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4 results

  • Case 64 - A 25-Year-Old with Post-cesarean Endometritis and Fever Unresponsive to Antibiotics

  • from Section 7 - Postpartum
  • Edited by Peter F. Schnatz, The Reading Hospital, Pennsylvania, D. Yvette LaCoursiere, University of California, San Diego, Christopher M. Morosky, University of Connecticut School of Medicine, Jonathan Schaffir, The Ohio State University College of Medicine, Vanessa Torbenson, Mayo Clinic Alix School of Medicine, David Chelmow, Virginia Commonwealth School of Medicine
  • Book:
    Pregnancy Complications
    Published online:
    08 April 2025
    Print publication:
    01 May 2025, pp 196-198

  • Summary

    Endomyometritis is a postpartum uterine infection that can lead to significant morbidity and mortality if not promptly recognized and managed. This case describes a 25-year-old primiparous patient with endometritis and how her condition was evaluated and managed. Endomyometritis is a clinical diagnosis. Key to the management is early introduction of antibiotics. If fevers persist, further evaluation is necessary to exclude alternative sources of infection. Early consideration of sepsis is crucial, and scoring systems can aid in identifying patients at risk for severe morbidity. Prevention strategies include reducing vaginal exams, minimizing the time between rupture of membranes and delivery, and implementing surgical bundles and prophylactic antibiotics for cesarean deliveries.

  • Case 67 - A 40-Year-Old 1 Week after Vaginal Delivery Presents with Shortness of Breath and Orthopnea

  • from Section 7 - Postpartum
  • Edited by Peter F. Schnatz, The Reading Hospital, Pennsylvania, D. Yvette LaCoursiere, University of California, San Diego, Christopher M. Morosky, University of Connecticut School of Medicine, Jonathan Schaffir, The Ohio State University College of Medicine, Vanessa Torbenson, Mayo Clinic Alix School of Medicine, David Chelmow, Virginia Commonwealth School of Medicine
  • Book:
    Pregnancy Complications
    Published online:
    08 April 2025
    Print publication:
    01 May 2025, pp 205-207

  • Summary

    Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure in the last month of pregnancy or within 5 months postpartum. Symptoms of PPCM can often be mistaken for normal pregnancy symptoms, which may delay the diagnosis. After a thorough history and physical examination are performed, a transthoracic echocardiogram should be ordered in any patient in which PPCM is suspected. A multidisciplinary approach to care is essential and should include maternal-fetal medicine and cardiology input. Treatment and management are usually supportive and directed toward immediately managing the signs and symptoms of heart failure as well as improving blood flow to vital organs and reducing fluid overload.

  • Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother–child cohort in Crete, Greece

  • K. Koutra, M. Vassilaki, V. Georgiou, A. Koutis, P. Bitsios, M. Kogevinas, L. Chatzi
  • Journal:
    Epidemiology and Psychiatric Sciences / Volume 27 / Issue 3 / June 2018
    Published online by Cambridge University Press:
    22 December 2016, pp. 244-255
  • Aims.

    Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum.

    Methods.

    A total of 1037 women who enrolled in the Rhea mother–child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders.

    Results.

    The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother.

    Conclusions.

    We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.

  • Chapter 15 - Intrapartum and Postpartum: Legal Commentary II

  • from Part II - INTRAPARTUM AND POSTPARTUM
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book:
    Operative Obstetrics
    Published online:
    07 May 2010
    Print publication:
    04 August 2008, pp 370-392

  • Summary

    Pregnancy, labor, and delivery are associated with major physiologic changes that can decrease maternal reserves. Consequently, various techniques of analgesia and anesthesia can have profound effects on maternal physiology. Furthermore, obstetric pain management and operative obstetric anesthesia are recognized as secondary causes of neonatal respiratory depression. Improper management of labor is the common claim in obstetrical malpractice cases. Malpresentation and/or dystocia are some of the most fertile areas for medical negligence lawsuits. The clinician must be fully aware of the general predisposing factors to complications in the third stage of labor. Common postpartum complications include urinary tract problems, such as infections, urine retention, or incontinence. Obstetricians have long recognized the excessive perinatal morbidity and mortality associated with the breech-presenting fetus. Multiple gestations often pose intrapartum management problems. Emphasizing the shoulder dystocia was a true obstetric emergency, and greater emphasis was placed on team approach, including neonatal resuscitation.