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PubMed1991

Maternal deaths at Songea Regional Hospital, southern Tanzania.

During the years 1986 and 1987 there were a total of 7523 deliveries at the Songea Regional Hospital, Southern Tanzania. There were 39 maternal deaths giving a Maternal Mortality Rate of 5.2/1000 deliveries. The major causes of deaths were sepsis following Caesarean section for obstructed labour, ruptured uterus and haemorrhage. 43.6% of the deaths were of women referred from long distances with a diagnosis of prolonged labour. It is stressed that early and facilitated referral, together with the use of the partogram in labour and use of family planning services will reduce the high maternal mortality rate in this region.

Adult↗
PubMed1979

[Regeneration of the Fallopian tubes following sterilization (author's transl)].

After any trauma to the fallopian tubes by a sterilizing operation, pregnancy occurs. If the sterilizing procedure was by high frequency current coagulation, large areas of the fallopian tube must be destroyed down into the mesosalpinx in order to avoid the preprogrammed recanalization tendency of the muellerian duct. Fertilization has occurred in recanalized fallopian tubes which only showed a cubic epithelium. Extensive destruction of the fallopian tube is today not justifiable because of the possibility of interference with the ovarian blood supply and subsequent hormonal damage. At present the safest method of female sterilization is by tissue coagulation of segment of the fallopian tube at 100 centigrade and division of the coagulated portion. In 1000 cases there were no pregnancies.

Electrocoagulation↗
PubMed1984

An epidemiologic study of postcesarean infection.

Cesarean section (CS) is associated with increased postpartum infectious morbidity, predominantly endometritis. In this prospective cohort study, endometritis was found in 28% of 229 patients who underwent consecutive CS from September 1979 to May 1980 at a university hospital. When the occurrence of bacteremia and wound infection was considered, the study found 31% of the patients were infected. Among the 20 potential epidemiologic and operative risk factors for infection that were studied, the most important were primary CS, membrane rupture, labor, and meconium staining (p = 0.0001). Failure to progress, breech presentation, and fetal distress were also significantly associated with infection (p = 0.001). Another factor correlated to the rate of infection was attendance by physician in training (p = 0.002). Discriminant function analysis was used to develop an equation that correctly classified, as infected or noninfected, 76% of a sample of CS patients (p = 0.004). This sample was not part of the original sample from which the discriminant function equation was developed. Finally toward the end of the study period, we observed a decrease in the infection rate among patients of house staff physicians. This decrease has resulted in similar infection rates for patients of attending physicians and patients of house staff physicians, which have continued to the present.

Bacterial Infections↗
PubMed1998

Bupivacaine 0.01% and/or epinephrine 0.5 microg/ml improve epidural fentanyl analgesia after cesarean section.

BACKGROUND: The authors studied the addition of bupivacaine and epinephrine, separately and together, to epidural fentanyl to determine whether this improved postcesarean analgesia and reduced the incidence of side effects. METHODS: After elective cesarean section, 100 parturient patients who received fentanyl (3 microg/ml) epidurally for 48 h were allocated randomly in a double-blinded manner to four groups to receive, in addition to the study solution, 0.01% bupivacaine, 0.5 microg/ml epinephrine, both, or neither. A neurologic assessment of breast-fed neonates was made at 2 and 48 h of life. Plasma fentanyl concentrations were determined in a subset of patients at intervals after treatment. RESULTS: Patients receiving fentanyl alone made more attempts at patient-controlled analgesia (P < 0.01), required a greater total dose of fentanyl (P < 0.01), reported more pain (P < 0.003) and less satisfaction (P < 0.003), and had more nausea and urinary retention (P < 0.05) than all other groups. Patients who received bupivacaine with or without epinephrine had better overall satisfaction scores than those who did not receive bupivacaine (P < 0.001), and they required less fentanyl (P < 0.02) than patients who received fentanyl with only epinephrine. Motor blockade or orthostatic hypotension did not develop in any patient, and all patients could ambulate without difficulty. Neurobehavioral scores, which were similar among all neonates, were within the normal range. Plasma concentrations of fentanyl increased after epinephrine-containing solutions were discontinued. CONCLUSIONS: During the conditions of this study, the addition of epinephrine and bupivacaine to a 3-microg/ml epidural fentanyl solution for postcesarean section pain relief provided superior analgesia compared with fentanyl alone or fentanyl with epinephrine. Whether increasing the concentration of fentanyl alone might improve the efficacy of fentanyl remains unclear.

Adult↗
PubMed1986

Significance of endometrial cultures performed at cesarean section.

To determine the bacterial pathogenesis of postcesarean endomyometritis, swab endometrial cultures of the lower uterine segment were taken intraoperatively in 160 cases. Both aerobic and anaerobic cultures were obtained. Of all patients, 16.8% developed endomyometritis. There was a statistically significant relationship between positive cultures and the development of endomyometritis. The organisms isolated were those commonly found in other types of pelvic infection: pathogenic aerobes and anaerobes as well as commensals. An average of 1.3 organisms were recovered per patient with positive cultures. An analysis is provided for findings depending on the status of membranes and the influence of labor. The following risk factors were identified for the development of endomyometritis: primary cesarean section, labor, ruptured membranes, and postoperative hematocrit. Implications of these findings and a review of similar studies is provided.

Bacterial Infections↗
PubMed1989

[Risk of developing peritonitis after cesarean section].

A retrospective study of 36 patients with postcesarean peritonitis has identified risk factors contributing to this complication, with urogenital inflammations in the past or during the current pregnancy, and an unreplaced gross blood loss as the major ones.

Adolescent↗
PubMed1989

[Various characteristics of the course of pregnancy and its outcome in women with a history of cesarean section].

An analysis of the course of pregnancy in 95 postcesarean patients, with ultrasonic scanning, antenatal cardiotocography and placental scintigraphy conducted in 65 of those, demonstrated a number of regularities of clinical significance. Anterior-wall attachment of the placenta, incompetent uterine scar, induced abortions between the first and the next cesarean sections are shown to be high risk factors with respect to perinatal morbidity and mortality. It is suggested that intrauterine fetal distress may be caused by uteroplacental circulation disturbance due to anatomical changes in the anterior uterine wall.

Adult↗
PubMedDate not supplied

Antibiotic therapy for postcesarean endomyometritis.

Puerperal uterine infection, or endomyometritis, occurs more commonly after cesarean section than after vaginal birth. With the rate of cesarean delivery almost 25% of all births in this country, such infection is relatively common. The classic therapy for postcesarean endomyometritis is the combination of clindamycin and an aminoglycoside, usually gentamicin or tobramycin. This regimen has requisite antimicrobial activity against the aerobes and anaerobes of the cervicovaginal flora that usually cause this illness. In the last decade, however, the availability of broad-spectrum beta-lactam antibiotics has enabled the clinician to combat postcesarean infection with single-agent antimicrobial chemotherapy, or monotherapy. "Higher-generation" cephalosporins such as cefoxitin, cefotetan, and moxalactam, as well as the semisynthetic penicillins ticarcillin, piperacillin, and mezlocillin, have all been used alone in the therapy for postpartum infection. The addition of a beta-lactamase inhibitor to this class of drugs now offers a further resource to the practitioner if beta-lactamase-mediated antibiotic resistance arises in the patient population being treated.

Anti-Bacterial Agents↗
PubMed1986

Effect of anesthesia for primary cesarean section on postoperative infectious morbidity.

It has been stated that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 252 women who had undergone primary cesarean section at the University of Iowa Hospital was conducted. Regional anesthesia was successfully administered to 170 patients, and general anesthesia was administered to 82 patients. Patients receiving general anesthesia were more likely to be indigent, to receive a vertical skin incision, and to be transfused intraoperatively and/or postoperatively. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, did not increase the risk of infectious morbidity after primary cesarean section. However, our surgeons apparently were influenced by the choice of anesthetic technique when selecting a skin incision.

Anesthesia, Conduction↗
PubMed2006

[Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period].

OBJECTIVE: To evaluate safety and effectiveness of the intrauterine device Multiload Cu375 compared with the TCu 380A inserted in the postpartum period. PATIENTS AND METHODS: In a randomized comparative study carried out in the National Perinatology Institute, intrauterine devices MLCu 375 and Tcu 380A were inserted to 157 patients who voluntary accepted, and previously signed informed consent. There were four instances for the intrauterine devices insertion: within 10 minutes after vaginal delivery, during cesarean section (immediate postplacental insertion) and postpartum-postcesarean insertion (in the time range of 10 min to 48 h). All insertions were made with ring forceps. From 1 h to 24 h later, abdominal ultrasound examinations were performed to assess the distances between the upper part of the device to the fundus of uterine cavity. Follow up visits were scheduled at 3, 6, 9 and 12 months. Net cumulative life table event rates of discontinuations were estimated at one year. RESULTS: The expulsion rates were 10.4 for the MLCu 375 and 7.7 for the TCu 380A and they were not influenced by the moment of the intrauterine device insertion, not by the cervical dilatation, neither by the distance of the intrauterine device to the fundus of uterine cavity. The removal rates for bleeding and pain were 4.9 and 4.8, the removal rates for non medical reasons were 3.7 and 4.9 respectively. There was one case of genital infection in the MLCu 375 group. There were no pregnancies, nor uterine perforation. The one year continuation rates were 77.1 and 82.6 respectively. There were no statistical significant differences in the comparative rates. CONCLUSIONS: The intrauterine device MLCu 375 is as safe and effective as the TCu380A when they are inserted in the postpartum period.

Adult↗
PubMed1995

Comparison of case-finding methodologies for endometritis after cesarean section.

BACKGROUND: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity. However, traditional case-finding methods for endometritis may not identify most cases. We compared various case-finding methods with a reference method to determine a simple and accurate method for collecting data on endometritis after cesarean section. METHODS: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991. These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and admission and discharge diagnoses. RESULTS: Each case-finding method was compared separately with the reference method ("gold standard"), which was designed to capture all cases among the patients in the study population (N = 145). This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures). The computerized report method linking patients who underwent cesarean section with antibiotic use had a positive predictive value of 0.53. Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively. CONCLUSIONS: In our institution, case finding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with i.v. antibiotic use data and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis. It also represents the most efficient use of the infection control department's resources.

Anti-Bacterial Agents↗
PubMed1984

Extraperitoneal cesarean section: a surgical form of infection prophylaxis?

The suggestion that extraperitoneal cesarean section might be a useful method of preventing postoperative infectious complications prompted a prospective study of 91 primary extraperitoneal cesarean sections on afebrile laboring patients with ruptured membranes longer than 4 hours. Fifty of 91 patients having extraperitoneal cesarean sections (group A) were compared with 36 patients having low cervical transperitoneal primary cesarean sections (control group) meeting the same entry criteria in a prospective randomized fashion. The other 41 patients (group B = 25 of 41, group C = 16 of 41) were selected from qualifying high-risk patients depending on the availability of an experienced operator with group C receiving perioperative prophylactic antibiotics. The only significant difference in outcome was: four of 16 (25%) patients in group C (extraperitoneal cesarean section plus prophylactic antibiotics) developed postoperative endomyometritis versus 20 of 36 (56%), 28 of 50 (56%), and 12 of 25 (48%) patients in the transperitoneal primary cesarean section control group and extraperitoneal cesarean section group A and B, respectively (p less than 0.05). There was a trend toward enhanced postoperative recovery in all extraperitoneal cesarean section groups compared with the transperitoneal primary cesarean section control group. Thus, the technique of extraperitoneal cesarean section apparently offers no significant advantage in the prevention of postcesarean endomyometritis, but the use of perioperative prophylactic antibiotics apparently has significant impact.

Adult↗
PubMed1988

A comparison of mezlocillin versus clindamycin/gentamicin for the treatment of postcesarean endomyometritis.

In a prospective, randomized study of 96 patients after cesarean section who had endomyometritis, there was a therapeutic cure in 35 of 47 (74.5%) patients who received mezlocillin, in comparison with 42 of 49 (85.7%) patients who received clindamycin and gentamicin (p = 0.17). Only wound infections in the study population were predictive for therapeutic outcome. Four of the five patients who received mezlocillin and none of the three patients who received clindamycin and gentamicin with wound infections were associated with therapeutic failures. This suggests mezlocillin may not be as effective as clindamycin and gentamicin in successfully treating wound infections. The number of vaginal examinations in patients sectioned for cephalopelvic disproportion was associated with increased febrile morbidity, suggesting that an excessive number of vaginal examinations should be avoided in the laboring patient.

Cesarean Section↗