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PubMed1983

Amniotic fluid cultures: post-cesarean section endomyometritis and neonatal infections.

Amniotic fluid cultures in 54 consecutive patients undergoing cesarean section were compared in regard to intrapartum and postpartum events. Neonatal outcome and cultures were also compared with amniotic fluid findings. Positive amniotic cultures were obtained in 57% and showed a multiplicity of organisms. Development of endomyometritis was correlated with a heavy growth of bacteria in culture. Positive cultures were significantly associated with duration of labor greater than eight hours and presence of ruptured membranes at the time of cesarean section. Thirty-three percent of the patients with positive cultures had intact membranes at the time of operation. Eighty-eight percent of cultures from infants and amniotic fluid grew organisms in common. Implications of the study for the pathogenesis of postcesarean endomyometritis and neonatal morbidity are discussed.

Amniotic Fluid↗
PubMed2006

Postcesarean splenic torsion.

OBJECTIVE: Splenic torsion is an exceedingly rare complication in pregnancy. We present a case of acute splenic torsion that manifested after cesarean section and which was successfully treated with laparotomy with splenectomy and partial pancreatectomy. CASE REPORT: A 35-year-old, gravida 7, para 1, aborta 5, woman presented at our hospital for planned cesarean section at 38 weeks of gestation. Thrombocytopenia was noted antenatally and enlarged spleen with smooth surface and contour was observed at the conclusion of cesarean section. One day after delivery, dyspnea and left upper abdominal pain developed. Abdominal computed tomography showed a huge abscess in the left anterolateral abdomen and bilateral pleural effusion. Acute splenic torsion was highly suspected, but the patient refused surgical intervention until the condition exacerbated 21 days after delivery. Splenic pedicle strangulation with thrombosis, a severely ischemic spleen with rupture and distal pancreatic necrosis were noted during emergent laparotomy. She had an uneventful recovery and was discharged 5 days after left splenectomy and partial pancreatectomy. CONCLUSION: Splenic torsion is a rare cause of acute abdominal pain during pregnancy or postpartum, and the symptoms vary depending on the degree of torsion. Early involvement of many complementary specialty services enabled early recognition of this rare entity and timely definitive treatment.

Abdominal Pain↗
PubMed2006

Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil.

BACKGROUND: There is a need to assess the effects of different antibiotic administration models on infectious complications among women from low-income populations who undergo cesarean delivery, and the cost benefit. DESIGN: Randomized, blinded controlled clinical trial study of a single preoperative dose of cephalothin, versus a postcesarean scheme for infection prophylaxis, versus no antibiotics. METHODS: The setting was a tertiary Brazilian center with 1,500 deliveries annually. Pregnant women (n = 600) with an indication for emergency or elective cesarean section were randomly allocated consecutively to one of three groups and treated as follows: Group 1 (n = 200), no antibiotics; Group 2 (n = 200), the standard antibiotics scheme followed at this center; Group 3 (n = 200), a single dose of intravenous cephalothin 2 g, intraoperatively. MAIN OUTCOME MEASUREMENTS: Prevalences of wound infection, puerperal and postcesarean infections, and costs of antibiotics used. RESULTS: Antibiotics reduced the incidence of puerperal infection, but did not change the percentages of wound and postcesarean infections and no use of antibiotics increased the puerperal infection risk sixfold. Cephalothin reduced the relative risk of puerperal infection by 89% (95% confidence interval: 7-87%). Penicillin reduced it by 78%, but this was not statistically significant. No deaths occurred. The costs of the two schemes were similar (almost US 1.00 dollars). CONCLUSIONS. Prophylactic cephalothin use was associated with decreased postcesarean puerperal infection and presented a cost benefit.

Anti-Bacterial Agents↗
PubMed1985

Risk factors for postcesarean endomyometritis.

Postcesarean endomyometritis is the most common nosocomial infection treated by obstetrician-gynecologists. One important prevention strategy is the use of perioperative antibiotic prophylaxis initiated after occlusion of the umbilical cord for parturient patients with a high risk of this infection. However, the identification of these high risk patients remains problematic. Numerous clinical risk factors have been identified in the literature. Important intrinsic risk factors include indigent socioeconomic status, anemia, and preterm gestational age at the time of cesarean section. The three most consistently identified extrinsic risk factors include labor prior to cesarean section, the duration of ruptured chorioamniotic membranes, and the number of preoperative vaginal examinations. Alternatively, many investigators have attempted to define high-risk patients utilizing various laboratory tests, such as Gram staining or bacterial culture of amniotic fluid, chorioamniotic membranes, or endometrial biopsy specimens; although specific, these tests have not been sufficiently sensitive predictors of infection. Currently, assessment of the duration of ruptured membranes and length of labor remain the most sensitive, readily available, and therefore clinically useful predictors of postcesarean endomyometritis.

Cesarean Section↗
PubMed1984

Correlation of laboratory and clinical criteria in the prediction of postcesarean endomyometritis.

The objective of this investigation was to develop a rapid diagnostic test to identify patients at exceptionally high risk for postcesarean endomyometritis. Intraoperative samples of endometrium, chorioamniotic membrane, and amniotic fluid were obtained from 70 patients undergoing nonelective cesarean section and were processed for bacterial culture, Gram stain, and histologic examination. Endomyometritis occurred in 57% of patients. Women with positive bacterial cultures (growth of high virulence organisms on the primary plates), positive Gram stains (bacteria in any oil immersion field), and histologic evidence of leukocytic infiltration in the chorioamniotic membrane and endometrium (greater than or equal to ten white blood cells per high-power field) were more likely than were patients with negative findings to develop endomyometritis. All of the laboratory tests evaluated were specific but insensitive predictors of infection. Assessment of duration of ruptured membranes and length of labor provided a diagnostic test that was as clinically useful in predicting postoperative infection as were any of the laboratory studies evaluated.

Bacterial Infections↗
PubMed1989

Use of cefuroxime in preventing postcesarean infection in high-risk patients.

Prophylactic antibiotic therapy is accepted for prevention of postceasarean infection in certain risk groups. Of the antibiotic regimens presented none appears superior. Patients having a cesarean section (CS) more than 6 h after membrane rupture were given three doses of cefuroxime (1.5 g every 8th hour) in a prospective study. This prophylaxis was as efficacious as a 7-day treatment with cefuroxime and cefadroxil. The infection rate was 21% which should be compared to approximately 50% when no prophylaxis was given. Patients with membrane rupture of less than 6 h and having a most urgent CS received the same 24-hour prophylaxis. No postoperative infection was recorded. Women having a CS with an ongoing uterine infection were treated with cefuroxime alone or combined with metronidazole. All but one (91%) had an uneventful recovery.

Bacterial Infections↗
PubMed1994

Endoscopic assessment of the integrity of the postcesarean uterine wall before a trial of labor. Transcervical Endoscopy Registry.

Endoscopic examination of the uterine scar site was performed on 52 women prior to a trial of labor after a previous cesarean section. A sterilized intraoperative fiberscope was introduced into the amniotic cavity after rupture of the fetal membranes under constant visual guidance. In 45 cases the site of the previous incision appeared unremarkable, and a scar from the previous surgery could not be identified. "Compromised" scars were detected in three patients, and scars were identified as vertical in four patients with no record of the type of uterine incision used for the previous surgery. Endoscopic data were confirmed postpartum in all cases. This approach seems beneficial in selected cases.

Adult↗
PubMed2001

Growth hormone treatment after cesarean delivery in rats increases the strength of the uterine scar.

OBJECTIVE: We sought to determine whether postcesarean treatment of rats with growth hormone (GH) affected the strength of the uterine incision in the puerperium and in a subsequent pregnancy. STUDY DESIGN: Forty-eight near-term pregnant rats were delivered by cesarean section. Half received subcutaneous recombinant human GH (2.0 mg x kg(-1) x d(-1)) for 7 days; control animals received saline injections. Four weeks after delivery, the uterine bursting pressure was determined in 5 treated and 5 control animals. Eight rats in each group were used to study uterine hydroxyproline concentrations and the histologic characteristics of the scar. Twenty-two animals were rebred 30 to 40 days after their cesarean sections. After repeat cesarean delivery, on day 19, the bursting pressure and hydroxyproline concentrations of the previous hysterotomy scar were determined. RESULTS: The uterine horn bursting pressure in the GH-treated animals was significantly greater than that in the control animals both 28 days postpartum and near term in a subsequent pregnancy. The uterine hydroxyproline concentrations followed the same pattern. Histologic study of the scars showed they were thicker and had less cellularity in the treated animals than in the control animals. CONCLUSION: Postcesarean treatment with GH increased the bursting strength of rat uterine incisions. This effect was accompanied by a significant increase in collagen content and persisted through a subsequent pregnancy.

Animals↗
PubMed1999

Sonographically diagnosed pelvic hematomas and postcesarean febrile morbidity.

OBJECTIVE: To evaluate the incidence of ultrasonographically-diagnosed postcesarean hematomas and correlate their presence with febrile morbidity. METHODS: Prospective study of 111 consecutive patients who had a pelvic ultrasound 4-6 days post-operatively. Ultrasonographic findings were correlated with clinical data. RESULTS: Postoperative fever was diagnosed in 28 (25%) patients. Fifteen (13.5%) women had hematomas; 10 (9%) had bladder-flap and five (4.5%) had subfascial hematomas. Only subfascial hematomas were significantly associated with post-operative fever (P = 0.01). CONCLUSIONS: Postcesarean bladder-flap hematomas are not predictive of post-operative fever. The presence of subfascial hematomas should be specifically sought in the evaluation of a febrile postcesarean patient.

Adult↗
PubMed1988

Ticarcillin disodium and clavulanate potassium in the treatment of post-cesarean-section endomyometritis.

The combination of ticarcillin disodium/clavulanate potassium is a potent, irreversible inhibitor of beta-lactamase that is active against a broad spectrum of gram-positive and -negative bacteria, which often are found in the polymicrobial infection of postcesarean endomyometritis. Eighty-four randomly chosen women with postcesarean endomyometritis received 3 g ticarcillin disodium plus 100 mg clavulanate potassium intravenously every six hours. The drug was discontinued after patients were afebrile and asymptomatic for 72 hours. The mean duration of therapy was 4.7 days. A clinical cure was achieved in 56 of the 70 evaluable patients (80%); 14 were clinical failures. Six of the 70 patients (9%) were bacteremic. One hundred eighty-five aerobic bacteria and 109 anaerobic bacteria were isolated. Of the 96 aerobic isolates tested, 75 (78%) were beta-lactamase positive, as were 68 of the 78 anaerobic isolates (87%).

Adult↗
PubMed2000

Puerperal infection after cesarean delivery: evaluation of a standardized protocol.

OBJECTIVE: Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis. STUDY DESIGN: Endometritis was diagnosed as a persistent fever > or =100.4 degrees F beyond 24 hours after cesarean delivery and one or more of the following: uterine tenderness, tachycardia, foul lochia, or leukocytosis. Antibiotic therapy included gentamicin plus clindamycin and ampicillin (or vancomycin) as a triple antimicrobial in 148 women. Antibiotic failure was defined as persistent fever after 5 days of antibiotics and 72 hours of triple antibiotics. RESULTS: Between 1993 and 1996, 322 of 1643 (20%) women were diagnosed with postcesarean endometritis. One hundred seventy-four patients (54%) were cured with clindamycin-gentamicin, and 129 who additionally received ampicillin or vancomycin (40%) were cured. Nineteen of the 322 (6%) women had persistent fever despite triple antibiotics. Of these, 6 had a wound complication, 12 were suspected to have antimicrobial resistance, and 1 had an infected hematoma. CONCLUSION: A prospective protocol consisting of clindamycin-gentamicin plus the selective addition of ampicillin or vancomycin cured 303 of 322 (94%) women with postcesarean endometritis.

Ampicillin↗
PubMed1996

Radiopelvimetry after cesarean section.

OBJECTIVE: To develop a method of identifying bony pelvic dystocia in a select group of primiparae who had had a cesarean delivery and might be at risk during a trial of labor in a subsequent pregnancy. STUDY DESIGN: Radiopelvimetry was performed on 70 postpartum primiparae after cesarean delivery for various reasons and prior to being discharged from the hospital. RESULTS: Using standard radiologic criteria, the pelvis was considered adequate in 32 patients (45.7%) and inadequate in 38 (54.2%). CONCLUSION: Postcesarean pelvimetry may be beneficial in some primiparae because it can guide the obstetrician in performing a cesarean delivery in subsequent pregnancies without an unnecessary trial of labor.

Adult↗