- Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. [Review]
- CDCochrane Database Syst Rev 2018 04 25; 4:CD011689
- CONCLUSIONS: Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies listed in this review there are two key studies that will inform a future update of this review. The first is a WHO-led multi-centre study comparing the effectiveness of a room temperature stable carbetocin versus oxytocin (administered intramuscularly) for preventing PPH in women having a vaginal birth. The trial includes around 30,000 women from 10 countries. The other is a UK-based trial recruiting more than 6000 women to a three-arm trial comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018.Consultation with our consumer group demonstrated the need for more research into PPH outcomes identified as priorities for women and their families, such as women's views regarding the drugs used, clinical signs of excessive blood loss, neonatal unit admissions and breastfeeding at discharge. To date, trials have rarely investigated these outcomes. Consumers also considered the side-effects of uterotonic drugs to be important but these were often not reported. A forthcoming set of core outcomes relating to PPH will identify outcomes to prioritise in trial reporting and will inform futures updates of this review. We urge all trialists to consider measuring these outcomes for each drug in all future randomised trials. Lastly, future evidence synthesis research could compare the effects of different dosages and routes of administration for the most effective drugs.
- Estimating the Risk of Vertical Transmission of Dengue: A Prospective Study. [Journal Article]
- AJAm J Trop Med Hyg 2018 Apr 23
- The incidence of dengue worldwide is increasing rapidly. A better understanding of dengue transmission may help improve interventions against this major public health problem. The virus is mostly tra...
The incidence of dengue worldwide is increasing rapidly. A better understanding of dengue transmission may help improve interventions against this major public health problem. The virus is mostly transmitted by vectors. There are, however, other modes of transmission, notably mother-to-child transmission or vertical transmission. We studied a prospective cohort of 54 women who had dengue while pregnant during the 2012-2013 epidemic in French Guiana to estimate the mother-to-child transmission rate and assess the clinical and biological presentation of neonatal dengue. The rate of vertical transmission was between 18.5% (95% confidence interval [CI]: 9.25-31.4) and 22.7% (95% CI: 11.5-37.8), depending on the calculation method used. Mother-to-child transmission occurred both in early and late pregnancy. There were 52 births, including three newborns who presented neonatal dengue with warning signs requiring platelet transfusion. This quantification of the mother-to-child transmission of dengue highlights three points: first, vertical transmission of dengue is not negligible; second, it is more frequent when maternal dengue occurs late during pregnancy near delivery; and third, reliable diagnostic tests must be used to allow the diagnosis of vertical transmission. Our findings indicate that if there is a known history of maternal dengue during pregnancy, or if there is fever during the 15 days before term, cord blood and placenta should be sampled after delivery and tested for the virus, and the newborn should be closely monitored during the postpartum period.
- Infectious complications in morbidly adherent placenta treated with leaving placenta in situ: a cohort series and suggested approach. [Journal Article]
- JMJ Matern Fetal Neonatal Med 2018 Apr 26; :1-6
- CONCLUSIONS: Majority of postpartum cervical discharge, fever, and increased CRP levels do not represent morbid infections and/or sepsis. With early detection, and implementation of antibiotherapy (combination of an aminoglycoside and clindamycin), they can be easily controlled and secondary surgical interventions can be prevented.
- A Case of Postpartum Ovarian Vein Thrombosis. [Journal Article]
- CCureus 2018 Feb 01; 10(2):e2134
- Ovarian vein thrombosis (OVT) is an rare condition, which can present in the postpartum period. We present a case of a 35-year-old female who presented with right lower quadrant pain and fever. Her c...
Ovarian vein thrombosis (OVT) is an rare condition, which can present in the postpartum period. We present a case of a 35-year-old female who presented with right lower quadrant pain and fever. Her computed tomography (CT) abdomen revealed a dilated right ovarian vein with soft tissue attenuation material in its lumen that extended into the inferior vena cava, along with fat stranding of the surrounding soft tissues signifying thrombophlebitis. She was treated with enoxaparin and piperacillin-tazobactam, which lead to a resolution of the thrombus. Our case highlights the importance of prompt diagnosis and treatment of OVT in order to prevent morbidity and mortality.
- Postpartum septic pelvic thrombophlebitis after caesarean delivery: a case report. [Journal Article]
- CRCase Rep Womens Health 2018; 17:5-7
- Septic pelvic thrombophlebitis is a rare puerperal complication. It is an important differential diagnosis of postpartum fever and abdominal pain and although the condition is well known its diagnosi...
Septic pelvic thrombophlebitis is a rare puerperal complication. It is an important differential diagnosis of postpartum fever and abdominal pain and although the condition is well known its diagnosis can be challenging. We report a case of a 41-year-old woman with fever and right abdominal pain three days after an uncomplicated caesarean delivery. Clinical, laboratory and imaging exams were unremarkable and the patient was treated for endometritis. In the absence of improvement despite an antibiotic adjustment, a clinical diagnosis of septic pelvic thrombophlebitis was made, and the patient presented a good response to anticoagulation in conjunction with broad-spectrum antibiotic therapy.
- Quantifying known and emerging uterine pathogens, and evaluating their association with metritis and fever in dairy cows. [Journal Article]
- TTheriogenology 2018 Mar 16; 114:25-33
- Metritis is caused by polymicrobial infection; however, recent metagenomic work challenges the importance of known pathogens such as Escherichia coli and Trueperella pyogenes while identifying potent...
Metritis is caused by polymicrobial infection; however, recent metagenomic work challenges the importance of known pathogens such as Escherichia coli and Trueperella pyogenes while identifying potential new pathogens such as Bacteroides pyogenes, Porphyromonas levii and Helcococcus ovis. This study aims to quantify known and emerging uterine pathogens, and to evaluate their association with metritis and fever in dairy cows. Metritis was diagnosed at 6 ± 2 days postpartum, a uterine swab was collected and rectal temperature was measured. 39 cows were classified into three groups: Healthy (n = 14), Metritis without fever (MNoFever; n = 12), and Metritis with fever (MFever; n = 13). Absolute copy number was determined for total bacteria and for 8 potentially pathogenic bacteria using droplet digital PCR. Both MNoFever and MFever cows had higher copy number of total bacteria, Fusobacterium necrophorum, Prevotella melaninogenica, Bacteroides pyogenes, Porphyromonas levii, and Helcococcus ovis than Healthy cows. MNoFever and MFever groups were similar. There was no difference among groups in copy number of Escherichia coli, Trueperella pyogenes, and Bacteroides heparinolyticus, and they all had low copy numbers. Our work confirms the importance of some bacteria identified by culture-based studies in the pathogenesis of metritis such as Fusobacterium necrophorum and Prevotella melaninogenica; however, it challenges the importance of others such as Escherichia coli and Trueperella pyogenes at the time of metritis diagnosis. Additionally, Bacteroides pyogenes, Porphyromonas levii, and Helcococcus ovis were recognized as emerging pathogens involved in the etiology of metritis. Furthermore, fever was not associated with the total bacterial load or specific bacteria.
- [Cystic fibroadenoma detected incidentally in a patient with postpartum infectious mastitis]. [Case Reports]
- PAPan Afr Med J 2017; 28:148
- We report the case of Ms. A.A, a primiparous woman aged 21 years presenting (4 months after delivery) with an increase in left breast volume occurred 1 week after delivery associated with fever. The ...
We report the case of Ms. A.A, a primiparous woman aged 21 years presenting (4 months after delivery) with an increase in left breast volume occurred 1 week after delivery associated with fever. The patient was put on amoxicillin, protected by suspending breast-feeding for several weeks without improvement. Clinical examination showed febrile patient with a temperature of 39°, an increase in left breast volume, inflammatory signs especially at the level of internal quadrants (A). Palpation showed a painful, hot collection adherent to the skin, measuring 16 cm, at the level of the internal quadrants, invading the external quadrants, without axillary adenopathies, suggesting breast abscess. Ultrasound (B) showed voluminous solidocystic predominantly liquid echogenic mass with thick walls and buds up to 46 mm, classified as ACR4. Puncture biopsy collected grayish green liquid, sent for bacteriological examination; antibiotic therapy with quinolones was started. Follow up of patient, after 3 days, showed reduction of the inflammatory signs and bacteriological examination of the liquid found no germ. After 15 days of antibiotic therapy, the inflammatory signs had disappeared and the volume of the mass had reduced enough, hence the indication for cystectomy. Cystectomy with simple enucleation was performed (C); surprisingly, the histological examination showed cystic fibroadenoma (D).
- Reprint of Milk fever in dairy cows is preceded by activation of innate immunity and alterations in carbohydrate metabolism prior to disease occurrence. [Journal Article]
- RVRes Vet Sci 2018; 116:72-82
- The objective of this study was to search for potential alterations in innate immunity reactants and carbohydrate and lipid metabolism in the blood of transition dairy cows before, during, and after ...
The objective of this study was to search for potential alterations in innate immunity reactants and carbohydrate and lipid metabolism in the blood of transition dairy cows before, during, and after clinical occurrence of milk fever (MF) and identify potential predictive biomarkers of disease. One hundred pregnant multiparous Holstein dairy cows were involved in the study starting from -8wks before the expected day of parturition until +8wks postpartum as part of a large retrospective longitudinal study. Health status, DMI, milk yield, and milk composition were monitored during the whole experimental period. Six healthy cows (CON) and 6 cows that showed clinical signs of MF were selected for blood analyses. Serum concentrations of lactate, non-esterified fatty acids (NEFA), β-hydroxybutyric acid (BHBA), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), haptoglobin (Hp), and serum amyloid A (SAA) were determined. Results indicated that concentrations of serum lactate, IL-6, TNF, SAA, and Hp were greater in cows with MF than those in the CON group at different time points. Moreover, serum lactate, TNF, SAA, and Hp were greater in cows with MF starting at -8 and -4wks prior to parturition. Both principal component analysis (PCA) and partial least squares - discriminant analysis (PLS-DA) showed separated clusters between MF and CON cows at -8, -4, and disease diagnosis weeks. Overall DMI and milk production were lower in MF-affected cows. Additionally milk fat and fat:protein ratio were greater in MF. In conclusion, cows affected by MF showed alterations in some of the innate immunity reactants and metabolites related to carbohydrate metabolism several weeks prior to appearance of clinical signs of MF. Variable importance in projection plots demonstrated that TNF and SAA in the serum were the strongest discriminators between MF cows and CON ones, which might be useful as predictive biomarkers of the disease.
- Dengue Maculopathy with Foveolitis in a Postpartum Female. [Journal Article]
- CCureus 2017 Dec 13; 9(12):e1942
- Dengue fever is common in the tropics and its clinical manifestations and complications are well-known. However, dengue-related ocular complications are rare. Here we present a postpartum female who ...
Dengue fever is common in the tropics and its clinical manifestations and complications are well-known. However, dengue-related ocular complications are rare. Here we present a postpartum female who complained of bilateral central scotoma, at five days after the clinical diagnosis of dengue fever. The ocular examination was suggestive of dengue maculopathy and foveolitis. She was treated with a combination of intravenous methylprednisolone and immunoglobulin. The final visual recovery was good.
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- HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda. [Journal Article]
- ACAIDS Care 2018 Feb 16; :1-11
- HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be hig...
HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm3, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications.