Microbiological and antibiotic sensitivity pattern of surgical site infection following caesarean section in a tertiary care center of Chhattisgarh

Background: It is one of the most common surgery practiced in present era in obstetric population it has led to rise in postoperative morbidity in the form of surgical site infection (SSI). It not only burdens the health system but it also puts a serious negative impact on patient’s life. The present study is aimed to determine the incidence, risk factors and the microbiological and antibiotic sensitivity pattern for SSI following caesarean section in our institute.Methods: The study is prospective, descriptive study carried out in department of obstetrics and gynecology of Pt. Jawaharlal Nehru medical college, Raipur between May 2019 and April 2020.Results: Out of the 1215 participants who underwent caesarean section, 251 patients had SSI, with incidence of 20.6% among them superficial SSI (n=154) was 61.3% while deep SSI (n=75) 29.8% and 8.7% (n=22) organ/space SSI. Gram positive organism was highest isolated from superficial SSI 66.2% while from deep SSI and organ/space SSI gram positive organism isolated was 45.2% and 54.2% respectively, gram negative organisms were maximum isolated from organ/space SSI 40.9%followed by deep and superficial SSI 36% and 34.4% respectively. Most isolates were highly resistant to cephalosporins, gentamycin and amoxicillin; moderately resistant to fluoroquinolones and highly sensitive to vancomycin, carbapenem and linezolid.Conclusions: Our tertiary centre had post caesarean SSI rate of 20.6% which was high. By analyzing the microbiological and sensitivity pattern we can use evidenced-based sensitive antibiotics to be commenced initially when wound infection is identified in our wards while awaiting the result of wound swab microscopy, culture and sensitivity (48-72 hours), to individualize our antibiotic prophylaxis and postoperative antibiotic protocol policy to reduce the further complications

Changing trends in genital cancer

Background: Globally, cancers in all forms are causing about 12% of all deaths. In developed countries cancer is the second leading cause of death accounting for 21% of mortality by other causes and in developing countries it ranks third, accounting for 9.5% of all deaths. The objective was to find the incidence of genital malignancy and any change in the trend at Pandit Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India.Methods: This was a cross-sectional, retrospective, observational study conducted in Dr. BRAM Hospital, Department of Obstetrics and Gynecology from 2000 to 2015. We analyzed data for demographic profile, type of the genital carcinoma and the stages in which they reported and observed any changing trends.Results: Over 15 years the contribution of genital cancer remained almost stable at 2.78% in 2000 to 2.48% in 2015. 85% women belonged to rural residence, 75% were educated up to high school level and 76% women were from low socioeconomic status. Maximum prevalence of genital cancer is 65.90% falls in 45-60 years age group. Young age at first sexual activity, low education, parity >4 were found to be associated risk factors. Most significant changing trend was that the incidence of cancer cervix decreased by 11%. There was a shift from stage III to stage II at the time of reporting. The cancer endometrium emerged as new site for genital cancer with increased incidence.Conclusions: Cervical cancers are the most common cause of mortality but it is a preventable disease. Its decreasing trend and shift to early stage diagnosis is a positive beginning

Sleep disorders in menopausal women

Background: Sleep disturbance is one of frequent sign and symptom encountered in post-menopausal women. It affects the quality of the life and may lead to depression in some women. Objective of present study was to find out the prevalence of sleep disorder in post-menopausal womenMethods: Prospective study done on the post-menopausal women coming to Gynaecology OPD of Dr Bheem Rao Ambedkar Hospital, Raipur. This study was a prospective cross sectional observational study, conducted in the outpatient department of Obstetrics and Gynecology from 1st August 2016 to 31st January 2017. It included 500 women of postmenopausal age. A detail Performa was provided to assess sleep patterns and disorders associated with it. All the data was analysed using chi square testResults: The prevalence of sleep disturbances was 29.58%. Home makers were affected more in comparison to working women, 71,43% women had problems in initiating sleep. About 2/3rd women in the study group developed insomnia within 5 years of menopause, whereas 1/3rd took more than 7years to develop insomnia. Co morbidities were present in 48% women. Our women have mean age of menopause around 45 years.Conclusions: Sleep disorders are common, with prevalence of 29.5% in menopausal women in present study. It significantly causes psychosocial problems in women. There is need for it to be asked for and to be treated promptly

Body mass index and gestational weight gain in pregnant women with gestational diabetes and its relation with adverse maternal and fetal outcome

Background: Raised body mass index (BMI) and excessive gestational weight gain (GWG) are important determinants in development of gestational diabetes.Methods: A prospective, observational study carried out on antenatal women since their first trimester. These women were screened for gestational diabetes mellitus (GDM) by diabetes in pregnancy study group of India (DIPSI) criteria. All participants were followed up by measuring their BMI, weight gain, blood sugars in every trimester. Also, data was collected regarding any adverse outcomes.Results: Among all participants, 16.8% were diagnosed as GDM. 44% women of study group had weight gain beyond Institute of Medicine (IOM) recommendations. Higher risk of GDM was observed in women with raised BMI and excessive GWG. Also, odds of preeclampsia, preterm deliveries, caesarean section, macrosomia, intrauterine fetal death, neonatal intensive care unit (NICU) admissions were higher in women with GDM.Conclusions: Compliance of recommended weight gain during pregnancy have a strong impact on the fetal outcome. Amount and timing of weight gain plays a crucial role in GDM

Feto-maternal impact of altered lipid profile in pregnancy

Background: This study was aimed to evaluate the association of lipid profile with development of feto-maternal complications.Methods: This observational study was carried out in the Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College Raipur during August 2015-November 2016. Total 200 study subjects were evaluated who were having normal lipid profile in 1st trimester.Results: Out of 200 antenatal women recruited in our study, 129 had normal lipid profile throughout pregnancy and 71 women developed dyslipidemia.89 % of those women having normal lipid profile did not develop any maternal or perinatal complication, showing a high negative predictive value (88.72%) and high specificity of 91.47%. We observed that the onset of dyslipidemia occurred in 2nd trimester and it was progressive. About 83.58 % of them developed toxemia of pregnancy (GHTN, preeclampsia, eclampsia), positive predictive value of 83.58%. The levels of TC (total cholesterol), TG(triglyceride), VLDL (very low-density lipoprotein) and LDL (low density lipoprotein) were significantly (p<0.0001) higher in hypertensive women than normotensive women. Dyslipidemic women have developed significant (p= 0.00001) level of perinatal complications like preterm (18.05%), IUGR (15.28%) and IUD (13.89%). Sensitivity- 78.9, Specificity- 88.72, Positive likelihood ratio-9.25, Negative likelihood ratio- 0.23.Conclusions: Early pregnancy dyslipidemia was significantly associated with an increased risk of preeclampsia and eclampsia. Thus, evaluating dyslipidemia in 1st and 2nd trimester may help in early prediction and management of maternal as well as fetal complication

An evaluation of recurrent pregnancy loss

Background: This study was aimed to know the demographic profile and categorizes the causes of RPL.Methods: This observational study was carried out in the department of obstetrics and gynecology, Pt. J.N.M. Medical College Raipur from Nov 2015-Sept 2016. Total 100 women were evaluated with history of RPL.Results: 100 women were recruited in our study. The incidence of primary RPL was more than secondary RPL. 48 % women had first trimester abortions. The identifiable causes accounted for 53% out of which anatomical defects were the commonest .Next were endocrinal factors (20%), and Genetic factors (1%),Immunological factors 7%., Medical causes were 3%. However, 47% were unexplained.Conclusions: Despite innumerable investigations, sometimes or rather most of the times, the etiology remains obscure. It is this group of women who become a challenge to manage. Ultimately, most effective therapy for women with unexplained RPL is antenatal counseling, psychological support and tender loving care

Incision length: an emerging risk factors for surgical‐site infection following cesarean section

Background: Since late nineteenth century, the caesarean section first done there is a tremendous improvement in the surgical and anaesthetic skills. It has emerged as a safe mode of delivery but now, in the present era there is a continuous rising trend of caserean section. Objective of present study is to evaluate the effect of some specific gestational factors and other known variables associated with poor wound healing in women who delivered by cesarean section.Methods: A total of 1215 women delivered by cesarean section at Pt. JNM Medical college, Raipur, Chhattisgarh, India from May 2014 to April 2015 were included in this study. The BMI was measured at gestational age when she got operated, grade of surgeons was noted. Subcutaneous tissue depth was intra-operatively measured from the fascia to the skin surface, while the incision length was measured after skin closure.Results: Out of 1215 women operated 251 cases developed SSI with incidence of 20.5%. Incision length (OR 2.40, 95% CI 2.11-2.73; p14.7; OR 2.40, 95% CI 2.11-2.73, p<0.0001.Conclusions: Incision length by itself was found to be an independent risk factor for development of surgical site infection

Study of assessment of awareness for screening of cervical cancer in women attending gynecology outdoor patient department

Background: Nearly every family in the world is touched by cancer, which is now responsible for almost one in six deaths globally. Aim of this study was to access Indian woman's awareness towards cervical screening methods to promote strategies for increasing its uptake.Methods: A comprehensive questionnaire based cross-sectional observational survey was conducted in Pt. JNM Medical College and Dr. BRAM hospital, Raipur, Chhattisgarh from September 2018 to July 2019. Participants were selected by sampling between 21 to 59 years of age who have given consent for study.Results: Out of 1008 participants only 336 (33.3%) participants were aware about screening of cervical cancer and less than 28% participants were aware about pap smear, time of investigation, method of pap smear, health centre, association of HPV virus with cervical cancer, availability at vaccination, and with regard to risk factors only 27.9% women were aware that there is increased risk of cervical cancer due to multiple partners, 17.6% aware of risk due to increase in number of children’s, 11.1% aware of increase in risk of cervical cancer due to early initiation of  sexual activity. Younger women (age 30-35, odds ratio 1.24, 95% CI 0.78-1.32, p-value 0.05), low socioeconomic status (odds ratio 1.74, 95% CI 0.76-2.12, p-value 0.01), education level (≤ secondary education odds ratio 1.64 95% CI 0.85-2.18 p-value 0.000, ≥ higher secondary or above education odds ratio 2.32 95% CI 1.21-2.89  p-value 0.001) and age at marriage (odds ratio 2.21, 95% CI 0.78-2.18, p-value 0.000) all had a significant relationship with the awareness of Pap smear test. Two-third of the females in the study stated that lack of awareness as the major reason for not getting a pap smear while another one- third stated lack of recommendation by health care professionals as major hurdle.Conclusions: This study found that woman's fear, pain and embarrassment, along with cultural influences, deterred them from undergoing screening

Prevalence of occult gynecological cancer in women undergoing surgeries for benign indications in a tertiary healthcare center of Chhattisgarh

Background: Hysterectomy, the surgical removal of uterus, is 2nd most frequently performed major surgical procedures on women,with90% of hysterectomies are performed for benign indications. However, there may be cases in which malignancy or premalignant lesions which are only confirmed on histopathology are defined as occult malignancy.Methods: We conducted a prospective observational study on a cohort of women undergoing various gynaecological surgeries for benign indications in a time period of January 2019 to January 2020 in the Department of obstetrics and gynaecology, Dr. BRAM hospital and Pt. J. N. M. medical college, Raipur (C.G) to find out the prevalence of occult pre malignant and malignant lesions.Results: Of 132 women who underwent surgeries for benign gynecological indications, based on final histopathological report, prevalence of occult premalignant lesion was 11.36% (95% CI 5.7-16.3%) and prevalence of occult malignancy was 2.27% (95% CI 0.2 -4.8%). Prevalence of occult premalignant lesion of corpus uteri and cervix uteri was 2.3 and 9.1% respectively. No occult premalignant lesion of ovary was found. Prevalence of occult malignant lesion of corpus uteri and ovary was 1.5 and 0.75% respectively.Conclusions: We observed that even after complete preoperative workup only 72.7% of the preoperative clinical diagnoses were correlated with their histopathological diagnosis. Thus, while making the diagnosis, risk factors along with standard preoperative approach should be strongly adhered to prevent misdiagnosis and to prevent missing of any pre malignant or malignant findings.

A rare case of vaginal sarcoma in pregnancy

Vaginal Sarcoma is an extremely rare tumour in pregnancy. Authors are presenting a case report of a pregnant woman who presented with vaginal mass and urinary retention at 32 weeks of gestational age. USG confirmed a live baby with possibility of cervical fibroid. Before further investigations for diagnosis of the mass her emergency LSCS has to be done. Histopathology and immunohistochemistry then confirmed sarcoma