英语学习-剖宫产用药指南

1、Cesarean delivery procedures,Content,Background Organisms Efficacy Choice of agent Timing Duration Recommendation,Background,Approximately 1.2 million infants are born by cesarean delivery in the United States annually.The infection rate after cesarean delivery has been reported to be 415%, though r

2、ecent NHSN data showed an infection rate of 24%. Postpartum infectious complications are common after cesarean delivery. Endometritis (infection of the uterine lining) is usually identified by fever, malaise, tachycardia, abdominal pain, uterine tenderness, and sometimes abnormal or foul-smelling lo

3、chia. Fever may also be the only symptom of endometritis. cesarean adj. 剖腹产的； n. 剖腹产 Postpartum adj. 产后的 adv. 在产后 Endometritis n. 妇产 子宫内膜炎 uterine adj. 子宫的；同母异父的 malaise n. 不舒服；心神不安 tachycardia n. 内科 心动过速；心跳过速 lochia n. 恶露；产褥排泄物,Background,Endometritis has been reported to occur in up to 24% of pati

4、ents in elective cesarean delivery and up to approximately 60% of patients undergoing nonelective or emergency section. Risk factors for endometritis include cesarean delivery, prolonged rupture of membranes, prolonged labor with multiple vaginal examinations, intrapartum fever, and low socioeconomi

5、c status. Patients with low socioeconomic status may have received inadequate prenatal care. prolonged rupture of membranes 延迟破膜 vaginal adj. 阴道的；叶鞘的 intrapartum adj. 分娩期的,Background,The factor most frequently associated with infectious morbidity in postcesarean delivery is prolonged labor in the pr

6、esence of ruptured membranes. Intact chorioamniotic membranes serve as a protective barrier against bacterial infection. Rupture of the membrane exposes the uterine surface to bacteria from the birth canal. The vaginal fluid with bacterial flora is drawn into the uterus when it relaxes between contr

7、actions during labor. Women undergoing labor for more than six to eight hours in the presence of ruptured membranes should be considered at high risk for developing endometritis. Other risk factors for SSIs after cesarean delivery include systemic illness, poor hygiene, obesity, and anemia. morbidit

8、y n. 发病率；病态；不健全 chorioamniotic adj. 绒毛膜羊膜的 hygiene n. 卫生；卫生学；保健法 anemia n. 贫血；贫血症,Organisms,The normal flora of the vagina include staphylococci, streptococci, enterococci, lactobacilli, diphtheroids, E. coli,anaerobic streptococci (Peptococcus species and Peptostreptococcus species), Bacteroides sp

9、ecies (e.g., Bacteroides bivius, B. fragilis), and Fusobacterium species. Endometritis infections are often polymicrobial and include aerobic streptococcus (particularly group B b-hemolytic streptococcus and enterococci), gram-negative aerobes (particularly E. coli), gram-negative anaerobic rods (pa

10、rticularly B. bivius), and anaerobic cocci (Peptococcus species and Peptostreptococcus species). Ureaplasma urealyticum has been commonly isolated from endometrial and surgical-site cultures. Additional commonly isolated organisms from SSIs include Staphylococcus species and enterococci.,staphylococ

11、ci n. 葡萄状球菌 streptococci n. 链球菌 enterococci 肠球菌 lactobacilli n. 乳酸杆菌 diphtheroids adj. 似白喉的 n. 类白喉 anaerobic streptococci 厌氧链球菌 Bacteroides species 拟杆菌属物种 Fusobacterium species 梭菌属的物种 aerobic streptococcus 有氧链球菌 hemolytic streptococcus 溶血性链球菌 aerobes n 需氧菌 anaerobic rods 厌氧杆菌 anaerobic cocci 厌氧球菌 Ur

12、eaplasma urealyticum 解脲支原体 Peptococcus species 球菌属 Peptostreptococcus species 消化链球菌属 Staphylococcus species 葡萄球菌,Efficacy,While the use of antimicrobial prophylaxis in low-risk procedures (i.e., those with no active labor and no rupture of membranes) has been brought into question by the results of

13、several randomized, placebo-controlled studies that found no reduction in infectious complications (fever, SSI, urinary tract infection, or endometritis) with the use of prophylaxis, the majority of these evaluations were underpowered and included administration of antimicrobial prophylaxis at cord

14、clamping. However, the efficacy of antimicrobial prophylaxis in cesarean delivery has been shown in several studies and two meta analyses for both elective and nonelective procedures. Therefore, prophylaxis is recommended for all patients undergoing cesarean delivery.,Efficacy,One meta-analysis that

15、 reviewed 7 placebo-controlled randomized trials in low-risk elective cesarean delivery found that prophylaxis was associated with a significant decrease in endometritis and fever. A larger meta-analysis of 81 randomized trials with 11,937 women undergoing both elective and nonelective cesarean deli

16、very found that antimicrobial prophylaxis was associated with a significant reduction in risk of fever, endometritis, SSI, urinary tract infection, and serious infection.The relative risk for endometritis in elective cesarean section was 0.38 (95% CI, 0.220.64) in those receiving antimicrobial proph

17、ylaxis compared to those receiving no prophylaxis.,Choice of agent,Although several different antimicrobials used alone or in combination for antimicrobial prophylaxis during cesarean delivery have been evaluated, the use of firstgeneration cephalosporins (specifically cefazolin) has been advocated

18、by ACOG and the American Academy of Pediatrics (AAP), based on their efficacy, narrow spectrum of activity, and low cost. This recommendation is supported by a meta-analysis of 51 randomized controlled trials comparing at least two antimicrobial regimens that concluded that ampicillin and first-gene

19、ration cephalosporins have similar efficacy. cephalosporins 头孢菌素类,Choice of agent,Newer prospective randomized controlled and cohort studies have evaluated the addition of metronidazole, azithromycin, or doxycycline to a first- or secondgeneration cephalosporin to extend the spectrum of activity aga

20、inst common organisms isolated from endometrial and surgical-site cultures, specifically U. urealyticum and Mycoplasma species. These studies found significantly lower rates of postoperative infections (including endometritis and SSI) and a shorter duration of hospital stay compared with prophylaxis

21、 with a first- or second-generation cephalosporin alone. Antibiotic administration occurred either postoperatively or after cord clamping in these studies. Further study, particularly with preoperative antimicrobial administration, is needed to confirm these preliminary findings and establish a plac

22、e in therapy for this practice. metronidazole n 甲硝唑 azithromycin n 阿奇霉素 doxycycline n 多西环素 U. urealyticum n 解脲支原体 Mycoplasma n 支原体 cord clamping 断脐,Timing,Historically, administration of antimicrobials in cesarean delivery was delayed until after cord clamping. The principal reasons were to avoid su

23、ppression of the neonates normal bacterial flora that could promote the selection of resistant organisms and concern that the antimicrobials could potentially mask neonatal infection, complicating evaluation of neonatal sepsis. However, more contemporary data support the administration of antimicrob

24、ial prophylaxis before surgical incision to protect against bacterial contamination of the surgical site and decrease the risk of infection. The practice of antimicrobial prophylaxis administration before surgical incision is endorsed by ACOG and AAP. See the Common Principles section of these guide

25、lines for additional discussion on antimicrobial timing. neonate n 婴儿 sepsis n 败血症,Timing,A meta-analysis of three randomized controlled trials and two nonrandomized controlled studies provided evidence that preoperative antimicrobial administration significantly decreased the rate of endometritis c

26、ompared with administration after cord clamping (3.9% and 8.9%, respectively; p= 0.012). A lower SSI rate was also seen with preoperative antimicrobial administration (3.2% versus 5.4%), though this difference was not significant. The overall rate of infection-related morbidity was also significantl

27、y lower. No differences between the groups were seen in neonatal outcomes, including sepsis, sepsis workups, and neonatal intensive care unit admissions. The largest study included in this meta-analysis was a prospective, randomized, controlled, doubleblind, single-center, double-dummy study of 357

28、patients comparing cefazolin 1 g i.v. given preoperatively and after cord clamping, which had results consistent with the overall meta-analysis. double-dummy 双安慰剂,Timing,In a recent randomized trial of more than 1100 women undergoing cesarean section between 2004 and 2010, Witt and colleagues found no difference in SSI rates for patients having antimicrobial administration before surgical incision compared