Evaluation of Puerperal and Postpartum Infections after Cesarean Section and Their Clinical Outcomes

Puerperal and postpartum infections after cesarean section are a leading cause of maternal and neonatal morbidity and mortality worldwide. Postpartum infections account for a significant, and often preventable, portion of the global healthcare burden. Puerperal sepsis is one of the top five causes of maternal deaths worldwide and accounts for 10% - 15% of deaths in the postpartum period. Postpartum infections also present a significant social burden: they increase maternal anxiety and the risk of postpartum depression, interfere with bonding, and negatively impact breastfeeding. To prevent complications and improve outcomes, the evaluation of these infections must be accurate and prompt. This review provided a summary of causes, clinical presentation, laboratory tests, imaging modalities, treatment options, complications, and prognosis of puerperal and postpartum infections following cesarean section. Future directions in the evaluation of these infections were also discussed, including the development of novel diagnostic assays, the use of point-of-care testing and risk factors responsible for the onset of infections. This review emphasized the significance of early diagnosis and prompted treatment of these infections in order to prevent complications and enhance maternal and neonatal outcomes. This article also provided an exhaustive overview of the evaluation and management of puerperal and postpartum infections and the clinical outcome of infections for both mother and neonate.

A Case Report: Puerperal Ovarian Cancer in a Patient with a Prior History of Fertility Treatment and Ovarian Endometrial Cyst

Introduction: It has been suggested the relationship between infertility treatment and ovarian cancer. Furthermore, endometriosis that is one of the causes of the infertility tends to develop into endometrioid adenocarcinoma and clear cell carcinoma in many studies. Case: A 38-year-old woman underwent laparoscopic enucleation of bilateral ovarian endometrial cysts at 29 and 33 years old. She then received 11 sessions of artificial insemination and 7 cycles of ovarian stimulation, egg collection,?in vitro?fertilization, and embryo transfer at multiple medical institutions before conceiving and giving birth to her first child. After naturally conceiving her second child, she presented at our hospital for pregnancy/delivery management with a right ovarian tumor. She underwent abdominal right adnexectomy for a mucinous cystic tumor of borderline malignancy at 36 years old (17 weeks of pregnancy with the second child). After vaginal delivery at 38 weeks, a 1-month postpartum checkup revealed a left adnexal mass and ascites. Further workup led to a diagnosis of left ovarian cancer. The cancer was diagnosed by ovarian biopsy as unresectable stage-IIIc endometrioid carcinoma. Despite chemotherapy, the patient developed liver metastasis during treatment and died due to worsened general condition 9 months after childbirth. In addition to ovarian endometrial cyst, repeated cycles of injury and repair of the ovarian surface epithelium are also suggested to mediate the development of epithelial ovarian cancer. Conclusion: Evaluation of long-term outcome and follow-up of patients who have undergone fertility treatment should be addressed.

Epidemiological, Clinical, Therapeutic and Prognostic Aspects of Puerperal Infections within the Gynecology Obstetrics Department of Yalgado Ouedraogo University Teaching Hospital (CHU-YO), Burkina Faso

Objective: Conduct a study about the epidemiological, clinical, therapeutic and prognostic aspects of puerperal infections within Gynecology Obstetrics department of CHU-YO during the study period. Patients and Methods: This was a cross-sectional and descriptive study. The study period was from January 1st to December 31st, 2019. Data collection was retrospective. The exhaustive sample included all female patients having a puerperal infection. Results: Our study included 65 patients. The frequency of puerperal infections represented 1% of deliveries, the average age of patients was 27 ± 7.26 years. Housewives represented 64.4% of the patients. Hyperthermia and abdominal-pelvic pain respectively occurred in 63.8% and 21.3% of patients. The patients had given birth by caesarean section in 83.1% of cases. Endometritis represented 76.9% of cases of puerperal infections. The patients were treated with antibiotics, uterotonics and symptomatic therapy. Maternal death occurred in 13.9% of cases. Conclusion: A focus should be put on preventive measures in front of any high-risk puerperal infection situation.

Determinants of Health Care Seeking Behaviors in Puerperal Sepsis in Rural Sindh, Pakistan: A Qualitative Study

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented.

Puerperal Sepsis Caused by Clostridium Innocuum in a Patient with Placenta Accreta and Literature Review

To editor:Clostridium innocuum is a gram-positive spore forming bacillus that normally exists in the oral cavity and gastrointestinal tract.Although it is a rare pathogen for humans,C.innocuum can cause sepsis,especially in patients with immunodeficiency,such as those presenting with acquired immunodeficiency syndrome,leukemia,tumors or organ transplants.Since C.innocuum is resistant to several common antibiotics(including vancomycin),it can lead to serious infection.1–5 We report a case of puerperal sepsis caused by C.innocuum in a patient with placenta accreta.The clinical characteristics of C.innocuum infection,as well as its antibiotic susceptibility,were reviewed.A treatment strategy for this rare infection was proposed.This is the first report of Puerperal sepsis caused by C.innocuum in English literature.

运动疗法对产褥期妇女的康复作用

目的 探讨运动疗法对产褥期妇女康复的影响。方法选择150例产褥期妇女(治疗组)，产后24 h起做产后康复体操，产褥期满即产后42 d进行评定，另外，选择同期150例未做产后康复体操的产褥期妇女产后42 d进行对比评定(对照组)。结果治疗组的妇妇子宫后倾后屈、子宫脱垂的发生率比对照组明显低(P< 0.01);子宫缩复不良、痔疮、张力性尿失禁、膀胱膨出、腰骶痛的发生率均比对照组低(P< 0.05);腰围的恢复亦明显优于对照组(P< 0.05)。结论运动疗法有利于妇女产后康复，可减少诸多并发症的发生，从而提高产后妇女的生存质量。

Changing picture of renal cortical necrosis in acute kidney injury in developing country

Renal cortical necrosis(RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome(HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury(AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications(septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main(60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.

Cause analysis and clinical management experience of the premature rupture of membrane

Based on the retrospective study on 189 cases of premature rupture of membrane maternity, we find that PROM can result in higher risks of dystocia, cesarean birth and maternal and fetal complications, upon examining our clinical management measures and searching for a positive clinical management , we are looking for a better way to reduce PROM and the risk of mother and child, to have a better pregnancy outcome.

Diagnosed corrected transposition of great arteries after cesarean section:A case report

BACKGROUND Corrected transposition of the great arteries(cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed.In general,this defect puts a load on the systemic circulation and causes heart failure,resulting in a poor prognosis.This article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart failure.CASE SUMMARY This was the case of a 36-year-old gravida 3 para 1 woman.No problems were noted in the puerperal course following the previous pregnancy.The current pregnancy was also uneventful.An elective caesarean section was performed and the patient was discharged from the hospital 7 d after the operation.On postoperative day 18,the patient became aware of breathing difficulty and presented at a nearby clinic,where she was referred to our institution after bilateral pleural effusions were detected.She was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO_(2) 91%(supine position and room air);the patient was promptly hospitalised for close examination and treatment.Although chest computed tomography revealed the presence of cTGA,no other cardiac malformations were observed.Owing to improvements in both the pedal oedema and pleural effusions,the patient was discharged on day 9.CONCLUSION Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.

Overview of Research on Zhuangyi in Treating Gynecological Pain

Pain Syndrome is a kind of unpleasant subjective feeling caused by poor Qi and blood circulation for many factors inside and outside the body or physical examination found abnormal signs,which is widely scattered in clinical departments.In recent years,Zhuangyi has made much progress in the treatment of gynecological pain diseases,and its curative effect has unique advantages,especially for gynecological diseases such as dysmenorrhea,pelvic inflammatory disease and mammary gland hyperplasia,for the treatment of gynecological diseases of pain,bruising has a significant effect.The characteristic therapy of Zhuangyi has various kinds with obvious characteristics,safe operation,remarkable effect and wide application prospect.

Safety of Internal Electronic Fetal Heart Rate Monitoring During Labor

Objective:To investigate the safety and efficacy of internal electronic fetal heart rate(FHR)monitoring during labor.Methods:This was a retrospective case-control study,which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe(94 pregnant women per group).In the internal monitoring group,when the opening of the uterine orifice was≥3 cm,the fetal scalp electrode was placed after natural or artificial rupture of the membrane.FHR was simultaneously monitored using a Doppler probe.In the external monitoring group,continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen.The toco transducer was used to record uterine contractions.Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group,respectively.Maternal-infant outcomes(e.g.fever,puerperal infection,puerperal morbidity,delivery mode,Apgar score,and scalp injury)were recorded.Umbilical artery blood was extracted for blood gas analysis.Differences between the two groups were compared using the pairedt-test,χ^(2) test,Yates correctedχ^(2) test or Fisher exact test.Results:Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis(1/94(1.06%)vs.3/94(3.19%),respectively;χ^(2)=0.255,P=0.613),cesarean section/operative vaginal delivery(8/94(8.51%)vs.15/94(15.96%),respectively;χ^(2)=2.427,P=0.181),fever during labor(18/94(19.15%)vs.15/94(15.96%),respectively;χ^(2)=0.331,P=0.565),puerperal morbidity(2/94(2.13%)vs.3/94(3.19%),respectively;χ^(2)=0.000,P=1.000),chorioamnionitis(9/49(18.37%)vs.7/48(14.58%),respectively;χ^(2)=0.252,P=0.616),and neonatal asphyxia(0/94(0.00%)vs.1/94(1.06%),respectively;χ^(2)=0.000,P=1.000).There were no puerperal infections,neonatal scalp injuries,or scalp abscesses found in either group.Using the internal monitoring value as reference,the incidence of FHR false deceleration in external FHR monitoring was 20.21%(19/94 women).Conclusion:Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes.External monitoring was associated with FHR false decelerations.

Cesarean delivery on maternal request: an overview in China

In recent years, the cesarean section rate has been high. Because of the lack of research on cesarean section without medical indication, the surgery is facing huge risks. To compensate for the lack of domestic-related research, and help clinicians to weigh the pros and cons of cesarean section, the paper reviews the reasons for cesarean delivery on maternal request （CDMR） and the advantages and disadvantages of CDMR so as to put forward constructive advice.

Analyses of levels of thyroid hormones and its receptor expression in puerperants and newborns from an e-waste dismantling site

In this study,the serum levels,including thyr-oid hormones free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)among the sub-jects from the exposed group(n 548)and the control group(n 545)were detected by immuno radiometric assay(IRMA).The expression levels of TRa1,TRb1,TSHR mRNA in placentas and umbilical cords were detected by fluorescent quantitative real-time PCR(FQ-PCR).The correlations between the thyroid hormone levels in maternal serum and umbilical serum,and between the expression levels of its receptors mRNA in placentas and umbilical cords were determined.We found that the FT4 levels of both maternal serum and umbilical cord serum in the exposed group were lower than those in the control(P<0.05).However,the increased TSH levels in the exposed group had statistically significance com-pared to those in the control group(P<0.05).The TRa1 and TRb1 mRNA levels both in placentas and umbilical cords in the exposed group were lower than those in the control group(P<0.05 and 0.01).How-ever,the TSHR mRNA levels in the exposed group were significantly different compared to those in the control group(P<0.01).The serum FT4 and TSH levels of par-turient women were positively correlated with those of the newborns in both groups(P<0.05 and 0.01).The mRNA levels of TRa1,TRb1 and TSHR in the placentas were positively correlated with those in umbilical cords in both groups(P<0.01).The findings suggest that some envir-onmental pollutants existing in the electronic waste(e-waste)dismantling region may affect the health of local parturient women and newborns,representing changes both in serum levels of thyroid hormones and in mRNA expression of its receptors.

Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges

Objective To describe the challenges in diagnosing concealed postpartum bleeding,a rare but potentially life-threatening condition,and to highlight key factors in identifying and managing this condition.Methods We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected,focusing on the role of imaging,serologic markers,and angiography.We examined instances of hemodynamic instability,the utility of pelvic space analysis via computed tomography,and the limitations of digital angiography,particularly in identifying bleeding sources in the posterior iliac internal artery division.Results Concealed postpartum bleeding often originates from venous damage or,less commonly,arterial injury.Hemodynamic instability was noted to occur periodically,despite negative findings on vaginal examination and ultrasound,leading to diagnostic delays.Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery.Bleeding typically arises from damage to the vaginal muscular layer or levator ani muscle,both supplied by branches of the internal pudendal artery(posterior iliac division).In some cases,laparotomy also failed to locate the source due to the bleeding being in the subperitoneal spaces.Conclusion Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results.A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are crucial.Advanced expertise,along with serologic markers of hidden bleeding,is essential for timely diagnosis and management.