Amp-CKlebsiella-Induced Chorioamnionitis and Associated Abnormalities in Cardiotocography: A Case Report with a Narrative Review

Introduction. Infections caused by multidrug-resistant organisms are on the rise in obstetric patients. Chorioamnionitis is associated with adverse pregnancy outcomes. If caused by multidrug-resistant organisms, chorioamnionitis is associated with high maternal and fetal morbidity. Due to the paucity of the literature and the challenges associated with their diagnosis, the diagnosis is usually delayed. This often leads to delays in management, and hence, adverse maternal and neonatal outcomes are noted. Important Clinical Findings. The patient presented with prelabour rupture of membranes for three days. She developed chorioamnionitis in labour, which was refractory to broad spectrum antibiotics. Persistent tachycardia with variable decelerations followed by prolonged fetal deceleration was observed in cardiotocography. Delivery of baby was done by cesarean section in the view of pathological findings in cardiotocography. The primary diagnoses, interventions, and outcomes. Based on the placental culture results, Amp-C Klebsiella-induced chorioamnionitis was diagnosed. Ertapenem was commenced after the sensitivity results. Good feto-maternal outcomes were observed. The neonate was admitted to the neonatal intensive care unit and discharged home in stable condition. Conclusions. Cases of multidrug-resistant organisms-induced chorioamnionitis are rarely reported, though they are associated with maternal morbidity and poor neonatal outcome. In cases of chorioamnionitis, caution should be taken in cases that are refractory to broad-spectrum antibiotics, and multidrug-resistant organisms should be suspected and managed to improve pregnancy outcome

A review of medical and surgical management of ectopic Pregnancy in Al Wakra Hospital

IntroductionAn ectopic pregnancy is a major cause of maternal morbidity in the short and long term. We propose a descriptive review to highlight management among all patients admitted to AWH with ectopic pregnancy.ObjectivesTo determine the ethnicity of patients diagnosed with ectopic pregnancy.To assess the successful rate of medical and surgical management between these patients. Retrospective chart review from medical records.MethodsA retrospective chart review of 156 patients who are admitted in inpatient obs/ gyn unit with ectopic pregnancy were reviewed.Demographic data, ethinicity, treatment and outcomes were analyzed using a excel sheet.Results156 cases of ectopic pregnancy were admitted in patient obs/gyn department in Al wakra hospital- HMC, Qatar during the period Jan 2020 till Nov. 2022. Patients were classified into two categories based on their management: either medically managed with methotrexate, or surgically.We found that the success rate in patients received one dose of methotrexate was (84%). The success rate of second dose of methotrexate was (6.4%); However (9.6%) went for surgical management due to rupture ectopic or ß-hCG level was more than 5000 IU.In terms of ethnicity, our review showed that the higher proportion of ectopic was seen in the Asian region (65%) compared to 26% in the African region and 9% in the other region. Among them, 36% speak Arabic, and 5% are Qatari.ConclusionMedical management with Methotrexate remains a very effective modality of treatment for ectopic pregnancy. Early identifying of underlying risk factors, diagnosis with the essential aids like transvaginal ultrasound and β-hCG and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality associated with ectopic pregnancy and to improve the future reproductive outcome.</p