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Re: IUPC placement was: glove use in L&D From: Jonathan Daniels (jdaniels@sd.cybernex.net) Sat Jan 11 01:16:10 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Jonathan Daniels: "Re: IUPC placement was: glove use in L&D" Previous message: Larry Kincheloe: "I'm back in the saddle again" Maybe in reply to: richardc@bcm.tmc.edu: "IUPC placement was: glove use in L&D" Next in thread: rbraun@indyunix.iupui.edu: "Re: IUPC placement was: glove use in L&D" Reply: rbraun@indyunix.iupui.edu: "Re: IUPC placement was: glove use in L&D" >On Thu, 9 Jan 1997, I wrote: > I am however very reluctant to insert an IUPC if I suspect chorioamnionitis. > At 08:37 AM 1/10/97 Daniel Braun, MD wrote: >Why ???? You already have the problem that you are afraid of the IUPC >causing Namely Chorioamnionitis. ... In fact there is some evidence that amnioinfusion is >beneficial with chorioamnionitis. It may cool the baby, it may by >irrigation effect decrease the colony count, and if you infuse >antibiotics, it may treat the problem. I agree. I didn't mean that I was worried that the patients might develop chorio. I was referring to placing an IUPC in patients that already have signs of infection. My concern was making the infection worse by introducing a foreign body and perhaps increasing the risk of sepsis. What they need is antibiotic therapy and delivery. Adding antibiotics to the infusion fluid is an intriguing idea, though. Has it been studied? I pulled up a couple of papers from the Journal of Reprod Med. that seem to show that amnioinfusions during labor reduce the risk of infection. I'll attach the abstracts. Again my question is what about putting IUPCs and doing amnioinfusions in patients who are already infected. Anybody have any ideas? Monahan E, Katz VL, Cox RL Amnioinfusion for preventing puerperal infection. A prospective study. Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill 27599-7570, USA. J Reprod Med 1995 Oct;40(10):721-3 Article Number: UI96130419 ABSTRACT: OBJECTIVE: To evaluate the hypothesis that irrigation of the uterine cavity by amnioinfusion in women with membranes ruptured for greater than six hours would decrease maternal puerperal infection. STUDY DESIGN: We designed a prospective study at three teaching institutions. Sixty-eight women were randomized to receive either amnioinfusion or routine care. Amnioinfusion was through preexisting internal uterine pressure catheters with a 300-500-mL bolus and a 125-150 mL/h constant drip. Chorioamnionitis and endometritis were evaluated as the outcome variables. RESULTS: Women from the amnioinfusion group, n = 36, and the control group, n = 32, had similar times in labor (mean 4 hours), times of ruptured membranes (mean 18 hours), vaginal examinations (mean 7), gestational age (mean 40 weeks), types of anesthesia and methods of delivery. Women who received amnioinfusion had significantly less puerperal infection, 9/36, as compared to women in the control group, 16/32 (P < .033, relative risk = .5, confidence interval .26-.94). There were no cases of neonatal sepsis in either group, and there were no complications from the amnioinfusions. CONCLUSION: In this study of women at high risk for puerperal infection, amnioinfusion was an inexpensive and safe technique for reducing the incidence of infection. -- =========================================================================== Moen MD, Besinger RE, Tomich PG, Fisher SG Effect of amnioinfusion on the incidence of postpartum endometritis in patients undergoing cesarean delivery. Department of Obstetrics and Gynecology, Loyola Stritch School of Medicine, Maywood, IL 60153, USA. J Reprod Med 1995 May;40(5):383-6 Article Number: UI95333083 ABSTRACT: We reviewed records from 251 consecutive cesarean deliveries performed over a six-month period to evaluate the effect of amnioinfusion during labor on the incidence of postpartum endometritis in patients who delivered by cesarean section. One hundred fifty-four patients were excluded because they were not in labor, were at less than 35 weeks' gestation or received antibiotics during labor. Twenty-three of the remaining 97 patients received amnioinfusion during labor and represented the study group. Seventy-four patients did not receive amnioinfusion during labor and were used as controls. The incidence of postpartum endometritis in the amnioinfusion group was 13%, while the incidence in the group not receiving amnioinfusion was 38% (relative risk, 0.34; 95% confidence interval, 0.13-0.88; P = .026). Amnioinfusion during labor appears to significantly decrease the incidence of postpartum endometritis in patients subsequently undergoing cesarean delivery. =========================================================================== J. Daniels MD Private Practice Ob/Gyn Next message: Jonathan Daniels: "Re: IUPC placement was: glove use in L&D" Previous message: Larry Kincheloe: "I'm back in the saddle again" Maybe in reply to: richardc@bcm.tmc.edu: "IUPC placement was: glove use in L&D" Next in thread: rbraun@indyunix.iupui.edu: "Re: IUPC placement was: glove use in L&D" Reply: rbraun@indyunix.iupui.edu: "Re: IUPC placement was: glove use in L&D"

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