with obesity. Maternal obesity is not a risk factor for neonatal infections.

Relationships between endometritis and metabolic state during the transition period in pasture-grazed dairy cows

The primary objective of this study was to identify relationships between endometritis and metabolic state during the calving transition and early lactation periods. A subset of mixed age and breed dairy cows (n=78) from a seasonal, pasture-grazed herd of 389 cows was examined. The selected cows were grouped as having endometritis at d 42 postpartum or being unaffected by endometritis. Endometritis was defined as >6% (upper quartile) of uterine nucleated cells being polymorphonuclear cells (H-PMN; n=38); unaffected by endometritis was defined as ≤1% of nucleated cells being polymorphonuclear (L-PMN; n=40). Milk yield was determined at each milking, and milk composition (fat and protein) was determined at 2-wk intervals. Blood samples collected on d −14, 0 (d of calving), 4, 7, 14, 28, and 42 were analyzed for indicators of energy status (nonesterified fatty acids, glucose, and urea), liver function (albumin, globulin, glutamate dehydrogenase, and aspartate aminotransferase), inflammation (haptoglobin), and mineral status (Ca and Mg). Samples collected weekly from d 21 to 63 or 70 were analyzed for progesterone content. The postpartum anovulatory interval was defined to end on the first day postpartum that plasma progesterone concentration was ≥1 ng/mL. A greater percentage of H-PMN cows failed to ovulate before d 63 or 70 (34%) compared with L-PMN cows (10%), although the proportions of cows ovulating within either polymorphonuclear group was similar through d 56 postpartum. Plasma concentrations of albumin and the albumin:globulin ratio were consistently lower in H-PMN cows. Plasma Mg was lower, whereas glutamate dehydrogenase and aspartate aminotransferase were higher, in H-PMN cows during early lactation compared with L-PMN cows. Circulating metabolites indicative of energy status (nonesterified fatty acids, glucose, and urea) were not different between polymorphonuclear groups. Among 3- to 5-yr-old cows, daily milk yield for the first 42 d after calving was lower for H-PMN cows than for L-PMN cows. Among cows >5 yr old, protein percentage was lower in H-PMN cows compared with L-PMN cows. In summary, endometritis at 42 d postpartum in the herd studied was associated with an increased likelihood of remaining anovulatory. These cows had lower albumin concentrations throughout the calving transition period, perhaps indicating impaired liver function, with lower plasma Mg and evidence of hepatocellular damage in early lactation. Similar profiles of nonesterified fatty acids and glucose indicated that energy status was not a risk factor for endometritis.

Effect of Intrapartum Antibiotic Prophylaxis Against Group B Streptococcal Infection on Comparisons of Rates of Endometritis and Urinary Tract Infection in Multicenter Surveillance

To establish whether antibiotic prophylaxis against group B streptococcal infection may be a confounding factor in comparisons of rates of endometritis and urinary tract infection after vaginal delivery. Prospective study. Maternity units at 48 hospitals in a regional surveillance network in France during 2001-2004. The maternity units used a common protocol to establish whether antibiotic prophylaxis was indicated. Risk factors for endometritis and urinary tract infections were evaluated using multiple logistic regression. We analyzed 49,786 vaginal deliveries. The percentage of women receiving antibiotic prophylaxis varied widely and significantly among the maternity units (range, 4.4%-26.0%; median, 15.8%; 25th percentile, 12.1%; 75th percentile, 19.0%) (P < .001, by Mantel-Haenszel chi(2) test). The incidence rate of endometritis was significantly reduced from 0.25% to 0.11% by antibiotic prophylaxis (P = .001). There was a decrease in the incidence of urinary tract infection from 0.37% to 0.32%, but it was not statistically significant (P = .251). A reduction in the incidence of endometritis was observed when intrapartum antibiotic prophylaxis against group B streptococcal infection was used. However, the proportion of women considered to be at risk of infection varied widely among institutions. Comparisons of rates of endometritis among maternity units, but not urinary tract infection rates, should take into account antibiotic prophylaxis as a significant confounding factor.

The effect of nutritional management of the dairy cow on reproductive efficiency

The cause of low fertility in dairy cows is multifactorial. Poor nutrition during the dry and early postpartum periods results in reduced glucose, insulin, insulin-like growth factor (IGF-I) and low LH pulse frequency with concomitant increases in β-hydroxy butyrate, non-esterified fatty acids (NEFA) and triacylglycerol. Cows must mobilize large lipid, but also some protein reserves, with a consequent increased incidence of such metabolic disorders as hypocalcaemia, acidosis, ketosis, fatty liver and displaced abomasums. The occurrence of milk fever and ketosis affects uterine contractions, delays calving and increases the risk of retained foetal membranes (RFM) and endometritis. The nutritional risk factors that cause RFM are hypocalcaemia, high body condition score (BCS) at calving and deficiencies in Vitamin E and selenium. The risk factors for endometritis are hypocalcaemia, RFM, high triacylglycerol and NEFA. Thus, metabolic disorders predispose cows to gynaecological disorders, thereby reducing reproductive efficiency. Cows that are overconditioned at calving or those that lose excess body weight are more likely to have a prolonged interval to first oestrus, thereby prolonging days open. Nutritionally induced postpartum anoestrus is characterized by turnover of dominant follicles incapable of producing sufficient oestradiol to induce ovulation due to reduced LH pulse frequency. High nutrition can also increase metabolic clearance rate of steroid hormones such as progesterone or oestradiol. Lower concentrations of oestradiol on the day of oestrus are highly correlated with the occurrence of suboestrus, thereby making the detection of oestrus in high yielding cows even more difficult. Nutrition also affects conception rate (CR) to AI. Cows that develop hypocalcaemia, ketosis, acidosis or displaced abomasums have lower CRs and take longer to become pregnant. Excessive loss of BCS and excess protein content of the ration can reduce CR while supplemental fats that attenuate the production of F2α can improve CR. The increased metabolic clearance rate of progesterone (P4), which decreases blood concentrations during early embryo cleavage up to the blastocyst stage is associated with decreased CRs. In conclusion, poor nutritional management of the dairy cow, particularly before and after calving, is a key driver of infertility.

Endometritis After Cesarean: The Effect of Age

In this study, we compared the rate of endometritis after cesarean section in two age groups. The first group consisted of patients who were 17 years old or younger (teenage group) and the second group of patients were 35 years of age or older (advanced maternal age group). Patients in each group were matched for length of labor, length of rupture of membranes, and the use of prophylactic antibiotics. In the teenage group, 18 of 41 (43.9%) developed endometritis compared with 6 of 41 (14.6%) in the advanced maternal age group (P < 0.003). This study supports the concept that young age is a risk factor for endometritis after cesarean section.

Infection and labor: VII. Microbial invasion of the amniotic cavity in spontaneous rupture of membranes at term

The purpose of this study was to determine the frequency, microbiologic characteristics, and clinical significance of microbial invasion of the amniotic cavity in women with premature rupture of membranes at term. Amniocentesis was performed in 32 women with term premature rupture of membranes and amniotic fluid cultured for aerobic and anaerobic bacteria and Mycoplasmas. The prevalence of positive amniotic fluid cultures was 34.3% (11/32). The most common isolates were Ureaplasma urealyticum, Peptostreptococcus sp., Lactobacillus sp., Bacteroides fragilis, and Fusobacterium sp. Clinical chorioamnionitis occurred only in one patient with a positive amniotic fluid culture. Her neonate had ophthalmitis. Three patients (9.4%) had endometritis. Among women who were delivered vaginally, those with a positive amniotic fluid culture had a significantly higher rate of endometritis than those with a negative culture (33% [3/9] vs 0% [0/20], respectively, p = 0.023). These data indicate that microbial invasion of the amniotic cavity occurs in approximately one third of patients with preterm premature rupture of membranes. Microbial invasion of the amniotic cavity is a risk factor for endometritis in women with term premature rupture of membranes.

Risk factors for fever, endometritis and wound infection after abdominal delivery

Risk factors for postoperative fever, endometritis and wound infection were analyzed in 761 consecutive cesarean sections. Postoperative fever was observed in 12%, endometritis in 4.7% and wound infection in 3% of cases. The relative risk for postoperative fever was increased in cases with postoperative hematoma (relative risk = 16.0), in cases with blood loss over 500 g (relative risk = 1.8) and if the duration of labor exceeded 6 h (relative risk = 1.9). The only significant risk factors for endometritis were amnionitis (relative risk = 8.7), postoperative hematoma (relative risk = 5.0) and age under 24 years (relative risk = 3.0). Wound infections were less frequent in cases with previous cesarean sections (relative risk = 0.15) and after elective cesarean sections (relative risk = 0.22), but duration of operation over 1 h (relative risk = 2.8), induction of labor (relative risk = 3.2) and puerperal endometritis (relative risk = 7.9) increased the risk of wound infection. By elimination of amnionitis and postoperative hematomas the rate of endometritis would have diminished only from 4.7% to 3.8%, a percentage equally unacceptable; diagnostics and prevention should be directed to young patients undergoing caesarean section. Besides technical procedures prevention of endometritis is important for the prevention of wound infection. In hospitals with low postcesarean infectious morbidity antibiotic prophylaxis seems to be unwarranted.