Aetiological Factors and Foetomaternal Outcome in PROM.

Premature rupture of membrane (PROM) refers to the disruption of foetal membranes before the beginning of labour, resulting in spontaneous leakage of amniotic fluid.Homeyr, GJ et al in his study “Amnio infusion for third trimester preterm rupture of membranes”, march 2014 states that premature rupture of membranes (PROM), or pre-labour rupture of membranes, is a condition occurring in pregnancy and defined it as rupture of membranes (breakage of the amniotic sac), commonly called breaking of the mother's water (s), more than one hour before the onset of labour.METHODSThe present study was carried out in the Department of Obstetrics and Gynaecology of Rajendra Institute of Medical Sciences (RIMS), Ranchi, during from April 2017 to October 2018. A total 595 cases were studied. The cases were divided into two groups, Study Group-195 cases and Control Group- 400 cases.RESULTSVarious factors were studied and analysed. Incidence of PROM in the present study was 7.49%. Out of 195 cases 68% were term PROM and 32% were preterm PROM. Mean age in the study group was 23 yrs. Risk factors associated with PROM in most of the cases was unknown (52%). Other causes were anaemia 34%, cervicovaginal infections 16%, malpresentation 10%, multiple gestation 3.5%, prior cervical surgery 1%, history of fall 1% PROM following coitus was 1.5%. In the present study the correlation between CRP and clinical chorioamnionitis was significant. Caesarean section was done was done in 19% cases in study group. There were 3 % cases of chorioamnionitis in study group. Out of 10 patients in the study group, maximum patients had puerperal sepsis (4 patients- 40%) followed by UTI (30%), wound infection (20%) and breast engorgement (10%).CONCLUSIONSPremature infant puts immense burden on the economy and health care resources of the country. Therefore, management of PPROM requires accurate diagnosis and evaluation of the risks and benefits of continued pregnancy or expeditious delivery. Once PROM is diagnosed, it is important to weigh the risk of PROM and prematurity and make the right choice for conservative management or active interventions. Adequate antenatal care should be advocated so that appropriate risk assessment can be done, and intervention provided where applicable. Neonatal units should also be equipped to be able to render necessary care for these preterm neonates thereby reducing the morbidity and mortality associated with PPROM.

Identification of causative pathogen and its antibiotic sensitivity in cases of preterm premature rupture of membranes

Background: Pre-labor rupture of membranes is defined as amniotic membrane rupture before the onset of labor contractions, and if it happens before 37 weeks, it is called preterm premature rupture of membranes (PPROM). Several organisms commonly present in the vaginal tract are E.coli, Group-B streptococci, staphylococcus aureus, chlamydia trachomatis, Gardnerella vaginalis and Enterococcus faecalis which secrete proteases that degrade collagen thereby weakening  the fetal membranes leading to PPROM. Appropriate antibiotic therapy has a significant role in the prevention and treatment of maternal and neonatal complications.Methods: This was a prospective observational study done in the department of obstetrics and gynaecology, Narayana medical college, Nellore. Selectively 100 patients with complaint of PPROM admitted to labor room were included in the study. Diagnosis of membrane rupture was established by speculum examination, and high vaginal swabs are taken and sent to laboratory for identifying bacteria using gram staining and cultured in aerobic and anaerobic methods. Antimicrobial susceptibility testing of the organisms was performed by disk diffusion method by Kirby and Bauer.Results: Out of 100, high vaginal swabs had growth in 82 patients, and 18 were sterile. The repeatedly isolated organism in patients with PPROM is E.coli amounting 32%, followed by candidal species 20%. Staphylococci are scoring 11% and enterococci 8%. However, organisms like gardenella vaginalis and Group B streptococcus are least common with a score of 6% and 5% respectively. In this study, E.coli is highly sensitive to tigecycline, colistin 100% each and highly resistant to gentamycin and amikacin.Conclusions: In this study, E.coli is related to the maximum number of cases with preterm premature rupture of membranes. Appropriate use of antibiotics significantly lowers maternal morbidity and neonatal mortality.

Prevalence of vulvovaginal candidiasis in females in the reproductive age group

Background: Vulvovaginal candidiasis (VVC) is a common infection among reproductive age group females. The objective of present study is to determine the prevalence of vulvovaginal candidiasis, its distribution and association of risk factors among reproductive age group females, attending the outpatient department of obstetrics and gynaecology of our Prime Medical Centre, Sharjah attached with Prime Hospital, Dubai, United Arab Emirates (UAE).Methods: It was cross-sectional descriptive study over a period of six months. Patients who came to our outpatient department with complains of vaginal discharge and itching in reproductive age group were included in this study. Patients characteristics i.e. age, parity, risk factors like diabetes, pregnancy, use of oral contraceptive pills (OCPills) and intrauterine contraceptive device (IUCD) were noted. High vaginal swabs (HVS) were collected and sent for culture. Candida positive cases were noted, and results were analyzed.Results: A total of 224 high vaginal swabs were collected. Prevalence of vulvovaginal candidiasis was found to be 31.6%. It was found more in 26-30 years age group and multiparous women. Previous history of candidiasis and diabetes were the commonest risk factors. Frequency of C. albicans was more (76.05%) than non-albicans candida (23.94%).Conclusions: Present study concluded that vulvovaginal candidiasis is more prevalent in reproductive age group females, therefore a routine high vaginal swab culture must be performed in every woman presenting with vaginal discharge and itching for correct diagnosis. Women should be educated on clinical symptoms.

Comparative study of microflora between birth canal and new born oral cavity

Background: New-born acquires mother’s microbiome from the birth canal during the delivery process and these bacteria then colonize in the gut. Studying the oral microbiome of infants offer a good perspective for us to understand the gut microbiome disruption caused by C-section. A previous study of three-month-old infants reported a higher amount of bacterial taxa of the oral microbiota in vaginally delivered infants than the ones with another birth mode. Aim: Comparison of microflora between the birth canal and the oral cavity of a newborn in Caesarean delivery. Materials and methods: 30 pregnant women selected for the study. Parturient canal samples obtained prior to delivery and infant’s oral cavity oral samples obtained immediately after birth. Samples transported to the lab for microbiological assays and data tabulated and statistically analyzed using Chi-Square Test. Results: E.coli was observed in 21.1% (N=7) in the vaginal swab whereas its occurrence in buccal smear was 10.3% (N=3). The chi-square test of independence was statistically insignificant (p> 0.05). The staphylococcus was observed in 44.8 (N= 13) of vaginal swab and 37.9% (N=11) of buccal smear and again the difference was statistically insignificant. The presence of pus cells was 31% (N=9) in vaginal swab and 10.3% (N=3) in the buccal smear. Conclusion: A significant number of mother-child pairs showed the presence of Staphylococcus aureus, Klebsiella, and E.coli. However, Klebsiella and pus cells were occasionally found.

Syndromic management approach and wet mount microscopy of trichomonas vaginalis in pregnant women and sexually transmitted infection clinic attendants in Merawi Health Center, Merawi, Amhara Regional State, Ethiopia.

Background: Trichomonas vaginalis is a flagellated single cell protozoan parasite, which carries the distinction of being the only truly sexually transmitted parasitic infection in humans. Aim: To determine the prevalence of Trichomonas vaginalis among pregnant women and sexually transmitted infection clinic attendants in Merawi Health center. Syndromic management approach was also evaluated for its effective diagnosis of trichomoniasis. Methodology: In this study, a total of 222 women were enrolled. Majority of them were in the age group of 15-25 years (48.6%, 108). Identification of the Trichomonas vaginalis trophozoites was performed by wet mount microscopy of vaginal samples (vaginal discharge and vaginal swab) and clinical diagnosis by the syndromic management approach was performed by health workers in the health center. Result: Syndromic management approach has identified 4 women (1.8%) who had selfreported symptoms related to trichomoniasis. However, the laboratory wet mount diagnosis has identified 14 (6.3%) women who were positive for the trophozoites of Trichomonas vaginalis. The sensitivity of syndromic management approach with respect to the wet mount microscopy was 21.4%. Conclusion: Syndromic management approach is highly insensitive in screening out trichomoniasis, even, as compared with the less sensitive laboratory test (wet mount microscopy). Hence, we support the need for improved diagnostic parameters to reduce adverse trichomoniasis associated reproductive health outcomes.

Detecção de DNA de Brucella spp. em amostras de sangue e de suabe vaginal ou prepucial de cães do município de Natal, Rio Grande do Norte, Brasil / Detection of Brucella spp. DNA in samples of blood and vaginal or preputial swab from dogs in the county of Natal, Rio Grande do Norte, Brazil

Objetivou-se com este trabalho detectar o DNA de Brucella spp. em amostras de sangue e de suabe vaginal ou prepucial de 80 cães sorologicamente positivos para brucelose pela prova de imunodifusão em gel de ágar (IDGA), no município de Natal, estado do Rio Grande do Norte, Brasil. Amostras de sangue total foram colhidas com anticoagulante (citrato de sódio) juntamente com amostras de suabe vaginal e prepucial , para extração de DNA e posterior realização da rea- ção em cadeia da polimerase (PCR) empregando-se os primers ITS66 e ITS279. O DNA de Brucella spp. foi amplificado em seis animais, sendo um animal em ambas as amostras, dois cães em amostras de sangue e três em amostras de suabe do trato reprodutivo. Concluiu-se que a infecção por Brucella spp. está presente em cães no município de Natal, e que a detecção de DNA do agente em amostras de suabe do trato reprodutivo podem ser utilizadas como ferramenta suple- mentar no diagnóstico de brucelose canina.

The aim of this work was to detect Brucella spp. DNA in samples of blood and vaginal or preputial swabs in 80 sero-positive dogs for brucellosis by agar gel immunodiffusion test (AGID) from the county of Natal, Rio Grande do Norte State, Brazil. Whole blood samples were collected with anticoagulant (sodium citrate) and vaginal and preputial swab samples for DNA extraction and polymerase chain reaction (PCR) employing ITS66 and ITS279 primers. Six animals showed amplification of Brucella spp., being one animal in both samples, two dogs only in blood samples, and three only in reproductive tract swabs. It is concluded that infection due to Brucella spp. occurs in dogs from the county of Natal, and the detection of DNA of the agent in reproductive tract swabs may be used as complementary tool in the diagnosis of canine brucellosis.

Motivos alegados para a não realização do exame de papanicolaou, segundo mulheres em tratamento quimioterápico contra o câncer do colo uterino / Reasons given by women undergoing chemotherapy for cervical cancer for not having had a Pap test / Motivos para la no realización del examen de papanicolaou según mujeres en Tratamiento quimioterápico contra cáncer de cuello uterino

Neste estudo, ressalta-se a importância de conhecer as dificuldades das mulheres em realizar o exame de Papanicolaou, ferramenta essencial no diagnóstico do câncer do colo do útero (CCU), o segundo mais comum entre as mulheres. O objetivo foi identificar, entre portadoras de CCU em tratamento quimioterápico, as dificuldades encontradas para a realização do exame de Papanicolaou. Trata-se de um estudo quantitativo com análise descritiva. O grupo foi composto por 20 mulheres, sendo que 65% delas realizavam o exame conforme preconizado, 70% já haviam realizado o exame em algum momento da vida, 75% descobriram o CCU por meio da consulta ginecológica e 25% pelo exame preventivo. Os motivos alegados para a não realização do exame foram: não tinha vida sexual ativa; tinha parceiro fixo; não conhecia o exame; não achava que fosse necessário; fazia uso de preservativo; utilizava contraceptivo; não apresentava corrimento vaginal ou queixa ginecológica; nunca tinha tido doença sexualmente transmissível; pensava que o exame fosse pago; não tinha acesso a unidades de saúde que realizassem o exame; as unidades que realizam o exame funcionavam no horário de trabalho; a unidade alegou falta de material; não conseguiu agendar consulta para realizar o exame; pela idade, achou que não fosse mais necessário; tinha vergonha de realizar o exame; esqueceu-se de realizar o exame; esqueceu-se de buscar o resultado; não sabia que se podia prevenir um câncer. Os motivos aqui elencados para a não realização do exame mostraram a necessidade de maior efetividade nas práticas de educação em saúde.

The present study is a descriptive quantitative analysis that highlights the importance of understanding women's difficulties in having A Pap smear test. Such procedure is an essential tool for the diagnosis of cervical cancer, the second most common type of cancer among women. The study aimed to identify, among women with cervical cancer undergoing chemotherapy, the difficulties for having a Pap smear exam. The group studied comprised 20 women; 65% of them performed the examination as recommended, 70% had had the test at some point in life, 75% were diagnosed during their gynaecological exam and 25% by preventive tests. The reasons given for not undergoing the test were as follows: not being sexually active; having a steady sex partner; unawareness about the exam; thinking it was not necessary; the use of condoms; the use of a contraceptive; not presenting vaginal discharge or other gynaecological complaints; never having had a sexually transmitted disease; believing the test had to be paid for; not having access to health facilities that performed the test; health care units performed the test only during working hours; the health unit lacked material to perform the test; could not schedule an appointment; assuming that it was no longer needed at a certain age; being ashamed of the examination; missing the test; forgetting to get the results; not knowing it could prevent cancer. The reasons listed above indicate the need for a greater effectiveness in health education actions.

El presente estudio resalta la importancia de conocerse las dificultades de las mujeres en realizar el examen de Papanicolaou, herramienta esencial en el diagnóstico del cáncer de cuello uterino (CCU), segundo más común entre las mujeres. El objetivo fue identificar entre portadoras de CCU, en tratamiento quimioterápico las dificultades encontradas para la realización del examen de Papanicolaou. Se trata de un estudio cuantitativo con análisis descriptivo. El grupo estuvo compuesto por 20 mujeres, entre las cuales un 65% de ellas realizaba el examen según lo preconizado, un 70% ya habían realizado el examen en algún momento de su vida, el 75% descubrió el CCU t ravés de la consulta ginecológica y un 25% t ravés del examen preventivo. Los motivos dados para no realizar el examen fueron: no tener vida sexual activa, tener compañero fijo, no conocer el examen, no hallar que fuera necesario, hacer uso de preservativo, utilizar contraceptivo, no presentar flujo vaginal o queja ginecológica, nunca haber tenido Enfermedad de Transmisión Sexual, pensar que el examen fuera pago, no tener acceso a unidades de salud que realizasen el examen, las unidades que realizan el examen funcionan en el horario de trabajo, la unidad señala falta de material, no conseguir programar el examen, considerar que el examen no fuera más necesario debido a la edad, tener vergüenza de realizar el examen, olvidarse de realizar el examen, olvidarse de buscar el resultado, no saber que podía se podía prevenir el cáncer. Los motivos señalados para la no realización del examen nos muestra la necesidad de mayor efectividad en las prácticas de educación en salud.

Análise dos laudos de papanicolaou realizados em uma unidade básica de saúde / Analysis of papanicolaou test results carried out in a primary health center / Análisis de los laudos de papanicolaou realizados en una unidad básica de salud

Estudo descritivo teve por objetivo caracterizar os aspectos microbiológicos e epiteliais presentes nos exames preventivos realizados em uma unidade básica de saúde de Juazeiro do Norte - Ceará. Os dados foram coletados de julho a novembro de 2011, mediante a análise de 782 resultados de Papanicolaou realizados entre março de 2008 e outubro de 2011 e que constavam no livro de registros de preventivos da unidade. Os dados foram analisados com auxílio do programa estatístico SPSS 16.0. Os resultados evidenciaram maior procura de mulheres entre 25 a 34 anos (28,4%) para a realização do exame; no esfregaço houve prevalência de epitélio escamoso (80,9%), Cocos (49,2%) e agentes infecciosos como Gardnerella vaginalis (65%), Cândida sp (23,7%) e Trichomonas vaginalis (5,6%). O profissional de saúde precisa identificar os fatores de risco associados às afecções, possibilitando prevenção do câncer do colo uterino e controle das Doenças Sexualmente Transmissíveis.

This descriptive study aimed to characterize the microbiological and epithelial aspects present in the screening exams carried out in a primary health center in Juazeiro do Norte - Ceará. The data was collected from July to November 2011, through the analysis of the results of 782 smear tests undertaken between March 2008 and October 2011, included in the center's record-book for screening tests. The data was analyzed with the help of the statistical program SPSS version 16.0. The results evidenced a greater demand among women between 25 and 34 years old (28.4%) for the test; in the swab specimen there was a prevalence of squamous epithelium (80.9%), coccus (49.2%) and infectious agents such as Gardnerella vaginalis (65%), Cândida sp (23.7%) and Trichomonas vaginalis (5.6%). The health professional needs to identify the risk factors associated with the conditions, making it possible to prevent cervical cancer and control Sexually Transmitted Diseases.

Estudio descriptivo que tuvo por finalidad caracterizar los aspectos microbiológicos y epiteliales presentes en los exámenes preventivos realizados en una unidad básica de salud de Juazeiro do Norte - Ceará. Los datos fueron obtenidos de julio a noviembre de 2011, por medio de análisis de 782 resultados de Papanicolaou realizados entre marzo de 2008 y octubre de 2011 y que estaban en el libro de registros de preventivos de la unidad. Los datos fueron analizados con ayuda del programa estadístico SPSS 16.0. Los resultados evidenciaron mayor búsqueda por mujeres entre 25 y 34 años (28,4%) para realización del examen; en la colecta hubo prevalencia de epitelio escamoso (80,9%), Cocos (49,2%) y agentes infecciosos como Gardnerella vaginalis (65%), Candida sp (23,7%) y Trichomonas vaginalis (5,6%). El profesional de salud debe identificar los factores de riesgo asociados a las afecciones, posibilitando prevención del cáncer de cuello de útero y control de las Enfermedades Sexualmente Transmisibles.

Avaliação funcional do transplante autólogo heterotópico de ovários: estudo experimental em ratas / Functional assessment of autologous heterotopic transplant of ovaries: An experimental study on female mice

Introduction: Two facts have been constantly reported in the literature over the lastdecades, namely: the increased number of reproductive-age women with cancer and theincreased age of primiparas. Both facts have encouraged studies on strategies to preserve women?s fertility. Objectives: To perform vaginal swab and morphological study to assess the functional viability of transplanted ovarian tissue. Methods: 30 female Wistar ablbinus mice with preserved hormonal function were randomly distributed in six groups: G1. Control ? laparotomy; G2. Bilateral oophorectomy. G3. Bilateral oophorectomy with intact ovarian implant in the femoral region; G4. Bilateral oophorectomy, with sliced ovarian implant in the femoral region; G5. Bilateral oophorectomy with intact ovarian implant in the great epiploon; G6. Bilateral oophorectomy with sliced ovarian implantat in the great epiploon. Vaginal swab and removal for morphological study of the transplanted ovaries were carried out on the 35th and 120th days after surgery. Groups G3 and G6 were submitted to new vaginal swab on the 150th day. Results: All G1 mice had hormonal function. All G2mice remained in diestrus. The patterns of four G3 mice were consistent with estrus on the 35th day, and one mouse ovulated on the 120th day. Only one G4 mouse remained in diestrus after transplantation. All G5 had functioning ovary. Four G6 mice manifested hormonal function on the 35th day and only three on the 120th day. All the 150th-day swabs were classified as diestrus.Conclusions: Autologous ovarian transplant is technically feasible in female mice as much as vaginal swab for hormonal function assessment.

Comparison of scpB gene and cfb gene polymerase chain reaction assays with culture on Islam medium to detect Group B Streptococcus in pregnancy.

Purpose: The purpose of the current study was to evaluate two low-costing PCR assays for rapid detection of Group B Streptococcus (GBS) in comparison to a pigment-based culture method. Materials and Methods: One-hundred and fifty vaginal swabs were collected from pregnant women at 35-40 weeks of gestation. Vaginal swabs were inoculated in selective enrichment broth medium, and examined using Islam medium, cfb PCR and scpB PCR assays. The demographic data were analysed to identify independent predictors of GBS colonization (age and gravidity), with GBS status as the dependent variable. Results: There was a significant association of age and gravidity with GBS colonization. GBS was detected in 25.3% of isolates by Islam medium, in 30.6% by using the cfb PCR assay and in 30% by using the scpB PCR assay. Conclusion: older pregnant women (≥30 years) and multigravida (>3 pregnancies) are at higher risk of GBS colonization. Both scpB-gene and cfb-gene-based PCR methods are highly sensitive techniques (100% sensitivity) compared to culture method. However, the specificities of the scpB and cfb PCR assays were 93.75 and 92.85%, respectively.