Background: Postpartum infections are a major cause of maternal mortality and morbidity worldwide. Breast infection, endometritis, urinary tract infection and wound infections are the most common postpartum infections and together they affect almost 20% of women after childbirth. Some risk factors for postpartum infections, for example cesarean section, have been relatively well studied, but other presumable risk factors are yet to be confirmed. The proportion of pregnant women who are overweight or obese is increasing in most parts of the world. Increased maternal body mass index (BMI) is associated with maternal and infant morbidity. The association between overweight / obesity and postpartum infections is incompletely understood. Vitamin D deficiency has in epidemiological studies been shown to increase the risk of various infections. Furthermore, vitamin D is an important factor in the human immune system. Concomitantly, vitamin D supplementation seems protective against some types of infections. Whether vitamin D deficiency is a risk factor for postpartum infections has not been studied. Material and Methods: In a population-based observational study using questionnaires, the prevalences of postpartum wound infections, endometritis, urinary tract infections and mastitis in the southeast region of Sweden were estimated (Paper I). All women giving birth in the region during one year (n=11 124) were asked to participate. Papers II and III were cohort studies based on all deliveries in Sweden during eight years (2005-2012). Data sources were the Swedish Medical Birth Register, the Swedish National Patient Register and the Swedish Prescribed Drugs Register. In paper II all term deliveries were included (n=795 072). Risk factors for postpartum wound infections, endometritis and urinary tract infection were evaluated. Paper III included all deliveries (n=841 780) and examined the impact of BMI on the risk of postpartum wound infections, endometritis and breast abscess after different modes of delivery. Infections were defined as the presence of applicable ICD-10 codes. The Mantel-Haenszel technique was used to calculate adjusted odds ratios. In paper IV the association between vitamin D deficiency and overall postpartum infectious morbidity was analyzed. Serum samples from the Pregnancy Biobank in Linköping, drawn at the time of delivery, were used to determine concentrations of 25-hydroxyvitamin D in 1397 women. ICD-10 codes were extracted from the women’s medical records. The prevalence of vitamin D deficiency was calculated and adjusted odds ratios for postpartum infections were estimated with multivariable logistic regression analysis. Results: More than one out of ten women in southeast Sweden reported wound infections; endometritis, urinary tract infection or mastitis postpartum and 7.5% reported antibiotic treatment for infection. Cesarean section was the strongest risk factor for wound infection, followed by obstetric anal sphincter injuries and episiotomy. For endometritis, the strongest risk factors were anemia, manual placental removal and emergency cesarean section. Urinary tract infection was associated with anemia, instrumental vaginal delivery and emergency cesarean section. There was a dose-dependent increased risk of postpartum infection with higher BMI. For morbidly obese women the risk of infection was over 50% higher than for normal weight women. The risk of endometritis after normal vaginal delivery increased the higher the BMI, as did the risk of wound infection after cesarean section, regardless of the type of cesarean section. For breast abscess, there was an inverse association with BMI. Vitamin D deficiency was present among almost 60% of pregnant women at the time of delivery. No association between vitamin D deficiency and postpartum infections was found. Conclusions: Every tenth Swedish woman acquired an infection postpartum and three quarters of them received antibiotics for infection. Anemia was an important risk factor for postpartum infection, and the strongest risk factor for endometritis and urinary tract infection. Strong efforts should be made to reduce blood loss during and after childbirth. This thesis confirmed cesarean section as a major risk factor for postpartum infection, especially wound infection. The risk increased if the woman was overweight or obese, regardless of whether it was a planned or an emergency cesarean section. Vitamin D deficiency was common among Swedish pregnant women, but it was not found to be associated with postpartum infections.

From early conception until the postpartum period, anaesthetists are required to provide pregnant women with the highest standard of anaesthetic care and pain relief whilst negotiating challenges such as concurrent systemic disease, infertility, and obesity as well as practising in accordance with new developments in fetal medicine surgery, pharmacology, and imaging. The Oxford Textbook of Obstetric Anaesthesia provides an up-to-date summary of the scientific basis, assessment for and provision of anaesthesia throughout pregnancy and labour. This highly authoritative textbook is conceptually divided into nine sections, detailing maternal and fetal physiology, fetal and neonatal assessment and therapy, anaesthesia before and during pregnancy, labour and vaginal delivery, anaesthesia for caesarean delivery, anaesthetic and obstetric complications, as well as systemic disease. Individual chapters address topics such as simulation and ultrasound. Authored by an international team of expert anaesthetists this textbook reflects current world-wide practice and guidelines. Designed for consultants and trainees in anaesthesia, the Oxford Textbook of Obstetric Anaesthesia is the definitive source of expert knowledge for anaesthetists in this subspecialty.

The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

This third edition reviews the epidemiology, policies, programs and outcome indicators that are used to determine improvements in nutrition and health that lead to development. This greatly expanded third edition provides policy makers, nutritionists, students, scientists, and professionals with the most recent and up-to-date knowledge regarding major health and nutritional problems in developing countries. Policies and programs that address the social and economic determinants of nutrition and health are now gaining in importance as methods to improve the status of the most vulnerable people in the world. This volume provides the most current research and strategies so that policy makers, program managers, researchers and students have knowledge and resources that they can use to advance methods for improving the public’s health and the development of nations. The third edition of Nutrition and Health in Developing Countries takes on a new context where the word “developing” is now a verb and not an adjective.

Provides effective diagnosis and management of infectious diseases in pregnant women in a single comprehensive available resource for busy clinicians.

Understand the rapidly growing complexities of obstetric hematology and high-risk pregnancy management, with experts in the field. Now in its second edition, this comprehensive and essential guide focuses on providing the best support for patients and clinical staff, to prevent serious complications in pregnancy and the post-partum period for both mother and baby. Wide-ranging and detailed, the guide offers discussions on basic principles of best care, through to tackling lesser-known hematological conditions, such as cytopenias and hemoglobinopathies. Updated with color illustrations, cutting-edge research, accurate blood film reproductions, and practical case studies, the revised edition places invaluable advice into everyday context. This unique resource is essential reading for trainees and practitioners in obstetrics, anesthesia, and hematology, as well as midwives, nurses, and laboratory staff. Clarifying difficult procedures for disease prevention, the guide ensures safety when the stakes are high. Reflecting current evidence-based guidelines, the updated volume is key to improving pregnancy outcomes worldwide.

Pregnancy affects the physiology of women as their bodies adapt to the growing life within them; but how does this affect how you manage general, or pre-existing medical complaints? How do you differentiate the effects of pregnancy from genuine medical conditions? What are the effects of the ‘standard’ treatments on the growing fetus? What about breastfeeding? In this brand-new edition of de Swiet’s Medical Disorders in Clinical Practice, expert physicians present the best evidence and practical wisdom to guide you and your patients through their pregnancy and illness, to a successful birth and early motherhood. Using a combination of algorithms, years of experience and an evidence-based approach, this book will help you to: Diagnose difficult to identify conditions during pregnancy Effectively prescribe for pregnant and lactating women Overcome the challenges of imaging, anesthesia and critical care for pregnant women de Swiet’s assists you in navigating the many challenges pregnancy presents for both the patient and physician.