Case report on necrotizing fasciitis following episiotomy

Necrotising fasciitis (NF) is an extremely rare but near fatal bacterial soft tissue infection, complicating the operative wounds. Here is a case report of Necrotising fasciitis in episiotomy wound in low socioeconomic, poorly nourished and anaemic women. A 39 years old, second gravida, delivered normally with medio-lateral episiotomy under local anaesthesia. On postnatal day four, patient developed high grade fever and on examination episiotomy was found to be unhealthy and gaped. She was started on broad spectrum antibiotics empirically but the cellulitis rapidly progressed to vulva, then to the bilateral thighs and extended till knees. Bilateral lower limb Doppler ultrasonography was done to rule out deep vein thrombosis which showed no abnormality. USG abdomen revealed huge pus collection in the lower abdomen. Under anaesthesia, surgical exploration was done, pus was drained followed by wound debridement and pus sent for culture and sensitivity. Pus and blood culture showed growth of Klebsiella pneumoniae, so started on appropriate antibiotics. Patient started recovering, when the wound was healthy, secondary suturing of episiotomy wound done. She was discharged on post-natal day 27 after full recovery. Early diagnosis and aggressive timely management are the corner stone to avoid morbidity and mortality of NF.

Cholestasis of pregnancy: a prospective analysis from a South Andaman teaching hospital

Background: Intrahepatic cholestasis of pregnancy (IHCP) is one of the commonest pregnancy related liver disorder. Although the maternal course is usually benign, there is an increased risk of spontaneous preterm delivery, fetal compromise, meconium stained amniotic fluid and even intrauterine fetal demise. The objective of this study was to study the incidence of IHCP and its impact on maternal and perinatal outcome.Methods: A prospective study carried out in 68 number of IHCP cases. Diagnosis was done on the basis of clinical and laboratory parameters. All the cases were followed up to the puerperium to find out maternal and perinatal outcome.Results: The incidence of cholestasis of pregnancy was 2.73%. Most (88%) of the cases were presented with generalized pruritus, relived with ursodeoxycholic acid and complete recovery was observed after delivery. The rate of instrumental delivery was 8.82% and caesarean section rate was 30.88%. Most common indication of caesarean section was fetal distress and non-progress of labour. There was one stillbirth at 35 weeks however none of the mother had complication during labour or puerperal period.Conclusions: Increased level of liver enzymes in patients of IHCP associated with poor perinatal outcome. Therefore, careful monitoring during antenatal period and termination of pregnancy at term will result in favourable outcome of both mother and baby.

Evaluation of cervical smear in high risk women.

Background: Objectives of current study were (i) To find out the pattern of cervical smear in females having risk factors. (ii) To observe the relationship between abnormal cervical smear with high risk factors. Methods: A cross-sectional descriptive study was carried out in the department of obstetrics and gynecology, Guwahati medical college & hospital from July 2009 to August 2010 with the help of Pathology department. 200 women attending gynecological OPD with associated risk factors were selected at random. Detailed history, demographic information, contraceptive history and coital history were taken. Smear was taken from endocervix with the help of Ayer’s spatula or cytobrush. Results: Out of 200 cases, in 110 (55%) the smear was reported negative for malignancy. 73(36.5%) had an inflammatory smear, 11 (5.5%) had CIN, 1(0.5%) had malignancy and 5(2.5%) the smear was inadequate for cytological examination. In the study mean age of Cervical Intraepithelial Neoplasia (CIN) was 42.64 ± 6.34 years. Low socio-economic status, high parity & the use of oral contraceptive pills were major risk factors. Conclusion: Cervical smear should be routinely used as a reliable diagnostic aid for early detection carcinoma cervix especially in high risk cases. The need of the hour is to create awareness and easy accessibility to proper screening.