scholarly journals Puerperal Complications in a Tertiary Hospital

2021 ◽  
Vol 23 (4) ◽  
pp. 329-333
Author(s):  
Hima Rijal ◽  
Suvana Maskey
Keyword(s):  
Cesarean Section ◽  
Surgical Site Infection ◽  
Medical Condition ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Tertiary Hospital ◽  
University Teaching ◽  
Site Infection ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Postnatal period is considered as an important part in reproductive life of women. Even though the antenatal phase and labour are utmost important, puerperal phase of pregnancy cannot be overlooked. Puerperal complication can sometime lead to diabilities for lifelong of women. For the prevention of postnatal complication, antenatal prepadareness is needed. The objective of this study was to find out the incidence of puerperal complications and associated risk factors. This is a retrospective, descriptive study conducted at Tribhuvan University Teaching Hospital, Department of Obstetrics and Gynaecology from April 2019 to March 2020. The cases of puerperal complications were noted from the record book from ward. The individual files were collected from record section. Data was collected from record files and analysed. Total number of deliveries were 4932 in one year. Out of which, 84 cases (1.7%) were admitted due to various puerperal complications. Majority of the women admitted with puerperal complications were between 21-29 years, 59.5%. Sixty-four percent (n=54) were primipara and 35.7%(n=30) were multipara. Seventy-six (90.5%) were term deliveries, 6(7%) were preterm and 2(2.4%) were post term deliveries. Sixty-two (74%) had emergency cesarean section as mode of delivery. Major indication of emergency cesarean section was fetal distress (29.8%, n=25). Surgical site infection (53/84,63%) was the commonest puerperal complication followed by puerperal sepsis (8/84,9.5%). Fifty- three cases of surgical site infection (SSI) were observed in patients who had undergone emergency cesarean section. Associated medical condition like hypertension, diabeties, anemia, obesity was seen in 33.5% (n=33) of the cases. Surgical Site Infection is the most common puerperal complication and commonly seen in women who had undergone emergency cesarean section.

scholarly journals Supplemental Perioperative Oxygen (80% FIO2) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Bleixen Admadé ◽  
Osvaldo Reyes
Keyword(s):  
Cesarean Section ◽  
Surgical Site Infection ◽  
Controlled Trial ◽  
Surgical Site Infections ◽  
Supplemental Oxygen ◽  
Site Infection ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Significant Difference ◽  
Oxygen Group

Objective. Cesarean section can be a lifesaving procedure. However, as with many surgeries, it is not exempt of complications. Surgical site infections generate higher costs, serious morbidity, and mortality. This study evaluates the benefits of perioperative oxygen to prevent surgical site infections. Methods. We conducted a randomized controlled trial to assess the effects of perioperative oxygen to prevent surgical site infection after emergency cesarean section. Patients were randomized to receive either oxygen (80% FIO2) during cesarean section plus two hours postsurgery or no supplemental oxygen. A sample of 326 patients was calculated for the primary outcome (163 in each group) and they were evaluated daily before leaving the hospital, at days 15 and 30. Results. Initially, 360 patients were enrolled, from which 17 were excluded (sample size: 343 (179 patients in the air group and 164 in the oxygen group)). We found no significant difference in the incidence of surgical site infection between these two groups at any of the evaluation times. Conclusion. In this study of patients with emergency cesarean section, we showed that the use of supplemental oxygen does not reduce the incidence of surgical site infection. This trial is registeres with ClinicalTrials.gov NCT01340534.

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

2020 ◽  
pp. 000486742095428
Author(s):  
Lei Sun ◽  
Su Wang ◽  
Xi-Qian Li
Keyword(s):  
Postpartum Depression ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Spontaneous Vaginal Delivery ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

scholarly journals Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khaled Gomaa ◽  
Ahmed R. Abdelraheim ◽  
Saad El Gelany ◽  
Eissa M. Khalifa ◽  
Ayman M. Yousef ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Control Group ◽  
Site Infection ◽  
Incidence Risk

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

scholarly journals Relation between immediate postpartum APGAR score with umblical cord blood pH and fetal distress

2019 ◽  
Vol 8 (12) ◽  
pp. 4690
Author(s):  
Varuna Pathak ◽  
Deep Shikha Sahu
Keyword(s):  
Cesarean Section ◽  
Cord Blood ◽  
Apgar Score ◽  
Ph Value ◽  
Fetal Distress ◽  
Well Being ◽  
Emergency Cesarean Section ◽  
Medical Disorders ◽  
Blood Ph ◽  
Emergency Cesarean

Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.

scholarly journals COMPARATIVE STUDY BETWEEN OXYTOCIN AND PROSTAGLANDIN IN INDUCTION OF DELIVERY IN POST TERM PREGNANCY

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Bushra Hashim Hameed ◽  
Walaa Abdulameer Mahdi ◽  
Suhad Abbas Jasim
Keyword(s):  
Cesarean Section ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Uterine Contractility ◽  
Emergency Cesarean ◽  
Significant Difference ◽  
Uterine Hyperstimulation ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Post Term Pregnancy

Induction of delivery using medication can be performed by stimulating uterine contractility for establishing delivery prior to the start of spontaneous labor. Two most common ecbolic are Oxytocin and prostaglandins analogues (PGs) e.g. misoprostol. The study aims to compare between the effects of oxytocin & misoprostol in ripening of the cervix and induction of delivery in postdate pregnancy. Results show that the induction delivery period mean was significantly higher when using misoprostol than when using oxytocin. No significantly different results between the both groups regarding uterine hyperstimulation. No significantly different results between the both groups regarding postpartum hemorrhage. No significantly different results between the both groups regarding the mode of delivery. No significantly different results between the both groups regarding Cesarean section indication. No significantly different results between the both groups regarding the mean of Apgar score at 1 and 5 minutes. No significantly different results between the both groups regarding meconium aspiration. No significantly different results between the both groups regarding emergency Cesarean section rate due to fetal distress (pathological fetal heart rates) between the two groups. There was no significant difference between the two groups as regards the neonatal admission to the intensive care unit (N.I.C.U). It is concluded that Usage of both IV oxytocin 5 mIU/minute & vaginal misoprostol 25 µg is safe to induce delivery. It is preferable to use IV oxytocin 5 mIU/minute if the time factor is considered. Keywords: oxytocin, prostaglandin, induction of delivery, postdate pregnancy

scholarly journals Comparative study of surgical site infection with or without post cesarean prophylactic oral antibiotics; a single-blinded randomized clinical trial

2021 ◽  
Vol 7 (1) ◽  
pp. e07-e07
Author(s):  
Farzaneh Broumand ◽  
Naghmeh Zand Vakili ◽  
Zahra Yekta ◽  
Shabnam Vazifekhah
Keyword(s):  
Clinical Trial ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Intervention Group ◽  
Prophylactic Antibiotic ◽  
Maternal Diabetes ◽  
Deep Infection ◽  
Control Group ◽  
Site Infection ◽  
Emergency Cesarean

Introduction: Surgical site infection (SSI) is caused by cesarean section in the hospital and its prevalence in the studies is up to 16%. Objectives: This study aimed to compare the rate of infection in women undergoing cesarean section. Oral clindamycin and cefalexin were administered for 48 hours as prophylactic antibiotics. Patients and Methods: In this clinical trial study, women with emergency cesarean section were divided into two groups. Intervention was oral administration of cefalexin 500mg every 6 hours and clindamycin 300 mg every 6 hours for 48 hours. All participants were referred to the gynecology center on day 7–10, at the time of removal of the sutures, and within 30 days after cesarean section, to assess the presence or absence of wound infection after surgery during 30 days. Results: In this clinical trial study, 462 pregnant women undergoing cesarean section were enrolled in the intervention and control groups. Of 231 patients in the intervention group, 15 women (6.5%) had cesarean section infection (13 cases with superficial, and 2 cases with deep infection). In the control group, 45 cases (19.5%) had cesarean section infection (31 cases with superficial, 10 cases with deep, and 4 cases with developed pelvic infection) (P = 0.001). Age, pre-cesarean length of stay, pre-term incision, type of incision, discharge longer than 18 hours after cesarean section, and maternal diabetes were significantly different regarding cesarean section infection in both groups. The frequency of cesarean section infection was less in the intervention group (P <0.001). Conclusion: Administration of prophylactic antibiotic can have a significant role in reducing cesarean section infection. Trial Registration: Registration of trial protocol has been approved in Thailand registry of clinical trials (identifier: TCTR20201204002, http://www.clinicaltrials.in.th/index.php?tp=regtrials & menu=trialsearch & s-menu=fulltext & task=search & task2=view1 & id=7120, ethical code; IR.UMSU.REC.1397.323).

scholarly journals Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

2008 ◽  
Vol 29 (6) ◽  
pp. 477-484 ◽  
Author(s):  
Margaret A. Olsen ◽  
Anne M. Butler ◽  
Denise M. Willers ◽  
Preetishma Devkota ◽  
Gilad A. Gross ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Tertiary Care ◽  
University Teaching ◽  
Skin Closure ◽  
Care Hospital ◽  
Site Infection ◽  
Increased Risk ◽  
Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

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