apr
Karin Dahlquist- Institutionen för kliniska vetenskaper, Lund
Title: Infections during pregnancy, labour, and in the postpartum period
Main supervisor: professor Karin Källén
Reviewers: MD, associate professor Cecilia Rydén and MD, associate professor Andreas Herbst
Abstract
Background
In the postpartum period infection occur in approximately 6 % of women and are more frequent after cesarean section than after vaginal delivery. Risk factors for developing an infection in the postpartum period - apart from cesarean section - are premature rupture of the membranes, frequent cervical examination, internal fetal monitoring, preexisting pelvic infection including bacterial vaginosis, diabetes, and obesity. Furthermore, urinary tract infection occurs in about 2-4% of all pregnant women and it can have negative consequences on the pregnancy and the fetal outcome. In Sweden, prophylactic intravenous antibiotics are administered to prevent maternal infection in case of cesarean section. Prophylactic antibiotics are also administered in the case of asymptomatic bacteriuria. To our knowledge no Swedish national overview survey has been performed to map the prevalence of antibiotics administered during pregnancy, labor and in the postpartum period.
Research questions
Study I: What are the maternal short-term risks of planned vaginal delivery compared to planned caesarean section, among women with no medical indication for caesarean section?
Study II: What is the effect of antibiotic prophylaxis used for planned caesarean section?
Study III: How does urinary tract infection during pregnancy affect maternal and foetal outcomes with special focus on preterm birth?
Study IV: Which are the strongest risk factors for postpartum infection and how do the infection risk interplay with mode of delivery and maternal characteristics’?
Preliminary results
1. Among patients without medical indication for planned cesarean section, the risks of short-term maternal complications were higher with planned cesarean section than with planned vaginal delivery.
2. Routinely administrated prophylactic antibiotics for women with planned cesarean section did not reduce the risk of a prescription of postpartum antibiotics. Instead, the rate of prophylactic antibiotics was positively associated with postpartum antibiotic prescriptions, and we speculate that this reflects local practice routines rather than complication rates.
3. Urinary tract infection during pregnancy was associated with increased risk of preterm birth.
4. Postpartum endometritis was more frequent after emergency caesarean section especially in combination with overweight and/or obesity and labour arrest as compared to spontaneous vaginal delivery.
Significance
Information about maternal infections during pregnancy and in the postpartum period enables a better risk prediction in a clinical setting. Evaluating and providing preventative measures improves care of those at highest risk of infection and in combination with improved awareness we hope to guide women and clinicians for an overall better maternal care avoiding complications and make a wise choice of delivery mode and antibiotic treatment for the individual woman.
Published studies
https://pubmed.ncbi.nlm.nih.gov/35841162/
“Planned cesarean section vs planned vaginal delivery among women without formal medical indication for planned cesarean section: A retrospective cohort study of maternal short-term complications.”
Om evenemanget
Plats:
Tornbladinstitutets seminariesal
Kontakt:
karin [dot] dahlquist [at] med [dot] lu [dot] se