study of post-caesarean section wound infections in a regional referral hospital, Oman

The aim of this study was to determine the incidence of surgical site infections [SSI] in patients undergoing a Caesarean section [CS] and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patients quality of life by increasing morbidity and extending hospital stays. A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean [PCS] SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSL Controls [220] were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSL Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. The total number of PCS wound infections was 211 [2.66%]. There was a four-fold higher incidence of premature rupture of the membranes [37, 17.53%] and a three-fold higher incidence of diabetes [32, 15.16%] in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus [66, 31.27%] and the Gram-negative Escherichia coli group [40, 18.95%]. The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 [19.90%], while 47 [22.27%] yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques

Perinatal mortality rate as a quality indicator of healthcare in Al-Dakhiliyah Region, Oman

This study aimed to provide insight into the causes of stillbirths and early neonatal deaths and identify better intervention strategies. This was a retrospective study during a 7-year period [January 2003 to December 2009] of all stillbirths and early neonatal deaths at the Nizwa regional referral hospital in Al-Dakhiliyah region, Oman. Of a total 27,668 births, there were 244 stillbirths and 157 early neonatal deaths. The perinatal mortality rate [PMR] was 14.49/1,000 births. The period-specific rates were 17.23/1,000 in 2003, 18.33/1,000 in 2004, 15.20/1,000 in 2005, 12.20/1,000 in 2006, 12.46/1,000 in 2007 and 12.09/1000 in 2008. This decline in the death rate was significant [P = <0.005]. The rate rose in 2009 to 15.63/1,000, mostly from an increase in early neonatal deaths [congenital anomalies]. The most common identifiable cause of stillbirth was congenital anomalies [18.82%], in which central nervous system anomalies were most common. Other causes include abruption placentae [13%], cord accidents [12%], and intrauterine growth restriction [IUGR], while the cause remained unknown in 22.59%. Congenital anomalies accounted for 53.50% of early neonatal deaths followed by prematurity [23.56%] and birth asphyxia [5.73%]. Extremes of maternal age were related to higher PMRs. An overall improvement in the stillbirths and neonatal death rates was witnessed; however, further improvement is warranted for common avoidable fetal and maternal risk factors. Extra care needs to be provided for women who are at risk of developing complications such as gestational diabetes, pregnancy-induced hypertension, IUGR, etc

Methotrexate treatment of ectopic pregnancy: experience at Nizwa hospital with literature review

Ectopic pregnancy occurs when the embryo fails to implant within the uterine cavity. Methotrexate, a folic acid antagonist has been widely used to treat ectopic pregnancy. The aim of this study is to determine the efficacy of methotrexate treatment for ectopic pregnancies in our settings which will in-turn help us reduce maternal mortality and morbidity. This was a retrospective review of 60 cases of ectopic pregnancy treated with single dose methotrexate in Nizwa hospital, Oman. Demographic data, clinical presentation, treatment progress, outcome, side effects and future fertility follow up were analysed using a computer database. Selection criteria included hemodynamically stable women with beta-hcg level of

Uterus didelphys with obstructed right hemivagina, ipsilateral renal agenesis and right pyocolpos: a case report

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis [OHVIRA Syndrome] is a rare congenital anomaly of the female genital tract. Uterus didelphys occurs when the midline fusion of the mullerian ducts is arrested, either completely or incompletely. Women with didelphic uterus may be asymptomatic and unaware of having a double uterus. They may present with complaints of dysmenorrhoea and dyspareunia. A 25 year old woman attending the infertility clinic at Nizwa regional referral hospital presented with history of dysmenorrhoea and foul vaginal discharge with right cystic pelvic mass. She was diagnosed as a case of double uterus with obstructed right hemivagina and right pyocolpos with ipsilateral renal agenesis after routine ultrasonography in the clinic followed by MRI. Excision of the right vaginal septum with drainage of 200 ml of purulent discharge was performed. She was relieved of her symptoms and conceived promptly after the surgical excision of the partial vaginal septum

Occlusion of upper genital tract following lower segment caesarean section for placenta praevia

Uterine cavity occlusion following caesarean section for central placenta praevia culminating in haematometra and thereby amenorrhoea is one of the rarest long term complications of lower segment caesarean section. We report a case of 28 year old primigravida with Grade 4 placenta praevia who underwent elective caesarean section at 35 weeks gestation. She presented at Nizwa Hospital, Sultanate of Oman, after 7 months with cyclical lower abdominal pain and amenorrhoea. She was treated by hysteroscopic adhesiolysis and an in utero Foley's catheter. She had complete resolution of her condition within 2 months and resumption of menstrual cycles. Multiple haemostatic sutures at caesarean section for placenta praevia can be an causative factor for such a complication along with other risk factors like multiple caesarean sections, chorioamniotis etc. Recognition of these factors, meticulous surgical technique and appropriate post operative care can effectively prevent it

Assisted vaginal delivery versus caesarean delivery for term breech presentation

To review the mode of breech delivery over a 4-year period in Nizwa Hospital, and to evaluate the trend and associated complications. Computer data recordings, delivery suite and Special Care Baby Unit records of women, who delivered at Nizwa hospital between 1st January 1999 and 31st December 2002, were analysed There were 286 term breech deliveries constituting 2.8% of the entire deliveries in the hospital; 49.6% of the breeches were delivered by Caesarean section while 50.3% had assisted vaginal delivery [P = 0.93] Amongst 70 primigravidae breeches, 48[68%] were delivered by Caesarean section, while 92 [42.5%] out of 216 multigravidae were delivered by Caesarean section. Congenital anomalies contributed three neonatal deaths, one among the vaginal delivery and two among the Caesarean section group in multigravidae. The only neonatal death in primigravidae group was due to birth asphyxia as a result of late admission in late second stage of labour with severe fetal bradycardia. Thus no neonatal death or fresh stillbirth could be attributed to assisted vaginal delivery. There was one case of fracture humerus in a primigravida who delivered by assisted vaginal delivery Considering the fact that most practicing obstetricians seem to be more inclined towards delivering breeches by Caesarean section, the art of assisted delivery is still practiced in our setting with an equally favourable outcome as that of Caesarean section mode of delivery