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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of chorioadenoma destruens with uterine rupture is reported. The patient was admitted because a persistent uterine bleeding after abortion about two months before. The titulation of gonadotrophic hormone resulted in 25,000 unities. After curettage she was complicated with hemoperitoneum and went to surgery. During hysterectomy were identified trophoblastic tissue in the broad ligament and partial blocking of the right ureter. After repeated chemotherapy she presented severe immuno depression and sepsis complicated with hemopericardium and died five months after the first admission. The pathology study demonstrated a perforation because a trophoblastic invasion in the right side of the cervix and in the autopsy was demonstrated right ureteral obstruction due to a fibro necrotic an inactive trophoblastic tissue determining significant right hydro-uretero nephrosis.
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PMID:[Invasive mole with uterine rupture]. 134 67

Over a period of 7 years, 230 cases of illegally induced abortions complicated by sepsis were treated at the University College Hospital, Ibadan, Nigeria. The number of terminations complicated by sepsis doubled from 25.4 (between 1981 and 1985) to 51.0 (between 1986 and 1987) cases per year. Peritonitis was the commonest associated complication while maternal mortality was 8.3%. The average cost of treatment was US$223.11, while the average monthly earnings was US$45.00. Legalization of abortion would have resulted in a saving of US$50,022.28. Provision of legal abortion would reduce the incidence of sepsis after termination while reproductive health education and information dissemination and provision of easily accessible family planning services would greatly reduce the number of unwanted pregnancies.
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PMID:Health and economic consequences of septic induced abortion. 135 Oct 6

The mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision in Roe v Wade are compared with post-Roe v Wade mortality and morbidity. Mortality data before 1973 are from the National Center for Health Statistics; data from 1973 through 1985 are from the Centers for Disease Control and The Alan Guttmacher Institute. Trends in serious abortion-related complications between 1970 and 1990 are based on data from the Joint Program for the Study of Abortion and from the National Abortion Federation. Deaths from illegally induced abortion declined between 1940 and 1972 in part because of the introduction of antibiotics to manage sepsis and the widespread use of effective contraceptives. Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100,000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100,000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100,000 live births between 1979 and 1986. Serious complications from legal abortion are rare. Most women who have a single abortion with vacuum aspiration experience few if any subsequent problems getting pregnant or having healthy children. Less is known about the effects of multiple abortions on future fecundity. Adverse emotional reactions to abortion are rare; most women experience relief and reduced depression and distress.
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PMID:Induced termination of pregnancy before and after Roe v Wade. Trends in the mortality and morbidity of women. Council on Scientific Affairs, American Medical Association. 847 94

In 1987 the worldwide health program, the Safe Motherhood Initiative, was launched in Nairobi by international organizations to combat the alarming rate of maternal mortality resulting from pregnancy and delivery complications that takes 500,000 lives a year, 98% of them in developing countries. Yet the rate has scarcely diminished since ten. In underdeveloped countries maternal mortality is around 400 per 100,000 live births compared to 10-20 in Europe. The rate is the highest in high fertility regions such as Africa and Southeast Asia. The causes are blood loss, infection, hypertensive episodes during pregnancy, rupture of the uterus, and sepsis from botched induced abortion. In postpartum hemorrhage, especially in grand multiparous women, blood transfusion can be lifesaving. However, in a large part of Africa blood is often unusable because of infection with AIDS. In Jamaica and Bangladesh family planning campaigns particularly aimed at adolescents have yielded good results. In Zimbabwe campaigns target mostly men because of their authority. The utility of basic training of traditional birth attendants (TBAs) in delivery is highly questionable, and more thorough going training is being evaluated. Obstacles to reduction of maternal mortality within the Safe Motherhood program include shortage of funds, lack of coordination with local entities, inadequate antenatal care, illiteracy, and cultural barriers. Communication and training activities are essential, as demonstrated by the Matlab project in Bangladesh. The Matlab region had 200,000 people, 83% of women were illiterate, and maternal mortality reached 400 per 100,000 live births. 3 years after schooled midwives trained TBAs and integrated care for pregnant women, and transportation by boat to a newly built clinic was arranged, the maternal mortality rate declined to 140 from 380 per 100,000 live births in the intervention area (p = 0.02) compared to the control region. In the coming year the halving of maternal mortality is envisioned through prevention of anemia, tetanus, and extensive contraceptive use.
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PMID:[Safe Motherhood Initiative: the art of the feasible]. 146 8

In 1991, the abortion literature comprised articles on epidemiologic issues in abortion care advances in abortifacient such as mifepristone (RU-486) and cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. A comprehensive analysis of American women having abortions indicated that although the overall abortion rate had declined since 1980, the rate of unintended pregnancies had remained the same since 1982. Among married, white women over age 30 and white, unmarried women in their twenties abortion rates declined. A prospective cohort study showed no overall differences in nonviable pregnancy outcome, birth weight, and length of gestation between 6188 women who had an abortion and 7073 who did not. In most developed countries prostaglandins are widely used for termination of pregnancy in the 2nd trimester, either as an intra-amniotic or extra-amniotic preparation. In a retrospective analysis, oxytocin was quite effective in achieving rapid, uncomplicated fetoplacental expulsion. It had a mean induction-to-delivery interval of 8.2 (+ or - 5.1) hours, which was significantly better than a mean induction-to-delivery interval of 13.1 (+ or - 7.8) hours in the group that had received prostaglandin E2 suppositories. The World Health Organization estimated that 22-56% of maternal mortality is directly attributable to abortion. In Enugu, Nigeria, the mortality rate from incomplete abortion amounted to 17.9%, and septicemia was documented in 49% of cases. Cervical pretreatment prior to a 2nd-trimester abortion has become standard in many institutions. In a double-blind, double-randomized trial both mifepristone and gemeprost resulted in a cervix that required less force to dilate to 9 mm (P 0.001). The gemeprost group had significantly more side effects than the mifepristone group. Mifepristone is a safe alternative for the termination of pregnancy when the beta human chorionic gonadotropin is below 20,000 IU/L. In spite of the small sample size (n = 50) and a rather high 12% rate of postabortal pelvic inflammatory disease, when the beta human chorionic gonadotropin decreased by at least 40% in the 1st week after receiving mifepristone, the abortion procedure was invariable complete.
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PMID:Abortion: epidemiology, safety, and technique. 150 70

In Ohio, a 33-year old woman who had never had an ectopic pregnancy presented at an emergency facility not physically attached to a hospital with abdominal pain over 24 hours which had become more intense during the preceding 4 hours. She did not have vaginal bleeding, diarrhea, vomiting, or pain while urinating. 2 weeks earlier she had a voluntary intrauterine abortion at 8 weeks' gestation. She had intercourse 1 week before coming to the emergency facility. She had widespread tenderness in her abdomen, especially in the lower areas. Blood cell studies suggested an infection. The attending physician presumed her to have pelvic inflammatory disease (PID) as a result of either sexual intercourse or the elective abortion. The physician called for a urinary beta human chorionic gonadotropin test to determine whether placental tissue remained in the uterus. It was positive. 60 minutes after admission, the supine patient's pain increased and her blood pressure dropped to 80/50 mm Hg from 100/60 mm Hg at admission. After administering Ringer's solution, the health team sat her up and she fainted. A repeat cell count indicated sepsis. Her blood pressure decreased to 60 by Doppler and the physician continued to give her fluids and began dopamine. After the team stabilized her, they transferred her to a hospital. Her private physician examined her and then began surgery. The physician found a tubal pregnancy and removed the affected tube and ovary. She recuperated completely. Combined intrauterine and extrauterine pregnancy occurs once in every 30,000 cases. Previous PID, use of ovulation inducing medication, and in vitro fertilization with embryo transfer increases the likelihood of this type of pregnancy occurring. Physicians should consider this possibility if a woman has any of these histories and a combination of abdominal pain, adnexal mass with pain and tenderness, peritoneal irritation, and an enlarged uterus.
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PMID:Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion. 157 Sep 21

The key problems of the theory of sepsis and criteria of its postmortem diagnosis are discussed on the basis of pathological and bacteriological study of about 4000 purulent-septic diseases observed for the last 40 years in the pathology department of N. V. Sklifosovsky Moscow Research Institute of Emergency Medical Aid (sepsis after abortion, surgical and iatrogenic sepsis, acute septic endocarditis, purulent peritonitis, mediastinitis, pleuritis, phlegmons of body and limbs, bacterial shock, etc.). Sepsis, according to the author, is a generalized infectious disease developing acyclically, produced mainly by purulent coccal flora and having the course of septicopyemia. A metastatic purulent focus is an obligatory sign of the generalization. Septicemia is a local inflammatory process produced mainly by bacterial gram-negative flora. It can be a prologue of sepsis but more frequently develops in two directions: 1) purulent-resorptive fever with an acute, subacute and chronic course; 2) bacterial shock with a fulminant course and high lethality.
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PMID:[Pathology and pathogenesis of sepsis]. 159 92

All consecutive women admitted for complications of induced abortion at the Obafemi Awolowo University, Nigeria, from November 1988 through December 1989 were studied and interviewed. The interviews, conducted at the end of the stay by the staff member with most rapport with the women, asked about the abortion method, abortionist, cost patient's socioeconomic background, knowledge and practice of contraception, and knowledge and attitude toward the Nigerian abortion law. The 74 admissions accounted for 12% of all gynecological admissions. The patients ranged in age from 15 to 49, mean 22.8 years, and parity from 0 to 8, median O. 42% were ever married. 80% were Christians. The abortions were performed in 32% of cases by medical practitioners, 27% by non-medical persons, and 19% were self-induced. Self-induction methods included coat hangers, injections, ingestion of strong alcohol or tablets, instillation of native pessaries, potash, or gunpowder vaginally. Complications included sepsis (84%), hemorrhage (51%), uterine perforation (8%), cervical laceration (4%), septic shock (4%), perforation of gut or bladder, pelvic abscess, and psychosis. Treatment was broad spectrum antibiotics in all cases, evacuation of retained products in 76%, laparotomy in 7%, and hysterectomy in 2 cases. Hospital stay ranged from 1 to 60 days (mean 9.8). There were 13 maternal deaths (18%), or 35% of total maternal deaths in the hospital in this period. Sepsis was the cause of all deaths except one from hemorrhage. 54% of the fatal abortions were done by medical personnel, although none were obstetricians. In interviews of 20 subjects, it was learned that the majority of their abortionists were physicians, and costs ranged from $2 to 25 (US). All 20 women knew about effective contraception, but did not use it because they feared side effects, disliked the lack of privacy in clinics, and could not afford private providers. Only 4 knew that abortion is illegal in Nigeria, and only 2 thought it should be legalized, because they believed it is immoral. Contrary to common opinion, these women included married as well as single women, and the deaths were caused by physicians as well as lay abortionists.
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PMID:Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria. 144 Aug 96

A retrospective study of 932 second trimester terminations between 12-27 weeks gestation was carried out to determine the efficacy of gemeprost for second trimester termination. A single course of 5 x 1 mg gemeprost pessaries was administered every three hours. If abortion had not occurred after the first course of pessaries, a further course of 5 x 1 mg pessaries was administered. Intravenous oxytocin was administered after 36 hours if abortion had not occurred. Eighty per cent and ninety five per cent of patients aborted within 24 and 48 hours respectively. Of the remaining 5 per cent of women, 3 per cent aborted with escalating doses of oxytocin. In the remaining 18 (2 per cent) women, the pregnancies were electively terminated with an alternative method. The median induction-abortion interval was 18.0 hours and 15.0 hours in nulliparous and parous women respectively (P less than 0.0001). The number of pessaries required to induce abortion was not influenced by parity. Significantly more parous women bled more than 500 ml. The incidence of pelvic sepsis (0.1 per cent) and cervical tear (0.1 per cent) was low. Twenty six per cent of women had diarrhoea and 23 per cent vomited following administration of prostaglandin. This study confirmed the efficacy of gemeprost for second trimester termination of pregnancy. This method of termination is safe, non-invasive, simple and has a low complication rate.
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PMID:A retrospective study of 932 second trimester terminations using gemeprost (16,16 dimethyl-trans delta 2 PGE1 methyl ester). 164 4

This study considers the effects of a maternity care program within a community based maternal and child health and family planning program (MCH--FP) in rural Bangladesh (Matlab subdistrict). The area is rural and poor, with literacy rates of 30% for men and 17% for women; total fertility rates range from 5.5 to 4.3/woman and infant mortality from 110/1000 live births to 75/1000 in 1989. A demographic surveillance system was begun in 1966, and in 1977, MCH-FP was set up as a special treatment area separate from a comparable area with only Government health services. There are 80 community health workers (CHWs) who visit and collect data on each household of every village every 2 weeks. Maternal mortality is established by protocol. Maternal mortality in this study is defined as deaths occurring during pregnancy, delivery, or 6 weeks postpartum and attributable to obstetric complications but not conditions aggravated by the pregnancy or postpartum status (diarrhea, hepatitis, respiratory tract infections). Maternity care and referral is provided by the CHWs. Up to 1986, contraceptive use prevalence rates increased but maternal mortality remained at 5.5/1000 live births. Interventions based on a retrospective study of causes and conditions of maternal mortality were instituted in 1987. These consisted of posting professional midwives equipped to treat immediately obstetric complications in villages and a backup referral system. The intervention program was set up in 50% of the MCH--FP area and consisted of 48,000 people living in 39 villages. There were 1600 pregnancies a year in the program area, or an average of 33 a month/midwife (4 midwives in 2 outposts). Backup included a new maternity clinic without surgical, radiological or modern laboratory facilities, but staff available to stabilize patients for transfer to a regional hospital. Data was collected by the midwives, including the ratio of deaths/1000 live births as the best measure of the risk of dying during pregnancy. The results of the comparison between the intervention area, which also had a higher infant and adult female mortality rate, and the control area for 1987-89 showed that the odds ratio of obstetric death in the pre and post period was .31 (95% CI .11-.81, p=.007); there was no significant change in the control area. The principal causes of death reduced by the program and ranked in decreasing order were abortion complications, postpartum hemorrhage, postpartum sepsis, obstructed labor and eclampsia. It is likely that the intervention was the significant factor in the mortality reduction since the areas were similar sociodemographically. Another method for reducing maternal mortality has been implemented and being evaluated: the use of female paramedical field workers to detect high risk pregnancies.
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PMID:Effect on mortality of community-based maternity-care programme in rural Bangladesh. 168 49


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