ABSTRACT
OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.
Subject(s)
Infections , Obstetric Labor Complications , Puerperal Infection , Risk Adjustment/methods , Systemic Inflammatory Response Syndrome , Adult , Cohort Studies , Colombia/epidemiology , Early Diagnosis , Female , Humans , Infections/complications , Infections/diagnosis , Infections/epidemiology , Infections/physiopathology , Intensive Care Units/statistics & numerical data , Leukocyte Count/methods , Maternal Mortality , Obstetric Labor Complications/diagnosis , Obstetric Labor Complications/etiology , Obstetric Labor Complications/mortality , Pregnancy , Pregnancy Outcome/epidemiology , Puerperal Infection/blood , Puerperal Infection/etiology , Puerperal Infection/mortality , Puerperal Infection/therapy , Risk Assessment/methods , Symptom Assessment/methods , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
Informamos un caso clínico de trombosis de la vena ovárica derecha post-cesárea. Se discute los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.
Subject(s)
Adolescent , Adult , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Ovary/blood supply , Venous Thrombosis/diagnosis , Venous Thrombosis/therapy , Cesarean Section/adverse effects , Diagnosis, Differential , Puerperal Infection/diagnosis , Puerperal Infection/therapyABSTRACT
La infección puerperal es la invasión directa, por microorganismos patógenos, de los órganos genitales, durante o después del parto. Los factores predisponentes se dividen en tres grupos: Grupo 1 Riesgo General, Grupo 2 Relacionados con el parto, Grupo 3 Relacionadas con la cesareas, existen otros riesgos relacionados con el parto. Se describe las vías de penetración de la infección, las sepsis más frecuentes, y las conductas a seguir en cada caso. Se establece los criterios de diagnóstico, los parámetros para la vigilancia de la respuesta clínica y la conducta a seguir. Se dan los lineamientos generales en el puerperio y los antibióticos recomendados para las infecciones leves, y para las infeccines graves se da la propuesta del tratamiento quirúrgico de la infección puerperal
Subject(s)
Puerperal Infection/therapySubject(s)
Humans , Female , Pregnancy , Infant, Newborn , Cross Infection , Puerperal Infection , Mastitis/diagnosis , Mastitis/therapy , Puerperal Infection/diagnosis , Puerperal Infection/etiology , Puerperal Infection/physiopathology , Puerperal Infection/prevention & control , Puerperal Infection/therapyABSTRACT
Os autores tem como objetivo apresentar uma revisÝo atualizada da literatura sobre o tema infecçÝo puerperal, levando em conta aspectos epidemiológicos, clínicos, terapêuticos e profiláticos
Subject(s)
Humans , Female , Pregnancy , Puerperal Infection/physiopathology , Puerperal Infection/epidemiology , Puerperal Infection/prevention & control , Puerperal Infection/therapy , Obstetric Labor Complications , Risk FactorsABSTRACT
La infección, aunque representa una fracción importante como causa de muerte en la mujer grávida, por fortuna rara vez conduce a la muerte en la paciente obstétrica, no obstante, la sepsis grave en obstetricia, es una de las causas más frecuentes de mortalidad. El shock séptico, expresión clínica de la sepsis grave, mantiene una mortalidad en obstétrica, entre 20 por ciento y 50 por ciento. La siguiente revisión, es la segunda parte del artículo Sepsis y Embarazo, en la cual trataremos los aspectos terapéuticos, farmacocinéticos de las drogas durante el embarazo, así como los relacionados con el feto, por último, el manejo obstétrico de la sepsis durante el embarazo
Subject(s)
Pregnancy , Humans , Female , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/therapy , Shock, Septic/therapy , Drug Evaluation/trends , Puerperal Infection/complications , Puerperal Infection/therapy , Pelvic Inflammatory Disease , Pregnancy/complications , Urinary Tract Infections/pathology , Urinary Tract Infections/therapyABSTRACT
Com o intuito de estabelecer a real necessidade do uso de antibióticos em cesariana, foram estudados 339 pacientes submetidas a essa operaçåo. Destas, 212 pacientes receberam antibióticos por 7 dias, 45 por 24 horas e 82 nåo receberam qualquer droga antimicrobiana. Os resultados revelam que nåo houve diferença significativa na incidência de infecçåo puerperal e morbidade febril pós-cesariana nos três grupos estudados, ocorrendo apenas maior incidência de infecçåo urinária e de parede nas pacientes que nåo receberam antibióticos.Os autores concluem que a operaçåo cesariana nåo é motivo para indicaçåo absoluta de antibioticoterapia profilática e que as complicaçöes infecciosas que ocorreram em maior proporçåo no grupo que nåo utilizou essa medicaçåo podem ser tratadas após seu aparecimento
Subject(s)
Humans , Female , Pregnancy , Adult , Antibiotic Prophylaxis , Cesarean Section/adverse effects , Postoperative Complications/prevention & control , Fever/prevention & control , Puerperal Infection/etiology , Puerperal Infection/mortality , Puerperal Infection/prevention & control , Puerperal Infection/therapy , Postpartum Period/drug effects , Ampicillin/therapeutic use , Cefazolin/therapeutic use , Cephalothin/therapeutic use , MorbidityABSTRACT
Endometritis is the most frequent infectious complication of the puerperal period; with the objective to know the clinical characteristics, etiology and evolution of this disease we did a retrospective study of the endometritis cases among the patients of the Instituto Nacional de Perinatología (INPer) from January 1st, 1990 to May 31, 1991. During the revision period were diagnosed 120 cases, but we were able to examine only 90. In the 90% the resolution of the pregnancy was by means of caesarean. A 24.4% of the patients had premature rupture of the membranes. The 10% had diagnose of chorioamniotis. The latency period to develop postpartum endometritis was 120 +/- 66 hours, and post-caesarean 56 +/- 30 hours (p = 0.001). The symptom most frequent were fever (100), foul-smelling lochia (61.1%) and uterine tenderness (60%). The infection was polymicrobial, being the microorganisms most frequent isolated Staphylococcus coagulase negative, Escherichia coli and Peptostreptococcus. A 3.3% developed pelvi-peritonitis. One patient died.
Subject(s)
Endometritis/diagnosis , Puerperal Infection/diagnosis , Endometritis/microbiology , Endometritis/therapy , Female , Humans , Infant, Newborn , Pregnancy , Puerperal Infection/microbiology , Puerperal Infection/therapyABSTRACT
Foram comparadas duas formas de administracao de antibioticos, orientadas por duas classificacoes distintas do risco de contaminacao em procedimentos obstetricos. O estudo inclui 3347 pacientes submetidas a procedimentos obstetricos durante o ano de 1990. Observou-se uma reducao significativa do indice de infeccao puerperal de 6,72 para 2,59 por cento com a introducao de uma classificacao mais rigorosa do risco de contaminacao e de antibioticoterapia profilatica. Os autores concluem que a utilizacao profilatica de antibioticos orientada por uma classificacao rigorosa do risco de contaminacao em procedimentos obstetricos foi eficiente na reducao do indice de infeccao puerperal.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Evaluation of Results of Preventive Actions , Puerperal Infection/epidemiology , Cephalothin/administration & dosage , Cephalothin/therapeutic use , Puerperal Infection/diagnosis , Puerperal Infection/therapy , Risk Factors , Thiamphenicol/administration & dosage , Thiamphenicol/therapeutic useABSTRACT
A prospective, longitudinal, comparative, experimental design, was carried out at CMN T HGZ No. 16, from Dec 5, 1988 to July 5, 1989, in order to evaluate the importance of cervical dilatation in puerperal endometritis management. Two groups of thirty patients each, were formed at random. Cervical dilatation was performed in Group A, and it was not done in Group B. Signs and symptoms as uterine pain, uterine sub-involution, fever, fetid and/or purulent lochia remitted in two to three days average, and hospital stay was six days for both groups. During the study two patients of each group showed complications (6.66%). Therefore, these results show that cervical dilatation, performed as a part of puerperal deciduometritis management, has little or none therapeutic value.
Subject(s)
Decidua , Labor Stage, First , Puerperal Infection , Uterine Diseases , Adult , Female , Humans , Longitudinal Studies , Models, Statistical , Pregnancy , Prospective Studies , Puerperal Infection/therapy , Uterine Diseases/therapyABSTRACT
A profilaxia antibiotica pode diminuir a incidencia de infeccao apos certos procedimentos cirurgicos. Embora isto seja particularmente verdadeiro para a cesariana, muito tem sido discutido quanto ao uso de antibiotico profilatico no parto normal com episiotomia. Em nossa instituicao, o cloranfenicol tem sido utilizado por varios anos como antibiotico profilatico no parto normal, para as pacientes com trabalho de parto prolongado, ruptura prolongada de membranas e aquelas que evacuam durante o parto, contaminando o campo operatorio. O esquema consiste na administracao de cloranfenicol, na dose de 500 mg a cada 6 horas apos o parto, por 72 horas. De modo a avaliar a eficiencia deste esquema, os autores realizaram um estudo prospectivo, randomizado, envolvendo 80 pacientes que eram designadas a utilizar ou nao o cloranfenicol. Os resultados demonstram nao haver diferencas estatisticamente significativas entre os grupos estudados, com respeito a incidencia de infeccao puerperal e/ou deiscencia da episiotomia. Como os riscos desta pratica superam os beneficios, conclui-se que tal esquema deva ser abandonado como profilaxia antibiotica no parto normal. Se alguma forma de profilaxia for necessaria no parto vaginal, deve-se optar por um agente menos toxico, administrado em regime de dose unica ou de no maximo tres doses apos clampeamento do cordao umbilical.
Subject(s)
Humans , Female , Pregnancy , Chloramphenicol/administration & dosage , Chloramphenicol/therapeutic use , Episiotomy , Puerperal Infection/prevention & control , Puerperal Infection/therapy , Natural ChildbirthABSTRACT
Se realiza una revision suscinta de la sepsis Neonatal, sus caracteristicas clinicas, terapeutica y factores de predisposicion, se remarca la necesidad de contar con medios minimos que aseguren un parto limpio y un sistema eficiente de referencia-contrareferencia para atencion por nivles. Finalmente se muestran algunos datos correspondientes a casuistica del Hospital del Niño de la ciudad de La Paz
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Puerperal Infection/complications , Puerperal Infection/physiopathology , Puerperal Infection/therapy , Obstetric Labor Complications/physiopathology , Anti-Bacterial Agents/administration & dosage , Bolivia , Hospitals, Public/trends , Cross Infection/complications , Maternal and Child Health , Infant, Newborn/physiologyABSTRACT
Se presenta un caso de una paciente que presentó en el puerperio mediato un cuadro clínico caracterizado por estado de choque, con alteraciones hepáticas, renales y del aparato musculoesquelético, a sí como una erupción eritematosa generalizada, el cual fue catalogado como un síndrome de choque tóxico, de tipo obstétrico, y el hemocultivo mostró estafilococo dorado como único germen infectante. Fue manejada en la Unidad d eCuidados Intensivos Adultos (UCIA), con medidas de sostén para su estado de choque y con eritromicina por vía oral, siendo su evolución muy favorable. Se revisan las características epidemiológicas, factores de riesgo, hallazgos clínicos, criterios para diagnóstico y recomendaciones para su tratamiento
Subject(s)
Pregnancy , Adult , Humans , Female , Puerperal Infection/diagnosis , Shock, Septic/diagnosis , Staphylococcal Infections/diagnosis , Combined Modality Therapy , Critical Care , Puerperal Infection/microbiology , Puerperal Infection/therapy , Shock, Septic/microbiology , Shock, Septic/therapy , Staphylococcus aureus/isolation & purificationSubject(s)
Puerperal Infection/diagnosis , Shock, Septic/diagnosis , Staphylococcal Infections/diagnosis , Adult , Combined Modality Therapy , Critical Care , Female , Humans , Pregnancy , Puerperal Infection/microbiology , Puerperal Infection/therapy , Shock, Septic/microbiology , Shock, Septic/therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/therapy , Staphylococcus aureus/isolation & purificationABSTRACT
Reviram-se as observaçöes de 99 histerectomias, praticadas no decurso do Ciclo Grávido-Puerperal, na Clínica Obstétrica da Faculdade de Medicina da Universidade de Säo Paulo, nos períodos de 1931-1945, 1951-1983. Foram indicaçöes de histerectomia, no ciclo grávido-puerperal: infecçäo puerperal, na rotura uterina, moléstia trofoblástica, atonia uterina, acretismo placentário, descolamento prematuro da placenta, mioma uterino, placenta prévia, câncer cervical e a necrose uterina puerperal. No período de 1951-1961 a real incidência de histerectomia foi: na rotura uterina 9,6%, no mioma 3,4%, na perfuraçäo uterina 1,9%, no deslocamento prematuro da placenta 0,9% e, na moléstia trofoblástica, no período 1973-1984, foi de 10,4%. No período 1931-1945 pontificaram as causas hemorrágicas, totalizando 83,2% das indicaçöes de histerectomias. Entre 1951-1961 e 1974-1983 esse número declinou para 45,1% e 24,0%, respectivamente. No período 1974-1983 foi flagrante a elevaçäo do índice de histerectomias, por moléstia trofoblástica (19,2%) e infecçäo puerperal (56,0%) pós-aborto. Entre os 28 casos de histerectomia praticada por infecçäo puerperal, em 11, tratava-se de pacientes com menos de 26 anos, das quais 5 eram nulíparas e 6 primíparas. Entre essas 11 observaçöes, em 8 havia, inclusive, perfuraçäo uterina. Chama a atençäo que incidência de pacientes jovens (menos de 26 anos) e idosas (mais de 36 anos) foi, nitidamente, maior no período 1974-1983, quando, por razöes sociais (jovens) e, possivelmente, econômicas (idosas), a configuraçäo de gestaçäo indesejada obrigou a prática do aborto. A histerectomia sub-total foi mais freqüente no período 1931-1945. Progressivamente , sua indicaçäo declinou, à medida em que a técnica total se elevava até atingir 74,0% de intervençöes, no período 1973-1984 ...