MyMedR

Puerperal pyrexia

LLEWELLYN-JONES D

Med J Malaya, 1958 Sep;13(1):100-2.

PMID: 13589378

Matched MeSH terms: Puerperal Disorders*

Transient blindness in pregnancy induced hypertension

Achanna S, Monga D, Sivagnanam

Asia Oceania J Obstet Gynaecol, 1994 Mar;20(1):49-52.

PMID: 8172527

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.

Matched MeSH terms: Puerperal Disorders/etiology

Thrombo-embolism in pregnancy

Ping WW, Kee TS

Med J Malaysia, 1976 Mar;30(3):169-72.

PMID: 958051

Matched MeSH terms: Puerperal Disorders*

Acute puerperal inversion of the uterus

Khoo KE

Med J Malaysia, 1978 Dec;33(2):143-5.

PMID: 755165

Matched MeSH terms: Puerperal Disorders/therapy*

Venous thrombosis in obstetrics

Thambu JA

Med J Malaya, 1967 Dec;22(2):87-93.

PMID: 4231984

Matched MeSH terms: Puerperal Disorders*

Fulltext Painful thyroiditis in postpartum period

Sakinah SO, Sharifah NA, Yusoff K

Med J Malaysia, 1993 Mar;48(1):83-5.

PMID: 8341177

Destructive thyroiditis commonly occurs during the postpartum period, with a prevalence rate of 5% to 16%, and is mainly due to postpartum autoimmune thyroiditis (PPT) and, very rarely, to subacute thyroiditis. The thyroiditis is similar to Hashimoto's thyroiditis and is generally painless in nature, although cases with painful thyroiditis have been described. We report a case of painful destructive thyroiditis occurring during the postpartum period, which was clinically and biochemically indistinguishable from the variant of painful PPT or subacute thyroiditis. Fine needle aspiration cytology showed multi-nucleated giant cells diagnostic of subacute thyroiditis.

Matched MeSH terms: Puerperal Disorders/diagnosis*; Puerperal Disorders/pathology; Puerperal Disorders/physiopathology

Post partum splenic artery aneurysm rupture

Asokan S, Chew EK, Ng KY, Thanaletchimy N, Asmiati A, Kong NM

J Obstet Gynaecol Res, 2000 Jun;26(3):199-201.

PMID: 10932982

Ruptured splenic artery aneurysm during pregnancy is a rare event with high maternal and fetal mortality rate. A case of ruptured splenic artery aneurysm in the post partum period is presented. The literature is reviewed on pathophysiology, clinical presentation and management of this rare and potentially fatal entity.

Matched MeSH terms: Puerperal Disorders*

Acute puerperal inversion of the uterus--an obstetric emergency

Rachagan SP, Sivanesaratnam V, Kok KP, Raman S

Aust N Z J Obstet Gynaecol, 1988 Feb;28(1):29-32.

PMID: 3214380

Over a 17-year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 deliveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.

Matched MeSH terms: Puerperal Disorders/therapy*

Acute inversion of the uterus: a report of 2 cases and reappraisal of the method of management

Ping WW, Sinnathuray TA

Med J Malaya, 1970 Sep;25(1):54-7.

PMID: 4249498

Matched MeSH terms: Puerperal Disorders/therapy*

A comparison of sexual function in primiparous and multiparous women

Banaei M, Alidost F, Ghasemi E, Dashti S

J Obstet Gynaecol, 2020 Apr;40(3):411-418.

PMID: 31537138 DOI: 10.1080/01443615.2019.1640191

Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p

Matched MeSH terms: Puerperal Disorders/etiology; Puerperal Disorders/epidemiology*

Diaphragmatic hernia: an unusual cause of postpartum collapse

Sharifah H, Naidu A, Vimal K

BJOG, 2003 Jul;110(7):701-3.

PMID: 12842063

Matched MeSH terms: Puerperal Disorders/etiology*

Fulltext Acute disseminated encephalomyelitis (ADEM) presenting with seizures secondary to anti-tetanus toxin vaccination

Hamidon BB, Raymond AA

Med J Malaysia, 2003 Dec;58(5):780-2.

PMID: 15190671

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system (CNS) that is known to occur spontaneously in association with specific and non-specific viral illnesses and after vaccination against various pathogens. Although it is often a self-limited monophasic illness, the fatality rate is estimated to be as high as 20%, and many patients suffer residual neurologic impairment 1. The diagnosis is mainly based on clinical and radiological findings. The clinical presentation varies from merely, an asymptomatic condition to loss of consciousness, seizures, ataxia, optic neuropathy, cranial nerve palsies, and motor dysfunction. MRI of the brain is the single most important diagnostic radiological investigation and can facilitate early diagnosis and prompt treatment. This case report describes a patient with ADEM presenting with only seizures after vaccination with anti-tetanus toxin.

Matched MeSH terms: Puerperal Disorders/etiology

Manual removal of placenta under hypoaesthesia

Menon R

Med J Malaya, 1970 Sep;25(1):17-20.

PMID: 4249487

Matched MeSH terms: Puerperal Disorders/surgery*

High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy

Ravichandran J, Woon SY, Quek YS, Lim YC, Noor EM, Suresh K, et al.

Am J Med, 2019 03;132(3):362-366.

PMID: 30503877 DOI: 10.1016/j.amjmed.2018.11.017

PURPOSE: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension.

METHODS: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI.

RESULTS: A total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations).

CONCLUSIONS: Cardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.

Matched MeSH terms: Puerperal Disorders/blood*

The Effectiveness of Hypnosis Intervention in Alleviating Postpartum Psychological Symptoms

Beevi Z, Low WY, Hassan J

Am J Clin Hypn, 2019 Apr;61(4):409-425.

PMID: 31017553 DOI: 10.1080/00029157.2018.1538870

Psychological symptoms, particularly postpartum depression, may impair women's well-being after childbirth. Mind-body treatments such as hypnosis are available to help prepare women to maintain or improve their well-being postpartum. The aims of the present study are to determine the effectiveness of a hypnosis intervention in alleviating psychological symptoms (stress, anxiety, and depression) and the symptoms of postpartum depression. A quasi-experimental design was utilized in this study. The experimental group participants (n = 28) received a hypnosis intervention at weeks 16, 20, 28, and 36 of their pregnancies. Participants in the control group (n = 28) received routine prenatal care. The final data collection, occurring at two months postpartum, included 16 women from the experimental group and 11 women from the control group. The Depression Anxiety Stress Scale-21 (DASS-21) was used to measure psychological symptoms, and postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The results at two months postpartum showed that the experimental group had significantly lower postpartum anxiety than the control group (M = 2.88 versus M = 38.36, p = .023). Similarly, the experimental group had significantly lower postpartum depressive symptoms than the control group (M = 1.25 versus M = 6.73, p

Matched MeSH terms: Puerperal Disorders/prevention & control*

Total dose imferon infusion using the fixed volume/time technique

Malek JT

Med J Malaysia, 1978 Jun;32(4):313-5.

PMID: 732630

Matched MeSH terms: Puerperal Disorders/drug therapy

Postpartum obsessive-compulsive symptoms in a case of peripartum-onset depression and infanticide

Lee KKS, Yahya B

Asian J Psychiatr, 2019 Jan;39:10-11.

PMID: 30466055 DOI: 10.1016/j.ajp.2018.11.004

Matched MeSH terms: Puerperal Disorders/diagnosis

Pregnancy-associated osteoporosis: a UK case series and literature review

Hardcastle SA, Yahya F, Bhalla AK

Osteoporos Int, 2019 May;30(5):939-948.

PMID: 30671611 DOI: 10.1007/s00198-019-04842-w

Mini Abstract: Pregnancy-associated osteoporosis (PAO) is a rare syndrome affecting women during late pregnancy and the early postpartum period. We set out to review the clinical features of ten cases of PAO from a single UK centre. Patients had attended the Royal National Hospital for Rheumatic Diseases, Bath (RNHRD) between January 2000 and June 2016. The principal criterion for inclusion was the occurrence of low trauma fractures either during pregnancy or the immediate post-partum period. Data were obtained from retrospective review of medical notes. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (Hologic ®Discovery system) at the lumbar spine and hip. Data pertaining to the pregnancy, as well as type and duration of treatment received, were reviewed. All ten cases presented with vertebral fractures. In four patients, no risk factors for fracture other than pregnancy or breastfeeding could be identified. Four patients were found to have vitamin D insufficiency at the time of diagnosis, and a further two patients had received treatment with low molecular weight heparin (LMWH). In one case, further investigation led to a diagnosis of osteogenesis imperfecta (OI) confirmed on genetic testing. In terms of treatment, eight out of the ten patients in this series received a bisphosphonate, most commonly risedronate due to its relatively short skeletal retention time. Clinicians should be aware of PAO, a rare but recognised complication of pregnancy. The condition should be especially considered in women presenting with new onset back pain in pregnancy or the postpartum period.

Matched MeSH terms: Puerperal Disorders/diagnosis; Puerperal Disorders/drug therapy; Puerperal Disorders/physiopathology

Combined team management of diabetes mellitus in pregnancy

Ng CS, Lim LS, Chng KP, Lim P, Cheah JS, Yeo PP, et al.

Ann Acad Med Singap, 1985 Apr;14(2):297-302.

PMID: 4037689

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Matched MeSH terms: Puerperal Disorders/etiology

Fulltext Antibiotic prophylaxis in ragged placental membranes: a prospective, multicentre, randomized trial

Voon HY, Pow JY, Tan LN, Suharjono HN, Teo WS

BMC Pregnancy Childbirth, 2019 Jul 11;19(1):240.

PMID: 31296180 DOI: 10.1186/s12884-019-2373-9

BACKGROUND: Ragged placental membranes is a distinct entity from retained placenta and not uncommonly reported in midwifery texts. Although the incidence of postpartum endometritis is merely 1-5% after vaginal births, it remains the most common source of puerperal sepsis, contributing up to 15% of maternal mortality in low income countries. Geographically-remote centres in Malaysia prophylactically administer antibiotics for women with ragged placental membranes after vaginal birth, extrapolating evidence from retained placenta. We sought to clarify the rationale in continuing such practices.

METHODS: This was an open-label, prospective, multicentre, randomized trial. Three hospitals where the current protocol was to administer prophylactic amoxycillin-clavulanic acid served as the sites of recruitment. Women who delivered vaginally beyond 24+ 0 weeks of gestation with ragged membranes were invited to participate in the trial and randomized into prophylaxis or expectant management with medical advice by blocks of 10, at a 1:1 ratio. A medication adherence diary was provided and patients followed up at 2 weeks and 6 weeks postpartum.

RESULTS: A total of 6569 women gave birth vaginally in three centres during the trial period, of which 10.9% had ragged membranes. The incidence of endometritis was not significantly raised in women with or without prophylaxis (0.90% vs 0.29%; p = 0.60). All cases of endometritis presented within the first 2 weeks and preventive use of antibiotics did not ameliorate the severity of endometritis since rates of ICU admission, surgical evacuation and transfusion were comparable.

CONCLUSION: Preventive use of antibiotics after vaginal delivery in women with ragged placental membranes did not result in a reduction of endometritis. Educating women on the signs and symptoms of endometritis would suffice. Based on the reported incidence of ragged membranes, a change in practice would result in 1500 less prescriptions of antibiotics per annum in these three centres.

TRIAL REGISTRATION: NCT03459599 (Retrospectively registered on 9 March 2018).

Matched MeSH terms: Puerperal Disorders/prevention & control*

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