Risk factors of puerperal sepsis in Alexandria

Puerperal infections are an important cause of maternal morbidity and mortality in developing nations. Investigators have noted several risk factors for developing puerperal sepsis. However, the relative importance of these risk factors varies and has to be determined for each setting. Therefore the aim of the present work was to determine the risk factors for puerperal sepsis in Alexandria, Egypt. A case-control design was used to study the risk factors of puerperal sepsis in Alexandria. The study included 160 puerperal sepsis cases and 160 controls. Puerperal sepsis cases were recruited from the fever hospital as well as from 3 rural health units and three urban health offices in Alexandria. A pre-designed interviewing questionnaire was used to collect data about risk factors of puerperal sepsis. Logistic regression analysis indicated that very low socio-economic score (OR = 6.4), no ANC (OR = 4.5), delivery at a governmental maternity hospital (OR = 203.4), frequent vaginal examinations (OR = 5.1), anemia during puerperium (OR = 4.3), unsanitary vaginal douching during puerperium (OR = 19.9) and unhygienic preparation of diapers used immediately after delivery (OR = 12.1) were significantly related to the occurrence of puerperal sepsis. Improving infection control measures during delivery, limiting the frequency of vaginal examinations, and avoiding all unhygienic practices related to delivery are strongly recommended.     

产褥感染相关因素分析

目的 探讨产褥感染的相关因素,提出预防措施.方法 对2005年1月-2010年1月医院收治的30例产褥感染相关因素进行回顾性分析.结果 剖宫产患者产褥感染率为0.30％,阴道分娩患者产褥感染率为0.42％,差异无统计学意义,因此产褥感染的发生与分娩方式不相关;产褥感染主要与妊娠、分娩的并发症相关,有妊娠并发症患者产褥感染率为1.04％,明显高于无妊娠并发症的0.05％(x2=51.6292,P＜0.01),可能是由于妊娠并发症致机体的免疫及防御功能下降而致病.结论 做好围产期保健,提高产科质量,及时治疗妊娠相关并发症,是降低产褥感染的重要措施.     

广东省急危重症孕产妇产褥感染流行病学特征与分析

目的:探讨广东省急危重症孕产妇产褥感染相关因素,力求降低产褥感染发生率。方法:按照各地经济水平,把广东省分为珠三角地区、山区、东翼、西翼,调查产褥感染的发生率,产褥感染与地理分布、产次特征、住院分娩数、产前检查数、活产数、孕产妇数的关系。结果:各地产褥感染发生率有显著差异,其中珠三角地区发生率高,山区其次,东西两翼最低。产褥感染患者的年龄特征是26～30岁组最多,<25岁其次。产褥感染发生率与产前检查率呈负相关,与住院分娩率、高危发现率正相关。结论:提高产前检查率、高危筛查率及住院分娩率,可以及时发现异常情况,有效降低产褥感染率;同时要坚持预防为主,积极治疗各种孕期合并症及并发症;大力推广新法接生,严格无菌操作;积极防治产褥感染,从而促进全社会生殖健康水平的提高。     

农村贫困地区孕产妇保健服务状况分析及对策

目的为了解农村贫困地区孕产妇保健服务状况,改善其服务提供参考依据。方法采取分层定额随机抽样的方法,获取样本。由统一培训的调查员进行调查。调查表用EPI Info3.3.2软件进行数据录入,用SPSS11.5软件进行统计分析。结果建立孕产妇保健手册率为62.8%,有89人(37.2%)没有建册,孕早期建册率为55.2%;产前检查率为92.9%,产前检查次数达标的比例为55.7%,还有17人(7.1%)没有做过产前检查,产前检查医院以区级及以下医院为主,其比例为93.3%;分娩方式,自然分娩率为72.4%,剖宫产率为27.6%;参加孕期保健保偿的比例为41.4%;产后访视次数达标率64%;对产前检查及产后访视需求的很好满足度,分别为24.7%、28.5%。结论孕早期建册率及产前检查次数达标比例较低,参加孕期保健保偿的比例有待提高。建议有针对性的对孕产妇进行健康教育,增强她们对孕产期保健服务的主动需求意识。     

白细胞介素、降钙素原及C-反应蛋白与产妇产褥感染的相关性分析

目的探讨分娩后产褥感染患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、降钙素原(PCT)及C-反应蛋白(CRP)的表达水平,并分析其与产褥感染的关系。方法选取2015年6月-2018年6月在该院分娩并确诊为产褥感染的产妇112例为研究组,另选取同期在该院住院的100例未发生感染的产妇为对照组。通过检测所有产妇生殖道病原体感染情况及血清IL-6、IL-10、PCT、CRP水平,分析其与产褥感染的关系。结果研究组检出支原体感染52例(66.67%),革兰氏阳性菌感染15例(19.23%),革兰氏阴性菌感染11例(14.10%)。分娩前,两组产妇血清IL-6、IL-10、PCT、CRP水平比较,差异无统计学意义(P>0.05)。分娩后24 h,研究组产妇血清IL-6、IL-10、PCT、CRP水平均高于对照组,差异均有统计学意义(均P<0.05);分娩后72 h,研究组产妇血清IL-6、PCT、CRP水平均高于对照组,差异均有统计学意义(均P<0.05);且研究组产妇血清IL-6、IL-10、PCT、CRP水平随感染时间延长而上升(P<0.05),对照组产妇血清IL-6、IL-10、PCT、CRP水平随着时间延长先上升,后下降至分娩前水平(P<0.05)。盆腔腹膜炎患者分娩后72 h的血清IL-6、IL-10、PCT、CRP水平高于子宫内膜及附件炎,子宫内膜及附件炎血清各指标水平高于外阴阴道及宫颈炎。结论产褥感染产妇分娩后血清IL-6、IL-10、PCT、CRP水平明显高于正常产妇分娩后水平,三者与产褥感染的发生、进展密切相关,对早期发现并干预产褥感染具有一定的临床价值。     

阴道助产与剖宫产对脐带脱垂预后的影响

目的:比较阴道助产与剖宫产对脐带脱垂预后的影响。方法:52例发生胎儿脐带脱垂的产妇,根据临床情况分别进行剖宫产和阴道助产,比较两组间新生儿死亡率、新生儿产伤和产妇产褥感染、出血或血肿、组织损伤的发生率。结果:剖宫产组新生儿死亡率和产伤发生率、出血和组织损伤发生率均较阴道助产组明显降低(P<0.05),而产褥感染在两组间无显著性差异(P>0.05)。结论:以剖宫产处理脐带脱垂可以相对降低新生儿死亡率及减少母婴并发症,优于阴道助产。     

Quality of birth care in maternity hospitals of Rio de Janeiro, Brazil

OBJECTIVE: To evaluate the quality of birth care based on the World Health Organization guidelines. METHODS: A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. RESULTS: There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. CONCLUSIONS: The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.     

The puerperal infection in a delivery center: occurrence and predisposing factors

The Delivery Center (DC) provides obstetric assistance centered on the parturient's needs according to scientific evidences. This study aimed to verify the occurrence of puerperal infection in the DC and to compare the clinical obstetric characteristics of the women readmitted in the hospital with puerperal infection to those who were not readmitted in the hospital. It is an exploratory and non-experimental research with retrospective data collection. The population was based on 51 puerparae who received assistance in the DC, from 2000 to 2003. The results demonstrated that among 10,559 deliveries, 0.16% of them presented puerperal infection and the obstetric assistance given in the DC was related to the puerperal infection, only when considering the duration of the labor. It was concluded that the obstetric assistance given by this model of care brings benefits to the women.     

Evaluation of the effectiveness of a clean delivery kit intervention in preventing cord infection and puerperal sepsis among neonates and their mothers in rural Mwanza Region, Tanzania

A study was carried out in Misungwi and Kwimba Districts, Tanzania to determine the effectiveness of clean delivery kits in preventing cord infection and puerperal sepsis and to provide qualitative information on community acceptability, correct use, and appropriateness of the kits. This study involved pregnant women aged 18-45 years old. In the delivery kit intervention population, the Maternal and Child Health Aide (MCHA) assigned to the health facility provided pregnant mothers with a clean delivery kit on their first antenatal visit. She explained how to use each of the kit components, with the aid of pictorial instructions included in the kit. The pregnant mothers were asked to convey the information to whoever assisted them during delivery. The MCHA also gave them health education based on the principles of the "six cleans" recognized by WHO (i.e., clean hands, clean perineum, clean delivery surface, clean cord cutting and tying instruments, clean cutting surface). Women received the clean delivery kit free of charge in accordance with the randomised stepped-wedge design schedule. During the first week following delivery, the Village Health Workers (VHWs) from both the intervention and control groups made two visits to the households of mothers who had delivered. They administered questionnaire about delivery to mother and birth attendant. During the two scheduled postpartum visits, those who were suspected to have puerperal sepsis or cord infection of the baby were referred to the health facility clinician for confirmation. Results indicated that use of clean delivery kit had a positive effect on reducing both cord infection and puerperal sepsis. The use of a clean home delivery kit coupled with an educational intervention about the "six cleans" had a significant effect on reducing the incidence of cord infection and puerperal sepsis among women enrolled in the study. In low resource settings where home birth is common and clean delivery supplies are scarce, disposable kits can be made available through health clinics, markets, pharmacies or other channels to help reduce rates of infection.     

产妇心理状况与产时相关因素的分析

对１６８例产妇进行心理状况的调查分析。结果显示：１６８例中发生抑郁症状９例，发生率为５．３６％。多元逐步回归分析显示，分娩方式及对分娩疼痛感到恐惧是产后抑郁症状发病的主要产时危险因素。分娩方式中的产钳助产产妇抑郁症状发生率明显高于剖宫产及自然分娩组（Ｐ＜０．０１）。产时有并发症的产妇抑郁症状发生率高于正常组，两者有显著性差异（Ｐ＜０．０１）。而产妇的年龄、职业、妊娠结局以及新生儿性别与产后抑郁的发生无明显关系（Ｐ＞０．０５）。提示：应加强围产期的心理卫生保健，对预防产妇抑郁症状有积极意义。     

产褥感染30例的影响因素及预防措施分析

目的分析产褥感染的相关影响因素，探讨治疗策略及预防措施。方法对荆门市康复医院2010年1月至2013年2月间收治的2849例产妇中的30例产褥感染患者进行随诊，观察产褥感染的相关因素及治疗方法，并制定相应预防措施。结果不同分娩方式、妊娠并发症、第二产程延长、产前贫血、产后出血、胎膜早破、孕期患有阴道炎、羊水污染、剖宫产32次均可增加产褥感染几率，，值依次为15．53、4．54、8．39、38．95、8．96、15．07、13．59、8．64、5．88，均P〈0．05。在30例产褥感染患者中，治愈27例，3例患者经过再次手术后痊愈。未见死亡病例。结论产褥感染诱发因素众多，需孕期至产后综合预防。对胎膜早破、第二产程延长及羊水污染等高危因素要积极应对，合理应用抗生素，降低产后不良事件发生。     

天津市宝坻区剖宫产因素初步探讨

目的：了解天津市宝坻区常住人口剖宫产的相关影响因素。方法收集天津市宝坻区产妇病历资料394例,分析医源性因素剖宫产和社会因素剖宫产的影响因素。结果医源性因素剖宫产占81.7％,主要医源性因素为剖宫产史（24.8％）、羊水过少（24.8％）、胎头跨耻征阳性（15.8％）等;社会因素剖宫产占18.3％,包括孕妇怕疼（6.9％）、孕妇精神紧张（5.6％）、孕妇家人担心（3.0％）等。年龄、产次和职业是医源性因素与社会因素剖宫产选择的影响因素。结论天津市宝坻区常住产妇剖宫产主要医源性因素为剖宫产史、羊水过少、胎头跨耻征阳性,主要社会因素为孕妇怕疼、孕妇精神紧张、孕妇家人担心;年龄、产次和职业对选择剖宫产有影响。     

重症监护病房下呼吸道感染的危险因素和预防

目的探讨重症监护病房(ICU)下呼吸道感染的危险因素并提出相应的预防措施.方法对2002年9月～2003年9月612例ICU患者进行前瞻性监测研究,符合医院感染诊断标准的45例患者为感染组,未感染者根据随机列表按1:1作为对照组,采用单因素分析与多因素分析下呼吸道感染的危险因素.结果对15个可能的危险因素进行单因素分析,有8个呈显著差异,再对这8个变量进行Logistic回归分析,结果表明气管切开、机械通气、ICU住院日是下呼吸道感染的独立危险因素.结论控制重症监护病房下呼吸道感染,应针对危险因素,采取相应的预防措施,从而控制和减少感染的发生.     

143例产后出血的临床分析

目的分析东莞市厚街医院产妇中产后出血的危险因素,以进一步针对性预防产后出血,降低产后出血发生率及死亡率。方法回顾性研究分析2012年1月1日至2012年12月31日在我院住院分娩发生产后出血的产妇143例,对其年龄、孕次、产次、胎数、分娩方式、出血量、可能影响产后出血的危险因素等指标进行统计学分析,筛选产后的高危因素。结果我院产后出血发生率为2．8T％。15岁-19岁年龄组高于20岁及以上年龄组（P〈0．05）,流动人口高于本地常住人口（P〈0．05）,胎盘因素,羊水污染、妊娠期高血压疾病、巨大儿、合并子宫肌瘤是产后出血的高危因素,而孕次、产次、胎数、分娩方式对产后出血无明显影响。结论加强产前健康教育,加强高危孕产妇的管理,及时对症处理可有效的降低产后出血的发生率及孕产妇死亡率。     

孕产妇保健服务利用现状调查

目的 了解中国孕产妇保健服务需求和利用现状,探讨影响孕产妇保健服务利用的主要因素.方法 应用自行设计的调查问卷对2009年7-12月间分娩的1 945名妇女进行调查,并对孕产妇保健服务利用的影响因素进行分析.结果 孕早期系统保健管理卡建卡率为49.77%,产前保健指导率为82.98%,产后保健指导率为52.75%,产前检查率为99.33%,产前检查5次率为74.24%,住院分娩率为98.61%,产后访视率为42.21%,产后访视3次率为9.51%;影响孕产妇保健服务利用的因素主要有孕产妇年龄、职业、文化程度、就医距离、活产生育数、居住地以及婚姻状况等.结论 孕产妇首次产前检查时间滞后,产后访视率低,孕产妇的孕期保健服务有待加强.     

综合医院产妇医院感染的调查与分析

目的 探讨综合医院产妇医院感染的现状及相关因素,为临床控制医院感染提供依据.方法 采用回顾性调查方法对2008-2011年产妇医院感染发生情况进行统计分析.结果 4年内共有13408例产妇分娩,发生医院感染37例,感染率为0.28％;感染前3位的是会阴侧切术引起的切口感染、剖宫产术后的切口感染、上呼吸道感染,分别占27.03％、16.22％、16.22％;24例剖宫产产妇发生医院感染,其中切口感染6例,其他部位的感染18例,剖宫产产妇发生其他部位的医院感染明显高于阴道分娩产妇,差异有统计学意义(x2 =9.578,P＜0.01);医院感染多发生于第一～三季度,第四季度少见,与南方春季呼吸道感染多,夏、秋季炎热潮湿容易发生切口感染有关.结论 产妇医院感染的相关因素很多,科学的围产期保健、严格无菌操作和感染管理等是预防和控制产妇医院感染的关键.     

A retrospective study of administration of vaccination for hepatitis B among newborn infants prior to hospital discharge at a midwestern tertiary care center

ObjectivesInfants are at high risk of developing chronic, life-threatening disease as a result of hepatitis B virus infection. Universal vaccination of infants against hepatitis B virus, before discharge from the hospital after delivery is recommended as a measure to eradicate infection and associated mortality and morbidity. The purpose of this study was to determine rates of perinatal hepatitis B vaccine (Hep B) administration at a tertiary care center in Iowa and to assess the impact of maternal factors on Hep B uptake.MethodsData concerning mother–infant pairs that received care at one institution from 1/2009 to 4/1/2013 were extracted from the system's electronic medical record. Characteristics of study participants were compared using chi-square tests. Multivariate logistic regression was used to assess the association between each factor and vaccination status, controlling for other characteristics.ResultsOf 5663 mother–infant pairs, 5175 (91.4%) infants received Hep B within 7 days after delivery. The majority of those not vaccinated had a medical indication to delay vaccination. Single women were significantly more likely to have an infant not vaccinated, after adjustment for all other factors. Women of minority groups were significantly less likely to have an infant who lacked Hep B at hospital discharge than Caucasian women.ConclusionsSignificant improvements have occurred in Hep B rates in the state and region. Infants of single mothers may be at the greatest risk for lacking vaccination at hospital discharge.     

Obesity and gestational weight gain: cesarean delivery and labor complications

OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.