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treatment sepsis obstetric

Sheryl E Parfitt, Mary L Bogat, Cheryl Roth
Sepsis during pregnancy is one of the five leading causes of maternal mortality worldwide. Early recognition and prompt treatment of maternal sepsis is necessary to improve patient outcomes. Patient education on practices that reduce infections may be helpful in decreasing rates of sepsis. Education of nurses about early signs and symptoms of sepsis in pregnancy and use of obstetric-specific tools can assist in timely identification and better outcomes. Although the Surviving Sepsis Campaign (SSC) criteria for diagnosis of sepsis in the general population are not pertinent for obstetric patients, their treatment bundles (guidelines) are applicable and can be used to guide care of obstetric patients who develop sepsis...
April 10, 2017: MCN. the American Journal of Maternal Child Nursing
Mahesh Eswarappa, Madhyastha Rakesh, Puri Sonika, K Snigdha, M Midhun, K Kaushik, Gurudev Konana Chennabasappa, Bande Sujeeth
Pregnancy-induced hypertension (PIH) is a known complication of late pregnancy and is an important cause of maternal and fetal morbidity and mortality. Data on clinical profile, especially renal profile of preeclampsia and eclampsia in Indian women are lacking. The aim of our study was to examine the renal profile and clinical outcomes of patients diagnosed with PIH in our institution with a focus on the spectrum of acute kidney injury (AKI). In this prospective, observational study, 347 patients with a diagnosis of preeclampsia-eclampsia, who were undergoing treatment at the M...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
Makiko Shinomoto, Tatsuya Kawasaki, Takuya Sugahara, Keiko Nakata, Tomoya Kotani, Hidetaka Yoshitake, Kento Yuasa, Masashi Saeki, Yasuhiro Fujiwara
Human parechovirus type 3 (HPeV3) can cause serious conditions in neonates, such as sepsis and encephalitis, but data for adults are lacking. The case of a pregnant woman with HPeV3 infection is reported herein. A 28-year-old woman at 36 weeks of pregnancy was admitted because of myalgia and muscle weakness. Her grip strength was 6.0kg for her right hand and 2.5kg for her left hand. The patient's symptoms, probably due to fasciitis and not myositis, improved gradually with conservative treatment, however labor pains with genital bleeding developed unexpectedly 3 days after admission...
March 24, 2017: International Journal of Infectious Diseases: IJID
Sheryl E Parfitt, Mary L Bogat, Sandra L Hering, Charlotte Ottley, Cheryl Roth
Morbidity and mortality associated with sepsis has gained widespread attention on a local, state, and national level, yet, it remains a complicated disorder that can be difficult to identify in a timely manner. Sepsis in obstetric patients further complicates the diagnosis as alterations in physiology related to pregnancy can mask sepsis indicators normally seen in the general population. If early signs of sepsis go unrecognized, septic shock can develop, leading to organ dysfunction and potential death. Maternal early warning tools have been designed to assist clinicians in recognizing early indications of illness...
March 15, 2017: MCN. the American Journal of Maternal Child Nursing
Hannah M Sebitloane, Dhayendre Moodley
HIV is the leading cause of maternal and neonatal morbidity and mortality in resource constrained countries. Highly active antiretroviral treatment (HAART) initiated in pregnancy has now almost eliminated mother to child transmission of the virus, and is beginning to show the desired effect of reducing HIV related maternal mortality. By modulating host immunological responses HAART has the potential to alter infections during pregnancy, in addition to modifying clinical conditions such as preeclampsia. There is increasing evidence of the benefits of HAART given to pregnant women, however there is paucity of data that distinguishes HIV or HAART as the cause or exacerbation of pre-existing medical conditions or conditions specific to pregnancy...
March 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Z Kokrdová, A Pařízek, M Koucký, A Pašková, B Boudová
OBJECTIVE: According to the World Health Organisation, sepsis is one of the four main causes of pregnancy-related mortality worldwide, together with hemorrhage, hypertensive disease and abortion. The main goal of this paper is an analysis of one case of septic shock in pregnancy. DESIGN: A case report. SETTING: Department of Obstetrics and Gynaecology of the First Faculty of Medicine and General Teaching Hospital, Prague. METHODS AND RESULTS: Authors would like to draw attention to the pitfalls of diagnosis and treatment of septic shock which developed in 25th week of pregnancy on the basis of pyelonephritis due to E...
2016: Ceská Gynekologie
T Schmitz
OBJECTIVE: To evaluate short- and long-term benefits and risks associated with antenatal administration of a single course of corticosteroids and the related strategies: multiple and rescue courses. METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death (LE1), and in possibly childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival (LE3)...
December 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Elio Castagnola, Livia Gargiullo, Salvatore Renna, Anna Loy, Francesco Risso, Andrea Moscatelli, Ivana Baldelli, Giuliana Cangemi, Roberto Bandettini
Background Colonization/infection by antibiotic-resistant bacteria is becoming a major threat to health care systems. Case report Two septic neonates were readmitted in our hospital few days after hospital discharge. In both of them, microbiological workup revealed an infection caused by multiresistant pathogens. Noteworthy, one baby had received intensive care management for 4 weeks, whereas the other had been vaginally delivered and sent home on his second day of life. Conclusion These cases suggest that in countries and/or hospital with high prevalence of colonization/infection by resistant pathogens in nurseries, neonatal intensive care units, and obstetric wards, the choice of initial therapy of suspected sepsis in a neonate readmitted from home soon after discharge should take into account the possibility of an infection due to a multiresistant pathogen...
September 2016: American Journal of Perinatology
Smruti B Vaishnav, Bhalendu Vaishnav, Kailas N Desai, Nitin S Raithatha, Neeta S Bose
BACKGROUND: There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. METHODS: We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality...
March 2016: National Medical Journal of India
Habib Md Reazaul Karim, Prithwis Bhattacharyya, Sonai Datta Kakati, Tridip Jyoti Borah, Md Yunus
Scrub typhus and malaria can involve multiple organ systems and are notoriously known for varied presentations. However, clinical malaria or scrub typhus is unusual without fever. On the other hand, altered sensorium with or without fever, dehydration, hemorrhage and hemolysis may lead to low blood pressure. Presence of toxic granules and elevated band forms in such patients can even mimic sepsis. When such a patient is in the peripartum period, it creates a strong clinical dilemma for the physician especially in unbooked obstetric cases...
2016: Qatar Medical Journal
Claire Grace Scrivener, Robert Gornall, Philip Rolland
A 34-year-old nullipara, wishing to start a family, presented to colposcopy clinic. Her most recent cervical cytology result showed high-grade dyskaryosis. Having undergone four large loop excisions of the transformation zone during the past 6 years, this woman had no remaining vaginal cervix. In order to excise presumed high-grade cervical intraepithelial neoplasia while mitigating obstetric risk, she underwent a simple vaginal trachelectomy and isthmic cerclage. 6 months later, the patient had a negative test of cure...
June 28, 2016: BMJ Case Reports
Hadas Ganer Herman, Hadas Miremberg, Ann Dekalo, Giulia Barda, Jacob Bar, Michal Kovo
OBJECTIVES: Patients with pregnancies complicated with premature uterine contractions (PMC), but delivered at term are considered as false preterm labor (PTL), and represent a common obstetric complication. We aimed to assess obstetric and neonatal outcomes of pregnancies complicated with PMC, but delivered at term, as compared to term normal pregnancies. STUDY DESIGN: Obstetric, maternal and neonatal outcomes of singleton pregnancies complicated with PMC between 24-33(6)/7 weeks (PMC group), necessitating hospitalization and treatment with tocolytics and/or steroids, during 2009-2014, were reviewed...
April 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Charles Osalumese Imarengiaye, Theodore Ojeide Isesele
INTRODUCTION: The burden of hypertensive diseases on the health care is enormous given to the high population in Sub-Saharan Africa and related disproportionate representation in global maternal mortality. MATERIALS AND METHODS: All women with hypertensive diseases of pregnancy who got admitted into the general ICU of the University of Benin Teaching Hospital between January 2006 and December 2010 were studied. Only the records of women who completed 28 weeks of gestation and were admitted during labour and delivery or puerperium to the ICU were examined...
September 2015: Nigerian Medical Journal: Journal of the Nigeria Medical Association
Jerrold H Levy, Roman M Sniecinski, Ian J Welsby, Marcel Levi
Many humoral and cellular components participate in bidirectional communication between the coagulation and inflammation pathways. Natural anticoagulant proteins, including antithrombin (AT), tissue factor pathway inhibitor, and protein C, suppress proinflammatory mediators. Conversely, inflammation blunts anticoagulant activity and, when uncontrolled, promotes systemic inflammation-induced coagulation, such as those that occur in disseminated intravascular coagulation and severe sepsis. This review discusses the mechanisms of action and clinical use of AT concentrate in critically ill patients and in the settings of perioperative anticoagulation management for surgery and obstetrics...
April 2016: Thrombosis and Haemostasis
Ezinne C Chibueze, Alexander J Q Parsons, Erika Ota, Toshiyuki Swa, Olufemi T Oladapo, Rintaro Mori
BACKGROUND: Manual removal of the placenta is an invasive obstetric procedure commonly used for the management of retained placenta. However, it is unclear whether antibiotic prophylaxis is beneficial in preventing infectious morbidity. We conducted a systematic review to determine the efficacy and safety of routine use of antibiotics for preventing adverse maternal outcomes related to manual placenta removal following vaginal birth. METHODS: A detailed search of MEDLINE, EMBASE, Cochrane library and the CINAHL databases was conducted for non-randomized studies involving women undergoing manual placenta delivery after vaginal births and where antibiotic prophylaxis use was compared with no treatment or placebo to prevent maternal infection...
November 26, 2015: BMC Pregnancy and Childbirth
Andreas du Bois, Gunnar Kristensen, Isabelle Ray-Coquard, Alexander Reuss, Sandro Pignata, Nicoletta Colombo, Ursula Denison, Ignace Vergote, Jose M Del Campo, Petronella Ottevanger, Martin Heubner, Thomas Minarik, Emmanuel Sevin, Nikolaus de Gregorio, Mariusz Bidziński, Jacobus Pfisterer, Susanne Malander, Felix Hilpert, Mansoor R Mirza, Giovanni Scambia, Werner Meier, Maria O Nicoletto, Line Bjørge, Alain Lortholary, Martin Oliver Sailer, Michael Merger, Philipp Harter
BACKGROUND: Angiogenesis is a target in the treatment of ovarian cancer. Nintedanib, an oral triple angiokinase inhibitor of VEGF receptor, platelet-derived growth factor receptor, and fibroblast growth factor receptor, has shown activity in phase 2 trials in this setting. We investigated the combination of nintedanib with standard carboplatin and paclitaxel chemotherapy in patients with newly diagnosed advanced ovarian cancer. METHODS: In this double-blind phase 3 trial, chemotherapy-naive patients (aged 18 years or older) with International Federation of Gynecology and Obstetrics (FIGO) IIB-IV ovarian cancer and upfront debulking surgery were stratified by postoperative resection status, FIGO stage, and planned carboplatin dose...
January 2016: Lancet Oncology
Patricia E Bailey, Emily Keyes, Allisyn C Moran, Kavita Singh, Leonardo Chavane, Baltazar Chilundo
BACKGROUND: The paper's primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection. METHODS: Two national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes...
2015: BMC Pregnancy and Childbirth
Ragini Kulkarni, Sanjay Chauhan, Rekha Daver, Yogeshwar Nandanwar, Anushree Patil, Archana Bhosale
OBJECTIVE: To review the incidence and patterns of near-miss obstetric events (defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy"), as well as studying the classification criteria for near-miss events. METHODS: A prospective observational study was conducted in two tertiary hospitals in Mumbai. Women with near-miss obstetric events were interviewed during the period September 2012-August 2013...
February 2016: International Journal of Gynaecology and Obstetrics
Masato Yoshihara, Kaname Uno, Sho Tano, Michinori Mayama, Mayu Ukai, Shinya Kondo, Tetsuya Kokabu, Yasuyuki Kishigami, Hidenori Oguchi
INTRODUCTION: Recombinant human soluble thrombomodulin (rhTM) is a novel anti-coagulant agent that regulates the imbalanced coagulation system by reducing the excessive activation of thrombin. rhTM potentially reduces the morbidity and mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC). However, the efficacy of rhTM in obstetric DIC has not yet been established. We performed this study to examine whether the administration of rhTM was a potentially effective treatment for DIC induced by one or more underlying obstetric disorders...
2015: Critical Care: the Official Journal of the Critical Care Forum
F Gary Cunningham, David B Nelson
Disseminated intravascular coagulation (DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of maternal deaths. The etiopathogenesis of DIC is complex and currently thought to be initiated by tissue factor or thromboplastin, which is released from trophoblastic or fetal tissue, or maternal decidua or endothelium. Tissue factor activates the coagulation sequence to cause fibrin clotting and its dissolution by the fibrinolysin system...
November 2015: Obstetrics and Gynecology
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