The aim: To obtain the prevalence of postpartum endometritis women and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study. The study population consisted of all women who had a vaginal delivery or cesarean section in 14 Regional Women’s Hospitals of Ukraine. Results: Total 2460 of 25,344 patients were found to have postpartum endometritis, for an overall infection rate of 9.7%. The postpartum endometritis rates were 7.6% after vaginal delivery and 16.4% after cesarean section. Incidence of postpartum endometritis after cesarean section is affected mainly by the mode of delivery (scheduled caesarean deliveries (done before labor starts) – 13.8% and unscheduled caesarean deliveries (done after labor starts) – 22.5%. The predominant pathogens were: Escherichia coli (32.7%), Enterococcus faecalis (13.0%), Streptococcus spp. (12.1%), Klebsiella spp. (10.4%) and Enterobacter spp. (10%). Among the antimicrobial agents tested, the ertapenem, piperacillin/ tazobactam, and cefotaxim were the most consistently active in vitro against Enterobacteriaceae in both vaginal deliveries and after cesarean section infections. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 22.8% and of methicillin-resistance in Staphylococcus aureus (MRSA) 15.4%. Conclusions: Postpartum endometritis and antimicrobial resistance of responsible pathogens presents a significant burden to the hospital system. Postpartum infections surveillance is required in all women’s hospitals. This knowledge is essential to develop targeted strategies to reduce the incidence of postpartum infections.
The aim: To obtain the prevalence of mastitis in the breastfeeding women and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: A retrospective multicenter cohort study was based on surveillance data for Postpartum Mastitis and included 18,427 breastfeeding women’s who gave birth in 11 regional hospitals of Ukraine. Results: 22.6% breastfeeding women’s were found to have breast infections. Among these patients, 11.6% breast abscess and 88.4% mastitis were observed. Of the total cases breast infections, 74.8% were detected after hospital discharge. The rate of healthcare-associated mastitis was 8.6%. The predominant pathogens were: Staphylococcus aureus (23.6%), Escherichia coli (19.4%), Enterobacter spp. (11.9%), Staphylococcus epidermidis (10.7%), Klebsiella spp. (8.7%), Pseudomonas aeruginosa (4.8%), Enterococcus faecalis (4.8%), and Proteus mirabilis (4.6%). The overall proportion of methicillin-resistance was observed in 27.9% of S. aureus (MRSA) and 24.3% of S. epidermidis (MRSE). Of the total methicillin-resistance strains, 74.8% of MRSA and 82.1% of MRSE is community-acquired, were detected after hospital discharge. Vancomycin resistance was observed in 9.2% of isolated enterococci. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 8.8% Klebsiella spp. and E.coli 9.1% isolates. Conclusions: Mastitis in the breastfeeding women in Ukraine requires medical attention it is common, and a lot of cases are caused by pathogens resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of mastitis, but prevention is the key element.
In recent years, there has been an increase in the number of operations on the uterus in women of reproductive age with the formation of "uterine scarring syndrome" (USS), which can lead to complicated pregnancy and childbirth. To assess of anatomical and functional features of uterine scar, pregnancy and perinatal outcomes in USS women. A prospective analysis of clinical anamnestic data, pregnancy and childbirth in 398 USS women was conducted; ultrasound and Doppler assessment of morpho-functional status of the uterus using the Accuvix V20 Prestige (Samsung Medison, Republic of Korea) was made. Statistical analysis was performed using Statistica 13.0 (Dell Inc., USA) software. In 74.62 % of 398 women, the scar on the uterus is due to a previous caesarean section (CS), in 24.11 % due to conservative myomectomy (CME), in 1.25 % –because of endoscopic interventions for incomplete uterine septum, in 25.87 % of women it was the result of "small" gynecological surgery. In 97 % of women with a scar on the uterus after the previous CS, there was no "passport of surgery": ultrasound revealed the localization of the scar in the lower uterine segment in 96.48 % of 398, corporate scar – in the remaining 3.51 % of women; ultrasound signs of relative "anatomic" scar failure were noted in 10.80 % of pregnant women. In 48.73 % of women pregnancy was complicated by the threat of abortion or premature birth, in 30.40 % anemia was diagnosed, in 24.87 % of the women under observation placental dysfunction took place. 78.1 % of women had delivery at term, 13.2 % had premature birth, 97.3 % had births CS, and 2.7 % of women had labours through canalis obstetricus. In 1.3 % of women labor was complicated by uterine hypotension, and uterine devascularization procedures was performed. The most common reasons for the formation of USS are cesarean section, conservative myomectomy and various "small" intrauterine operations. Pregnancy with this syndrome is most often complicated by the threat of its termination and childbirth before term, anemia, placental dysfunction and Intrauterine growth retardation . The choice of delivery tactics is conditioned by the totality of hystory, the status of the scar on the uterus, obstetric status and the wishes of the woman herself. It is advisable to look for methods to assess the morpho-functional status of the operated uterus and predict the perinatal consequences of pregnancy in these women at the stage of preconception preparation.
Introduction. Recently, the attention of researchers has again attracted the problem of pregnancy in the presence of scar on the uterus.The aim of the study is to evaluate the processes of myometrium remodeling in women with uterine scar using non-invasive ultrasonic monitoring. It is shown that the frequency of relative failure of yellowing in the uterus does not exceed 2.7% of the total number of women examined. The ratio of the thickness of the residual in the plane of the yellow and normal endometrium indicates complete remodeling and is in women after KP, this index was 0.96 ± 0.08, and after KME -0.94 0.06 (p> 0.05). The difference in maximum systolic velocity of arterial blood flow in patients after CR (38.8 ± 1.2 cm / s) and after CME (34.2 1.4 cm / sec, p <0.05) can be explained by differences in localization cuts during these surgical interventions. The expediency of using both linear and dopplerometric methods of ultrasound examination in evaluating the ability of rumen on the uterus and myometrium remodeling processes is discussed.
Annotation. The aim of the study was to assess the characteristics of hemostasis and the formation of a scar on the uterus in women who underwent conservative myomectomy. Medical records of 426 women with a scar on the uterus were analyzed. The results of pathomorphological examination of biopsy materials obtained in the area of the “old” scar during myomectomy with recurrence of fibroids with a gestational age of 33 to 40 weeks. The micromorphological structure of postoperative scars and pericycatric region of the myometrium was determined and immunohistochemical examination was performed on serial paraffin sections of biopsy material using primary and secondary monoclonal antibodies of Dako kits (USA). To quantify the immunohistochemical results in the sections, the number of cells in which the immunoperoxidase label (positive staining) was detected in 10 fields of view randomly selected (>200 cells) was counted. FW expression was determined using a semi-quantitative method with H-score calculation. Statistical processing of the obtained results was performed by non-parametric methods using the software TIBCO Statistica 13.5 (USA). It was shown that 40.1% of uterine scars are due to conservative myomectomy. In the postoperative period, patients who underwent conservative myomectomy have a tendency to hypercoagulation, while the frequency of thromboembolic complications after conservative myomectomy does not exceed 3%. High FW expression indicates the presence of endothelial dysfunction and should be taken into account when assessing the risk of thromboembolic complications in patients after conservative myomectomy.
Мета дослідження – аналіз частоти розриву матки у жінок, які перенесли консервативну міомектомію, та оцінка ефективності системи клінічного моніторингу на прегравідарному та інтрагравідарному етапах. Матеріали та методи. Дослідження виконано на базі обласного перинатального центру та міського пологового будинку № 5 (м. Одеса) впродовж 2016-2021 рр. Проаналізовано 2633 історії вагітностей жінок з рубцем на матці, з яких у 1798 випадках рубець утворився після кесаревого розтину, а у 835 – після консервативної міомектомії. Визначено частоту розриву матки та загрозливих для життя породіллі станів (near miss). Проведений аналіз відповідності програми обстеження вагітних чинним клінічним протоколам. Статистичну обробку проведено параметричними методами за допомогою програмного забезпечення MS Excel (Microsoft Inc., США). Результати досліджень та їх обговорення. Середній вік жінок склав (39,6±0,7) року. Частота розриву матки у вагітних із рубцем на матці після кесаревого розтину склала 0,2 %, після консервативної міомектомії – 0,1 %. Чинниками ризику для розриву матки були вік пацієнтки старше 35 років, наявність повторних вагітностей в анамнезі, похибки в реалізації плану ведення вагітної у І–ІІ триместрах. Повноцінний ультрасонографічний моніторинг проводили лише у 2 (40,0 %) із 5 хворих, соногістерографію – лише в одному випадку (20,0 %). Висновки. Частота розриву матки після консервативної міомектомії не перевищує 0,1 %, після кесаревого розтину – 0,2 %. Наявність розриву матки в анамнезі не є протипоказанням до реалізації репродуктивної функції в подальшому. Одним із чинників ризику розриву матки у жінок, що перенесли операційні втручання на матці, є низький комплаєнс щодо заходів клінічного моніторингу функціонального стану післяопераційного рубця впродовж вагітності.
The increase in the frequency of surgical interventions on the uterus in women of fertile age caused increasing occurrence of pregnancies with one or more scars on the uterus. Purpose — to evaluate perinatal outcomes in women with a uterine scar. Materials and methods. The study involved 120 pregnant women who had a history of reconstructive surgery. The total sample was divided into the following clinical groups: I (n=70) — women who underwent conservative myomectomy, including 6 12 months before conception (group IA, n=30) and more than 1 year before conception (IB group, n=40); Group II (n=50) — women who underwent a cesarean section. All patients were examined in accordance with the order of the Ministry of Health of Ukraine No. 676 dated December 31, 2004 «On the approval of clinical protocols for obstetric and gynecological care» (as amended by the order of the Ministry of Health No. 782 (v0782282-05) dated December 29, 2005, No. 624 (v0624282-08) from 03.11.2008, No. 205 (v0205282-14) from 24.03.2014). Statistical processing was performed using the ANOVA method using post-hoc correction with Bonferoni. The null hypothesis was accepted at p<0.05 Results. When analyzing the results of measuring the main fetometric indicators, it was found that in most cases there were no deviations from the population standard values. Only 7 (5.8%) pregnant women were expecting the birth of children with low birth weight, they had a fetal weight that did not correspond to gestational age (so-called SGA — small for gestational age). There were no cases of perinatal mortality. There were 8 (6.5%) cases of children born with malnutrition. There were 2 children born with asphyxiation (1.6%). There were 5 (4.0%) with respiratory disorders syndrome, 6 (4.8%) with manifestations of conjugational jaundice. 4 (3.2%) cases of morphofunctional immaturity were registered. Perinatal lesion of the central nervous system of hypoxic-ischemic origin was detected in 3 (2.4%) newborns. Conclusions. With the correct choice of tactics for the management of pregnancy and childbirth in women who have undergone surgery on the uterus, the number of perinatal complications does not exceed the general population levels. The incidence of unfavorable perinatal outcomes does not exceed 19.4%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: uterine scar, pregnancy, childbirth, complications, perinatal outcomes.
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