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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A recent case of postpartum maternal endometritis and neonatal sepsis due to Streptococcus pneumoniae prompted this report and a review of previous citations. Although this rare presentation of pneumococcal infection is potentially fatal to both mother and child, early empiric antibiotic coverage for the most frequent etiologic agents of this syndrome, group B streptococci, was and is adequate for systemic pneumococcal infections.
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PMID:Pneumococcal endometritis and neonatal sepsis. 223 19

A retrospective study was conducted to assess the predictive value and clinical usefulness of amniotic fluid Gram stain and culture in the management of preterm premature rupture of the membranes (PROM). Amniocentesis was attempted in 79 patients and was successful in 53 patients for a success rate of 67%. The complication rate was 1.8%. Fifty-three patients from whom amniotic fluid was obtained after preterm PROM were studied. Patients were managed expectantly unless clinical chorioamnioitis developed, a positive Gram stain or culture was found, or a mature lung profile after 34 weeks' gestation was established. A low incidence of chorioamnionitis (5.5%), postpartum endometritis (11%), and neonatal sepsis (3.5%) was found with expectant management. A statistically significant association between Gram stain and antepartum infection, postpartum infection, and neonatal infection was noted. Gram stain had a 100% sensitivity and 82% specificity as predictor of chorioamnionitis. Amniotic fluid culture had a 100% sensitivity and 76% specificity as predictor of chorioamnionitis. As predictor of a positive culture result, Gram stain had a sensitivity of 60% and specificity of 92%. No patient with a negative Gram stain or culture developed infectious sequelae regardless of the timing of amniocentesis. All positive Gram stains and cultures were found within 48 hours of rupture of membranes. Amniocentesis for Gram stain and culture has clinical usefulness in preterm PROM and, despite false-positive tests, the authors' data support intervention on the basis of a positive Gram stain.
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PMID:Amniocentesis for gram stain and culture in preterm premature rupture of the membranes. 241 Aug 39

Gram stain examination of amniotic fluid is a method used for the rapid diagnosis of intraamniotic infection in patients with preterm premature rupture of membranes and preterm labor. The management of these patients relies heavily on the Gram stain results. Therefore, it is critical that the diagnostic value and limitations, optimal technique, and outcome correlates be precisely established. Most studies have focused on culture results rather than on Gram stain results to describe neonatal and maternal outcome. However, management is based on the Gram stain because culture results are not immediately available. One hundred eighty-seven amniocenteses were performed in 131 patients with preterm premature rupture of the membranes (n = 90) and preterm labor (n = 41). Spun and unspun Gram stains were performed. Centrifugation of the sample did not improve the sensitivity of the technique significantly. The agreement between the two methods was substantial (kappa index 0.89, p less than 0.001). The sensitivity of the Gram stain was 44.8% and the specificity was 97.6%. The sensitivity of the Gram stain was directly proportional to the number of bacteria present in amniotic fluid. In the presence of greater than 10(5) colony forming units per milliliter, 80% of the Gram stains were positive. The absence of both bacteria and white blood cells in a smear was associated with a negative culture of amniotic fluid in 95% of the cases. Clinical chorioamnionitis was associated with a positive Gram stain of amniotic fluid (p less than 0.001). There was a trend toward a higher incidence of endometritis in patients with a positive Gram stain compared with those with a negative Gram stain (p = 0.07). There was no neonatal infectious morbidity in patients with a true negative Gram stain. Patients with a false negative Gram stain had a 25% incidence of neonatal infectious complications (proved and suspected sepsis).
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PMID:The value and limitations of the Gram stain examination in the diagnosis of intraamniotic infection. 245 13

Clostridium perfringens is commonly present in the female genital tract. Uterine infection with this organism is a potentially fatal disease infrequently seen in obstetric practice. The manifestations of C. perfringens uterine infection are variable, ranging from endometritis to gas gangrene with fulminant septicemia. The usual precipitating event has been septic abortion, but such infections can also occur spontaneously in uterine tumors and after complicated deliveries requiring mechanical intervention. Diagnosis may be aided by radiologic techniques, and treatment involves high-dose penicillin and possibly surgery. We report two cases and review the clinical presentation and the diagnostic and therapeutic aspects of this disease.
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PMID:Postpartum uterine infection with Clostridium perfringens. 254 43

Gynaecological infections range from vaginitis to septic shock. Postoperative infections are common sequelae of hysterectomy. Sexually transmitted infections start as vaginitis or rather as cervicitis. During pregnancy and delivery we find septic abortion, amnionitis, endometritis, wound infections, thrombophlebitis, sepsis, mastitis and urinary tract infections. In most infections cephalosporins are drugs of first choice because of their broad spectrum, their beta-lactamase stability and their lack of toxicity, which is especially important in pregnancy.
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PMID:Infections in gynaecology and obstetrics and cefotaxime. 261 36

Group B streptococci, a frequent cause of neonatal sepsis and meningitis, postpartum endometritis, and bovine mastitis, may be acquired by several modes of transmission. Detailed epidemiologic study is hampered by the lack of a sufficiently discriminatory typing system, especially for type III and nontypable strains. We examined 54 epidemiologically well-characterized strains by restriction endonuclease analysis (REA) and compared the results with those obtained by serotyping. REA patterns were inspected without knowledge of the epidemiological or serotyping data. Among 21 type Ia, Ia/c, and Ib/c isolates, we found 10 REA patterns; among 5 type II and IIc isolates, we found 5 REA patterns; among 13 type III isolates, we found 6 REA patterns; and among 15 nontypable human and animal isolates, we found 7 different REA patterns. Double digestion of type III isolates with EcoRI and BglII helped us to distinguish the isolates. In total, 28 REA patterns were found in six serotype groups and one nontypable group. Some geographically and epidemiologically separate isolates had identical REA patterns, suggesting dissemination of a limited number of clones. We conclude that REA is a promising tool for detailed epidemiological study of group B streptococci.
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PMID:Restriction endonuclease analysis of human and bovine group B streptococci for epidemiologic study. 266 44

The measurement of colloid-oncotic pressure (COP) in 160 women with pyoseptic disease (pyodermia, soft-tissue abscesses, suppurative mastitis, endometritis, sepsis) has demonstrated a regular pattern of change, depending on the clinical condition. A classification of COP disorders has been proposed, identifying the hyperoncotic state (COP above 3.29 kPa), normoncotic state (COP between 2.84 and 3.29 kPa) and hypo-oncotic state (COP below 2.84 kPa), on which a differential remedial therapy is based. A reliable assessment of COP values during the infusion therapy can only be made by means of oncometry, since estimations of any kind lead to considerable error.
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PMID:[Differential correction of disorders of colloid-oncotic blood pressure in pregnant women and puerperants with suppurative-septic diseases]. 273 6

The identification of risk factors for intra-amniotic infection may allow changes in obstetric management and reduce complications. In a pilot study, stepwise logistic regression identified duration of ruptured membranes and duration of interval monitoring as significant risk factors for intra-amniotic infection. Using the preliminary regression equation, we established critical durations (risk criteria) to predict a 20% or greater probability of intra-amniotic infection. Subsequently, 2908 patients were screened prospectively for risk criteria and/or the presence of intra-amniotic infection. Seven hundred five patients of the 2908 (24%) met the risk criteria, and 107 of 124 cases of intra-amniotic infection (86%) met the risk criteria. In patients meeting the risk criteria, the relative risk of intra-amniotic infection was 19.7. In addition, 81 of 705 (12%) of mothers developed endometritis. Ten neonates of mothers with criteria developed sepsis or pneumonia. A stepwise logistic regression performed on the prospectively gathered data showed that among patients meeting risk criteria, parity, duration of internal monitoring, and duration of membrane rupture were the significant risk factors for intra-amniotic infection.
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PMID:Logistic regression analysis of risk factors for intra-amniotic infection. 292 51

The efficacy of sulbactam plus ampicillin in the treatment of various gynecologic infections was evaluated in 24 women (median age, 35 years). Ten women had pelvic cellulitis plus vaginal cuff abscess; six, pyeloperitonitis; three, vaginal cuff abscess; three, surgical wound sepsis; one, tubo-ovarian abscess; and one, endometritis. Surgical procedures preceding infection included abdominal hysterectomy, ovarian cyst removal, ectopic pregnancy, correction of cystocele, and uterine dilatation and curettage. Twenty patients received 1 g of sulbactam plus 1 g of ampicillin per dose; four received 0.5 g of sulbactam plus 1 g of ampicillin per dose. The combination was given iv every 6 hr for three to four days and then im every 8 hr for three to five days (mean treatment duration, seven days). Pus cultures yielded Enterobacteriaceae (21 cases), enterococci (two), Bacteroides fragilis (12), other Bacteroides species (five), Peptococcus species (nine), Peptostreptococcus species (seven), and other anaerobes (five). Six infections were purely anaerobic; 18 were mixed. All but two infections were cured by both clinical and bacteriologic criteria, with no adverse reactions. Parenteral sulbactam/ampicillin seems safe and effective in the treatment of gynecologic infections of moderate severity.
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PMID:Efficacy of sulbactam plus ampicillin in gynecologic infections. 302 7

Chlamydia trachomatis is now recognized as the most common sexually transmitted disease organism in the United States. Although the potential for vertical transmission of C. trachomatis from pregnant women to their infants is well established, the extent to which infection adversely affects pregnancy and causes perinatal complications remains controversial. We report herein the results of a prospective study of 270 pregnant women with endocervical C. trachomatis compared with 270 matched control subjects (age +/- 1 year, race, and socioeconomic status). Among the entire group (n = 540), the rates of pregnancy complications were: premature rupture of the membranes, 54/270 (10%); preterm delivery, 55 (11%); amnionitis, 20 (4%); intrapartum fever, 23 (4.3%); small for gestational age, 76 (14.5%); postpartum endometritis, 31 (6%); and neonatal sepsis, 10 (1.8%). No statistically significant differences were noted between cases and controls for any of these variables. In the subset of women with recent or invasive chlamydial infection, indicated by the presence of IgM antibody against C. trachomatis, preterm delivery occurred in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03) cases. Premature rupture of the membranes was present in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03).
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PMID:Chlamydia trachomatis infection and pregnancy outcome. 310 88


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