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Cochrane Database Syst Rev ; 3: CD008726, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661539


BACKGROUND: Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects.  OBJECTIVES: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant. SEARCH METHODS: For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register,, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section.  RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'.   We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes. AUTHORS' CONCLUSIONS: Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.

Antibacterianos/uso terapêutico , Infecções Bacterianas/prevenção & controle , Cefalosporinas/uso terapêutico , Cesárea/efeitos adversos , Penicilinas/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Antibacterianos/efeitos adversos , Antibacterianos/classificação , Antibioticoprofilaxia/métodos , Cefalosporinas/efeitos adversos , Feminino , Humanos , Recém-Nascido , Penicilinas/efeitos adversos , Gravidez , Infecção Puerperal/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de beta-Lactamases/uso terapêutico
Rev. enferm. UFPE on line ; 15(1): [1-13], jan. 2021. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1147654


Objetivo: analisar a associação entre infecção de sítio cirúrgico pós-cesariana e idade materna. Método: estudo quantitativo, retrospectivo, realizado com 692 prontuários de puérperas pós-cesárea atendidas em hospital do Extremo Oeste de Santa Catarina, Brasil, no período de 2015 a 2017. Os dados foram analisados por meio de análises de prevalência, qui-quadrado de Pearson ou exato de fisher, teste de Mann Whitney e avaliação do risco relativo. Resultados: a taxa global de infecção nas puérperas foi de 4,6%, contudo, nas mulheres com mais de 35 anos de idade, a taxa foi de 5,3%. Ao comparar a média de idade das puérperas em relação à presença de indicadores de infecção de sítio cirúrgico, identificou-se diferença significativa nas variáveis dor ou aumento de sensibilidade na incisão cirúrgica e hiperemia e/ou vermelhidão na incisão cirúrgica. Conclusão: identificou-se diferença estatística significativa nas médias de idade, na presença de indicadores de infecção, sendo que mulheres que desenvolveram a ISC apresentaram média de idade maiores, além disso, observou-se que mulheres em idade avançada (>35 anos) apresentaram prevalências maiores em relação às taxas de infecção de sítio cirúrgico global em relação as demais faixas etárias.(AU)

Objective: to analyze the association between post-cesarean surgical site infection and maternal age. Method: quantitative retrospective study performed with 692 medical records of post-cesarean women admitted to a hospital in the West of Santa Catarina, Brazil, from 2015 to 2017. Data were analyzed using prevalence analyzes, Pearson's chi-square or Fisher's exact test, Mann Whitney test, and relative risk assessment. Results: the overall infection rate in puerperal women was 4.6%. However, in women aged over 35 years, the rate was 5.3%. When testing associations between average age and surgical site infection indicators, a significant difference was identified in the variables pain or increased sensitivity in the surgical incision, and hyperemia and/or redness in the surgical incision. Conclusion: a statistically significant difference was identified in the mean age concerning the presence of infection indicators, and women who developed SSI had a higher mean age. In addition, it was observed that women with advanced age (> 35 years) had higher prevalence of infection based on global surgical site infection rates than those belonging to other age groups.(AU)

Objetivo: analizar la asociación entre la infección del sitio quirúrgico poscesárea y la edad materna. Método: estudio cuantitativo, retrospectivo, realizado con 692 historias clínicas de madres poscesáreas atendidas en un hospital del Lejano Oeste de Santa Catarina, Brasil, en el período de 2015 a 2017. Los datos fueron analizados mediante análisis de prevalencia, chi -cuadrado de la prueba de Mann Whitney exacta de Pearson o Fisher y la evaluación del riesgo relativo. Resultados: la tasa global de infección en las puérperas fue del 4,6%, sin embargo, en las mujeres mayores de 35 años la tasa fue del 5,3%. Al comparar la edad promedio de las madres en relación con la presencia de indicadores de infección del sitio quirúrgico, se identificó diferencia significativa en las variables dolor o aumento de sensibilidad en la incisión quirúrgica e hiperemia y / o enrojecimiento en la incisión quirúrgica. Conclusión: se identificó una diferencia estadísticamente significativa en la edad media, en presencia de indicadores de infección, y las mujeres que desarrollaron ISQ tenían una edad promedio más alta, además, se observó que las mujeres de edad avanzada (> 35 años) presentaron mayores prevalencias en relación con las tasas de infección del sitio quirúrgico global en relación con los otros grupos de edad.(AU)

Humanos , Feminino , Gravidez , Adolescente , Adulto , Infecção Puerperal , Infecção da Ferida Cirúrgica , Cesárea , Idade Materna , Período Pós-Parto , Registros Médicos , Estudos Retrospectivos
Ann Afr Med ; 19(2): 103-112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499466


Background: Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Chi-square test and Fisher's exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects.

Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Infecções Bacterianas/prevenção & controle , Cesárea/efeitos adversos , Ácido Clavulânico/administração & dosagem , Metronidazol/administração & dosagem , Infecção Puerperal/prevenção & controle , Adulto , Antibioticoprofilaxia/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hospitais de Ensino , Humanos , Nigéria , Gravidez , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
Acta Obstet Gynecol Scand ; 99(7): 819-822, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32386441


The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non-pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty-three women aged 20-45 years with SARS-CoV-2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory-confirmed SARS-CoV-2 in Sweden, compared with non-pregnant women of similar age.

Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Cuidados Críticos , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Infecção Puerperal , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Infecção Puerperal/epidemiologia , Infecção Puerperal/fisiopatologia , Infecção Puerperal/terapia , Infecção Puerperal/virologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Suécia/epidemiologia
Postgrad Med ; 132(6): 526-531, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32379557


Background: Streptococcal Toxic Shock Syndrome (STSS) is a serious condition that can arise from streptococcal postpartum endometritis. It is associated with a substantial increase in mortality rate and can rarely result in multiorgan infarction. Early recognition plays a vital role in patients' outcome. Objective: To report a case of complicated STSS and review the literature for previous case reports of streptococcal postpartum endometritis to determine if STSS diagnostic criteria (published by the Centers for Disease Control and Prevention) were fulfilled. Case presentation: This is a 41-year-old woman who presented 5 days after an uncomplicated vaginal delivery with endometritis complicated by invasive group A ß-hemolytic streptococcus (GAS) infection and confirmed toxic shock syndrome. The patient was initially admitted to the critical care unit due to hemodynamic compromise requiring intravenous (IV) fluids, IV antibiotic therapy with penicillin and clindamycin, and IV immunoglobulin therapy. The patient subsequently developed multi-organ infarctions, acute respiratory distress syndrome requiring noninvasive respiratory support, and severe reactive arthritis. Literature review revealed 15 case reports of GAS postpartum endometritis, five met criteria for confirmed STSS. One patient died from severe septic shock leading to cardiopulmonary arrest. Thirteen out of 15 cases of postpartum endometritis occurred after uncomplicated vaginal delivery. Conclusion: STSS is a serious and possibly fatal medical condition that requires early diagnosis and treatment to prevent poor patient outcomes and death. Careful consideration to the patient's postpartum clinical presentation with the implementation of an intradisciplinary approach should be utilized.

Antibacterianos , Artrite Reativa , Endometrite , Rim , Infecção Puerperal , Infarto do Baço/diagnóstico por imagem , Infecções Estreptocócicas , Streptococcus pyogenes/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Artrite Reativa/etiologia , Artrite Reativa/terapia , Endometrite/microbiologia , Endometrite/fisiopatologia , Endometrite/terapia , Feminino , Hidratação/métodos , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Oxigenoterapia/métodos , Infecção Puerperal/microbiologia , Infecção Puerperal/fisiopatologia , Infecção Puerperal/terapia , /terapia , Choque Séptico/microbiologia , Choque Séptico/fisiopatologia , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/fisiopatologia , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
Wien Med Wochenschr ; 170(11-12): 293-302, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32130558


Ignaz Semmelweis' (1818-1865) discovery of the endemic causes of febris puerperalis is a striking example of the role of pathology in medicine. Transdisciplinarity encounters Semmelweis' biography, which is neither linear nor totally focused on medicine. He completed the philosophicum (artisterium), studying the septem artes liberales (1835-1837) in Pest, comprising humanities and natural science. After moving to Vienna, he began to study law, but turned to medicine as early as 1838. In 1844, he graduated with a botanical doctoral thesis composed in Neo-Latin, showing linguistic and stylistic talent and a broad knowledge of gynecology and obstetrics. The style and topoi demonstrate the interchangeability of what he learnt during his propaedeuticum. Nowadays, hardly anyone is familiar with this booklet, for two main reasons: the language choice and the life-saving impact of the physician's opus magnum on the reasons for puerperal fever (Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers). In later life, he became convinced that he had no talent as a (scientific) author-a fatal error that led him to become a victim of what we now call "publish or perish." Semmelweis had felt rejected for years. This negative feeling was the reason for his decision not to publish his great book for 14 years. When it finally went to the printer in 1861, the scientific community did not accept it. This experience caused psychosomatic symptoms owing to his long-standing and deeply felt disappointment. Bad conscience tortured him. This permanent stress destroyed his health: in 1865, his relatives (including his wife) and friends took him from Budapest to Vienna. He thought he was going to spend some time relaxing, but in fact was led into a newly built asylum for the mentally ill, the Niederösterreichische Landesirrenanstalt. When he realized what was happening, he tried to escape. Badly abused, he died from sepsis caused by open wounds and a dirty straightjacket 2 weeks later. This article will show Semmelweis to be a multilingual author of scientific literature and (open) letters; it will present him as a researcher who became a victim of harassment and what is referred to as the "Semmelweis reflex" ("Semmelweis effect"); and it will focus on his afterlife in (children's) literature, drama, and film.

Obstetrícia , Médicos , Infecção Puerperal , Feminino , Febre , História do Século XIX , Humanos , Obstetrícia/história , Gravidez , Infecção Puerperal/terapia
Cochrane Database Syst Rev ; 3: CD004455, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32215906


BACKGROUND: Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. This is an update of a review last published in 2017. OBJECTIVES: To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps delivery, or both. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register,, the WHO International Clinical Trials Registry Platform (ICTRP) (5 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA: All randomised controlled trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium). DATA COLLECTION AND ANALYSIS: Two review authors assessed trial eligibility and risk of bias. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the two included studies using the GRADE approach. MAIN RESULTS: Two studies, involving 3813 women undergoing either vacuum or forceps deliveries, were included. One study involving 393 women compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. The other study involving 3420 women compared a single dose of intravenous amoxicillin and clavulanic acid with placebo using 20 mL of intravenous sterile 0.9% saline. The evidence suggests that prophylactic antibiotics reduce superficial perineal wound infection (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.40 to 0.69; women = 3420; 1 study; high-certainty evidence), deep perineal wound infection (RR 0.46, 95% CI 0.31 to 0.69; women = 3420; 1 study; high-certainty evidence) and probably reduce wound breakdown (RR 0.52, 95% CI 0.43 to 0.63; women = 2593; 1 study; moderate-certainty evidence). We are unclear about the effect on organ or space perineal wound infection (RR 0.11, 95% CI 0.01 to 2.05; women = 3420; 1 study) and endometritis (average RR 0.32, 95% CI 0.04 to 2.64; 15/1907 versus 30/1906; women = 3813; 2 studies) based on low-certainty evidence with wide CIs that include no effect. Prophylactic antibiotics probably lower serious infectious complications (RR 0.44, 95% CI 0.22 to 0.89; women = 3420; 1 study; high-certainty evidence). They also have an important effect on reduction of confirmed or suspected maternal infection. The two included studies did not report on fever or urinary tract infection. It is unclear, based on low-certainty evidence, whether prophylactic antibiotics have any impact on maternal adverse reactions (RR 2.00, 95% CI 0.18 to 22.05; women = 2593; 1 study) and maternal length of stay (MD 0.09 days, 95% CI -0.23 to 0.41; women = 393; 1 study) as the CIs were wide and included no effect. Prophylactic antibiotics slightly improve perineal pain and health consequences of perineal pain and probably reduce costs. Prophylactic antibiotics did not have an important effect on dyspareunia (difficult or painful sexual intercourse) or breastfeeding at six weeks. Antibiotic prophylaxis may slightly improve maternal hospital re-admission and maternal health-related quality of life. Neonatal adverse reactions were not reported in any included trials. AUTHORS' CONCLUSIONS: Prophylactic intravenous antibiotics are effective in reducing infectious puerperal morbidities in terms of superficial and deep perineal wound infection or serious infectious complications in women undergoing operative vaginal deliveries without clinical indications for antibiotic administration after delivery. Prophylactic antibiotics slightly improve perineal pain and health consequences of perineal pain, probably reduce the costs, and may slightly reduce the maternal hospital re-admission and health-related quality of life. However, the effect on reduction of endometritis, organ or space perineal wound infection, maternal adverse reactions and maternal length of stay is unclear due to low-certainty evidence. As the evidence was mainly derived from a single multi-centre study conducted in a high-income setting, future well-designed randomised trials in other settings, particularly in low- and middle-income settings, are required to confirm the effect of antibiotic prophylaxis for operative vaginal delivery.

Antibioticoprofilaxia , Extração Obstétrica/efeitos adversos , Infecção Puerperal/prevenção & controle , Doenças Vaginais/prevenção & controle , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/efeitos adversos , Cefotetan/uso terapêutico , Endometrite/prevenção & controle , Episiotomia/efeitos adversos , Feminino , Humanos , Tempo de Internação , Forceps Obstétrico , Períneo/lesões , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/prevenção & controle , Vácuo-Extração/efeitos adversos
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716


PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.

Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
Rev. inf. cient ; 99(1): 12-19, ene.-feb. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1093925


RESUMEN Introducción: La sepsis y el choque séptico representan una de las complicaciones más graves durante el puerperio. Objetivos: Identificar los factores asociados a la presentación de sepsis puerperal en las pacientes que ingresaron en el Servicio de Cuidados Intensivos del Hospital General Docente "Dr. Agostinho Neto" durante el período 2017-2018. Método: Se realizó un estudio explicativo-observacional, longitudinal, retrospectivo y tipo caso control. Resultados: La endomiometritis fue la principal causa de ingreso con el 79,5 %. Las variables que se comportaron como predictoras de sepsis puerperal fueron la paridad-multípara, la edad gestacional menor de 37 semanas, el parto por cesárea, el antecedente de preclampsia, de sepsis vaginal y sepsis urinaria, la rotura prematura de membranas y el trabajo de parto mayor a 12 horas. Las variables que constituyeron factores de riesgo independiente para la morbilidad por sepsis grave fueron el exceso de base <- 4 (OR=11,9; IC 95 %; 3,9-35,3; p<0,05) la proteína C reactiva >8 mg/L (OR=9,67; IC 95 %; 5,9-14,24), la SatO2< 75 (OR=6,35; IC 95 %; 1,72-23,4), el anión gap >16 mmol/L (OR=5,88; IC 95 %; 3,86-8,97), el APACHE II y la escala SOFA (Sequential Organ Failure Assessment) al ingreso con el (OR=2,57; IC 95 %; 0,97-6,80) y el (OR=2,67; IC 95 %; 1,95-3,66), respectivamente. Conclusiones: La sepsis puerperal significa una problemática en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo, por lo que su reconocimiento y tratamiento adecuados son las claves para disminuir la morbilidad por esta causa.

ABSTRACT Introduction: Sepsis and septic shock represent one of the most serious complications during the puerperium. Objective: To identify the factors associated with the presentation of puerperal sepsis in patients admitted to the Intensive Care Service of the General Teaching Hospital "Dr. Agostinho Neto" during the 2017-2018 period. Method: An explanatory, observational, longitudinal, retrospective and case-control study was conducted. Results: Endomyometritis was the main cause of admission with 79.5%. The variables that behaved as predictors of puerperal sepsis were multiparous parity, gestational age under 37 weeks, delivery by caesarean section, history of preclampsia, vaginal sepsis and urinary sepsis, premature rupture of membranes and work of delivery greater than 12 hours. The variables that constituted independent risk factors for severe sepsis morbidity were base excess <- 4 (OR=11.9; 95% CI; 3.9-35.3; p <0.05) protein C reactive> 8 mg/L (OR=9.67; 95% CI; 5.9-14.24), SatO2 <75 (OR=6.35; 95% CI; 1.72-23.4), the gap anion> 16 mmol/L (OR=5.88; 95% CI; 3.86-8.97), APACHE II and the SOFA (Sequential Organ Failure Assessment) scale upon admission with (OR=2, 57; 95% CI; 0.97-6.80) and (OR=2.67; 95% CI; 1.95-3.66), respectively. Conclusions: Puerperal sepsis means a problem at the "Dr. Agostinho Neto" General Teaching Hospital in Guantanamo, so that its recognition and adequate treatment are the keys to reducing morbidity from this cause.

RESUMO Introdução: Sepse e choque séptico representam uma das complicações mais graves durante o puerpério. Objetivo: Identificar os fatores associados à apresentação de sepse puerperal em pacientes internados no Serviço de Terapia Intensiva do Hospital Geral de Ensino "Dr. Agostinho Neto" no período 2017-2018. Método: Estudo explicativo, observacional, longitudinal, retrospectivo e caso-controle. Resultados: A endomiometrite foi a principal causa de admissão com 79,5%. As variáveis que se comportaram como preditores de sepse puerperal foram: paridade multípara, idade gestacional abaixo de 37 semanas, parto por cesariana, história de pré-eclâmpsia, sepse vaginal e sepse urinária, ruptura prematura de membranas e trabalho de parto. entrega superior a 12 horas. As variáveis que constituíram fatores de risco independentes para morbidade grave por sepse foram excesso de base <- 4 (OR=11,9; IC 95%; 3,9-35,3; p<0,05) proteína C reativo> 8 mg/L (OR=9,67; IC 95%; 5,9-14,24), SatO2 <75 (OR=6,35; IC 95%; 1,72-23,4), o ânion de gap> 16 mmol/L (OR=5,88; IC 95%; 3,86-8,97), APACHE II e SOFA (Sequential Organ Failure Assessment) na admissão com (OR=2, 57; IC95%; 0,97-6,80) e (OR=2,67; IC95%; 1,95-3,66), respectivamente. Conclusões: Sepse puerperal representa um problema no Hospital Geral Dr. Agostinho Neto, em Guantánamo, para que seu reconhecimento e tratamento adequado sejam as chaves para reduzir a morbidade por essa causa.

Humanos , Feminino , Infecção Puerperal/etiologia , Fatores de Risco , Estudos de Casos e Controles , Estudos Retrospectivos , Estudos Longitudinais , Estudo Observacional
Am J Obstet Gynecol ; 223(2): 252.e1-252.e14, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31962107


BACKGROUND: Fragmentation of care, wherein a patient is readmitted to a hospital different from the initial point of care, has been shown to be associated with worse patient outcomes in other medical specialties. However, postpartum fragmentation of care has not been well characterized in obstetrics. OBJECTIVE: To characterize risk for and outcomes associated with fragmentation of postpartum readmissions wherein the readmitting hospital is different than the delivery hospital. METHODS: The 2010 to 2014 Nationwide Readmissions Database was used for this retrospective cohort study. Postpartum readmissions within 60 days of delivery hospitalization discharge for women aged 15-54 years were identified. The primary outcome, fragmentation, was defined as readmission to a different hospital than the delivery hospital. Hospital, demographic, medical, and obstetric factors associated with fragmented readmission were analyzed. Adjusted log-linear models were performed to analyze risk for readmission with adjusted risk ratios and 95% confidence intervals as the measures of effect. The associations between fragmentation and secondary outcomes including (1) length of stay >90th percentile, (2) hospitalization costs >90th percentile, and (3) severe maternal morbidity were determined. Whether specific indications for readmission such as hypertensive diseases of pregnancy, wound complications, and other conditions were associated with higher or lower risk for fragmentation was analyzed. RESULTS: From 2010 to 2014, 141,276 60-day postpartum readmissions were identified, of which 15% of readmissions (n = 21,789) occurred at a hospital different from where the delivery occurred. Evaluating individual readmission indications, fragmentation was less likely for hypertension (11.1%), wound complications (10.7%), and uterine infections (11.0%), and more likely for heart failure (28.6%), thromboembolism (28.4%), and upper respiratory infections (33.9%) (P < .01 for all). In the adjusted analysis, factors associated with fragmentation included public insurance compared to private insurance (Medicare: adjusted risk ratio, 1.68; 95% confidence interval, 1.52, 1.86; Medicaid: adjusted risk ratio, 1.28; 95% confidence interval, 1.24, 1.32). Fragmentation was associated with increased risk for severe maternal morbidity during readmissions in both unadjusted (relative risk, 1.84; 95% confidence interval, 1.79, 1.89) and adjusted (adjusted risk ratio, 1.81; 95% confidence interval, 1.76, 1.86) analyses. In adjusted analyses, fragmentation was also associated with increased risk for length of stay >90th percentile (relative risk, 1.48; 95% confidence interval, 1.42-1.54) and hospitalization costs >90th percentile (adjusted risk ratio, 1.74; 95% confidence interval, 1.67, 1.81). CONCLUSION: This study of nationwide estimates of postpartum fragmentation found discontinuity of postpartum care was associated with increased risk for severe morbidity, high costs, and long length of stay. Reduction of fragmentation may represent an important goal in overall efforts to improve postpartum care.

Continuidade da Assistência ao Paciente/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Período Pós-Parto , Infecção Puerperal/epidemiologia , Tromboembolia/epidemiologia , Adolescente , Adulto , Parto Obstétrico , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente , Gravidez , Transtornos Puerperais/epidemiologia , Infecções Respiratórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
BMC Pregnancy Childbirth ; 20(1): 37, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937285


BACKGROUND: A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. METHODS: Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. RESULTS: Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. CONCLUSIONS: Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

Cesárea/estatística & dados numéricos , Coagulação Intravascular Disseminada/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Infecção Puerperal/epidemiologia , Sepse/epidemiologia , Cirurgiões/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Cirurgia Geral , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Modelos Logísticos , Novo Brunswick/epidemiologia , Obstetrícia , Razão de Chances , Hemorragia Pós-Operatória/epidemiologia , Gravidez , Infecção da Ferida Cirúrgica/epidemiologia
Sex Transm Infect ; 96(5): 322-329, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31836678


BACKGROUND: Genital chlamydia infection in women is often asymptomatic, but may result in adverse outcomes before and during pregnancy. The purpose of this study was to examine the strength of the relationships between chlamydia infection and different reproductive health outcomes and to assess the certainty of the evidence. METHODS: This review was registered and followed the Cochrane guidelines. We searched three databases to quantitatively examine adverse outcomes associated with chlamydia infection. We included pregnancy and fertility-related outcomes. We performed meta-analyses on different study designs for various adverse outcomes using unadjusted and adjusted analyses. RESULTS: We identified 4730 unique citations and included 107 studies reporting 12 pregnancy and fertility-related outcomes. Sixty-eight studies were conducted in high-income countries, 37 studies were conducted in low-income or middle-income countries, and 2 studies were conducted in both high-income and low-income countries. Chlamydia infection was positively associated with almost all of the 12 included pregnancy and fertility-related adverse outcomes in unadjusted analyses, including stillbirth (OR=5.05, 95% CI 2.95 to 8.65 for case-control studies and risk ratio=1.28, 95% CI 1.09 to 1.51 for cohort studies) and spontaneous abortion (OR=1.30, 95% CI 1.14 to 1.49 for case-control studies and risk ratio=1.47, 95% CI 1.16 to 1.85 for cohort studies). However, there were biases in the design and conduct of individual studies, affecting the certainty of the overall body of evidence. The risk of adverse outcomes associated with chlamydia is higher in low-income and middle-income countries compared with high-income countries. CONCLUSION: Chlamydia is associated with an increased risk of several pregnancy and fertility-related adverse outcomes in unadjusted analyses, especially in low-income and middle-income countries. Further research on how to prevent the sequelae of chlamydia in pregnant women is needed. TRIAL REGISTRATION NUMBER: CRD42017056818.

Infecções por Chlamydia/epidemiologia , Infertilidade Feminina/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Chlamydia trachomatis , Endometrite/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Nascimento Prematuro/epidemiologia , Infecção Puerperal/epidemiologia , Infecções do Sistema Genital/epidemiologia , Natimorto/epidemiologia
J Matern Fetal Neonatal Med ; 33(4): 577-582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29973085


Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use.Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation.Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn't find any significant risk factors associated with treatment change following the CT scan.Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.

Febre/diagnóstico por imagem , Infecção Puerperal/diagnóstico por imagem , Adulto , Feminino , Febre/terapia , Humanos , Gravidez , Infecção Puerperal/terapia , Radiografia Abdominal , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
Am J Perinatol ; 37(4): 436-452, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30818401


OBJECTIVE: This study aimed to develop a core outcome set of primary outcomes for studies involving cesarean deliveries with infectious morbidity outcomes. STUDY DESIGN: Authors reported primary outcomes from 11 Cochrane systematic reviews (SRs), 12 other SRs, and 327 randomized controlled trials (RCTs). These outcomes were condensed into 20 primary outcome groups. Next, a modified Delphi technique was used to gain consensus on key outcomes. Authors from included SRs were sent a questionnaire consisting of a free response and multiple-choice questions. These data were used to propose a set of core outcomes. RESULTS: The most frequent outcomes in RCTs were composite "infectious outcomes" (24%) with the second most common being endometritis (12%). The most common reported SR outcomes were wound infection (21%) and endometritis (16%). For the Delphi survey free response portion, wound infection (88%) and endometritis (79%) were the most commonly endorsed outcomes. Chosen list outcomes were maternal mortality (83%), wound infection (83%), wound complications (86%), and postpartum endometritis (80%). The proposed final core outcome set for cesarean trials was endometritis (primary outcome), maternal mortality, wound infection, wound complications, febrile morbidity, and neonatal morbidity. CONCLUSION: Utilizing defined core outcomes in all studies of cesarean section can harmonize trial reports and allow data synthesis for meta-analyses.

Cesárea/efeitos adversos , Endometrite/etiologia , Transtornos Puerperais/etiologia , Infecção Puerperal/etiologia , Infecção da Ferida Cirúrgica/etiologia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Técnica Delfos , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/etiologia , Gravidez , Revisões Sistemáticas como Assunto
Rev. esp. med. prev. salud pública ; 25(1/2): 34-38, 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197522


A lo largo del siglo XIX se produjeron numerosos cambios históricos, políticos, sociales y médicos. Uno de los protagonistas de los avances médicos fue Ignaz Philipp Semmelweis, quien estudió las posibles causas de las altas tasas fiebre puerperal de la época. Semmelweis, tras el fallecimiento de un amigo suyo por un corte accidental, llegó a la conclusión de que las exploraciones médicas eran la principal causa de contagio de la fiebre puerperal. En 1850 Semmelweis expuso sus ideas en una conferencia científica, aunque muchos médicos de la época las rechazaron al no haberse demostrado en diversos experimentos. Carl Braun continuó con los estudios de Semmelweis y propuso que la fiebre puerperal se producía por la transmisión de microorganismos, idea que también fue ampliamente rechazada. Semmelweis falleció en 1865 sin poder ver la importancia de sus trabajos para la prevención de la transmisión de enfermedades a través del lavado de manos

During the 19th century some historical, political, social and medical changes took place. One of the principal actors of these medical changes was Ignaz Philipp Semmelweis, who studied possible causes of puerperal fever at that time. Semmelweis, as a result of the death of a friend of his due to an accidental cut, concluded that medical explorations were the main cause of transmission of puerperal fever. In 1850 Semmelweis exposed his ideas in a scientific conference but they were rejected as they had not been demonstrated in several experiments. Carl Braun continued Semmelweis' studies and he stated that puerperal fever occured as a result of transmission of microorganisms al-though this idea was also rejected. Semmelweis died in 1865 without knowing the importance of his work in terms of diseases prevention through hand hygiene

Humanos , História do Século XIX , Infecção Puerperal/história , Infecção Puerperal/prevenção & controle , Higiene das Mãos/história , Higiene das Mãos/métodos , Retratos como Assunto , Obstetrícia/história
PLoS One ; 14(12): e0226673, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856242


BACKGROUND: Postpartum infections are a common cause of morbidity after childbirth. Vitamin D deficiency has been shown to increase the risk for several infections in a non-pregnant population. Vitamin D deficiency has been described as common in pregnant women. OBJECTIVE: To investigate whether vitamin D deficiency in pregnant women in labor was associated with an increased risk of overall postpartum infectious morbidity within eight weeks of delivery. A secondary aim was to estimate the prevalence of vitamin D deficiency among pregnant women in Linköping, Sweden at the time of delivery. MATERIAL AND METHODS: Serum vitamin D levels in labor were analyzed for 1397 women. Vitamin D deficiency was defined as serum levels <50 nmol/L. All ICD-10 codes given to the women eight weeks postpartum were reviewed and postpartum infections were defined as the presence of an ICD-10 code suggestive of infection. The prevalence of postpartum infections among women with sufficient vitamin D levels was compared with women with vitamin D deficiency. Adjusted Odds Ratios and 95% confidence intervals for postpartum infections were calculated using multivariate logistic regression analysis. RESULTS: Fifty eight per cent of the women had serum vitamin D levels <50 nmol/L. The proportion of women with vitamin D deficiency varied, as expected, with season. No association between vitamin D deficiency and postpartum infections was found. For vitamin D 25-50 nmol/L the adjusted Odds Ratio was 0.85 (95% confidence interval 0.56-1.29) and for vitamin D <25 nmol/L the adjusted Odds Ratio was 1.15 (95% confidence interval 0.66-2.03). Women who smoked or who had a cesarean section had an increased risk of postpartum infections. CONCLUSIONS: Vitamin D deficiency was more common than previously reported in Swedish pregnant women. No association between vitamin D deficiency and postpartum infections was found. Other well-known risk factors for postpartum infection were identified.

Infecção Puerperal/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Infecção Puerperal/sangue , Suécia , Vitamina D/sangue , Deficiência de Vitamina D/sangue
Enferm. actual Costa Rica (Online) ; (37): 16-29, Jul.-Dez. 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1039753


Resumo Objetivou-se identificar ocorrências de infecção do sítio cirúrgico pós-cesárea em uma maternidade. Trata-se de um estudo transversal retrospectivo com abordagem quantitativa desenvolvido em uma maternidade pública de referência em obstetrícia localizada na Região Nordeste do Brasil. A amostra constou de 53 prontuários de mulheres com infecção no sítio cirúrgico pós-cesárea no período de 2010 a 2013 e o instrumento de coleta de dados foi um formulário estruturado. Os dados foram analisados em software estatístico Statistical Package for the Social Sciences versão 20.0 apresentados na forma descritiva com frequências e percentuais. Os resultados mostraram taxa de infecção no sítio cirúrgico pós-cesárea de 2,92%; as usuárias apresentaram como fatores de risco baixa escolaridade, ocorrência de infecção urinária, hipertensão arterial, obesidade e tabagismo. Observou-se que a taxa de infecção no sítio cirúrgico pós-cesárea e fatores de risco identificados ressaltam a necessidade de investigação prévia e registro destes com cuidados preventivos de orientação e preparo das usuárias de forma segura com protocolos que direcionem condutas mais uniformes no tratamento destas infecções.

Resumen El objetivo fue identificar casos de infección del sitio quirúrgico post cesárea en una maternidad. Se trata de un estudio transversal retrospectivo con abordaje cuantitativo desarrollado en una maternidad pública de referencia en obstetricia localizada en la Región Noreste de Brasil. La muestra constó de 53 prontuarios de mujeres con infección en el sitio quirúrgico post-cesárea en el período de 2010 a 2013 y el instrumento de recolección de datos fue un formulario estructurado. Los datos fueron analizados en software estadístico Statistical Package for the Social Sciences versión 20.0 presentados en la forma descriptiva con frecuencias y porcentajes. Los resultados mostraron tasa de infección en el sitio quirúrgico post cesárea del 2,92%; las usuarias presentaron como factores de riesgo baja escolaridad, ocurrencia de infección urinaria, hipertensión arterial, obesidad y tabaquismo. Concluye que la tasa de infección en el sitio quirúrgico post cesárea y factores de riesgo identificados resalta la necesidad de investigación previa y registro de éstos con cuidados preventivos de orientación y preparación de las usuarias de forma segura con protocolos que direccionan conductas más uniformes en el tratamiento de estas infecciones.

Abstract The objective of this study was to identify the occurrence of post-cesarean surgical site infection in a maternity hospital. This is a cross-sectional retrospective study with a quantitative approach developed in a reference public maternity in obstetrics located in the Northeast Region of Brazil. The sample consisted of 53 medical records of women with post-cesarean surgical site infection from 2010 to 2013, and the data collection instrument was a structured form. The data were analyzed in Statistical Package for Social Sciences version 20.0 presented in descriptive form with frequencies and percentages. The results showed post-cesarean surgical site infection rate of 2.92%; the users presented as low risk factors schooling, occurrence of urinary infection, hypertension, obesity and smoking. It was concluded that the post-cesarean surgical site infection rate and identified risk factors underscore the need for prior investigation and registration of these with preventive care of orientation and preparation of the users in a safe way with protocols that guide more uniform conduct in the treatment of these infections.

Humanos , Gravidez , Infecção Puerperal , Infecção da Ferida Cirúrgica , Brasil , Cesárea , Fatores de Risco
Artigo em Inglês | MEDLINE | ID: mdl-31605585


INTRODUCTION: Maternal and neonatal infections can be prevented, but they are still common in low and middle-developed countries. There is a connection between childbirth on one hand and postpartum and newborn care on the other. Globally, several efforts are being made to improve quality of childbirth by providing initial assessment of procedures, risk prevention and continuous monitoring of childbirth process and possible complications. The World Health Organization has developed Checklists for Safe Delivery with procedures to be implemented as routine care, in order to promptly detect and manage complications related to childbirth. MATERIAL AND METHODS: A retrospective study was conducted in the University Clinic of Gynecology and Obstetrics in Skopje, a maternity hospital in R. Macedonia from the tertiary level of the public health care system. In this study 300 obstetric and 307 neonatal histories from childbirths in February and March 2018 have been analyzed. The collected data refers to the care of the prepartum, intrapartum, early postpartum and early neonatal periods. RESULTS: An initial assessment at admission proved that 14.7% of pregnant women had existing infection, in 93% of them the body temperature was measured and in only 9.3% urine analysis was made, 10.3% of the women had arterial hypertension, and 66.5% of them with hypertension had a headache. In the continuous monitoring and prevention of potential risk, arterial tension was measured in 33% of all mothers. In all women the placenta quality was checked up, as well as vaginal bleeding, application of oxytocin and hemoglobin level before discharge. CONCLUSION: The quality and quantity of documented data in the maternity hospital medical histories is high. There were no standard protocols for assessment of pregnant women. Certain procedures are conducted in every woman during childbirth. Standardized procedures are needed to be applied during every childbirth.

Serviços de Saúde Materno-Infantil/normas , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção Puerperal/prevenção & controle , Qualidade da Assistência à Saúde/normas , Parto Obstétrico/normas , Feminino , Maternidades/normas , Humanos , Saúde do Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Infecção Puerperal/epidemiologia , Infecção Puerperal/mortalidade , República da Macedônia do Norte/epidemiologia , Estudos Retrospectivos , Fatores de Risco