557: Use of Bakri balloon for postpartum hemorrhage as a risk factor for postpartum endometritis and sepsis

Franklin-Dumont, Tina; Harvie, Heidi; Kole, Martha B.; Hillman, Jennifer; Kieserman-Shmokler, Caroline; Sehdev, Harish M.; Ludmir, Jack

doi:10.1016/j.ajog.2012.10.723

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…51 On the other hand, a different retrospective cohort study from 2008 to 2011 demonstrated a significantly increased risk of endometritis with the use of Bakri balloon for PPH. 52 One prospective cohort study in 3 African countries studying condom catheters showed no significant difference in rates of postpartum endometritis between PPH patients who were treated with condom catheter balloons and those who were not. 53 Importantly, 90% of condom catheter patients were given prophylactic antibiotics in the immediate postpartum period; the low rate of postpartum endometritis in the condom catheter patients could very well be explained by the high rate of prophylactic antibiotic administration.…”

Section: Intrauterine Tamponade Balloonmentioning

confidence: 99%

“…One Japanese retrospective cohort study from 2014 to 2018 of 2144 deliveries found no significant difference in the rates of endometritis between patients who did and did not require Bakri balloons in the setting of PPH 51 . On the other hand, a different retrospective cohort study from 2008 to 2011 demonstrated a significantly increased risk of endometritis with the use of Bakri balloon for PPH 52 . One prospective cohort study in 3 African countries studying condom catheters showed no significant difference in rates of postpartum endometritis between PPH patients who were treated with condom catheter balloons and those who were not 53 .…”

Section: Exploration and Instrumentation Of The Postpartum Uterusmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

Lambert

Honart

Hughes

et al. 2023

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

Importance Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care. Objective To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario. Evidence Acquisition Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed. Results These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens. Conclusions Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV. Relevance Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After reading this article, the provider should be better able to discuss diagnosis and management of endometritis; describe antibiotic regimens recommended in the setting of uterine exploration postpartum; and identify antibiotic regimens recommended in the setting of postpartum uterine instrumentation.

show abstract

Section: Intrauterine Tamponade Balloonmentioning

confidence: 99%

Section: Exploration and Instrumentation Of The Postpartum Uterusmentioning

confidence: 99%

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

Lambert

Honart

Hughes

et al. 2023

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

show abstract

“…4 One concern regarding the use of IBT is an increased risk of postpartum endometritis. 5 Current recommendations for other in-dwelling catheters (such as bladder catheters) recommend early removal and that in some groups that antibiotics be considered to reduce the likelihood of infection. 6,7 IBT is becoming a common tool in obstetric management of PPH.…”

mentioning

confidence: 99%

Antibiotics during Intrauterine Balloon Tamponade Is Associated with a Reduction in Endometritis

et al. 2019

View full text Add to dashboard Cite

Objective To evaluate whether prophylactic antibiotics at the time of placement of an intrauterine balloon tamponade (IBT) is associated with a reduction in postpartum endometritis. Study Design Retrospective cohort study of patients who received an IBT from January 1, 2012, to December 12, 2016. Patients were included if the IBT remained in place at least 2 hours and excluded if chorioamnionitis was present. Patients who received prophylactic antibiotics at the time of IBT placement were compared with those who did not. Results A total of 149 subjects received an IBT; 36 were excluded due to early removal or chorioamnionitis. Of the remaining, 59 received prophylactic antibiotics and 54 did not. Baseline characteristics were similar between the groups except mode of delivery. The majority (65%) of those who did not receive prophylactic antibiotics had a cesarean delivery (p = 0.03). The overall incidence of endometritis was 15%. The incidence of endometritis was greater among those patients who did not receive prophylactic antibiotics compared with those who did (5 vs. 26%; p < 0.002; odds ratio [OR]: 6.53; 95% confidence interval [CI]: 1.76–24.25). This association remained after adjustment for mode of delivery and receiving group B Streptococcus antibiotics prior to delivery (adjusted OR: 5.9; 95% CI: 1.58–22.35). Conclusion Prophylactic antibiotics were associated with a reduction in postpartum endometritis among patients receiving an IBT.

show abstract

“…[10][11][12][13] The common obstetric scenarios of (1) 3rd and 4th degree vaginal lacerations, (2) manual placental extraction, and (3) uterine tamponade have all independently been associated with increased rates of endometritis and wound infection. [14][15][16] Currently, trends in use of antibiotics for these conditions during delivery hospitalizations in the United States are not well characterized. Characterizing antibiotic use in these scenarios may be important in subsequent quality implementation efforts and outcomes research.…”

mentioning

confidence: 99%

Antibiotics for 3rd and 4th Degree Vaginal Lacerations, Uterine Tamponade, and Manual Placental Extraction

et al. 2019

View full text Add to dashboard Cite

Objective Trends in use of antibiotics during delivery hospitalizations complicated by (1) 3rd/4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade are not well characterized. The objective of this study was to analyze trends in antibiotic use during vaginal delivery hospitalizations complicated by these three clinical scenarios. Study Design An administrative inpatient database was used to perform a serial cross-sectional analysis of antibiotic administration during delivery hospitalizations in the United States from January 2006 to March 2015. The primary outcome was receipt of antibiotics during vaginal delivery hospitalizations complicated by (1) 3rd and 4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade. Patients with other indications for antibiotics were excluded. The Cochran–Armitage test was used to assess trends. Adjusted log linear regression analyses including demographic, hospital, and obstetric factors were performed to analyze factors associated with antibiotic receipt for each of these three clinical scenarios in both primary and sensitivity analyses. Results From 2006 to 2015 the rate of antibiotic administration during delivery hospitalizations decreased from 43.1% in 2006 to 25.5% for 3rd and 4th degree lacerations and from 59.6% to 49.2% for manual extraction (p < 0.01). Administration of antibiotics in the setting of uterine tamponade decreased from 48.6% in 2006 to 27.6% in 2009 before rising to 62.5% in the first quarter of 2015. In adjusted analyses, comparing the first quarter of 2015 to 2006 adjusted risk ratios for antibiotic administration were 0.61 (95% confidence interval [CI] 0.56–0.66) for 3rd and 4th degree vaginal lacerations, 0.76 (95% CI 0.53–1.09) for manual placental extraction, and 0.83 (95% CI 0.76–0.92) for uterine tamponade. Conclusion Antibiotics are not used consistently during vaginal deliveries complicated by 3rd/4th degree lacerations, manual placenta extraction, and uterine tamponade. These findings support that a significant opportunity exists for comparative effectiveness research to assist in characterizing best practices.

show abstract

557: Use of Bakri balloon for postpartum hemorrhage as a risk factor for postpartum endometritis and sepsis

Cited by 3 publications

References 0 publications

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

Antibiotics during Intrauterine Balloon Tamponade Is Associated with a Reduction in Endometritis

Antibiotics for 3rd and 4th Degree Vaginal Lacerations, Uterine Tamponade, and Manual Placental Extraction

Contact Info

Product

Resources

About