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

2 studies have been done in China: 1) a longitudinal study on maternal mortality in Beijing from 1949 to 1983; and 2) a cross-sectional study on maternal mortality in the year 1984 in 21 of 29 provinces, municipalities, and autonomous regions. A maternal and child health network for care and referral of abnormal cases was set up with ambulances and transfusion facilities in place and training for traditional birth attendants. Aseptic delivery reduced the number of deaths due to sepsis from 213/100,000 live births to 4.2 in 5 years and to 0 in 9 years. Deaths from hemorrhage (including ruptured uterus) dropped by 86% in 5 years. With legalized abortion came a dramatic fall in maternal mortality from 685,100/000 live births to 15, a decrease of 98%. In 1949, 27% of women who died in childbirth had received hospital care; another 27% had no cure. In 1958, however, 80% of the fetal cases had obtained hospital care; the remaining 20% had been seen by a traditional practitioner or health worker. From 1959-68, the total maternal mortality was 1.3-28.1/1 00,000. From 69-78, the turmoil of the cultural revolution had "ill effects" on maternal and child health but by 1979, order was brought back again. The cross-sectional study covered a population of about 177 million. About 2.5 million live births occurred. 1211 maternal deaths were registered for a maternal mortality rate of 48.4/100,000. Maternal mortality varied a good deal in different parts of the country--from 17.7 in Shanghai to 108.2 in the region of the Hai people in Ningxia in northwest China. Maternal mortality rates correspond roughly to the level of economic development. The 5 main causes of death were hemorrhage, heart failure, pregnancy- induced hypertension (including eclampsia), postpartum infection and liver failure.
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PMID:Maternal mortality in China. 263 3

Topical prostaglandins and intracervical tents at present comprise the most widely used methods for priming of the cervix before surgery. While tents and prostaglandins are comparable in terms of shortening the time interval between labor induction and delivery, tents do not initiate powerful myometrial contractions and thus are not associated with the complication of uterine hypertonus. In early abortion, tents are regarded as superior to prostaglandins, estrogen, and relaxin. In the midtrimester abortion, however, best results are achieved through the combined use of tents and prostaglandins. This approach facilitates a shorter abortion time, a lesser risk of sepsis, and use of a lower dose of prostaglandin. The effect of the particular type of tent selected--Clamicel, Dilapan, or Laminaria--is related to the initial state of the cervix, with the best results achieved in the soft patulous cervix of young pregnant women. Laminaria tents are declining in popularity as a result of their lengthy duration of action, unreliability, pain, or insertion and as the tent expands, and need for several insertions of multiple tents. The synthetic Dilapan tent does not share the disadvantages of inconsistency, long duration of action, and risk of sepsis, but tends to fragment and fracture so that the distal portion remains within the uterus. Lamicel, a polyvinyl alcohol sponge impregnated with magnesium sulfate, has a less impressive speed of action than Dilapan (3 hours and 2 hours, respectively), yet its softness makes it easy to withdraw without fragmentation or fracture. Lamicel has been used successfully in 1st-trimester abortion, before induction of labor or IUD insertion, for hysteroscopy and removal of lost IUDs, and in formal diagnostic curettage.
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PMID:Intracervical tents: usage and mode of action. 266 35

As increasing numbers of children and adults with leukemia have become long-term survivors, the impact of an existing pregnancy on leukemia treatment, as well as the significance of prior leukemia therapy on future pregnancies, have become sources of concern. The information presently available, derived from small, retrospective series or case reports, indicates that leukemia may develop throughout pregnancy, that a leukemia woman who is pregnant need not undergo an abortion if she does not desire, and that standard antileukemic chemotherapy can be administered safely during the second and third trimesters. The antifolates (eg, methotrexate), being particularly teratogenic, should be avoided during the first trimester. Cytarabine and anthracycline treatment, the fundamental components of management for patients with AML, has not been associated with birth defects. The risk for placental injury, sepsis, and spontaneous abortion or premature birth is undoubtedly increased in women who experience the periodic episodes of myelosuppression that accompany leukemia treatment. Once remission has been achieved, decisions regarding adjustments of the intensity of therapy must be made with each individual patient; such dose alterations may diminish the mother's potential for long-term leukemia control, while possibly securing the viability of the fetus. Similarly, issues such as elective delivery prior to term and vaginal delivery v caesarean section should be resolved on a patient-by-patient basis. The offspring of leukemic mothers appear to mature normally.
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PMID:Pregnancy and leukemia. 267 88

In societies with restrictive abortion laws, clandestine induced abortion by unskilled personnel results in needless and very high mortality and morbidity, tremendous strain on limited health resources, and inexcusable human suffering. Sepsis, hemorrhage, genital tract trauma, and related ill health and sterility, could be prevented by legalizing abortion, making appropriate sex education and contraceptive services available and training physicians and nonphysicians in uterine vacuum aspiration.
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PMID:Preventing and managing complications of induced abortion in Third World countries. 268 4

The purpose of this randomized, controlled study was to determine the efficacy of tetracycline as a prophylactic antibiotic therapy in treating nonseptic, incomplete abortion patients in Zimbabwe. In 1984, the gynecology emergency unit of Harare Central Hospital admitted 3240 cases of incomplete abortion, of which 2891 were nonseptic on admission. For this prospective study, patients presenting with nonseptic, incomplete abortion (n = 140) from February through May 1985 were recruited at Harare Central. These patients were randomly divided into treatment and control groups, and all patients received aseptic evacuation procedures. Following evacuation, the treatment group (n = 62) was given tetracycline (500 mg 4 times daily to be taken for a week). The remainder (n = 78) acted as controls. Diagnosis for sepsis, based on defined parameters, was performed a week later by the author, who did not know the group to which the patient belonged. The majority of the patients in both groups were 15-24 years old and of parity 1-4. An overall sepsis rate of 35.6% was obtained in this study. No significant difference in sepsis rates between treatment and control groups was noted. The apparent higher proportion of sepsis recorded in the treatment group (25/62, or 40.32%) in comparison to the control group (23/78, or 29.5%) was not significant. Although all patients insisted they took their drugs as instructed, further questioning and counting of remaining capsules revealed that the majority (82.6%) had not taken any or part of the course; the patients who did complete the course had not followed the instructions properly. Thus, the lack of significant reduction in the sepsis rate with the use of prophylactic tetracycline was thought to be due to poor compliance. The author argued that this was due to the young age, low socioeconomic status, and lack of understanding of the regimen among the patients. Thus, it is suggested that tetracycline treatment be replaced with a cheap, single-dose, hospital-administered prophylaxis regimen, such as doxycycline, that covers a wide range of organisms.
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PMID:Evaluation of prophylactic use of tetracycline after evacuation in abortion in Harare Central Hospital. 269 Dec 33

From 1 January 1980 to 31 December 1985, 81 maternal deaths occurred at Pelonomi Hospital, Bloemfontein; these were classified as direct obstetric-related (74 cases), indirect obstetric-related (6) and non-obstetric (1). The overall maternal mortality rate was 2.87 per 1000 deliveries, including deaths related to abortion and ectopic pregnancy, but excluding the non-obstetric death. Among booked patients the maternal mortality rate was 0.32 and among unbooked patients 11.13 per 1000 deliveries. The maternal mortality rate for patients from the Bloemfontein area was 0.72 per 1000. Puerperal sepsis and postabortal sepsis accounted for 45.7% of the deaths. Avoidable factors were considered to be present in 65 cases (80.2%).
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PMID:Maternal deaths at Pelonomi Hospital, Bloemfontein, 1980-1985. A survey of 81 consecutive cases. 274 Sep 55

Maternal mortality, i.e., death during pregnancy or within 42 days of an abortion or delivery, has declined in Hong Kong from .45/1000 births in 1961 to .05/1000 births in 1985. 68% of all maternal deaths during this period were due to hemorrhage (34%), pre-eclampsia (20%), and ectopic pregnancy (14%). The number of legal abortions, on the other hand, increased from 184 in 1973 to 15,411 in 1985, but no maternal deaths were associated with legal abortion. The major cause of the declining maternal mortality is a decline in known risk factors. High parity is associated with maternal mortality, and parity in Hong Kong has steadily decreased. Another risk factor is maternal age. Births to women over 35 constituted 16.2% of total births between 1962 and 1970 but only 8.6% of the total between 1971 and 1985. Adverse living conditions due to poverty are another high risk factor. Between 1966 and 1985, the gross domestic product rose 14-fold, and the maternal mortality rate dropped 9-fold. Other factors are the fact that all deliveries occur in institutions, and adequate prenatal care is available, as are transfusions and oxytocics. Pulmonary embolism and sepsis, which cause many maternal deaths in developing countries, are rare in Hong Kong.
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PMID:Maternal mortality in Hong Kong 1961-1985. 278 26

The microbial flora of the genital tract of 95 women who developed clinical signs of infection within 48 hr of vaginal delivery, Cesarean section delivery or abortion were compared with 111 women who delivered at the same hospital during the same time period but who showed no signs of sepsis. While there were no significant differences in the prevalence of most organisms in the lower genital tract of women with and without sepsis, there was evidence of a higher prevalence of gonococcal, chlamydial and anaerobic infection in the former. Gonococci were isolated from over 20 percent of untreated women with sepsis, more than three times the prevalence in controls. A third of the isolates were penicillinase-producing and another third showed in vitro resistance to penicillin. Chlamydial antigen was detected in 16-20 percent of women with sepsis following vaginal delivery or abortion, compared with 6 percent of controls. Neither gonococcal nor chlamydial infections were significantly associated with sepsis following Cesarean section delivery. Clue cells, indicative of G. vaginalis infection were noted in 20 percent of patients with sepsis compared with 7 percent of controls while amongst the other anaerobes only pigment producing Bacteroides were associated with sepsis. These findings suggest that antepartum investigations for clue cells, chlamydial antigen, gonococci and pigment producing anaerobes may identify patients most at risk from obstetric sepsis in Harare, and identify those for whom prophylactic administration of antibiotics may be of benefit.
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PMID:Vaginal flora of women admitted to hospital with signs of sepsis following normal delivery, cesarean section or abortion. The Puerperal Sepsis Study Group. 278 4

A case report of a ligamentary ectopic pregnancy that failed to respond to prostaglandin E2 for induced abortion for sepsis at 24 weeks is presented. The 27-year-old nullipara had normal ultrasound findings for gestational age up to 21 weeks gestation. She had consulted at 5 weeks for abdominal pain and bleeding, at 14 weeks again for abdominal pain, shoulder pain and vaginal bleeding, although both times the pain and bleeding resolved spontaneously. She was seen again at 16 and 21 weeks gestation, when ultrasound scans were normal for dates. At 24 weeks, she experienced vaginal discharge of blood and tissue, and was managed as premature rupture of membranes. She became septic 12 days later. She was treated with transcervical PGE2 and iv oxytocin without response for 3 days. Surgical evacuation was successful, but bleeding persisted. During laparotomy she had a large left broad ligament hematoma, a left ruptured uterus, and open left internal iliac artery and vein. These were repaired, and she received 40 units of blood, 8 platelets and 14 of plasma. Only after histology was the diagnosis of ligamentary pregnancy made. The lack of response to PG for abortion should raise suspicion of ectopic pregnancy, although preoperative diagnosis of ligamentary pregnancy is extremely rare.
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PMID:A rare gynecologic contraindication to the use of prostaglandins and oxytocin to induce abortion. A case report. 279 68

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.
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PMID:Intravascular coagulation in relation to pregnancy and delivery. 281 60


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