The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes.

OBJECTIVE: As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. STUDY DESIGN: The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9, 50-59.9, 60-69.9, and >70 kg/m2). RESULTS: Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50-59.9 kg/m2; 13.7% BMI: 60-69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50-59.9 kg/m2; 6.2% for BMI: 60-69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35-4.02 for BMI 50-59.9 kg/m2; aOR = 4.91, 95% CI: 2.07-11.7 for BMI of 60-69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45-176 for BMI >70 kg/m2). CONCLUSION: Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. KEY POINTS: · Women with super obesity have higher rates of wound complications.. · Women at extremes of obesity experience worse postpartum infectious morbidity.. · More research is needed on effective strategies to minimize morbidity in this population..

Post-partum rectus sheath hematoma complication: case report.

Pregnancy, surgery, and trauma are known risk factors for the development of rectus sheath hematomas (RSHs). The exact incidence of RSH during pregnancy is unknown, however this disease carries a risk of complication and even mortality. The role of infection in this condition is less known with only a few reported case studies in medical literature. In our case a 26-year-old G4P2113 1-month status post cesarean section presented with 2 weeks of progressive lower abdominal pain after her 50-pound daughter jumped on her. Upon further work up a computed tomography (CT) scan found a 15-cm RSH. Expectant management is the recommended first line of treatment, however, this failed after the patient presented with signs and symptoms of infection. An exploratory laparotomy was performed that had evidence of necrotizing fasciitis of the rectus muscle and subcutaneous tissue. This is a very atypical presentation of a RSH complicated with myonecrosis after a cesarean delivery. Review of the medical literature shows appropriate work up and diagnosis of RSH in pregnant patients is critical for early intervention. Furthermore, while conservative treatment is typically appropriate for non-pregnant patients it may not be sufficient for pregnant and post-partum patients. Improved understanding of this condition will result in heightened clinical suspicion, faster intervention, and more appropriate treatment. This is critical to reducing the maternal and perinatal morbidity/mortality associated with this disease.

More Than Just a Room: A Scoping Review of the Impact of Homesharing for Older Adults.

BACKGROUND AND OBJECTIVES: "Aging in place" is commonly defined as the ability to remain living safely and independently for as long as possible either in the home or community of one's choosing. Yet, the literature indicates that older adults prefer to remain specifically in their own homes. Homesharing, an innovative exchange-based housing approach, is a means by which older adults can obtain additional income, companionship, and assistance by renting out a room to a home seeker, potentially increasing capacity to remain living independently in their homes. But what is known about their experiences of homesharing? RESEARCH DESIGN AND METHODS: A scoping review was conducted to map and consolidate the literature related to the experience of homeshare participation for adults aged 55 and older published from 1989 to 2018. Fifteen databases were searched, including 3 medical, 5 social science, and 7 gray literature databases. Following abstract and full-text review, 6 sources were retained for study inclusion. Thematic content analysis was used to identify major themes. RESULTS: Within included studies, 4 major themes were identified: (i) benefits of homeshare participation for older adults; (ii) challenges of participating in homeshare for older adults; (iii) intergenerational engagement as social exchange; and (iv) the key role of agency facilitation. DISCUSSION AND IMPLICATIONS: Findings were used to derive practice, policy, and research implications. By focusing on older adults and the ways homesharing impacts their lives, we can better determine the viability of homeshare as a means for improving and prolonging experiences of living at home.

Raoultella Bacteremia Presenting as an Acute Self-Limited Illness in an Obstetric Patient.

A 20 year-old female at 27-week gestation was admitted for threatened preterm delivery. Following an initially unremarkable hospital course for 12 days, the patient developed fever, chills, generalized malaise, abdominal pain, and diffuse myalgias on day 13 of hospitalization. Raoultella species was isolated from blood cultures on day 16 of hospitalization. The patient's condition improved within 24 hours of symptom onset, prior to antibiotic initiation, and a premature, viable male infant at 29 weeks and 6 days of gestation was delivered via caesarean section four days later due to breech presentation in the setting of preterm labor. Here, we present the first case of a Raoultella species infection in a gravid female reported in the literature.

Tips and tricks for retrieval of permanent TRAPEASE filters for inferior vena cava.

The placement of permanent inferior vena cava filters has definite indications and some filters have been shown to be more problematic in the long term than others. This report outlines the technique for TRAPEASE filter removal in two patients. The first filter was retrieved four weeks after insertion and the second filter was retrieved 14 months after it was inserted at another institution. A planned approach for retrieval is described in these case reports.