Revisiting Puerperal Sepsis in Obsteric Referal Centres in Port Harcourt, Southern Nigeria

Background: As the frontier of knowledge expands, surgicalskills improve;and with the advent of increasingly potent antibiotics, it is expected that puerperal sepsisand itscomplications as captured in the literature of studieswill be on the down turn. With this in mind,we decided to find out what is current as par risk factors and complications of puerperal sepsis in these obstetric referral centres in Port Harcourt.Objective:To determine the risk factors and complications of puerperal sepsis at the University of Port Harcourt Teaching Hospital(UPTH), Port Harcourt and the River State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria.Methods: The case notes of these patients were retrieved from the medical records departments and relevant data extracted using a well-structured proforma. Data collected included the demographic characteristics, booking status, background immune suppression (HIV/AIDSor DM) abour characteristics, place and mode of delivery, fetal outcome, length of hospital stay. Morbidities like septicaemia, pelvic abscess, disseminated intravascular coagulopathy among others; and the presence of mortality was also noted.The data was analyzed using SPSS version 23.0. Statistical analysis of data was done by Chi-square test. A p-value less than 0.05 was considered significant. The result is presented in tables of frequencies and percentages.Results: The prevalence of puerperal sepsis was 1.7%. Risk factors were low parity,unbooked status (84.35%) and wound infection (29.9%),among otherintrauterine foetal death (22.8%), obstructed labour (14.2%)and perineal tear (11.0%). The main complications of puerperal sepsis noticed were prolonged hospital stay (58.3%) and septicaemia (13.4%); pelvic abscess (10.2%) and intestinal obstruction (4.7%) while (1)3.1% ended in mortality.Conclusion:Complications of puerperal sepsis were still high in these centres. Worrisomely, a huge number of these patients wereunbooked.

Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.

Factores asociados a la presentación de sepsis puerperal en provincia Guantánamo, 2017-2018 / Factors associated with the presentation of puerperal sepsis in Guantanamo province, 2017-2018 / Fatores associados à apresentação de sepse puerperal na província de Guantánamo, 2017-2018

RESUMEN Introducción: La sepsis y el choque séptico representan una de las complicaciones más graves durante el puerperio. Objetivos: Identificar los factores asociados a la presentación de sepsis puerperal en las pacientes que ingresaron en el Servicio de Cuidados Intensivos del Hospital General Docente "Dr. Agostinho Neto" durante el período 2017-2018. Método: Se realizó un estudio explicativo-observacional, longitudinal, retrospectivo y tipo caso control. Resultados: La endomiometritis fue la principal causa de ingreso con el 79,5 %. Las variables que se comportaron como predictoras de sepsis puerperal fueron la paridad-multípara, la edad gestacional menor de 37 semanas, el parto por cesárea, el antecedente de preclampsia, de sepsis vaginal y sepsis urinaria, la rotura prematura de membranas y el trabajo de parto mayor a 12 horas. Las variables que constituyeron factores de riesgo independiente para la morbilidad por sepsis grave fueron el exceso de base <- 4 (OR=11,9; IC 95 %; 3,9-35,3; p<0,05) la proteína C reactiva >8 mg/L (OR=9,67; IC 95 %; 5,9-14,24), la SatO2< 75 (OR=6,35; IC 95 %; 1,72-23,4), el anión gap >16 mmol/L (OR=5,88; IC 95 %; 3,86-8,97), el APACHE II y la escala SOFA (Sequential Organ Failure Assessment) al ingreso con el (OR=2,57; IC 95 %; 0,97-6,80) y el (OR=2,67; IC 95 %; 1,95-3,66), respectivamente. Conclusiones: La sepsis puerperal significa una problemática en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo, por lo que su reconocimiento y tratamiento adecuados son las claves para disminuir la morbilidad por esta causa.

ABSTRACT Introduction: Sepsis and septic shock represent one of the most serious complications during the puerperium. Objective: To identify the factors associated with the presentation of puerperal sepsis in patients admitted to the Intensive Care Service of the General Teaching Hospital "Dr. Agostinho Neto" during the 2017-2018 period. Method: An explanatory, observational, longitudinal, retrospective and case-control study was conducted. Results: Endomyometritis was the main cause of admission with 79.5%. The variables that behaved as predictors of puerperal sepsis were multiparous parity, gestational age under 37 weeks, delivery by caesarean section, history of preclampsia, vaginal sepsis and urinary sepsis, premature rupture of membranes and work of delivery greater than 12 hours. The variables that constituted independent risk factors for severe sepsis morbidity were base excess <- 4 (OR=11.9; 95% CI; 3.9-35.3; p <0.05) protein C reactive> 8 mg/L (OR=9.67; 95% CI; 5.9-14.24), SatO2 <75 (OR=6.35; 95% CI; 1.72-23.4), the gap anion> 16 mmol/L (OR=5.88; 95% CI; 3.86-8.97), APACHE II and the SOFA (Sequential Organ Failure Assessment) scale upon admission with (OR=2, 57; 95% CI; 0.97-6.80) and (OR=2.67; 95% CI; 1.95-3.66), respectively. Conclusions: Puerperal sepsis means a problem at the "Dr. Agostinho Neto" General Teaching Hospital in Guantanamo, so that its recognition and adequate treatment are the keys to reducing morbidity from this cause.

RESUMO Introdução: Sepse e choque séptico representam uma das complicações mais graves durante o puerpério. Objetivo: Identificar os fatores associados à apresentação de sepse puerperal em pacientes internados no Serviço de Terapia Intensiva do Hospital Geral de Ensino "Dr. Agostinho Neto" no período 2017-2018. Método: Estudo explicativo, observacional, longitudinal, retrospectivo e caso-controle. Resultados: A endomiometrite foi a principal causa de admissão com 79,5%. As variáveis que se comportaram como preditores de sepse puerperal foram: paridade multípara, idade gestacional abaixo de 37 semanas, parto por cesariana, história de pré-eclâmpsia, sepse vaginal e sepse urinária, ruptura prematura de membranas e trabalho de parto. entrega superior a 12 horas. As variáveis que constituíram fatores de risco independentes para morbidade grave por sepse foram excesso de base <- 4 (OR=11,9; IC 95%; 3,9-35,3; p<0,05) proteína C reativo> 8 mg/L (OR=9,67; IC 95%; 5,9-14,24), SatO2 <75 (OR=6,35; IC 95%; 1,72-23,4), o ânion de gap> 16 mmol/L (OR=5,88; IC 95%; 3,86-8,97), APACHE II e SOFA (Sequential Organ Failure Assessment) na admissão com (OR=2, 57; IC95%; 0,97-6,80) e (OR=2,67; IC95%; 1,95-3,66), respectivamente. Conclusões: Sepse puerperal representa um problema no Hospital Geral Dr. Agostinho Neto, em Guantánamo, para que seu reconhecimento e tratamento adequado sejam as chaves para reduzir a morbidade por essa causa.

Medical complications of puerperium: a single center observational study

Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia & Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.

Management of severe sepsis and septic shock in pregnancy to improve the survival

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.