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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A brief perioperative course of ampicillin was recommended for high-risk patients undergoing cesarean section at our institution. High-risk patients were defined as those with two or more of the following factors: general anesthesia, obesity, hematocrit less than or equal to 30%, and labor prior to delivery. Fifteen percent of high-risk patients who received prophylactic antibiotics experienced postoperative febrile morbidity compared to 63% for the high-risk untreated group (P less than 0.001). Twenty-five percent of low-risk patients (less than 2 risk factors) developed this complication. Endometritis was the leading cause of postoperative febrile morbidity. Postoperative stay was only slightly decreased in the prophylactically treated group (5.9 vs 6.2 days). Prophylactic amplicillin given perioperatively was an effective agent in reducing post-cesarean-section febrile morbidty among high-risk patients.
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PMID:Prophylactic antibiotics in high-risk cesarean section. 65 5

A retrospective analysis of 1000 case histories of women who delivered by cesarean section has helped define the principal factors of postsurgical endometritis risk. If the risk factors are combined, the potentiality of the disease development increases. The most hazardous combinations of risk factors are as follows: grave gestosis combined with obesity, anemia, and a chronic infection focus, as well as clinical non-correspondence of the maternal pelvis to fetal head, combined with dry labor.
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PMID:[Endometritis after cesarean section: mutually aggravating risk factors]. 195 73

Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. Infant complications of shoulder dystocia include traumatic brachial plexus injury, humeral fracture, clavicular fracture and severe birth asphyxia. With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.
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PMID:Shoulder dystocia. 200 18

In a prospective clinical study of post-operative infection in 124 patients undergoing Caesarean section, 39 (31.5%) patients developed a total of 45 infections. There was no significant difference in infection rates between elective and emergency procedures. Five patients (4%) developed endometritis, wound infection was found in 14 (11.3%) and 18 patients (14.5%) developed a post-operative urinary tract infection. Pre-operative C-reactive protein levels and intraoperative swabs of the uterine cavity were not helpful in the early detection of endometritis. The risk factors predisposing to post-caesarean infection were obesity and low socioeconomic status.
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PMID:Infection following caesarean section. 256 65

Fifty consecutive patients undergoing cesarean section were evaluated prospectively. A data collection form was developed and 113 variables relating to demographic features, antepartum care, intrapartum events and postpartum course were evaluated. All of the patients were seen and evaluated within 24 hours of delivery and all forms were completed when the patients were discharged from the hospital. Twenty-five of the 50 patients had postpartum febrile morbidity develop. There were 14 instances of endometritis; five, wound infections; two, urinary tract infections; two, upper respiratory tract infections; three pulmonary infections; one patient with phlebitis, and two with febrile morbidity and no apparent source. Factors significantly associated with an increased risk of developing febrile morbidity included antepartum infections, resident staff as primary surgeon, extension of the uterine incision and positive endometrial culture at the time of the operation. Patients undergoing elective repeat cesarean section had less febrile morbidity than others (p less than 0.025). Statistically significant differences between the two groups were not found for the variables obesity, anemia, rupture of membranes, number of pelvic examinations, fetal monitoring, fetal tachycardia, general anesthesia and skin preparation. Operative blood loss was greater in the patients having febrile morbidity develop, but this difference was not statistically significant.
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PMID:Risk factors in the development of cesarean section infection. 636 24

During a 3-year period, 1,319 women delivered of their infants by cesarean section were prospectively studied to determine the type and rate of postcesarean complications and to identify risk factors which predispose to postoperative morbidity. The overall complication rate was 14.5% and the most common complication was infection (13.3%), in particular, endometritis (6.6%), urinary tract infection (3.1%), and wound infection (1.6%). A lower complication rate was seen in elective operations (4.7%) compared with emergency operations (24.2%). Four significant factors that predispose to postoperative morbidity were identified: duration of ruptured membranes prior to operation (p less than 0.001), duration of labor prior to operation (p less than 0.001), anemia (p less than 0.01), and obesity (p less than 0.01). Patients with a combination of risk factors had an increased complication rate, in some cases as high as 91%. The clinical relevance of these findings in trying to decide possible ways to reduce the complication rate by changing the delivery routines is discussed.
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PMID:Postoperative cesarean section morbidity: a prospective study. 688 Dec 24

Recent studies have identified clinical features that are major risk factors for puerperal infection. Patients of low socioeconomic status undergoing cesarean section who have had prolonged labor and rupture of membranes (ROM) incur a 40 to 85% risk of endometritis. Infection occurs generally in less than 10% of women undergoing vaginal delivery, even when complicated by prolonged ROM, and often in considerably fewer cases. Other features such as internal monitoring, obesity, anemia, and general anesthesia have not been consistent determinants in recent studies.
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PMID:Clinical risk factors for puerperal infection. 699 Mar 33

A set of new guidelines were formulated by an expert group meeting in Sweden organized by the pharmaceutical office during March 31-April 1, 1993. It contains various methods to avoid an undesired pregnancy and also advice about postcoital contraception. Among barrier methods, the condom is the only reversible method for men with a method failure of 2 and user failure of 10. It protects against gonorrhea, chlamydia, condyloma, herpes simplex, HIV, and hepatitis B. The diaphragm can be used with a spermicide and protects to a lesser degree against chlamydia, gonorrhea, and cervical cancer. The female condom is as effective as the condom. Among spermicides, nonoxynol-9 is not only effective against sperms but also against bacteria, viruses, and certain vaginal and cervical cells. The vaginal sponge is impregnated with nonoxynol-9 and is effective up to 24 hours. The copper IUD, with a method failure of less than 1, can cause profuse menstrual bleeding, dysmenorrhea, and endometritis-salpingitis. Hormonal methods include combination pills (2-phase and 3-phase pills) and gestagen methods (high dose with 150 mg of medroxyprogesterone acetate injection every 3 months and low-dose minipills with levonorgestrel, norethisterone, or lynestrol). Mechanisms of action concern combination pills, gestagen methods, minipills, Norplant, and Levonova. Drug cross reaction can reduce effectiveness. Side effects include bleeding and amenorrhea. Risk-benefit determination is based on health effects. Possible risks are associated with breast cancer, cervical cancer, blood pressure increase, venous thromboembolism, and heart infarction. Various phases of the reproductive age include young women, lactating women, and women in the later part of the reproductive age. Special groups include those who have experienced ectopic pregnancy, infections (candida, sexually transmitted diseases: chlamydia trachomatis, HIV infections), obesity, cardiovascular diseases, diabetes mellitus, tumors of the reproductive organs, liver diseases, migraine, epilepsy, surgery, and handicapped women. Postcoital contraception is used only in need, and methods for postcoital contraception include hormonal method and the copper IUD.
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PMID:[Contraception. Recommendations from a group of experts]. 790 65

This study examined the effects of massive maternal obesity on medical complications, mode of delivery, postpartum complications, and hospital confinement. In this retrospective case control study, women weighing > 300 pounds delivering from January 1, 1986, to November 1, 1991, were matched for age, race, parity, and height with lean parturient women (mean weight 160 +/- 21 pounds). Among massively obese women there was a greater incidence of chronic hypertension (p < 0.05) and diabetes (p < 0.05) than in the control group. Primary cesarean section was more frequent (p < 0.05), as was the postoperative complication of endometritis when obese patients were compared with lean women (p < 0.05). Cephalopelvic disproportion was the only indication for primary cesarean section, which occurred with greater frequency in the obese group. The postpartum hospital confinement was also significantly longer in the obese study group (p < 0.05). The gestation of a massively obese parturient woman is more frequently complicated by chronic hypertension and diabetes. Abdominal delivery for cephalopelvic disproportion is more likely, and this mode of birth is more often followed by endometritis, which results in longer hospital stays.
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PMID:Obstetric challenges of massive obesity complicating pregnancy. 816 71

Objective: To compare single-dose antibiotic prophylaxis (cefotetan 1 g vs cefoxitin 2 g) in various subpopulations based upon risk factors for postsurgical infection following cesarean section.Methods: Patients undergoing cesarean section from April 1993 through March 1994 were included in a retrospective analysis if either of the above antibiotics were administered, surgery was non-emergent, gestational age was less than 32 weeks, absence of fever or prior antibiotics therapy within 72 hours, and no history of organ transplantation or HIV. Cases classified as high risk for infection: IDDM, obesity, autoimmune disease, sickle cell disease, or corticosteroid use. Cases classified as high risk for endometritis (any 2 factors): labor >12 hours, >4 vaginal examinations, ruptured membranes >9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A chi(2) analysis was used to test for differences in infection rates between groups (P <.05).Results: Of 1383 cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% (P =.056) as was the rate of endometritis (3.2% vs 1.2%, P =.185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P =.003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection (P =.13).Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.
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PMID:Single-dose antibiotic prophylaxis during cesarean section. 1083 70


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