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Background@#The WHO recommends the ideal rate for cesarean section to be 15% of the total birth, but researchers are still attracting attention to the fact that in recent years this rate has been steadily increasing, and risk is not decreasing worldwide. Incidence of postcesarean section inflammation and infection are 8-10 times higher than vaginal birth. The determination of lactate levels in early diagnosis of sepsis is clinically significant and the higher the lactate level increases the risk of mortality. @*Objective@#The aim of the study is to improve early detection of inflammation and infection and prevention of serious complications by using risk factors of postcesarean section inflammation and infection, and detecting procalcitonin and lactate in maternal blood.@*Materials and Methods@#This research is conducted between 2015-2017 based at the “Urguu” Maternity Hospital, Obstetric Clinic of National Center for Maternal and Child Health of Mongolia. Factors affecting postcesarean section inflammation and infection are calculated based on multifactorial regression analysis. Procalcitonin was determined by enzyme binding assay while lactate, C-reactive protein, and lactate dehydrogenase were determined by “E-311” the fully automated analyzer.@*Results@#According to the results of the study, the probability of inflammatory and infectious complication is 2.4% when the duration of labor increases by one unit, 34.8% when the risk of amniotic fluid increases, 14.6% when the pregnancy process become more complicated. Whereas, excessive fetal weight statistically increases the risk of infection, but its impact is low. The result of the study shows that the procalcitonin sensitivity was 65%, and the specificity was 96%. Lactate resulted in sensitivity of 56%, but with only 67% specificity. C-reactive protein had a sensitivity of 65% and a specificity of 96%. Lactate dehydrogenase resulted in sensitivity of 95%, and specificity of 82% in the diagnosis of sepsis. @*Conclusion@#Postterm pregnancy, premature rupture of membranes, multifetal pregnancy, prolonged labor, placenta previa, pyelonephritis, chronic hepatitis, chronic hypertensive disorder, anemia, emergency cesarean section, preeclampsia are risk factors and it is statistically significant at (P<0.0001). The biomarkers have a direct correlation to all stages of inflammation and infections, which are important for the diagnosis.
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Objective@#To compare the nature of pregnancy and deliveryin women with leiomyoma who were treated with uterine artery embolization to the outcomes in women who were treated with abdominal myomectomy. @*Material and Methods@#A prospective, clinical study was conducted in 2010-2013 at “Urguu” Maternity Hospital, Ulaanbaatar. 94 women meeting the criteria were selected for the study. Post-treatment, the patients were reviewed for a period of two years. Uterine artery embolization was performed using polyvinyl alcohol particles (300-500 µm in diameter).@*Results@#The percentage of conception in UAE group was 25.5% and 31.9% in myomectomy group (p=0.494); complication of pregnancy was 50.0% and 57.1% respectively (p=0.729); complication of delivery was 33.3% and 0.0% respectively (p=0.047). 88.9% and 90.0% (p=0.596) had Caesarean delivery. 16 (84.2%) women had uncomplicated and 3 (15.8%) women had complicated delivery due to placenta praevia, placenta acreta and uterine hypotonia. These cases all belonged to UAE group. @*Conclusion@#Pregnancy rates in women with leiomyoma who were treated by uterine artery embolization, compared with pregnancies after abdominal myomectomy, were similar.(p=0.494) In this study, there was the rate of Cesarean delivery above 80 percent in both group. There were no differences in newborn weights and Apgar scores.
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Background. Puerperal infection following caesarean section remains a major cause of maternalmorbidity and mortality. It is still one of actual problems in Obstetrics and has incidence rate 2-10%. It isestimated 150 000 maternal deaths due to infection worldwide, despite tendency to decline septicemiaafter C-section due to wide usage of antibiotics in the obstetric practice, postpartum infection hasincreased last decade. Post-Caesarean sepsis incidence rate is above 20%. An assortment of pathologicagents may cause puerperal infection including bacteria, virus and parasites. In 30-40s of last centurymain reason of infection was Streptococcus, then in 40-60s major role was played by Staphylococcus,later in 70-80s Gram-Negative Aerobic Bacteria took its place.Objective. To improve prevention and treatment of post-caesarean sepsis by detection of its causes andantibiotic sensitivity. Materials and methods: We reviewed patients admitted to First Maternity Hospitaland National Center for Maternal and Child Health and who had post-caesarean sepsis between 2011-2013. Statistics analysis had been performed by SPSS-17 software programme, whereas statisticsprocess by X2 test, Fisher test, and t-test. Confi rmation rate was 95%. P<0, 05.Results. The clinical course of 361 post-caesarean patients with septicemia was reviewed prospectively.Primary dysfunctional labour (P<0.033), preterm rupture of the membranes (P<0.0001), ineffectivelabour induction (P<0.001) are risk factors for infectious morbidity. Considerations should be given toprophylactic antibiotic therapy by choosing correct medicine at the correct time. E.coli 29,4%, Intestinalbacteria 9,1%, Staphylococcus epidermis’s 8,9%, Staphylococcus aureus 7,2%, Gram-NegativeBacteria 6,6%, Streptococcus 5,3%, Gram-Positive Bacteria 2,8%, Candida albicans 1,4%, Micoplasma1,1% were responsible for bacteremia, respectively.Conclusion. Bacteriology of all patients diagnosed with post-caesarean sepsis in 74, 7% was positivefor pathologic bacterial cultures. Infection caused by 1 bacteria in 141 cases (39, 1%), by 2 bacteria in 56cases (15, 5%), by 3 bacteria in 2 cases (0, 6%), without any detection of bacteria 162 cases (44, 9%).
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Uterine leiomyomas are common (20-50%) in women of reproductive age. It is a benign tumor and it ranks second place among genital organ disorders in women.To date, abdominal laparotomy and laparoscopic surgical treatment (myomectomy and hysterectomy) are widely used to manage symptomatic leiomyomas.Although, hysterectomy is considered to be a radical method to manage uterine leiomyomas, women who have had hysterectomy are left totally infertile and they also are at risk to develop post-surgical and post-anesthetic complications. The advantage of myomectomy is to preserve women’s fertility and menstrual function but, the probability of recurrence of leiomyoma is 15-30% [1, 2]. Furthermore, depending on the location, size and number of fibroids, duration of surgery lingers, volume of blood loss is high and the risk to develop post surgical adhesions are high too.In recent, more than a decade period, effective and minimally invasive new, non-surgical methods to manage uterine leiomyomas have been introduced in many countries around the world. These methods have short recovery period and are advantageous to women to preserve their reproductive organ and fertility. They include: uterine artery embolization, uterine artery occlusion via transvaginal route and MRI– guided focused ultrasound surgery of uterine fibroids. Antiprogesterone-low-dose mifepristone for uterine leiomyomas are being introduced as well.In our country, managing leiomyomas surgically is still occupying high rate among surgical treatments. Further, to prevent and reduce complications of surgical treatment and to preserve organ, it is essential and imperative to introduce some of the above- mentioned contemporary non-surgical methods.
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One of the important problems in obstetricians science is wound infection following cesarean deliveries.It occurs in 2-10%.In the obstetricians practice these disorders decline associated with the use of antibiotics but the last 10 years all countries of the world puerperal infection increases, obstetric causes sepsis purulent difficulties of 150 thousand women deaths per year. Objective: To identify risk factories for wound infection following cesarean delivery.A population – based study. To comparing women who have and have not developed a wound infection prior to discharge from First maternity hospital, Mother and Child National health Centre of Ulaanbaatar, between 2011-2013.Using a logistic regression model, the following risk factors were identified: Sepsis purulent difficulties were more likely to develop in women who have twin pregnancy (OR=4.5; 95% CI 2.4-8.6) and vaginal exam multiple times (OR=6.7; 95% CI 2.1-22). No significant differences between the 2 group who underwent cesarean delivery for indications such as induction of labor, falled induction of labor, presence of meconium – stained amniotic fluid, nonreassuring fetal heart rate patterns. Sepsis purulent difficulties (p=0.001) occurred more often in women who were older, multiple pregnancy and delivery, pre-eclampsia, emergency cesarean delivery. The risk to develop sepsis purulent difficulties following cesarean delivery is maternal age, pregnancy, recurrent abortion, gestation age, emergency cesarean delivery, premature rupture of membranes, twin pregnancy and labor complication. (p=0.001)
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Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tractinfection. Most surgical site infections occur after discharge from the hospital and increasingly beingused as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidencebasedguidelines recommended the use of prophylactic antibiotics before surgical incision. An exceptionis made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cordclamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision,broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage tothe neonate. The beneficial effect of prophylactic antibiotics in reducing the occurrence of infectiousmorbidity form caesarean section, whether elective or emergency is well established. A single dose offirst-generation cephalosporin is as effective as multiple doses of broad-spectrum agents. Prophylacticantibiotics for caesarean section are commonly used worldwide, and in most institutions a single dose isadministered, generally after clamping of the umbilical cord. However, a recent survey (published in 2011)of maternal and fetal medicine physicians in the USA revealed that 84% of those who responded (theresponse rate was 25%) used preoperative administration. The effectiveness of prophylactic antibioticsdepends on their presence in effective concentrations throughout the operative period. Classen et al.found that administration of prophylactic antibiotics within a 2-hour period preoperatively was associatedwith the lowest surgical wound infection rate. Because of concerns about unnecessary fetal exposure,masking of fetal infection, increases in neonatal septic work-up and the emergence of resistant strainswhen prophylactic antibiotics are given preoperatively, it is a common obstetric practice to administerprophylactic antibiotics after cord clamping.Conclusion:1. Probability for occurring wound infection happens in case of urgent caesarean delivery for patientswho have not administered by preventative antibiotic.2. It has been confirmed that preventative antibiotic administration is proper in special occasions ofcaesarean delivery for women who suffer from anaemia obesity, diabetes, or chronic inflammatorydisease prior to their delivery.3. When preventative antibiotic administration is used 60 minutes before the caesarean delivery,concentration in blood and tissue reaches up to the maximum amount.
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INTRODUCTION:Uterine leiomyoma occurs with broad range of 20-50% among reproductive aged women. It takessecond place of all women’s genital diseases that cause abnormal menstrual bleeding. Leiomyomadependent surgical frequency such as hysterectomy is around up to 80, 6%. Lately uterine fibroidembolization treatment is highly effective, less painful, and more rapid recovery, most importantlykeeping organ while maintaining the reproductivity, is successfully entered in practice. We successfullyperformed 40 cases first time in Mongolia and 8 of them conceived naturally after treatment.GOAL:To determine if arterial embolization in women with uterine fibroids (leiomyomata) is an effectivemethod to keep their reproductive organ intact.OBJECTIVES:• To study pregnancy cases in women who had uterine fibroid embolization• To monitor and determine the features of course of pregnancy and childbirth.• To evaluate uterine fibroids.MATERIALS AND METHODS:The study was conducted in 2009-2012. A total of forty women between 23-50 years of age,diagnosed with symptomatic uterine fibroid that received embolization treatment of dominatingarterial blood vessel feeding the uterine fibroids were involved in the study. Eight of the forty womenwho conceived naturally were selected for the study. The study focused on monitoring the course oftheir pregnancy and delivery and its outcome.RESULTS:Among 40 women who underwent bilateral uterine artery embolization, 31 (75.5%) were seeking tobecome pregnant, and 8 of the 31 (25, 8%) became pregnant, four having been nulliparous. Onepatient had two pregnancies. All 8 pregnancies were spontaneous. The mean time from embolizationto conception was 12±3, 5 months (range, 6-27 months). Three medical terminations occurred. Theother 5 pregnancies went to term; one pregnancy had to be terminated pre-term due to placentapraevia. 60% experienced threatened abortion and 1 case with advanced age mother complicatedwith mild preeclampsia. 62,5% of the women’s pregnancy ended with childbirth, of which one woman(20%) had vaginal delivery and the remaining four pregnancies (80%) ended with C-section. On anaverage, post-treated uterine fibroids decreased in volume by 94% in comparison to pre-treateduterine fibroids in the patients who became pregnant. All of the neonates were healthy with Apgarscores greater than8. The mean weight of the neonates was 3,189± 200 g (range, 2,100–3,800 g). One neonate waspreterm due to placenta praevia (2,100 g).CONCLUSION:1. Of the forty women that received arterial embolization treatment with uterine fibroid, thirty one(75, 5%) women desired to keep their uterine for further reproduction, of which eight women (25,8% of the patients) between the ages of 23-42 years (mean age=35) conceived naturally. Arterialembolization to treat women with uterine fibroids is an effective method for women who wish to keeptheir reproductive organ intact to conceive and reproduce.2. 60 percent of the women who conceived experienced threatened abortion and 20 percent of thewomen’s pregnancy had to be terminated pre-term due to placenta praevia. 62,5 percent of thewomen’s pregnancy ended with childbirth, of which one woman (20%) had vaginal delivery and theremaining four pregnancies (80%) ended with C-section.3. On an average, post-treated uterine fibroids decreased in volume by 94% in comparison to pretreateduterine fibroids.
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As Mongolia is one of the countries with a high maternal mortality rate, the main goal of the Ministry of Health is to reduce the maternal mortality rate. According to the 2005 social survey, Mongolias average population growth reached 1.5 percent and 50.4 percent of the population are females including those of reproductive age making up 28.3 percent. Health and sociological surveys conducted in recent years have shown that the number of multiparae and multigravidae is unlikely to fall in the coming years, probably in the next 10 years. The lack of studies of hemostasia and hemodynamic in multiparae who underwent Cesarean sections has served as the grounds for this research. Goal The goal of this research is to develop a method of preventing surgical complications by studying the causes and characteristics of Cesarean sections in multiparae. Objectives: 1. To do a comparative study of changes in hemodynamic and hemostasia before, during, and after Cesarean sections and process the results, 2. To evaluate laboratory test results during Cesarean sections in multiparae. Methodology 1. Research Materials: Analysis materials are the laboratory samples and birth histories of mothers having Cesarean sections. 2. Research Methodology 3. Sampling Frame: The study will involve mothers (approximately 70 mothers) who are hospitalized in Maternal Departments 1 and 2 of the Clinical Maternity Hospital No. 1 and who will be delivered of their children by Cesarean sections. 4. To study the characteristics of Maternal Coagulation System and to do a selective comparison to the result. Results We have made an analysis to determine the indicators of the erythrocytes and coagulation systems before, during, and after sections in order to study the changes taking place in hemodynamic and hemostasia for discovering the changes in the coagulation systems of multiparae. Our research has identifi ed the following indicators of coagulation: clotting time, activated decalcifi cation time, artifi cially activated thromboplastin time, and fi brinogen amount. Each indicator of the test takes part in a particular stage of clotting and indicates failure of clotting factors or dysfunction of particular stages. According to the analysis, the clotting time in multiparae accelerates 1.5 times more than in prima gravidae, creating over clotting of blood. It indicates that the members of this group should be included in a group with a high risk of thromboembolism. The average level of the artifi cially activated thromboplastin time in prima gravidae was 32.24.6 before sections, 32.74.8 during sections, and 383.4 on the second day after sections, while multiparae had 39.73.4 seconds before sections, 37.34.4 seconds during sections, and 35.73.4 seconds on the second day after sections. It shows that these two indicators have no dramatic changes in prima gravidae, but they are shortened in multiparae during all stages of sections, proving a risk of thromboembolism. During normal pregnancy, both fi brinogen and its procoagulant level increase, reaching the maximum level before delivery, and therefore, the protein level is usually high during normal pregnancy. That is to say, changes in the coagulation system are directly dependent (P=0.01). Discussion Some Mongolian researchers who have studied the coagulation system disorders concluded that all indicators of clotting reach their maximum levels at the end of pregnancy and cause over clotting of blood through adaptation mechanisms.Our study has shown that these women have certain infl ammations or clotting disorders, since their pregnancy continues together with obstetrical or system disorders. During our research, the tests for the artifi cially activated thromboplastin time and the activated recalcifi cation time have determined the over clotting of blood, in particular the activity of the internal tract of hemostasia, and identifi ed a risk of thromboembolism. These results are similar to those of the studies conducted by A.Ts. Makatseriya (1997), and Sh.Sh. Rajabova (1997), and other scientists of the Dagestan University. Conclusion 1. Compared to those in the prima gravidae who had Cesarean sections, the artifi cially activated thromboplastin time and the activated recalcifi cation time in the multiparae who have had Cesarean sections fall signifi cantly (P=0.01), and this proves a high risk of thromboembolism. The above mentioned two groups have different fi brinogen levels. The fact that the fi brinogen level in the multiparae increases during and after the sections proves that pregnancy continues together with system or obstetrical disorders. 2. Multiparae belong to a high-risk group. If these women receive antenatal care as early as possible and timely complex measures are taken to reveal and cure system disorders in the mothers and normalize the changes taking place in hemodynamics and hemostasia. It is possible to prevent potential complications during or after sections and reduce maternal and fetal mortality rates.