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PubMed2006

Frequency and determinants of vaginal infection in postpartum period: a cross-sectional survey from low socioeconomic settlements, Karachi, Pakistan.

OBJECTIVE: To determine the frequency and factors associated with perceived vaginal infections among married women in their postpartum period. METHODS: A cross-sectional study was conducted from July 2000 to October 2000 in five squatter settlements of Karachi, Pakistan. These squatter settlements were selected on the basis of an existing surveillance system run by female community health workers for maternal and child healthcare which identified women who had delivered 42-56 days prior to the date of interview. Vaginal infection was considered present when a mother perceived foul smelling vaginal discharge during the postpartum period. Mothers were interviewed to gain insight into socioeconomic and demographic variables, materials used to staunch lochia, duration of labour, personal and perineal hygiene and past obstetric history. RESULTS: A total of 525 women were interviewed. The estimated prevalence of perceived vaginal infection was 5.1%. Factors associated with perceived vaginal infections included, delivery conducted by a non-medical personnel (AOR 3.5, CI 1.3-9.5) and use of unhygienic cloth or cotton for staunch of lochia (AOR 2.7, CI 1.1-6.2). CONCLUSION: Among women who reported perceived vaginal infection, a higher proportion were delivered by non-medical personnel, and used unhygienic material (cloth or cotton) for staunch of lochia as compared to women who did not perceive vaginal infection. We recommend deliveries to be conducted by trained personnel and provision of health education for persons who conduct delivery and women to use hygienic material for staunch of lochia during post partum period.

Adolescent↗
PubMedDate not supplied

[Perception of common symptomatology during pregnancy, puerperium and lactation].

The objective of this investigation was to identify women's perception on normal and abnormal symptoms of pregnancy, puerperium and breastfeeding; its purpose was to assess the varying educational needs in the geographical area where a reproductive health education program will be implemented. 405 fertile females living in non-residential areas were interviewed in their homes. A predominantly pre-coded questionnaire was used; items related to reproductive health, preventable and susceptible to education were included. Symptomatology perceived incorrectly as normal: a) In pregnancy: Dysuria: 24 percent, genital hemorrhage: 15 per cent, absence of fetal movement: 23 per cent, did not know how to recognize preterm birth symptoms: 70 per cent. b) In puerperium: Increased quantity in lochia rubra: 17 per cent, fever: 22 per cent, fetid lochia: 28 per cent, and c) In breastfeeding: Breasts red and warm: 48 per cent, fever: 30 per cent, nipple fissures: 70 per cent. Symptomatology perceived incorrectly as abnormal: a) In pregnancy: Frequent urination: 17 per cent, morning nausea in the 1st trimester: 9 per cent, emotional instability: 21 per cent, Braxton Hicks contractions: 41 per cent, and b) Postpartum period: Decreased quantity in lochia rubra: 9 per cent, non-fetid lochia alba: 43 per cent, calostrum: 20 per cent. The assessment educational needs showed an inaccurate identification of abnormal and normal obstetric events; its frequency varied. It is essential that a pregnant woman be well informed and educated in order to preserve her own health as well as that of her unborn child. She must be able to recognize warning signs, take action and demand appropriate medical care. Health care personnel and health educators must be responsible for the promoting of maternal and child health during pregnancy.

Adolescent↗
PubMed1991

Genetic analysis of reproductive disorders in Israeli Holstein dairy cows.

The heritability of common reproductive disorders was asessed in Israeli Holstein cows. Data were collected from 76,000 calvings on 102 collective farms (kibbuts) over a 36-mo period. The disorders considered were those of retained placenta, abnormal lochia, endometritis, anestrus, ovarian cysts with anestrus and ovarian cysts with nymphomania. The statistical model included fixed effects of herd-year, month of calving, duration of previous pregnancy, interaction between calving difficulty and sex of offspring, and the random effect of the sire. Herd-year effects consituted 0.68 of the explained variance of the incidence of retained placenta and approximately 0.89 of all the other disorders. Sire and calving-month effects were significant (P<0.05) for all the disorders. Heritability estimates of the disorders were 0.01 for retained placenta, abnormal lochia, and endometritis; 0.02 for anestrus; and 0.03 for all disorders. Correlations between any two disorders did not exceed 0.20. High genetic correlations were found between retained placenta and either abnormal lochia (0.90) or endometritis (0.70), while moderate genetic correlations were found among each of these and anestrus (0.30). Reproductive disorders occur as part of a complex which may be efficiently controlled by management measures. Nevertheless, breeding for resistance to reproductive disorders may also be feasible by using appropriate sires evaluated on a large number of daughters.

Journal Article↗
PubMed1998

Methylergometrine during the early puerperium; a prospective randomized double blind study.

BACKGROUND: The purpose of the study was to determine the efficacy of 72-hour prophylactic oral methylergometrine in reducing postpartum hemorrhage and endometritis during the early puerperium, and the effect of methylergometrine on lochia and requests for analgesics. MATERIAL AND METHODS: A prospective randomized double-blind study was undertaken; a total of 217 women received 0.2 mg methylergometrine intravenously after delivery of the placenta and randomized to either tabl. Methergin 0.125 mg or placebo three times a day for three days. The main measures were weight of sanitary towels, temperature, consumptions of analgesics and length of hospital stay. RESULTS: We found no significant difference in the median amount of lochia, the need for analgesics or length of hospital stay between the two groups. Incidence of infection and postpartum hemorrhage were low in both groups. CONCLUSION: We conclude that prophylactic use of methylergometrine during early puerperium has no effect on lochia. Endometritis and postpartum hemorrhage were rare in both groups. There was no increase in requests for analgesics among women given oral methylergometrine.

Administration, Oral↗
PubMed1980

[The role of anaerobic bacteria in the post-partum period: clinical significance and treatment (author's transl)].

Anaerobic bacteria in the lochia are frequently isolated healthy post-partum patients and from those with post-partum infections. The true pathogenic significance of these anaerobic bacteria is uncertain. Investigations appeared to show that the incidence of anaerobic bacteria is by and large the same as in the vaginal and intestinal flora. In this investigation we showed: 1) anaerobic bacteria are rare in the vaginal flora of pregnant patients in the third trimester, 2) a definite difference exists in the number of anaerobic bacteria in normal lochia versus infected lochia, 3) in post-partum infections qualitative differences exist between the anaerobic isolates. The strains of the bacteroides oralis group become the predominant anaerobic bacteria. It is concluded that members of the bacteroides oralis group which are normally not present in the human intestinal flora play a specific role in post-partum infections. The anti-microbial treatment of post-partum infections has to take this into account. The eminent therapeutic importance of the 5-Nitro-Imidazoles is discussed.

Anaerobiosis↗
PubMed1998

[The influence of immediate postpartum insertion of GyneFix PP-intrauterine devices on puerperal period].

OBJECTIVE: To investigate the effects of immediate postpartum insertion of GyneFix PP-intrauterine devices (IUD) on postpartum hemorrhage, bloody lochia and postpartum endometritis. METHODS: 126 women had GyneFix PP-IUD inserted immediately postpartum (IUD group) and another 118 cases with no IUD insertion were served as control. Blood loss during delivery, 2 and 24 hours after delivery were determined, the time of bloody lochial lasted and the incidence of postpartum endomeritis were recorded. RESULTS: There were no significant differences in the blood loss during and after delivery, and the incidence of endometritis between the 2 groups, but the bloody lochia was lasted significantly longer in the IUD group (P < 0.05). CONCLUSION: This results suggested that the immediate postpartum insertion of the GyneFix PP-IUD is a safe and good postpartum contraceptive method, and the cause of prolonging bloody lochia awaits for further study.

Adult↗
PubMedDate not supplied

[Corynebacteria isolated in colpitis and puerperal complications].

The role of microorganisms belonging to the genus Corynebacterium in normalization of vaginal biocenosis by creating acid medium is discussed. A total of 300 samples of lochia and vaginal and cervical secretion were examined, 140 of these taken from women without gynecological diseases and women with a normal course of the postpartum period (controls) and 160 from patients with colpitis of various origins and a complicated course of the puerperium. An appreciable increase of the level of diphtheroids was observed in the lochia of control subjects and in all samples of patients (p < 0.01). Eight species of Corynebacterium were isolated. Urease-negative C. minutissimum, C. equi, C. aquaticum, and C. xerosis predominated in both controls and patients (p < 0.01). Opportunistic C. bovis, C. enzymicum, C. kutshevi, and C. sp. possessing urease activity were seldom isolated. No differences between the 2 groups in the species composition of the isolated bacteria were detected (p > 0.05). Two species of Corynebacterium were sometimes isolated from the same sample, this being more frequently with vaginal and cervical secretion samples than with lochia both in controls and patients (p < 0.01). The most incident association was C. aquaticum and C. equi. 59.6 +/- 2.7 isolated strains proved to be sensitive to antibiotics manufactured in this country.

Adult↗
PubMed2006

Analysis of free hemoglobin level and hemoglobin peptides from human puerperal uterine secretions.

OBJECTIVE: Hemocidins are a novel class of antibacterial peptides generated proteolytically from hemoglobin. These peptides play a particularly important role in maintaining vaginal homeostasis during menstrual bleeding. To investigate the hemoglobin fragmentation process during the last stages of pregnancy, we examined uterine secretion (lochia) samples from a group of 22 healthy women who underwent cesarean delivery at term. METHODS: Patients were divided into three groups: (1) the elective cesarean deliveries without symptoms of spontaneous labor, (2) the nonelective cesarean deliveries with spontaneous beginning of labor, and (3) the nonelective cesarean deliveries during advanced labor. The samples were subjected to chromatographic estimation of free hemoglobin and peptides. In three representative patients the identification of all lochial peptides was performed. RESULTS: All samples contained a significant amount of free hemoglobin and its level increased with labor progression. The presence of peptide fractions was also detected in most lochia samples. They were confirmed to be human hemoglobin fragments, almost identical to the recently described bactericidal hemocidins from menstrual discharge. The level of peptides also increased during labor. The subgroup with advanced labor demonstrated the highest amount of hemocidins. CONCLUSIONS: The presented results prove that proteolysis of free hemoglobin in the female upper reproductive tract begins together with the clinical symptoms of normal labor. We speculate that cesarean delivery affects molecular mechanisms involved in antibacterial hemocidins generation and, in effect, might be responsible for the increased risk of gynecologic infections in cesarean deliveries.

Anti-Bacterial Agents↗
PubMed1999

A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study).

OBJECTIVE: To describe the range of normal vaginal loss as reported by women from 24 hours after delivery until three months postnatally. SETTING: Two health districts in the south of England. METHODS: A prospective survey of women's experiences and expectations of the duration, amount and colour of vaginal loss after childbirth. The term vaginal loss includes all types of fluid loss from the vagina following childbirth. FINDINGS: Five hundred and twenty-four women were recruited to the survey in 1995. Vaginal loss, as reported by the women, was considerably more varied in duration, amount and colour than descriptions in current midwifery textbooks. The median number of days reported for the duration of vaginal loss was 21 days and the interdecile range (10th to 90th percentile) was 10-42 days. For colour of lochia, women overall reported their vaginal loss to be more predominantly red/brown in colour and the traditional descriptions of the timing and colour phases of lochia rubra, serosa and alba are not supported by the majority of the women's experiences. Primiparous women were significantly more likely to report feelings of surprise or shock about their experiences of vaginal blood loss after the birth (odds ratio 4 [95% Confidence Interval 2-9]). Seven primiparous women (2%) were unaware that they would have a blood loss at all after the birth. IMPLICATIONS FOR PRACTICE: The findings from this survey have been used to develop information leaflets for women and health professionals about vaginal loss following childbirth. These leaflets include descriptions of normal ranges for the colour, amount and duration of vaginal loss in the first three months after childbirth.

Adolescent↗
PubMed2004

[Influence of interventional radiotherapy for severe postpartum hemorrhage on postpartum menorrhea].

OBJECTIVE: To discuss the influence of interventional radiotherapy for treating severe postpartum hemorrhage on postpartum menorrhea. METHODS: From Mar. 1995 to Feb. 2002, 18 cases of severe postpartum hemorrhage treated with arterial embolization served as the interventional group. Twenty parturients without postpartum complication were recruited as control group. The continuance of lochia, recovery of menorrhea between the two groups were compared. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) of the non-lactating women in the two groups were assayed during the 3rd-5th days of the first menstrual cycle. RESULTS: Continuance times of lochia were (33.9 +/- 2.0) days, and (36.2 +/- 3.1) days in interventional group and control group, respectively. Recovery times of menorrhea were (75 +/- 17) days, and (95 +/- 16) days in interventional group and control group. The quantity of the postpartum menorrhea was 1.3 +/- 0.1 times of that before delivery in interventional group, 1.3 +/- 0.2 times of that in control group. The number of menstrual cycle before recovery to normal menorrhea was 2 cycles in interventional group, 1.9 cycles in control group. Postpartum menstrual cycle was (33.9 +/- 2.2) days in interventional group, (33.2 +/- 1.6) days in control group. Serum FSH, LH, E(2) of the non-lactating women during the 3rd approximately 5th days of the first menstrual cycle were (5.2 +/- 1.1) U/L, (7.5 +/- 1.6) U/L, (262 +/- 14) pmol/L in interventional group, (4.3 +/- 2.1) U/L, (6.3 +/- 1.3) U/L, (280 +/- 12) pmol/L in control group. There was no significant difference between the two groups (P > 0.05). CONCLUSIONS: No obvious influence of interventional radiotherapy for postpartum hemorrhage on postpartum menorrhea was observed.

Adult↗
PubMed2005

[Psychiatric disorders and psychopathologic manifestations associated with pregnancy and postpartum in Cameroon].

This retrospective study was conducted from Januaty 1, 2002 to May 31, 2004 to ascertain the sociodejnographlc profile of women phychiatric disorders and psychopathologic manifestations during puerperiuni and determine the most common clinical entities at the Jamot Hospital in Yaounde, Cameroon. Study included 40 paturient women who presented psychiatric disorders related to pregnancy, postpartum, abortion, or breastfeeding. Most patients (80%) were less than 34 years of age including 50% under 20 years. Psychiatric disorders were often observed in married women (62.5%) but one of three women (30%) in this study was single. Most of these women (85%) had no income. Primagravid women accounted for 35% of the cohort. Manifestations generally began after delivery (80%) but sometimes appeared during pregnancy (12.5%). A particularly noteworthy finding of this study is the high rate of late postpartum or breastfeeding psychosis. In 40% of cases symptoms appeared between 1 and 6 months after delivery. Acute psychosis was by far the most frequent disorder (77.5%) followed by depression (15%) and manic fits (7.5%). With regard to symbolic representations and social implications, we concur with the Bell people in considering that these manifestations are related to anemia resulting from massive blood loss after delivery. This occurs during the traditional hot water massages performed to eliminate lochia (blood and debris). This sudden blood loss is called "esere meld" in the Ewondo language. In contrast it is considered as lochia retention due to the lack of massage by the Bassa people who use the term "ndjeg gwal" or delivery madness.

Adolescent↗
PubMed1991

[The clinico-pathogenetic significance of general and local defense and injury factors in endometritis after cesarean section].

Analysis of phagocytosis parameters in uterine lochia and measurements of polyvalent proteinase inhibitor and alkaline phosphatase activities, as well as of lipid peroxidation parameters in uterine lochia are recommended for the early diagnosis of endometritis following a cesarean section. Local changes in the defense and injurious factors forerun the development of an inflammation in the uterine cavity whereas systemic changes develop after the manifestation of clinical symptoms of endometritis. The findings indicate that development of endometritis following an abdominal delivery may be prevented by routine therapy supplemented by thymalin and intrauterine metronidazole. Therapy of endometritis developing after cesarean section should include immunomodulators, chosen individually, and administered in combination with intrauterine contrycal.

Adjuvants, Immunologic↗
PubMed1990

[Isolation of Listeria ivanovii in Slovakia].

From October 1977 to May 15, 1989 in Slovakia 39 strongly haemolytic strains of L. ivanovii were isolated from a woman after delivery of a stillborn foetus--from the lochiae, placenta and rectal smear, from five symptom-free subjects from the faeces, from the rectal smears of two sheep, from the intestinal contents in the portion of the terminal ileus from 28 free living small terrestrial mammals, one strain from meat--beef steak, from the lungs, liver and kidneys of a dead young sheep and one strain from silage. The strains from the lochiae and placenta as well as those from the organs of sheep were detected already as primocultures on commonly used blood agar, the other strains after varying periods of cold enrichment and subsequent inoculation on a solid selective medium with nalidixic acid and acriflavin. All strains had typical biochemical properties, among which from the diagnostic aspect in particular the catalase formation and acid formation from d-xylose is important, as well as the negative reaction with mannitol, rhamnose and alpha-methyl-d-mannoside. All strains agglutinated in O-factor serum X and gave a typical shovel-like shape CAMP test with Rhodococcus equi. The frequent incidence of L. ivanovii in micromammals indicates their importance as reservoir animals for this species of microorganism. The latter were detected on the territory of all three Slovak regions and in the capital of Slovakia, Bratislava.

Animals↗
PubMed1980

Behavior of venous thrombi: historical observations.

Charles White in 1784 first demonstrated that milk leg was not caused by retained milk or lochia but rather by obstructing clots in the veins. In 1847, Virchow observed that venous thrombi often migrated to the lungs. Workers since then have found that, in general, thrombi in veins and in pulmonary arteries tend to form large recanalizing channels, accompanied by the destruction of any valves that are present, but that those in arteries form only small "arteries of organization." On the other hand, observers have reported capricious instances of opposite behavior. Furthermore, fresh thrombi and emboli in both systems occasionally disappear in the early period after formation or lodgement. It is urged that we use the full potential of modern diagnostic and monitoring methods to procure more data on the details of intravascular clot behavior.

Animals↗
PubMed1988

BHV4 (bovine herpes virus 4) related disorders in Belgian cattle: a study of two problem herds.

Two cattle farms, with a ten year history of BHV4 related postpartum metritis accompanied by fertility problems, were monitored during the winter season 1985-1986. BHV4 was isolated from the lochia from 55% of the animals on farm A and 66% of those on farm B. Respectively 59% and 30% of the animals presented postpartum metritis. In some animals virus multiplication was followed by severe leucopenia lasting several weeks. Indirect immunofluorescence (IIF) BHV4 seropositive as well as IIF seronegative animals were affected. The latter responded with a rapid or late IIF antibody reaction. No BHV4 seroneutralizing antibodies could be detected. The authors also suggest a possible role of BHV4 in the respiratory problems observed during the study.

Animals↗
PubMed1997

Peri-operative multimodal pain therapy for caesarean section: analgesia and fitness for discharge.

PURPOSE: To compare, the efficacy of a multi-modal analgesic regimen and single drug therapy with iv PCA morphine alter Caesarean delivery with spinal anaesthesia. METHODS: Forty ASA 1-2 parturients presenting for elective Caesarean section were randomized to receive multimodal pain treatment with intrathecal morphine, incisional bupivacaine and ibuprofen+acetaminophen po until hospital discharge (Group 1) or conventional therapy with iv PCA morphine weaned to acetaminophen+codeine po (Group 2). Both groups received spinal anaesthesia with 1.7 ml hyperbaric bupivacaine 0.75%. Visual analog pain scores at rest (RVAPS) and with movement (DVAPS) were recorded q 2 hr during the first 24 hr, then q 4 hr until discharge. Time to first walking, eating solid food, flatus, bowel movement, voiding and hospital discharge were recorded. RESULTS: Pain scores were lower in Group 1 patients during the first 24 hr after spinal injection RVAPS 0.6 +/- 0.1 in Group 1 vs 2.1 +/- 0.1 in Group 2 (mean +/- SEM), DVAPS 1.9 +/- 0.1 in Group 1 vs 4.1 +/- 0.1 in Group 2 (P < 0.0001). Times to first flatus, 36.1 hr +/- 2.9 vs 20.5 +/- 1.8 (P < 0.05) and to first bowel movement, 74.8 hr +/- 5.6 vs 57.4 +/- 4.7 (P < 0.0001) were longer in Group 2 patients. There was no difference between groups in time to eating solid food, walking or hospital discharge. CONCLUSION: Multi-modal pain therapy resulted in improved early post-operative analgesia during the first 24 hr after Caesarean delivery. Patients receiving iv PCA morphine followed by acetaminophen+codeine po were more likely to develop decreased bowel mobility. All patients, with one exception, achieved discharge criteria (eating solid food, absence of nausea, normal lochia, dry incision and DVAPS < 4) at 48 hr after spinal injection.

Analgesia, Obstetrical↗
PubMed1982

Puerperal and perinatal infections with group B streptococci.

Twenty-one patients were seen with puerperal sepsis owing to group B streptococci (GBS), resulting in an attack rate of 2/1,000 deliveries. Most were young primiparous black women from a population with a known high incidence of GBS carriage. The association among abdominal delivery, endometritis, and puerperal sepsis was striking. Cultures of the birth canal or lochia were commonly positive for the same serotype recovered from the blood. Forty-seven patients with nonbacteremic GBS infections were seen; 27 had endometritis or amnionitis. Twenty patients had GBS urinary tract infection: Eight infections occurred prenatally, seven at delivery, and five post partum. Seven neonates developed serious GBS infections; intrauterine exposure occurred in at least four cases. Fetal exposure to GBS also occurred in three of four cases in which parturients with GBS bacteremia were delivered of their infants by cesarean section. Because of the high incidence of puerperal and perinatal GBS infections in this population, antibiotic prophylaxis regimens may be beneficial.

Adolescent↗
PubMed1988

Analysis of fertility indices of cows with extended postpartum anestrus and other reproductive disorders compared to normal cows.

An analysis of computerized data on the incidence and consequences of reproductive disorders was performed on 84,818 lactations in more than 100 high producing Kibbutz dairy herds during six semiannual recording periods. The average incidence of primary reproductive disorders, which included retained placenta, abnormal lochia, endometritis, postpartum anestrus, cystic ovaries, negative pregnancy examinations and repeat breeders, was 50.4%. During all recording periods we were able to observe recurrence and repeatability of these reproductive disorders and of the fertility indices consequently seen. Cows with uterine infections diagnosed and treated before Day 20 post partum had better fertility indices than those diagnosed and treated later. The conception rate to first inseminations and the overall conception rate to all inseminations of cows with postpartum anestrus was significantly lower, while the percentage of "problem cows" (not pregnant by Day 150 post partum) was significantly higher, than in normal cows. The incidence of cystic ovaries in cows with a previous diagnosis of reproductive disorders was 2 to 3 times higher when compared to cows without such a diagnosis.

Journal Article↗