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

This reviews 431 maternal deaths over 3 periods of 3-4 years each from January 1958 to December 1968. Trends in mortality are noted. A steady decline was noted. Associated diseases increased maternal mortality but age and parity had no significant influence. 47% of the deaths were intrapartum, 35% postpartum, and 18% antenatal. Major causes were hemorrhage, preeclampsia, eclampsia, sepsis, and anemia, in that order. Deaths due to infection diminished markedly during the period. 58.2% of the deaths were considered avoidable. Delay by patient or doctor and lack of facilities in rural areas were principle avoidable factors. Extension of obstetrical service to villages, emergency mobile squads, and periodic review of mortality statistics are recommended.
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PMID:Maternal mortality at government maternity hospital. Hyderabad, Andhra Pradesh (a review of 431 cases). 1230 76

Until the 20th century, women and families worldwide knew that it was always a possibility that women would die from childbearing (e.g., over 2000 maternal deaths/100,000 births in Europe). Increased knowledge about pregnancy and its complications and the application of that knowledge in maternal health care systems in developed countries reduced maternal mortality considerably (e.g., 20 in northern Europe). Improvements in delivery management helped greatly to reduce maternal deaths, which include aseptic techniques, appropriate use of forceps, safe blood transfusion, sulphonamides, and proper management of preeclampsia and eclampsia. Maternal mortality is still high in developing countries (e.g., 5% of women in some parts of Africa die from a pregnancy-related condition) where 99% of all maternal deaths occur. These pillars of family life die in the prime of their life and often leave other children. Their loss adversely affects social and economic development. Just 78 countries (35% of the world's population) have a vital registration system recording causes of death, thereby making it difficult to understand the extent of maternal mortality. The 1st cause of maternal death to fall in developed countries and now in developing countries is sepsis. Other causes of maternal death are obstetric hemorrhage, eclampsia, ectopic pregnancy, unsafe abortions, and obstructed labor. Lack of access to maternal health services keeps many women with pregnancy complications from receiving the care they need to survive. Trained persons help only about 50% of women worldwide with labor and delivery. Upgrading of local health centers and training midwives in recognizing complications and in aseptic delivery techniques are needed to improve the quality of maternal health care. Each health center must have the means to transport women to district hospitals. Health centers must offer contraception to prevent unwanted pregnancies. Countries need to reduce the social inequalities that women face.
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PMID:Maternity care for all. 1231 74

During 1981-1986, 86 maternal deaths transpired at the obstetrics department of the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India. The maternal mortality rate stood at 5.8/1000 births. 31.4% were primigravidae. The percentage of maternal deaths characterized as gravidae 2-4, 5, and multigravidae was 42.9%, 9.3%, and 16.4%, respectively. The leading causes of death were sepsis (41.9%), especially septic abortion (30.2%); eclampsia-severe preeclampsia (10.5%); ruptured uterus (9.3%); and hemorrhage and prolonged labor (8.1% each). Direct obstetric causes of death accounted for 81.4% of all maternal deaths. Indirect obstetric causes of death were hepatitis (5.8%), heart disease (4.7%), and severe anemia (2.3%). Most of the women who died were illiterate (97.6%), poor (98.8%), and had received no prenatal care (94.2%). 47.7% traveled more than 60 km to the hospital. Quacks or untrained traditional birth attendants had excessively interfered with about 33% before they reached the hospital, especially the septic induced abortion, obstructed labor, and ruptured uterus cases. Among the 48 women who delivered before dying, there were 24 live births (5 of whom died during the early neonatal period) and 24 still births. These findings indicate a need for a cooperative effort to improve and expand maternal and child health care in the community.
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PMID:Determinants of maternal mortality: a hospital based study from south India. 1231 6

To clarify the relationship between chorioamnionitis and chronic lung disease (CLD) in very low birth weight (VLBW) infants, we performed a retrospective cohort study of all inborn patients between 1995-1997 with gestational age (GA) less than 32 wk, birth weight less than 1.5 kg, survival to 36 wk adjusted GA, and placentas submitted to pathology (n = 371). Racial distribution as defined by the mother was 40% white/60% nonwhite. Prevalence of CLD, defined as O(2) dependence at 36 wk adjusted GA, was 30%. In a preliminary analysis GA and birth weight for GA (standard deviations from the mean, Z-score), considered together, were inversely related to CLD. After adjustment for GA and Z-score, other risk factors for CLD were white race, acute respiratory distress, pulmonary air leak, patent ductus arteriosus, and septicemia. Two placental lesions were inversely related to CLD: histologic chorioamnionitis and acute atherosis (a placental indicator of preeclampsia). Following multivariate analysis, independent risk factors for CLD were GA (OR, 0.6; 95% CI = 0.5, 0.7), birthweight for GA (OR, 0.4; 95% CI = 0.3, 0.6), white race (OR, 1.9; 95% CI = 1.0, 3.3), patent ductus arteriosus (OR, 2.0; 95% CI = 1.0, 3.5), and pulmonary air leak (OR, 3.0; 95% CI = 1.3, 7.1). Acute atherosis was inversely related to CLD (OR, 0.2; 95% CI = 0.1, 0.8). Chorioamnionitis was stratified by subtype and again no association with CLD was seen in the population as a whole. Finally, chorioamnionitis of all subtypes tended to be increased in white infants and decreased in black infants with CLD. This dichotomy was not explained by differences in death rates, acute respiratory distress, intubation on d 2 of life, or total duration of assisted ventilation. We conclude that while chorioamnionitis was not a risk factor for CLD in our total population, racial differences in its relationship to CLD are worthy of further study.
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PMID:Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants. 1240 18

Modulations of maternal immune cell function are critical for successful growth and development of an antigenically distinct fetus. It has been proposed that pregnancy is associated both with suppression of the adaptive immune system and a generalised maternal inflammatory response with changes in immune function resembling those associated with septicemia, and these changes are more exaggerated when pregnancies are complicated with pre-eclampsia. The nuclear factor (NF)-kappaB family of transcription factors play a significant role in immune regulation. We hypothesised therefore that if pregnancy is associated with activation of the maternal immune system, this would be supported by the activation of NF-kappaB and degradation of IkappaBalpha and beta in peripheral blood mononuclear cells (PBMCs). We demonstrate the contrary: NF-kappaB activity is suppressed in PBMCs from pregnant females and more in pre-eclampsia. The inhibition of NF-kappaB activation in pregnancy is not attributed to over-expression of IkappaBalpha or beta. In contrast, levels of IkappaBalpha and beta in cytoplasmic extracts from PBMCs in pregnancy are decreased compared with non-pregnant controls, and IkappaBalpha levels are decreased more so in pre-eclampsia. We have shown that activation of NF-kappaB in PBMCs from patients with septicemia follows the classical pathway. This pathway is differentially regulated in pregnancy. Alterations in NF-kappaB nuclear binding and IkappaBalpha levels were reproducible by culturing PBMCs in pooled pregnant serum. Taken together, these data indicate that pregnancy-specific factors exist to regulate expression of NF-kappaB/IkappaB in a pregnancy-specific manner, and may underlie one mechanism by which the fetus avoids maternal rejection throughout pregnancy.
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PMID:Pregnancy is associated with suppression of the nuclear factor kappaB/IkappaB activation pathway in peripheral blood mononuclear cells. 1260 23

The objective of this study is to identify the risk factors for neonatal thrombocytopenia among preterm infants. During a 4-year study period all consecutive, singleton preterm deliveries (between 27 and 35 weeks of gestation) were evaluated, and separate cohorts were compared-growth restricted (small-for-gestational-age; SGA) and appropriately grown (appropriate-for-gestational-age; AGA) infants. An initial comparison was done for the presence of thrombocytopenia (platelet count below 150,000/mL) and marked thrombocytopenia (below 100,000/mL). Following that, a comparison was made between the groups as determined by platelet count for various possible risk factors. Three hundred and five preterm infants were included in the study. Mean platelet count was significantly lower in the SGA group (p = 0.0009). Ninety-three neonates (31%) were thrombocytopenic and 212 infants with a normal platelet count served as controls. In the thrombocytopenic group, the rate of preeclampsia was significantly higher (p = 0.002). Thrombocytopenic infants had a significantly lower average gestational age at delivery (p = 0.002), lower birth weight (p = 0.0001), and low 5-minute Apgar score (p = 0.0002). They were more likely to suffer from intraventricular hemorrhage (IVH) ( p = 0.04) and sepsis (p = 0.002). Growth restriction, lower gestational age and low 5-minute Apgar score (<7) were found to be significantly independent risk factors for marked thrombocytopenia, when analyzed separately. Growth restriction, lower gestational age at delivery, and low 5-minutes Apgar score are significantly associated with neonatal thrombocytopenia in preterm infants, which may lead to significant morbidity. Screening these high-risk groups for thrombocytopenia might be beneficial in terms of early diagnosis and management.
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PMID:Risk factors for neonatal thrombocytopenia in preterm infants. 1263 81

L-Selectin is an adhesion molecule shed from the surface of lymphocytes and granulocytes upon activation. Soluble L-selectin in the plasma can thus reflect immune activation and is elevated in several pathological states. Our objective was to evaluate plasma levels of L-selectin as an immune activation marker in neonates and to determine whether it can serve as a marker of infection, either neonatal or congenital, or if it is affected by the mode of delivery and obstetrical or perinatal complications. A solid-phase ELISA was used on 89 sera from neonates less than 2 days of age, according to the manufacturer's instructions. Levels of soluble L-selectin in the neonate were lower than those of older infants and children and comparable to the levels seen in adults. There was no difference between levels of soluble L-selectin of premature (median, 1172 ng/ml) and full-term babies (median, 1151 ng/ml) or between babies born via vaginal (median, 1233 ng/ml) or cesarean delivery (median, 1146 ng/ml). Conditions such as preeclampsia or administration of steroids to the mother did not affect the levels of L-selectin in the neonate. In contrast, the presence of maternal clinical chorioamnionitis resulted in an increase in levels of L-selectin in the neonate (median, 1377 vs 1072 ng/ml, p = 0.02), as did neonatal sepsis (median, 1331 vs 1149 ng/ml, p = 0.026). Soluble L-selectin, and thus immune activation level, is highest in neonates with neonatal infection and needs to be further evaluated as a surrogate marker for diagnosing sepsis in the neonate.
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PMID:Soluble L-selectin, a marker of immune activation, in neonatal infection. 1459 21

Female genital mutilations, as well as forcible childhood marriage and their correlate adolescent pregnancies are traditional practices which, not only violate the dignity, but also jeopardize the health, and even the life, of women and their children. The complications of genital mutilations are frequent for a number of reasons: the fact that the clitoris is highly vascularized, the nature of the mutilations, excision or infibulation, and the poor conditions of hygiene. The short term complications are pain, hemorrhage, shock, and urinary retention. Medium term complications include gangrene, septicemia, tetanus, pelvic inflammatory disease, HIV/AIDS, and hepatitis B or C infections. Serious sequelae may occur, including infertility and gynecologic disorders, and sexual life is invariably altered. The main obstetrical complications of genital mutilations are genital lacerations involving the labia minor and the perineum, which can lead to hemorrhage and sequelae such as urinary or anal incontinence, recto-vaginal and vesico-vaginal fistulas. The role of doctors, which is delicate because these customs are entrenched, is to detect genital mutilations, repair them and prevent them, by participating in health education programs. The consequences of forcible childhood marriage are serious, besides the fact that this is a disguised form of rape. The obstetrical risks favored by the underdevelopment of the uterus and the pelvis, include uterine rupture, preeclampsia and eclampsia, and obstetrical hemorrhage. The fetus/neonate are jeopardized by these complications, which can result in perinatal asphyxia and death, as well as the high rates of intrauterine growth retardation and preterm delivery. The impact of genital mutilations on delivery are compounded in childhood pregnancies for anatomical reasons, but also because these adolescents or children are extremely vulnerable and have poor access to perinatal care. In France, as well as in Africa, non-governmental and women's rights organizations are active in preventing these practices. We strongly recommend that these groups should receive aid and encouragement.
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PMID:[Female genital mutilations, forced marriages, and early pregnancies]. 1497 67

MODS is a rare but potentially lethal complication of pregnancy. Pregnancy induces physiologic changes in all major maternal organ systems that mimic early changes seen in SIRS and MODS. When a potentially life-threatening event occurs, such as hemorrhage,sepsis, or severe preeclampsia, the perinatal nurse must monitor subtle changes in maternal and fetal status and intervene to optimize maternal status.
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PMID:Multiorgan dysfunction in the perinatal patient. 1514 62

A total of 2456 deliveries took place at the University of Maiduguri Teaching Hospital, Maiduguri, between January 1995 and December 1996 inclusive. Two hundred and five women were delivered by caesarean giving a caesarean section rate of 8.3%. One hundred and ninety-eight (96.6%) case records were retrieved for analysis. Eighty-eight patients (44.4%) had one or more intra- and/or postoperative complications. Sepsis was the commonest complication involving 62 (70.4%) women. All were cases of emergency caesarean section. The incidence of other complications were anaemia, 59 (67%); hemorrhage, 38 (43.2%); and wound dehiscence, 11 (12.5%). There were two maternal deaths (2.3%) due to an anaesthetic accident and septicaemia respectively. The factors resulting in complications of the caesarean deliveries were prolonged obstructed labour, prolonged rupture of fetal membranes, previous caesarean sections, antepartum haemorrhage and severe pre-eclampsia and eclampsia. A review of the use of prophylactic antibiotics in selected cases, early recourse to operation in cases with cephalo-pelvic disproportion, and the acquisition of trained anaesthetists are advocated.
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PMID:Caesarean morbidity and mortality at Maiduguri, Nigeria. 1551 65


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