Analysis of Various Types of Rupture Uterus and to Assess Maternal and Perinatal Outcome in Cases of Rupture Uterus over a Period of 5 Years: An Experience from Madhya Pradesh.

Background: Uterine rupture in pregnancy is a deadly obstetrical emergency endangering the life of both mother and fetus. Methods: The present prospective study was conducted to analyse the various types of rupture uterus, changing trends of uterine rupture and surgical management along with maternal morbidity, mortality and perinatal outcome in these cases. Results: In this study, total cases were 42,205 of deliveries and 179 cases of rupture uterus giving incidence as 0.42 % that is 1 per deliveries. Complete uterine rupture are mush common i.e. (77.71 %) than incomplete rupture. Postnatal rupture was found in 11 cases. Uterine / scar repair was done in 53.11 % while obstetric hysterectomy was done in 46.89 % of cases. Most common additional surgical procedure was repair of rupture bladder i.e. 13 cases. Cervical / vaginal / perennial tear repair was performed in cases of rupture uterus from obstructed labour. A total 13 mortality occurred in cases of rupture uterus. Most common cause of maternal mortality is haemorrhagic shock, accounting for 61.23% of total maternal mortality. Majority of babies i.e. 71.9 % were still born and only 21.2 % were born alive and healthy. Neonatal death occurred in 6.7 % of cases. Fetal mortality in cases of uterine rupture is very high. Conclusion: It is concluded that due to changing obstetric practices and with liberalization of practices of caesarean section, the incidence of scar rupture is on a rise and will further increase in near future therefore pregnant woman with previous scar should be given trial after proper risk assessment and only in set up where 24 hrs emergency services for caesarean section.

Screening of syphilis using rapid plasma reagin test in apparently healthy population in Madhya Pradesh: a 6 years study.

To analyze the prevalence of syphilis in apparently healthy population in Madhya Pradesh during last 6 years. Methods: Serum samples were collected from Departments of Obstetrics and Gynecology, Skin and Venereal diseases, Medicine, Surgery, etc., of the period of 6 years. All the serum samples were screened for syphilis by rapid plasma reagin (RPR) test using standard methods. Results: Out of 21,742 samples, 133 (0.62%) serum samples were found to be positive. The highest seroprevalence was observed in the group aged 25-31 years (0.89%) and lowest in 18-24 years (0.31%). Conclusion: RPR testing in this populations group plays a special value in the diagnosis, treatment and prevention of syphilis.

Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study.

Background: Ventilator-associated pneumonia (VAP) is the most common infection diagnosed in intensive care units (ICUs). The causative organisms of VAP vary among different populations and are increasingly associated with resistance against various antimicrobial agents. Objective of current study was to determine the bacteriological etiology of VAP, antimicrobial susceptibility pattern of the isolates and detect the presence of extended-spectrum -lactamases (ESBL), metallo β-lactamases (MBL) and AmpC -lactamases in multidrug resistant isolates causing VAP in the medical ICU. Methods: A prospective study was carried out over a year to know the various etiological agents of VAP and their drug susceptibility patterns. ESBL, MBL and AmpC -lactamases were detected in various isolates by combination disk method, imipenem-EDTA combined disk method and AmpC disk method respectively. Results: The majority of bacterial isolates causing VAP were found to be gram negative bacilli. Acinetobacter spp accounted for 34.28% of VAP cases followed by Pseudomonas aeruginosa which was responsible for 25.71% cases. Other gram negative bacilli isolated were Klebsiella pneumoniae, Citrobacter freundii, Enterobacter spp, and Escherichia coli. Out of the total 70 isolates, 67 (95.7%) were multidrug resistant and not even a single isolate was sensitive to all the drugs tested. Conclusions: Most of the pathogens causing VAP in our institute were multidrug resistant and in many isolates this resistance was due to production of ESBL, MBL, and AmpC β-latamases. Polymixin-B and colistin were found to be highly effective against multidrug resistant Acinetobacter spp and P. aeruginosa.

Incidence of neonatal sepsis in tertiary care hospital: An overview.

Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. Aims & Objective: To determine the bacteriological profile of neonatal septicaemia, their antibacterial susceptibility pattern (AST) and production of extended spectrun β-lactamase (ESBL) by gram negative bacteria. Material and Methods: Blood culture specimens were collected from 238 neonates. Identification of organisms, their AST, methicillin resistant Staphylococcus aureus (MRSA) and ESBL detection was done. Results: Gram negative bacteria were more frequently isolated than gram positive bacteria. The gram positive bacteria were highly resistant to penicillin. Vancomycin and amoxyclav exhibited good activity against both Staphylococcus aureus and coagulase negative Staphylococcus. Gram negative bacteria also exhibited high resistance to the commonly prescribed group of drugs such as penicillins, cephalosporins and aminoglycosides. Out of the total 16 isolates of S. aureus, 31.25% were MRSA. ESBL production was seen in 52.9% of Escherichia coli and 50% of Klebsiella pneumoniae. Conclusion: E. coli and S. aureus were the most common bacteria associated with neonatal sepsis. Gram negative bacteria were isolated predominantly and many of them were resistant to several groups of drugs. Also high resistance was seen to third generation cephalosporins in case of E. coli and K. pneumoniae due to ESBL production.

Surgical site infections with special reference to methicillin resistant Staphylococcus aureus: experience from a tertiary care referral hospital in North India.

Objective: Surgical site infections are an important cause of health care associated infections among surgical patients. Aim: To determine the prevalence of Staphylococcus aureus and Methicillin resistant Staphylococcus aureus (MRSA) in surgical site infections with relation to age and sex and its antimicrobial susceptibility pattern. Methods: During a period of three years, 5,259 specimens received from surgical site infections were processed for isolation and identification of bacterial pathogens according to the standard microbiological techniques. Results: Abscess drainage was the most common type of surgical site infection (26.62%) and Staphylococcus aureus (34%) was the most common isolate. The most frequent isolation of the S. aureus in relation to age was noted in the age group of 21–40 years and the prevalence rate was higher in male patients. Out of the total S. aureus isolates, 27.96% were found to be methicillin resistant. Conclusions: There is a need for continuous surveillance and monitoring for the frequency of MRSA with its antimicrobial resistance patterns which may help in decreasing the prevalence of MRSA and antibiotic resistance.