Journal articles on the topic 'Puerperal Infection, surgery'

Background: Surgeon has a vital role during operation related with wound infection. Objective: The purpose of the present study was to see the role of wound infection of non-traumatic emergency laparotomy surgeries.Methodology: This descriptive cohort study was carried out in the Department of Surgery at Dhaka Medical College, Dhaka from July 1997 to June 1998 for a period of 1(one) year. Pre-operative patients were carefully assessed for any host factors related to wound infection. Different per-operative factors that influence the rate of postoperative wound infection were also analyzed. Swabs were taken from the suspected postoperative wound and sent for bacteriological examination. The details related to the surgeon were recorded according to their experience.Result: In this series, 100 cases of emergency laparotomies (non-traumatic) were analyzed. Wound infection rate of specific type of operation were 12.5%, 20.0%, 6.6%, 40.0%, 40.0%, 33.3%, 50.0%, 50.0%, and 100.0% in duodenal ulcer perforation, pre-pyloric and gastric ulcer perforation, acute appendicitis, burst appendix, ileal perforation, small intestinal obstruction due to bands and adhesions, volvulus of sigmoid colon, obstructed inguinal hernia, generalized peritonitis due to puerperal sepsis respectively. Surgical site infections are more commonly occur in the operation performed by inexperience younger surgeon (44.4%).Conclusion: The rate of wound infection of non-traumatic emergency laparotomy cases are frequently found in the operation performed by inexperience younger surgeon.Journal of Science Foundation 2016;14(2):52-55

There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.

Even though they are quite uncommon, puerperal genital haematomas can be associated with serious maternal morbidity. Key findings are significant perineal pain and, depending on the location, visible swelling. However, attention can be drawn to its progression by the rare occurrence of persistent painful “bearing down” efforts, even after the successful delivery of the baby. The final size of this haematoma and the rare presentation make it truly uncommon. The primary goals of treatment include the prevention of further blood loss, minimizing tissue damage, relieving pain, and reducing the risk of infection. Management is generally conservative for small collections, but surgery is indispensable when they acutely expand in size or are large with worsening symptoms.

Background: Wound infection is an important issue for surgical operations. Objective: The purpose of the present study was to measure the rate of wound infection of non-traumatic emergency laparotomy cases.Methodology: This descriptive cohort study was carried out in the Department of Surgery at Dhaka Medical College, Dhaka from July 1997 to June 1998 for a period of 1(one) year. Pre-operative patients were carefully assessed for any host factors related to wound infection. Different per-operative factors that influence the rate of postoperative wound infection were also analyzed. Swabs were taken from the suspected postoperative wound and sent for bacteriological examination. Result: In this series, 100 cases of emergency laparotomies (non-traumatic) were analyzed. Bacteriological examination showed positive culture in most of the cases but three were found to be negative result. Wound infection rate of specific type of operation were 12.5%, 20.0%, 6.6%, 40.0%, 40.0%, 33.3%, 50.0%, 50.0%, and 100.0% in duodenal ulcer perforation, pre-pyloric and gastric ulcer perforation, acute appendicitis, burst appendix, ileal perforation, small intestinal obstruction due to bands and adhesions, volvulus of sigmoid colon, obstructed inguinal hernia, generalized peritonitis due to puerperal sepsis respectively. The overall surgical wound infection rate was 19.0%. Conclusion: The rate of wound infection of non-traumatic emergency laparotomy cases are frequently found in a well-established tertiary care teaching hospital. Bangladesh J Infect Dis 2015;2(1):9-12

Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia & Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.

Cesarean delivery is the most commonly performed major abdominal operation in women with prevalence ranging from 12% in public sectors to 28% in private sectors in India (DLHS-3 survey). Parallel to this, the complications of surgery are increased. Among these complications, uterine dehiscence and pelvic hematoma with abscess collection is rare but serious complication which might end in hysterectomy. We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery. We encountered a 25-years-old woman presenting to our emergency department (ED) with severe suprapubic pain and high-grade fever. She had an emergency cesarean delivery performed 14 days prior to presentation due to non-reassuring fetal heart rate. At the ED, ultrasonography revealed collection with septation around uterus with communication into uterine cavity. CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac. During postoperative follow up, patient was stable with no symptoms or signs of uterine/pelvic infection. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients.

Rationale: puerperal endometritis is the major cause of formation of incompetent uterine scar and spread of infection. By contrast, reparative processes concerning uterine walls are the basis for formation of a competent uterine scar. In the past decades, there have been observed significant changes in the clinical course of puerperal endometritis. Apart from other factors, they are caused by improper antibiotics prophylaxis and antibiotic treatment. The key factors responsible for uterine scar incompetence also include improper surgery methods, namely: application of uninterrupted, continuous suture of uterus, reactogenic material, inappropriate hemostasis, pathological blood loss, surgery duration over two hours, using technique of manual fetal exteriorization. The aim of the present research is to identify a group of maternity patients that could avoid being administered perioperative antibiotic prophylaxis and the further antibiotic therapy on condition that their lower uterus segments are processed with interrupted sutures. It also involves the assessment of the early postoperative care period as well as eliminating possible complications. Materials and methods: The article analyses a group of 63 maternity obstetrics patients in early postoperative care period. They had their lower uterus segments processed with interrupted sutures. In all cases we used peritonization with help of plica vesicouterina. Antibiotic prophylaxis was avoided in both perioperative and early postoperative care periods. The article also presents the lab test values, data on thermometry and ultrasound diagnostic. The latter analyzed the following: length, width, thickness and the size of uterus, thickness of the front part of the uterus in the scar area, echoicity and echo structure of the mentioned area. Ultrasound examination allows us to estimate the uterus size, the scar condition, possible pathologic elements in the uterus body. The article also presents data on physical examination and bacteria culturing of the content of the uteri cavity during three days. The results: the complications were not presented by such nosological forms as endometritis or postoperative peritonitis, as well as inflammatory urinary conditions. No cases of any partial suture line disruption have been observed on the anterior abdominal wall or hyperthermia over 37,5 within the first three days of the postoperative period. Conclusions: during the rehabilitation period for the lower uterus segments by using synthetic suture material for the low-risk group of obstetrics patients it is not necessary to provide antibiotics prophylaxis and antibiotic treatment in the case of a planned or postponed caesarian section

Depression is an emotion that has always linked with pregnancy. Anxious positive emotions may face a stressor as a protection, which could be a problem if overdone. Teenage pregnancy with about 20 years of age at risk, often suffer from anemia, impaired fetal development, miscarriage, prematurity, or low birth weight, birth disorders that need surgery labor, pre-eclampsia, antepartum haemorrhage, post-parturition may experience subinvolution uterus, puerperal infection, the formation of and spending less breast milk, the baby may be low IQ. Kedawung contained in abortion incidence in pregnant women aged teens as much as 3 people. Social problems include most unwanted pregnancies that require abortion measures, associated with AIDS disease that requires intensive treatment, psychological not ready to become parents, dropped out of school or work, the birth of a child without a father who jelas.The purpose of this research was to determine differences in the level of anxiety in the third trimester pregnant women teens and adults. The design used comparative analytic with from cross sectional design. The population was all pregnant women TM III adolescence and adulthood in as many as 31 people Polindes Kedawung Mojo Kediri sub district. The sample in this research was 31 respondent using saturated sampling technique. Analysis of the results of research using a statistical (different test) Mann Whitney U-Test with a standard error of 5% (0.05) obtained calculation results U = 32.5 ;U a table = 52 so there are differences in the level of anxiety in pregnant women TM III tenn and adults. Women pregnant teen age had higher anxiety than women pregnant adult.;Keywords: Anxiety, Pregnancy, Teen and Adult

Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is0.01–0.5%in gynecologic patients; however, as far as elderly patients are concerned, its incidence is13.6%[3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

Background: Caesarean section constitutes a major surgical procedure characterized with morbidity even if it is performed a planned procedure. Postoperative infection in obstetrics continues to affect the practice of every surgeon. Infection can cause an increase in patient’s stay in the hospital, create discomfort, cause disfigurement and lead to morbidities to the patient. Thus, preventive measures need to be constantly evaluated and updated and hence authors have to study and analyse prevalence of postoperative infectious morbidities.Methods: The study was conducted in an Urban Based Medical College Hospital in Ahmedabad. It was a retrospective cross-sectional study of 50 cases of patients who suffered infectious complications post caesarean from 1st March 2019 to 31st March 2020.Results: The prevalence rate of surgical site infection in my study is 5.9% whereas of post-operative puerperal sepsis is 0.6%, of post-operative urinary tract infection is 1.09%, of post-operative breast abnormalities is 0.16%. The most common infectious morbidity amongst all was surgical site infection (surgical site) infection and its prevalence was 5.9%.Conclusions: The development of post-operative infection is an important event that can be prevented by taking proper precautions and following prescribed guidelines. There should be specific use of antibiotics in the post-operative period. In the event of early signs of sepsis antibiotics should be administered properly as per culture sensitivity report. The decrease in infection rate also indirectly reduce the health costs involved in treating them post operatively.

The history of asepsis and antisepsis has been presented along with the doctors and scientists acclaimed in the field. Ignacy Semmelweis (1818 – 1865), an obstetrician from Vienna, noticed that the puerperal fever arises from the fact that doctors and students after their classes in dissecting room come to the rooms for the ill in hospitals without washing their hands. But, his recommendations to wash hands in chlorine water were criticized and rejected. Józef Lister (1827 – 1912), an English surgeon, after the discovery of pyogenic bacteria such as staphylococcus and streptococcus by Ludwik Pasteur (1822 – 1912), suggested washing hands and sterilization of the surgical instruments and dressings as well as spraying the operating rooms with the use of carbolic acid. He is considered to be the father of antisepsis. The paper also underlines the role of Kurt Schimmelbusch (1870 –1895) in fighting with the perioperative infections. He was the creator of an autoclave used for sterilization of surgical materials and instruments. Jan Mikulicz Radecki (1850 – 1905), from Wrocław, was the first to use a sterile uniform with a face mask and cotton gloves for surgical treatments.

Abstract Maternal mortality results among women with sickle cell disease (SCD) from recent population-based studies using US hospital discharge data range from 72 (Villers, 2008) to 160 per 100,000 (Alayed, 2014). Researchers use hospital discharge or death certificate data to examine maternal death, as no national SCD surveillance system exists. We analyze California's surveillance data to describe the in-hospital maternal mortality rate among women meeting a stringent case definition for SCD, compare that rate to rates for all women and for Black women, and describe cases of SCD maternal demise. The CDC has developed the Sickle Cell Data Collection (SCDC) program to conduct state level surveillance in this disease. SCDC uses a validated case definition: confirmed SCD with known genotype (via newborn screening or clinical case reports) or three or more healthcare encounters in administrative or claims data with SCD ICD-9 codes. California SCDC collected hospitalization data for years 2004-2014 on 1,829 women with SCD. We queried hospitalization data for women ages 15-45 at time of admission for ICD-9 codes for delivery (V27.X) with disposition codes indicating death during the same admission. We used the same query for all women and for Black women to calculate comparable in-hospital maternal mortality rates. We reviewed death records for ICD-10-CM underlying cause of death (COD) codes, and prior ED and inpatient records, and describe the history of the women with SCD who died. We found 636 delivery hospitalizations among 441 of the 1,829 eligible women with SCD during the 11-year period. The maternal death rate for SCD was 629 per 100,000 (n = 4 of 636 deliveries), compared to 6 per 100,000 deliveries in the general population and 12 per 100,000 among Black women. There was an additional death (#5) among the women with SCD that occurred shortly after discharge; we include this death in the case descriptions, but not in the mortality rates. All of the women with SCD who died were Black. All births were live, singleton deliveries by cesarean surgery. Case #1: 29 years old at death with no prior pregnancies in nine years of utilization data. She had a history of eight hospitalizations for septicemia, pneumonia and Hb SS with crisis, but none during her pregnancy. There were 16 ED visits, most related to SCD crisis and pain, but none in the prior three years. COD was 'O96.0, Death from direct obstetric cause.' Case #2 was 34 years old and had seven prior years of medical history. She had no record of previous pregnancies, but had 44 prior hospital admissions and 95 ED encounters, including 12 in the year prior to her death. She had a history of venous thromboembolism, and deep phlebothrombosis was the primary diagnostic code for her final hospital admission. COD was 'D57.1 Sickle cell disease without crisis.' Case #3 was 28, with four years of prior data. There was one previous cesarean birth 2.5 years prior to her death, and a record indicating that there were one or more prior cesarean deliveries before that. She had 11 prior ED encounters, most for pain, with one in the year prior to her death; there were 46 prior hospitalizations, most for SCD crisis. Primary diagnosis was severe pre-eclampsia. COD was 'D57.1 Sickle cell disease without crisis.' Case #4 was 27, and had eight years of prior data and no prior births. She had 11 admissions, three in the months prior to her death for antepartum anemia. There were 12 prior ED encounters, three for antepartum anemia. Her death included codes for heart, liver, kidney and respiratory failure after delivery. COD was 'O96.0,' as described in Case #1. She died 11 days after delivery. Case #5 was 20, and had five years of utilization data with no prior births. Her labor was induced due to fetal distress, and she was hospitalized for six days. Records included a code for infection of the amniotic cavity. Four days after release, she was re-admitted for puerperal sepsis, suffered multi-organ failure, and died. There were 10 prior ED encounters, including four during and related to the pregnancy. COD was 'O23.5, Infections of the genital tract in pregnancy.' We found maternal mortality among women with SCD to be significantly higher than previous estimates. Statewide surveillance based on multiple data sources, and that follows individual patients over time whether or not they are seen in sickle cell disease clinics, can provide less biased information on health outcomes than analyses of single data sources or clinical sites. Disclosures Raider: Pfizer: Research Funding; Biogen: Research Funding. Paulukonis:Pfizer: Research Funding; Biogen: Research Funding.

Background: Granulomatous lobular mastitis is an uncommon disease. This condition may resemble malignancy and tuberculosis. It is characterised by granulomatous inflammation with multinucleated giant cells, epithelioid histiocytes. The inflammation is centred on lobules. The purpose of this study is to review the clinical and pathological aspects in 8 cases of granulomatous lobular mastitis and review of pertinent literature.Methods: This is a prospective observational study. A total of 8 patients were studied. Investigations done. Patient were treated by erythromycin 250mg qid, tinidazole 500mg bid, for 7 days and steroids for two months. The lumps were excised, sinuses were excised and abscesses were drained, and oral steroids were given. Follow-up was done for 6 months.Results: Most of the patients were multiparous and lactating, with age range from 18 to 36 years. Clinically the lesion was felt as malignant in 3 patients and benign in 5 patients. Most patients were using contraceptive pills. There was suppuration in 3 patients and sinuses were found in 2 patients. Histopathological examination revealed granulomatous inflammation centred on lobules.Conclusions: The diagnosis of granulomatous lobular mastitis should be made very carefully to avoid any confusion with malignancy, tuberculosis, fungal infection, sarcoidosis, mammary duct ectasia, cystic changes in breast with over palpation and puerperal mastitis with over palpation. Though it is rare disease, but complete understanding by pathologist and surgeon is required for improving its identification.

Background: Caesarean section is the most commonly performed major surgery among women. The aims and objective of this study was to know the incidence of primary Caesarean section in multigravidas, its indications and to know the maternal and foetal outcome among these patients. Methodology: This was an observational study conducted at Department of Obstetrics and Gynaecology of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Aim of the study was to study the indication, maternal and fetal outcome in primary cesarean in multiparous women. All multiparous women admitted for delivery were included in the study Results: The total number of deliveries were 3064 and cesarean section were 1026 (33%).The total number of primary cesarean section in multiparous women were 84 constituting 2.7%. In this study, majority of women were Gravida 2. 91.6% of the cases were underwent emergency cesarean section and anesthesia was spinal. Majority of patients were between age group of 22 to 27 yrs (70%). Indications for cesarean section in our study were severe oligohydroamnios (22%), fetal distress (15.4%), and breech presentation (14%), premature rupture of membrane (12%).Intra operative ndings were meconium stained liquor, post partum hemorrhage, thinned out lower segment and extension of incision. Out of 84 cases, 48 cases needed intra operative or immediate post operative blood transfusion. The post operative morbidity was present in 6 cases i.e paralytic ileus, puerperal fever, urinary tract infection and wound gaping. Majority of babies, weighed in the range of 2-3kgs (55%).Out of 84 cases 7 were causes were placenta previa, obstructed labor and fetal distress. Conclusion: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular antenatal care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.

AbstractOvarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70–80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.