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

Several articles investigated the impact of prolonged second stage of labor on maternal and neonatal outcomes; however, strict consensus is still lacking. The purpose of the present meta-analysis is to investigate risk factors that contribute to the pathophysiology of prolonged labor as well as effect sizes of maternal and neonatal morbidity. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar database. Observational studies (prospective and retrospective) were considered eligible for inclusion in the present meta-analysis. To minimize the possibility of article losses we avoided language, country and date restrictions. Meta-analysis was performed with the RevMan 5.3 and secondary analysis with Rstudio. Overall, 13 studies were included in the present systematic review that comprised 337.845 parturient. Prolonged second stage was associated with higher odds of postpartum hemorrhage, chorioamnionitis, endometritis, postpartum fever and obstetric anal sphincter injury. Persistent occiput posterior position and shoulder dystocia were also more prevalent compared to women with normal duration of the second stage. The need for admission to the neonatal intensive care unit was higher as well as the risk of developing neonatal sepsis. On the other hand, the odds of perinatal death were comparable among cases with prolonged and normal duration of the second stage. The results of the present meta-analysis clearly indicate that deliveries following a prolonged second stage of labor are at increased risk of maternal and neonatal complications. The presented effect estimates can be used in current clinical practice during patient counseling.
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PMID:Maternal and neonatal outcomes following a prolonged second stage of labor: A meta-analysis of observational studies. 3257 Jan 87

Background: Pregnant women with chronic genital and non-genital infections are at a high risk of infections complication during pregnancy and the postpartum period. Preterm birth is one of the leading causes of obstetric and neonatal complications and occurs in one in nine women. Forty per cent of preterm births are considered to be caused by the abnormal vaginal microbiome, and there is currently no consensus on the contribution of combined bacterial and viral infections.Aim: To assess the course of pregnancy and delivery in women with a high risk of chronic infections and the association with the presence of specific microorganisms in the genital microbiome.Materials and methods: We performed a prospective controlled observational study in 355 pregnant women with a high risk of chronic infections. The high risk was defined as presence acute or chronic genital or extragenital infections, reactivation of chronic infections/inflammatory diseases during current pregnancy and history of obstetric complications during previous pregnancies such as miscarriages, missed miscarriages, preterm deliveries, postpartum endometritis, and sepsis.Results: In women with a high risk of chronic infections, pregnancy was associated with recurrent threatened pregnancy loss (49.8%), preterm premature rupture of fetal membranes (64.3%), followed by prolonged oligohydramnios. Almost in one in two women (47.9%), pregnancy resulted in the delivery of preterm, low-birth-weight neonates. One in three women (30%) experienced uterine hypotony and bleeding after vaginal and cesarean delivery. Almost a third of women (32.1%) developed inflammatory complications postpartum, and more than half of complications (54.4%) was observed in women giving birth prematurely. Vaginal and cervical cultures in women who experienced preterm birth were dominated by non-obligate pathogens. We observed persistence of the Herpesviridae family both in the cervical canal and uterine cavity, specifically the Epstein-Barr virus (17.2%; 95% CI: 10%, 26.8%).Conclusions: Pregnancies in women with a high risk of chronic infections were associated with high rates of recurrent threatened pregnancy loss, preterm rupture of membranes and preterm delivery.
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PMID:Pregnancy and delivery in women with a high risk of infection in pregnancy. 3257 52


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