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Francesca Raffi, MBChB, MRCOG; Saad Amer, MBChB, MSc, MRCOG, MD, 01 Jun 2012

Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.

 

Vaginal cleansing useful in preventing endometritis following caesarean delivery

05 Sep 2017

Vaginal cleansing immediately prior to caesarean delivery in women who are in labour and have ruptured membranes may lower the risk of developing postoperative endometritis, according to a meta-analysis.

Researchers accessed several electronic databases for randomized controlled trials comparing the efficacy of vaginal cleansing (any method with any type of antiseptic solution; intervention group) with either placebo or no intervention (control group) in preventing endometritis in women undergoing a caesarean procedure.

A total of 16 trials involving 4,837 women were included in the analysis. Most of the studies performed cleansing with 10% povidone-iodine and using a sponge stick for approximately 30 seconds.

Pooled data showed that compared with the control group, the intervention group had a significantly lower incidence of postcaesarean delivery endometritis (4.5 vs 8.8 percent; relative risk [RR], 0.52; 95 percent CI, 0.37 to 0.72; 15 studies; n=4,726) and of postoperative fever (9.4 vs 14.9 percent; RR, 0.65; 0.50 to 0.86; 11 studies; n=4,098).

In the planned subgroup analyses, the protective effect of vaginal cleansing against the incidence of endometritis was limited to women in labour before caesarean delivery (8.1 vs 13.8 percent; RR, 0.52; 0.28 to 0.97; four studies; n=440) and in those with ruptured membranes (4.3 vs 20.1 percent; RR, 0.23; 0.10 to 0.52; three studies; n=272).

In light of the present data and the fact that vaginal cleansing is a generally inexpensive and simple intervention, researchers recommended performance of vaginal cleansing prior to caesarean delivery in women who are either in labour or with ruptured membranes using a sponge stick preparation of povidone-iodine 10 percent for at least 30 seconds.

Additional studies are warranted to evaluate whether vaginal cleansing may be also useful for caesarean deliveries performed in women not in labour and those without ruptured membranes, researchers said.

Caesarean delivery is the most important risk factor for postpartum maternal infection, with women undergoing such procedure having a five to 20 times greater risk of infection and infectious morbidity compared with those undergoing a vaginal birth. The most common postcaesarean infective complications include endometritis (6 to 27 percent), clinically significant fever (5 to 24 percent) and wound infection (2 to 9 percent). [Obstet Gynecol 2007;109:669–77]

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Most Read Articles
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In pregnant women, adherence to recommended dietary intake of fat and fibre is associated with a more beneficial and richer gut microbiota which, in turn, decreases levels of the inflammation marker glycoprotein acetylation (GlycA), a study has shown.
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Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.