ABSTRACT
RESUMEN Introducción. Las infecciones y la sepsis materna durante o después del parto aumentan la mortalidad materna y provocan una carga alta de enfermedad en la Región de las Américas. El riesgo de infección después de la cesárea y el parto instrumentado puede ser reducido mediante el uso de antisépticos cutáneos y profilaxis antibiótica apropiados. Objetivos. Sintetizar las recomendaciones desarrolladas por la Organización Mundial de la Salud (OMS) con el fin de mejorar la calidad del cuidado y los desenlaces en salud relacionados con la profilaxis antibiótica de rutina en mujeres con parto vaginal instrumentado, la profilaxis antibiótica de rutina en mujeres con parto por cesárea, la elección de antisépticos y el método de aplicación para la preparación de la piel antes de una cesárea, y la irrigación vaginal con antisépticos en las mujeres en quienes se realiza una cesárea. Métodos. Las directrices elaboradas por la OMS siguieron los métodos de elaboración de la directriz GRADE (Grading of Recommendations Assessment Development and Evaluation) del Manual para el desarrollo de directrices de la OMS. Se llevó a cabo una síntesis de las recomendaciones de cuatro directrices de la OMS. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en las Américas para identificar barreras, facilitadores y estrategias de implementación, y para establecer indicadores. Resultados. Se formularon cinco recomendaciones para la profilaxis antibiótica de rutina en mujeres con parto vaginal instrumentado, la profilaxis antibiótica de rutina en mujeres con parto por cesárea, la elección de antisépticos y el método de aplicación para la preparación de la piel antes de una cesárea, y la irrigación vaginal con antisépticos en las mujeres que tienen una cesárea. Se identificaron barreras y facilitadores para la implementación, y se crearon indicadores de adherencia y resultado. Conclusiones. Las recomendaciones formuladas proveen orientación para mejorar la calidad del cuidado y los desenlaces en salud relacionados con la profilaxis antibiótica y la elección de antisépticos en las mujeres con parto vaginal instrumentado o cesárea.
ABSTRACT Introduction. Maternal sepsis and infections during or after childbirth increase maternal mortality, leading to a high burden of disease in the Region of the Americas. The risk of infection after a cesarean section or instrumental vaginal delivery can be reduced with the appropriate skin antiseptic agents and antibiotic prophylaxis. Objectives. To synthesize World Health Organization (WHO) recommendations to improve the quality of care and health outcomes related to routine antibiotic prophylaxis in women during instrumental vaginal delivery; routine use of antibiotic prophylaxis in women having a cesarean section; the choice of antiseptics and skin preparation methods before a cesarean; and vaginal irrigation with antiseptics in women undergoing a cesarean. Methods. The WHO guidelines were based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology as described in the WHO Handbook for Guideline Development. Recommendations contained in four WHO guidelines were synthesized and a systematic search for studies carried out in the Region of the Americas was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature to identify barriers, facilitators, and implementation strategies. Results. Five recommendations were made on the routine use of antibiotic prophylaxis in women undergoing instrumental vaginal delivery, routine use of antibiotic prophylaxis in women having a cesarean section, the choice of antiseptics and skin preparation prior to a cesarean section, and vaginal irrigation with antiseptics during a cesarean section. Implementation barriers and facilitators were identified, and indicators were created to assess adherence and outcomes. Conclusions. The formulated recommendations aim to provide guidance on how to improve quality of care and outcomes related to antibiotic prophylaxis and the choice of antiseptics in women undergoing instrumental vaginal delivery or a cesarean section.
RESUMO Introdução. As infecções maternas e a sepse durante ou após o parto aumentam a mortalidade materna e causam uma alta carga de doenças na Região das Américas. O risco de infecção após a cesariana e o parto operatório pode ser reduzido com o uso apropriado de antissépticos cutâneos e profilaxia antibiótica. Objetivos. Sintetizar as recomendações desenvolvidas pela Organização Mundial da Saúde (OMS) para melhorar a qualidade da assistência e os desfechos de saúde relacionados à profilaxia antibiótica de rotina em mulheres submetidas a parto vaginal operatório, à profilaxia antibiótica de rotina em mulheres submetidas a parto cesáreo, à escolha de antissépticos e ao método de aplicação para a preparação da pele antes de uma cesariana e à ducha vaginal com antissépticos em mulheres submetidas à cesariana. Métodos. As diretrizes desenvolvidas pela OMS seguiram os métodos de desenvolvimento da diretriz GRADE (Grading of Recommendations Assessment Development and Evaluation), do Manual para o desenvolvimento de diretrizes da OMS. Foi realizada uma síntese das recomendações de quatro diretrizes da OMS. Além disso, foi realizada uma busca sistemática nas bases de dados PubMed, Lilacs, Health Systems Evidence e Epistemonikos e na literatura cinzenta de estudos realizados nas Américas para identificar barreiras, facilitadores e estratégias de implementação, e para estabelecer indicadores. Resultados. Foram formuladas cinco recomendações para a profilaxia antibiótica de rotina em mulheres submetidas a parto vaginal operatório, a profilaxia antibiótica de rotina em mulheres submetidas a parto cesáreo, a escolha de antissépticos e o método de aplicação para a preparação da pele antes de uma cesariana e a ducha vaginal com antissépticos em mulheres submetidas a cesariana. Foram identificadas barreiras e facilitadores para a implementação e foram criados indicadores de adesão e resultados. Conclusões. As recomendações formuladas fornecem orientações para melhorar a qualidade da assistência e os desfechos de saúde relacionados à profilaxia antibiótica e à escolha de antissépticos em mulheres submetidas a parto vaginal operatório ou cesariana.
ABSTRACT
Background: Maternal mortality in India is reported to be 300 to 500 per 100,000 births in the Bulletin of World Health Organisation. It is far away from Millennium development goal 5 where it is required to reduce MMR to 109 per 100, 000 live births. Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Aim: It was to critically analyze all the mothers who died due to sepsis in order to identify factors associated with deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died due to sepsis were included in the study and they were all analyzed modelled on the United Kingdom Confidential Enquiries into maternal deaths. Results: During the study period there were 44 total maternal deaths out of 5863 births giving maternal mortality ratio of 641 per 100,000 maternities. Out of 44 maternal deaths, 14 were due to sepsis making it the leading cause of maternal mortality in our institute. Out of fourteen deaths due to Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Hyma, Sirisha, Syamala, Sravanthi, Sagarika. Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned. IAIM, 2017; 4(12): 5-9. Page 6 sepsis nine were due to direct causes and the remaining five were due to indirect causes such as pneumonia, sickle cell disease with malaria, and pancytopenia. The ages of the women who died ranged from 19 to 38 years with a median age of 26 years. All had normal body mass index. Five women who died were tribals, six from rural areas and the remaining three from slums of urban areas. Eight women were primigravid. Eight women died from sepsis in the antenatal period, two deaths were in the first trimester after criminal abortion, three due to pneumonia, one had intrauterine dead fetus infected and the other was due to pancytopenia. Four deaths were due to genital tract sepsis after cesarean section and two were due to genital tract sepsis after normal delivery. These six had risk factors such as anemia, prolonged rupture of membranes etc. Conclusion: In few cases, the outcome was inevitable, but for majority it might have been different had the infection been diagnosed and treated more promptly. There are lessons learned from the deaths of these women to improve the survival of mothers and to achieve millennium development goal 5.
ABSTRACT
Background: The thymus is a central lymphoid organ that plays a vital role in the development and maturation of the immune system during childhood, the thymus appears as a bilobed triangular structure located in the anterior mediastinum. Aim and objectives: To provide radiologists a comprehensive understanding of Recognition of the variable appearance of thymic lesions and evaluation of thymic lesions on different radiological modalities like X-Rays and CT-scan for early diagnosis as well as management. Materials and methods: 10 cases of either strong suspicion or symptoms related to thymic lesion were evaluated who came to Dhiraj Hospital with different radiological modalities (X-ray, CT-scan). Results: Out of total no. of 10 patients who were diagnosed and evaluated with thymic lesion on Xrays and CT-scan are: Thymic Hyperplasia, Thymic Cyst, Thymic Lymphoma, Thymoma, Benign Teratoma, Malignant Teratoma. Conclusion: CT Imaging remains the ideal scanning modality to evaluate Radiologists play a major role in differentiating normal thymus from its variants, various thymic lesions and tumor. But common associated radiological modality used along with CT scan done is X-ray.