Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections.

OBJECTIVES: Gestational IDA has been linked to adverse maternal and neonatal outcomes, but the impact of iron supplementation on outcome measures remains unclear. Our objective was to assess the effects of gestational IDA on pregnancy outcomes and compare outcomes in pregnancies treated with either oral or intravenous iron supplementation. METHODS: We evaluated maternal and neonatal outcomes in 215 pregnancies complicated with gestational IDA (Hb<100 g/L) and delivered in our tertiary unit between January 2016 and October 2018. All pregnancies from the same period served as a reference group (n=11,545). 163 anemic mothers received oral iron supplementation, and 52 mothers received intravenous iron supplementation. RESULTS: Gestational IDA was associated with an increased risk of preterm birth (10.2% vs. 6.1%, p=0.009) and fetal growth restriction (FGR) (1.9% vs. 0.3%, p=0.006). The gestational IDA group that received intravenous iron supplementation had a greater increase in Hb levels compared to those who received oral medication (18.0 g/L vs. 10.0 g/L, p<0.001), but no statistically significant differences in maternal and neonatal outcomes were detected. CONCLUSIONS: Compared to the reference group, prematurity, FGR, postpartum infections, and extended hospital stays were more common among mothers with gestational IDA, causing an additional burden on the families and the healthcare system.

Caesarean wound care for midwives.

With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who died from sepsis having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem.

Frequency and treatment of methicillin resistant Staphylococcus aureus in obstetric and gynaecological sepsis.

OBJECTIVE: To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus (MRSA) in such infections. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. METHODOLOGY: All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen (Ampicillin, Metronidazole and Gentamicin) was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. RESULTS: Staphylococcus aureus was the most frequent organism isolated in 34.6% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, (17) 77% was associated with puerperal sepsis and rest (5) 23% was associated with postoperative wound infection. It showed best sensitivity to vancomycin. CONCLUSION: Staphylococcus aureus and E. coli were common causative agent of postoperative infections and puerperal sepsis.

Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population.

OBJECTIVE: The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery. METHODS: A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (>500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections. RESULTS: A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss > 500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p > 0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p > 0.05). CONCLUSION: The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications.

Perforación uterina por mioma necrosado en el puerperio / Perforation of the uterus due to myoma infarction in the puerperium

Se presenta el caso de una puérpera que acudió a urgencias 13 días después del parto por dolor abdominal y vómitos. Ante la presencia de un abdomen agudo se realizó una laparotomía y se evidenciaron 2 miomas necrosados, uno de los cuales había perforado el útero (AU)

Mastitis today: incidence, prevention and treatment.

The study concerned 664 women of South-West Finland, and they were studied 5-12 weeks after delivery. The total frequency of mastitis in this population was much higher than generally reported in literature, 24% as opposed to 3%. The frequency of mastitis was similar among nulli- and multiparous women. The diagnosis was based on the judgement of midwives of physicians. If a multiparous woman has had mastitis during a previous puerperium, the probability of mastitis during a subsequent puerperium is threefold. The type of skin, its reaction of the sun, allergies, rashes, getting cold and oxytocin medication during delivery did nto affect the incidence of mastitis. Mothers under 21 and over 35 years of age had a decreased incidence (P = 0.034) of mastitis. If the women had sore nipples, the frequency increased (P = 0.003). Prophylaxis, by means of physical training, neither decreased nor increased the frequency of puerperal mastitis. The treatment advised by midwives and physicians was primarily conservative, but 38% received antibiotics; some of the antibiotics were not effective against staphylococcal infection.

Ciprofloxacin versus gentamicin/clindamycin for postpartum endometritis.

An open, randomized, comparative study of intravenous ciprofloxacin versus gentamicin and clindamycin was performed on women with postpartum endometritis. Ciprofloxacin alone successfully eradicated the infections in 35 of 49 patients (71%), while the combination of gentamicin/clindamycin cured 41 of 48 (85%) (P = .15). The microbiology and antibiotic sensitivity of the endometrial isolates confirmed the poor activity of ciprofloxacin against anaerobic bacteria and less-than-optimal activity against Streptococcus faecalis. Ciprofloxacin, when used alone, may not be suitable for the treatment of postpartum endometritis.

Susceptibility of female pelvic pathogens to oral antibiotic agents in patients who develop postpartum endometritis.

Fifteen hundred patients were enrolled in a prospective, randomized study on the effect of antibiotic prophylaxis during cesarean section. Two hundred thirty-one patients developed postpartum endometritis, and the isolates obtained from the endometrium were tested for sensitivity to ampicillin, cefuroxime, ofloxacin, ciprofloxacin, and clindamycin. Minimum inhibitory concentrations of 50% and 90% of ampicillin, cefuroxime, and clindamycin were similar to previously reported values; however, slight differences were noted in the activity of the two quinolones to common pelvic isolates. The minimum inhibitory concentrations of 90% of ofloxacin and ciprofloxacin to 119 isolates of Enterococcus faecalis were 4.0 and 2.0, to 17 isolates of Staphylococcus aureus 1.0 and 0.5, to 39 isolates of Escherichia coli 0.5 and 1.0, to 46 isolates of Bacteroides bivius 4.0 and 8.0, to 57 isolates of Gardnerella vaginalis 1.0 and 2.0, to 71 isolates of Staphylococcus epidermidis 0.5 and 0.5, to 16 isolates of Proteus mirabilis 0.25 and 0.12, and to 50 isolates of Lactobacillus species 32.0 and 8.0 micrograms/ml, respectively. In summary, the quinolones have activity comparable with a variety of other oral agents versus female pelvic pathogens, with the quinolones ofloxacin and ciprofloxacin having better activity against most of the gram-negative isolates. Anaerobic activities were comparable with the beta-lactams, but inferior to clindamycin and metronidazole as expected.