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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The number of cesarean births for dystocia has increased dramatically in the United States. Central to the management of dystocia is correction of ineffective labor by oxytocin administration, and contemporary obstetric practice is to stimulate labor with a low-dose oxytocin regimen. We prospectively compared a low-dose oxytocin regimen (1-mU/minute dosage increments) with a high-dose regimen (6-mU/minute dosage increments) in 2788 consecutive singleton cephalic pregnancies. The low-dose regimen was used first for 5 months in 1251 pregnancies, and the high-dose regimen in 1537 pregnancies during the subsequent 5 months. Indications for oxytocin stimulation were divided into augmentation (N = 1676) and induction (N = 1112). Labor stimulation was more than 3 hours shorter (P less than .0001) with the high-dose oxytocin regimen and associated with a reduction in neonatal sepsis (0.2 versus 1.3%; P less than .01). Uterine hyperstimulation was more common (55 versus 42%; P less than .0001) with the high-dose regimen, but no adverse fetal effects were observed. High-dose augmentation resulted in significantly fewer forceps deliveries (12 versus 16%; P = .03) and fewer cesareans for dystocia (9 versus 12%; P = .04). Similarly, failed induction was less frequent with high-dose compared with low-dose oxytocin (14 versus 19%; P = .05). Although the high-dose induction regimen was associated with a significantly increased cesarean incidence for fetal distress (6 versus 3%; P = .05), the incidence of umbilical artery cord blood acidemia was not increased in this subset. Induction of labor with high-dose oxytocin is problematic because of risk-benefit considerations. Although induction failed less frequently with the high-dose regimen, cesarean for fetal distress was performed more frequently. In contrast, high-dose oxytocin to augment ineffective spontaneous labor minimized the number of cesareans done for dystocia.
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PMID:High- versus low-dose oxytocin for labor stimulation. 160 79

The periodicity of morbidity rate in heifers and dairy cows kept on pasture (278 animals) and in stables (187 animals) was studied in relation to macroclimatic conditions under the assumption of two peaks per annum. The following conditions were used as the parameters of morbidity: purulent inflammations of uterus, sterility, lesions of the female tract and sepsis, dystocia, retention of placenta, mastitis, foot diseases and lying down after parturition. No significant differences were found between the studied groups of animals. A statistically significant up to highly significant dependence was found between the health of the heifers and cows and macroclimatic conditions both in stables and on pasture; an increase in morbidity rate was recorded in spring and autumn.
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PMID:[Health status of cattle in relation to the time of year]. 641 43

During 15 years (1965 through 1979), 9,718 cesarean sections were performed at Hutzel Hospital. This report concerns the indications, incidence, morbidity, and mortality. Dystocia, fetal distress, and breech presentations were the most common indications for primary cesarean section. The incidence rose from 9.8% to 16.8% during this study. Forceps deliveries dropped from 47.5% to 12.0% and vaginal breech deliveries decreased from 86% to 35%. Spinal anesthesia was used in 90%. Caesarean section hysterectomies were performed in 128. The most common indications were carcinoma in situ of the cervix, uterine leiomyoma, and hemorrhage. Puerperal sepsis and urinary tract and wound infections were the major causes of morbidity. Perinatal mortality decreased from 40% to 29%. There were 10 maternal deaths. Sepsis was the major cause of death. At least four deaths could have been avoided if ultra-high-risk patients had not been pregnant in the first place.
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PMID:Caesarean section: a 15-year review of changing incidence, indications, and risks. 722 16

A one-year retrospective study of cesarean section (CS) at Women and Infants Hospital of Rhode Island is reported. There were 5,467 women delivered, including 1,011 who delivered by CS, yielding a total CS rate of 18.5% and a primary rate of 13.4%. The four leading indications for primary CS were: dystocia (38.8%), breech presentation (14.9%), malposition (11.9%) and fetal distress (11.3%). Sepsis was responsible for 75% of the complications. The incidence of low-birth-weight infants was 14.2% for primary CS and 6.7% for repeat CS. The perinatal death rate was 21.2% per 1,000. The relationship of these findings to changing obstetric practice is discussed.
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PMID:Cesarean section: a contemporary assessment. 737 98

In settings where most births occur at home, collection of data on complications experienced around the time of delivery is often dependent on self-reported data, collected through individual interviews. This paper describes a study designed to validate interview data on obstetric complications by comparing women's responses with data extracted from their medical records. The major complications of hemorrhage, dystocia, sepsis, and eclampsia were the main focus of the study. The sample was drawn from women hospitalized for delivery in a Manila hospital within the past 4 years. The main goal of the study was to assist in development of a survey instrument to be used in a national sample survey of women in the Philippines. The best sensitivity and specificity, respectively, for combinations of questions on these four conditions were: for hemorrhage, 0.70 and 0.78; for dystocia, 0.69 and 0.97; for sepsis, 0.89 and 0.83; and for eclampsia, 0.44 and 0.96. There were no significant differences in the duration of the recall periods according to diagnosis.
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PMID:Validation study of women's reporting and recall of major obstetric complications treated at the Philippine General Hospital. 767 75

This study examines the impact of the Maternal-Child Health and Family Planning (MCH-FP) program in the Matlab, Bangladesh. Data were obtained from the Matlab surveillance system for treatment and comparison areas. This study reports the trends in maternal mortality since 1976. The MCH-FP area received extensive services in health and family planning since 1977. Services included trained traditional birth attendants and essential obstetric care from government district hospitals and a large number of private clinics. Geographic ease of access to essential obstetric care varied across the study area. Access was most difficult in the northern sector of the MCH-FP area. Contraception was made available through family welfare centers. Tetanus immunization was introduced in 1979. Door-to-door contraceptive services were provided by 80 female community health workers on a twice-monthly basis. In 1987, a community-based maternity care program was added to existing MCH-FP services in the northern treatment area. The demographic surveillance system began collecting data in 1966. During 1976-93 there were 624 maternal deaths among women aged 15-44 years in Matlab (510/100,000 live births). 72.8% of deaths were due to direct obstetric causes: postpartum hemorrhage, induced abortion, eclampsia, dystocia, and postpartum sepsis. Maternal mortality declined in a fluctuating fashion in both treatment and comparison areas. Direct obstetric mortality declined at about 3% per year. After 1987, direct obstetric mortality declined in the north by almost 50%. After the 1990 program expansion in the south, maternal mortality declined, though not significantly, in the south. Maternal mortality declined in the south comparison area during 1987-89 and stabilized. The comparison area of the north showed no decline.
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PMID:Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale. 973 75

In India, physicians analyzed data on 56 women (18-20 weeks gestation) at the Marie Stopes Clinic in Jodhpur who underwent pregnancy termination to evaluate the efficacy and safety of ethacriding lactate which has antiseptic properties. They injected 150 cc 0.1% ethacriding lactate into the intrauterine, extra-amniotic space. They used iv infusion of oxytocin to expedite the delivery of the abortus. 59% of cases were unmarried teenagers. Ethacridine lactate induced successful abortion in 92.8% (52) of cases which was much higher than that found in the literature (about 82%). Abortion failure occurred in the other 4 cases because of transverse lie of fetus (2), cervical dystocia (1), and uterine inertia (1). The transverse lie and cervical dystocia cases would have experienced failure regardless of the uterotonic abortifacient used. 3 of the failure cases underwent evacuation while the other underwent hysterotomy. Most women (73.2%) experienced the abortion 12-24 hours after induction. The mean interval was 20.1 house which was shorter than that of previous reports (29.5-38 hours). The shortest induction-abortion interval was 10.5 hours and the longest was more than 36 hours. Complications occurred in 6 (14.4%) cases. 3 (5.4%) women suffered from cervical tear. 3 (5.4%) women experienced incomplete expulsion which was much lower than that reported in the literature (16-30%). On the other hand, the 5.4% incomplete expulsion rate was higher than that for prostaglandin and hypertonic saline. There was 1 case each of severe bleeding and vaginal laceration. The antiseptic properties of ethacridine lactate likely accounted for the complete absence of sepsis in these women. In conclusion, ethacridine lactate performs better than other instillation abortion methods and it is a safe and effective method.
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PMID:Ethacridine lactate -- a safe and effective drug for termination of pregnancy. 1231 89

A critical evaluation of the maternal deaths that occurred in the performance of 745 caesarean sections performed in the rural environment of India over the 1965-1973 period was conducted. During this period there were 20 maternal deaths, giving an incidence of 2.7%. In the series there were 11 moribund cases of placenta previa with history of internal examination done outside in 9 cases. Out of 5 deaths in obstructed labor, 4 were in group 2 (obstructed labor with pronounced effect on mother but with a living fetus) and 1 in group 3 (obstructed labor with dead fetus). Out of 4 deaths in secondary cervical dystocia, 3 were associated with prolapse and 1 with carcinoma cervix. The clinical condition at the time of section was severe anemia with shock and bleeding in 8 cases, features of exhaustion with or without evidence of sepsis in 10 cases and apparently normal in 2 cases. While there was no death in elective section, in emergency cases the mortality was 4.1%. With increasing duration of labor the risk was found increased from nil to as high as 6.8% where caesarean section was performed beyond 48 hours of labor. Shock, sepsis and embolism accounted for 75% of deaths. 7 of 20 deaths were within 6 hours of operation and as many as 9 deaths occurred after 72 hours. There were 13 stillbirths and 2 neonatal deaths out of 20 maternal deaths.
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PMID:A critical evaluation of maternal deaths in caesarean section met in rural obstetric practice. 1232 30

Since launching of the safe motherhood initiative in 1987, much work has been undertaken, understanding of the situation in developing countries has improved, and numerous health programs have been designed. However the end result of action has been considered disappointing more often than encouraging especially in Sub Saharan Africa. What is the true picture? The purpose of this article is to review the means available for studying all facets of maternal mortality and methodological precautions that must be applied in the interpretation of statistical data. Perusal of recent reports on maternal mortality reveals that estimated incidences in different populations vary widely from 85 to 1000 per 100,000 live births, that rural zones are more affected than urban areas, that reductions have been achieved in the major cities, that the most common direct obstetrical causes are postpartum hemorrhage, dystocia with uterine rupture, eclampsia, and sepsis, and that 70% of deaths are avoidable, i.e., due to absent or insufficient care. Although currently underused, qualitative study methods are gradually being implemented and will identify the health care sectors requiring priority improvement. Based on previous experience, it is unlikely that technical or obstetrical measures and action on the part of medical professionals alone will achieve any reduction in maternal mortality without the commitment of political authorities.
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PMID:[Maternal mortality in developing countries: statistical data and improvement in obstetrical care]. 1476 89

Foals may present to a referral hospital with the primary diagnosis of uroperitoneum (UP), or they may develop UP while hospitalized for other reasons. Historical, physical, laboratory, and diagnostic variables of foals presenting with UP were compared to those developing UP while hospitalized. Emphasis was placed on the presence of electrolyte abnormalities, evidence of sepsis or infection, and development of anesthetic complications during surgical correction of the defect. Foals developing UP while in the hospital frequently had a history of dystocia and presented at a very young age (< 48 hours) with primary clinical signs compatible with intrauterine compromise or presumed hypoxic or ischemic insult with or without sepsis. Foals referred with suspected UP often had additional problems unrelated to the urinary system. These foals had hyponatremia and hyperkalemia on presentation, whereas foals receiving intravenous fluid therapy consisting of a balanced electrolyte solution did not develop the classical pattern of electrolyte abnormalities, yet a similar increase in serum creatinine and, frequently, decreasing urine production were noted. Infection was present in 63% of the foals, and 78% of foals revealed signs suggestive of sepsis or infection. Intrauterine compromise, presumed hypoxia or ischemia, and sepsis may predispose foals to development of UP. Anesthetic complications occurred in 16% of the foals undergoing surgical correction of the defect, although hyperkalemia was only present in half of the foals with anesthetic complications.
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PMID:Uroperitoneum in 32 foals: influence of intravenous fluid therapy, infection, and sepsis. 1635 86


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