Efficacy of betadine vaginal toileting before caesarean section in postoperative infections

Background: The objective of the current study was to evaluate the efficacy of preoperative betadine vaginal toileting in reducing post caesarean infections (endometritis, febrile illness, wound sepsis).Methods: This prospective longitudinal study was conducted at Maulana Azad Medical College, New Delhi over 3 months among 200 women who underwent caesarean delivery. Inclusion criteria were defined as women undergoing caesarean section. Exclusion criteria included placenta previa, active genital herpes, cord prolapse, chorioamnionitis, allergy to iodine. After taking informed consent, subjects were divided into two groups by simple randomization method using computer generated random numbers- Group 1 (case) - subjects who underwent 5% povidone iodine sponge stick cleansing in all the fornices and walls of vagina for 30 seconds after foley’s catheter insertion and before abdominal scrubbing. Group 2 (control) - subjects who didn't receive betadine vaginal toileting before caesarean section Subjects were followed for 10 days postpartum (or till suture removal/ discharge from hospital, whichever was late). Demographic data, operative details and postoperative parameters were compared between the two groups.Results: Both groups were matched for baseline patients’ characteristics (age, BMI, gestational age, operative time). Women who received preoperative betadine vaginal toileting had markedly less incidence of endometritis (case-3%, control-10%, p<0.05), overall postoperative morbidity (case-13%, control-33%, p<0.001). Incidence of postoperative febrile illness (case-6%, control-12%, p>0.05) and wound sepsis (case-5%, control-12%, p>0.05) were found to be less but not significant between both groups.Conclusions: Preoperative vaginal cleansing helps in reducing postoperative morbidity by decreasing incidence of postoperative infection.

Prediction of severe adverse maternal outcome in women admitted in obstetric ward using physiological and biochemical parameters

Background: To study physiological and biochemical parameters to predict serious adverse maternal outcomes and to develop risk score using above parameters.Methods: This prospective study was conducted in 500 high risk pregnant women attending tertiary care teaching hospital. We noted physiological and biochemical parameters as soon as they were available .The primary outcome measures was “severe adverse maternal outcome(SAMO)” in form of one or more among  mortality, near miss morbidity and ICU admissions.Results: Out-off 500 women, severe adverse maternal outcomes were seen in 158 (31.6%) women. Most common cause of near miss maternal morbidity was hypertensive disease of pregnancy (62.7%) followed by major obstetric hemorrhage (18.9%). There were 33(6.6%) ICU admission, 23 (4.6%) maternal death and 153 (30.6%) near miss maternal morbidity. The most common cause of maternal death in our study was obstetric hemorrhage. The significant variables after multivariate analysis [temp, pulse, urine protein] were used  to devise a Maternal early warning score (MEWS) based on physiological parameters at score value of  ≥1/6 was found to have  sensitivity of 70% and specificity of 82% in predicting SAMO with AUROC of 0.76. The significant laboratory parameters after multivariate analysis were blood urea, serum creatinine, serum bilirubin and liver enzymes. The obstetric risk score (Maternal risk prediction score MRPS) which incorporated of these laboratory parameters in addition to physiological parameters has sensitivity of 82% and specificity of 75% with AUROC 0.79 value ≥ 2/18.Conclusions: The addition of laboratotory parameters to physiological variables improves performance of risk score to predict SAMO.

Fatal outcome in acute fatty liver of pregnancy and review of literature

Acute fatty liver of pregnancy (AFLP) is an uncommon life-threatening disorder of pregnancy seen commonly in third trimester. When not diagnosed at right time it can lead to hepatic failure, encephalopathy, coagulopathy, maternal and fetal mortality. The clinical symptoms and signs are nonspecific, and it needs to be identified early in order to prevent poor outcome. The gold standard for diagnosis of AFLP is liver biopsy, which is difficult in an acute setting and in abnormal coagulation profile hence the diagnosis is usually based on clinical criteria   Early termination of pregnancy and good intensive care support are the mainstay of management. The authors here presented a case report where even early delivery and good critical care failed to prevent maternal mortality. Review of literature regarding etiopathogenesis, management and recurrences of AFLP are also discussed.