[Show abstract][Hide abstract] ABSTRACT: Urinary tract infections are very common during pregnancy. Escherichia coli is the most common pathogen isolated from pregnant women. Ampicillin should not be used because of its high resistance to Escherichia coli. Pyelonephritis can cause morbidity and can be life-threatening to both mother and fetus. Second and third-generation cephalosporins are recommended for treatment, administered initially intravenously during hospitalization. Cultures and the study of virulence factors of uropathogenic Escherichia coli are recommended for the adequate management of pyelonephritis. The lower genital tract infection associated with pyelonephritis is responsible for the failure of antibiotic treatment. Asymptomatic bacteriuria can evolve into cystitis or pyelonephritis. All pregnant women should be routinely screened for bacteriuria using urine culture, and should be treated with nitrofurantoin, sulfixosazole or first-generation cephalosporins. Recurrent urinary infection should be treated with prophylactic antibiotics. Pregnant women who develop urinary tract infections with group B streptococcal infection should be treated with prophylactic antibiotics during labour to prevent neonatal sepsis. Preterm delivery is frequent. Evidence suggests that infection plays a role in the pathogenesis of preterm labour. Experimental models in pregnant mice support the theory that Escherichia coli propagated by the transplacental route, involving bacterial adhesins, induces preterm delivery, but this has not been demonstrated in humans. Ascending lower genital tract infections are the most probable cause of preterm delivery, but this remains to be proved.
Current Opinion in Urology 02/2001; 11(1):55-9. · 2.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment.
Administrative data for all nonfederal Illinois hospitals in 2001 were used to analyze the association of a hospital's obstetric trauma rates with patient and hospital-level factors. Multivariable random effects logistic regression analyses was used to account for hospital-level clustering.
A total of 175,374 deliveries from 142 Illinois hospitals were available for analysis. The frequency of obstetric trauma was significantly associated with multiple patient-specific and hospital-level factors. Specifically, for any vaginal delivery, premature delivery, multiple gestation, excessive fetal growth, and prolonged pregnancy was associated with obstetric trauma risk. For spontaneous delivery, a prior cesarean was associated with trauma risk as well. Maternal age was associated with trauma risk at cesarean as well as at vaginal delivery. With regard to hospital-level factors, a higher annual delivery volume and a higher cesarean rate were associated with increased risk of trauma with either type of vaginal delivery, whereas in the intensity with which hospitals coded their medical records was associated with trauma risk for all routes of delivery.
The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety.
American journal of obstetrics and gynecology 10/2006; 195(3):868-74. · 3.28 Impact Factor
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