Assessment of risk factors for surgical site infection following caesarean section

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery

Pregnancy with third degree uterine prolapse: a rare case report

Occurrence of prolapse of uterus during pregnancy is an extremely rare event. Less than 300 cases have been reported in the literature till date. Incidence of uterine prolapse in pregnancy is 1 in 10,000-15,000 deliveries worldwide. A 35 year old G5P3L1A1 with history of five months amenorrhea was referred to our hospital in view of uterine prolapse. On enquiring she gave history of something coming out of vagina since one month. On local examination, third degree uterovaginal prolapse with cord prolapse seen. Patient went into labour spontaneously and expelled an abortus. She was discharged next day with advice regarding follow up visit after six weeks. Uterine prolapse during pregnancy is a rare occurrence which increases both maternal and fetal morbidity. There are many etiological factors which have been cited to be responsible for this condition, important ones are: Multiparity, vaginal delivery, advanced maternal age, increased body mass index. Elective caesarean section can be planned in cases with edematous and elongated cervix. Individualized approach and careful monitoring is the key to manage such patients. Uterine prolapse during pregnancy is a rare event. While managing such patients, an obstetrician should keep in mind threats of spontaneous abortion, preterm labour, cervical dystocia, etc

A retrospective analysis of ectopic pregnancy at a tertiary care centre: one year study

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality especially in developing countries where the majority of patients present late with rupture and hemodynamic compromise. The aim of this study was to determine the risk factors, clinical profile of the patients and management options for ruptured ectopic pregnancies.Methods: We conducted a retrospective study about ectopic pregnancy at obstetrics and gynaecology department over a period of one year, from 01 January 2015 to 31 December 2015. Information on the biosocial data, clinical symptoms and signs, risk factors for the disease, site of ectopic pregnancy and treatment options, quantity of hemoperitoneum and need for blood transfusion was extracted. The data was analyzed and presented in frequency tables and charts.Results: Frequency of ectopic pregnancy was 1.6% of total 10235 deliveries. 131 (89.1%) cases were of ruptured ectopic pregnancy. 147 patients underwent laparotomy while 22 patients were managed conservatively. All patients were symptomatic at presentation. Majority (86, 50.8%) of the patients were in the age group of 20-24 years. 33 (19.5%) patients were nulliparous. Risk factors were found in 86 (50.8%) patients. Majority (38, 44.1%) had history of previous tubal surgery (tubal sterilization and/or recanalisation) as risk factor. The highest number of ruptured ectopic occurred between 7-12 weeks of gestation. Most common surgical procedure employed was salpingectomy in 140 (95.2%) patients.  There was no maternal mortality due to ectopic pregnancy.Conclusions: Ectopic pregnancy is still a major life threatening emergency condition which if treated early has good prognosis. Most cases present late making tubal conservation inapplicable. Efforts should be made towards woman education, improved hospital accessibility and better diagnostic skills

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology

Functional analysis of mce4A gene of Mycobacterium tuberculosis H37Rv using antisense approach

Antisense strategy is an attractive substitute for knockout mutations created for gene silencing. mce genes have been shown to be involved in mycobacterial uptake and intracellular survival. Here we report reduced expression of mce4A and mce1A genes of Mycobacterium tuberculosis using antisense technology. For this, 1.1 kb region of mce4A and mce1A was cloned in reverse orientation in pSD5 shuttle vector, resulting into antisense constructs pSD5-4AS and pSD5-1AS, respectively. In M. tuberculosis H37Rv approximately 60% reduction in Mce4A and 66% reduction in expression of Mce1A protein were observed. We also observed significantly reduced intracellular survival ability of both antisense strains in comparison to M. tuberculosis containing pSD5 alone. RT-PCR analysis showed antisense did not alter the transcription of upstream and downstream of mceA genes of the respective operon. The colony morphology, in vitro growth characteristics and drug susceptibility profile of the antisense construct remained unchanged. These results demonstrate that antisense can be a promising approach to assign function of a gene in a multiunit operon and could be suitably applied as a strategy

Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar

Background: Women with previous LSCS often have to make a decision about mode of delivery of their second baby. As the rate of caesarean section is continuously increasing, vaginal birth after caesarean section (VBAC) is a good strategy to decrease caesarean rate. The present study was planned to assess the fetomaternal outcome in pregnancies with previous lower segment caesarean section undergoing trial of scar and to identify the factors, which can influence the outcome of trial of scar.Methods: This was a prospective observational study on 100 patients at a tertiary care institute. Pregnant women with previous LSCS were selected randomly for the study on the basis of the inclusion and exclusion criteria. Each labor monitored closely using a partogram. Decision for repeat emergency caesarean was taken by consultant. All women included in the study were followed through delivery and till discharge.Results: Out of 100 pregnant women 49 % cases had successful VBAC, 50% had emergency caesarean and one patient had laparotomy for rupture uterus. In women, who also had a prior vaginal delivery, 72% delivered vaginally, as compared to 40% of the women who did not undergo prior vaginal delivery (p value=0.003). Women who were in spontaneous labor, 59.21% delivered vaginally, whereas women who were induced, 16.6% delivered vaginally. The rate of perinatal complication was more in the patients who required an emergency CS after a failed trial. Conclusions: Our findings may encourage obstetricians to encourage VBAC in the properly screened ANC patients and decrease the rate of recommending caesarean section

Challenges with Takayasu arteritis in pregnancy: a case report

Takayasu’s arteritis (TA) is a rare, chronic, inflammatory, large vessel vasculitis (LVV) of unknown etiology characterized by narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes, so one should pay special attention to these patients. We present a case of 30-year-old female G5P3L2A1 with 9 months of amenorrhea with previous 2 LSCS with chronic hypertension and superimposed pre-eclampsia with oligohydraminos. She was a known case of Takayasu arteritis, diagnosed since she was 16 years old. Her lower limb pulses were palpable with absent upper limb pulses. On Echocardiography there was dilated aortic root, moderate MR and LVEF was 55%. She proceeded to have emergency LSCS under spinal anesthesia in view of severe pre-eclampsia with previous 2 LSCS at 35 week and delivered alive healthy female baby weight 2.1 kg. A life-threatening maternal cardiovascular complication is observed in more than 5% of pregnant women with TA. Hypertension is present in 90% cases of Takayasu arteritis. A good control of TA disease activity and arterial hypertension before conception and during pregnancy is important to improve feto-maternal outcomes. Pregnancies in the setting of TA should be considered high-risk, requiring a close interdisciplinary collaboration of rheumatologists, nephrologists and obstetrician’s specialists involved in care of TA