Comparison of Short Course Versus Long Course Antibiotic Prophylaxis for Caesarean Section: A Randomised Controlled Trial.

BACKGROUND: The need for restrictive use of antibiotics has become a contemporary issue, hence the drive for reduction in the duration of perioperative antibiotic use without compromising care. OBJECTIVE: The aim of this study was to compare the efficacy of short course versus long course antibiotic prophylaxis for caesarean section. METHODOLOGY: This was a randomised controlled study in which I66 patients admitted for elective or emergency caesarean section at National Hospital Abuja were randomly allocated into two parallel treatment groups in 1:1 allocation ratio. The study group received intravenous dose of 1g of ceftriaxone with 500mg of metronidazole stat post umbilical cord clamping. While the control group received post-operative doses of intravenous ceftriaxone 1g 12 hourly with 500mg of metronidazole eight hourly for 24 hours, then oral cefuroxime 500mg twice daily and metronidazole 400mg thrice daily for five days. Outcome measures included febrile morbidity, wound infection and clinical endometritis. Data was analysed with SPSS version 23. RESULTS: The socio-demographic and clinical characteristics were comparable in both groups. There were no statistical differences in the incidence of febrile morbidity (0% vs. 1.3%, P=1.000) and wound infection (12.2% vs. 12.8%, P=0.902, RR=0.902, 95% CI 0.409-2.203) in the study and control groups. There was no case of clinical endometritis in both groups. The difference in the cost of antibiotics was however statistically significant (t=26.847, P=0.001). CONCLUSION: Short course antibiotics has comparable efficacy to long course antibiotics in the prevention of post caesarean section infectious morbidity.

L'ARRIERE PLAN: La nécessité d'une utilisation restrictive des antibiotiques est devenue un enjeu contemporain d'où la volonté de réduire la durée d'utilisation des antibiotiques périopératoires sans compromettre les soins. OBJECTIF: Le but de cette étude était de comparer l'efficacité de l'antibioprophylaxie de courte durée à celle de longue durée en cas de césarienne. MÉTHODOLOGIE: Il s'agissait d'une étude contrôlée randomisée dans laquelle 166 patients admis pour une césarienne élective ou d'urgence à l'hôpital national d'Abuja ont été répartis au hasard en deux groupes de traitement parallèles dans un rapport d'attribution de 1: 1. Le groupe d'étude a reçu une dose intraveineuse de 1 g de ceftriaxone avec 500 mg de métronidazole stat après le clampage du cordon ombilical, tandis que le groupe témoin a reçu des doses postopératoires de ceftriaxone intraveineux 1 g 12 heures avec 500 mg de métronidazole huit heures par heure pendant 24 heures, puis du céfuroxime oral 500 mg deux fois par jour. et 400 mg de métronidazole trois fois par jour pendant cinq jours. Les mesures des résultats comprenaient la morbidité fébrile, l'infection des plaies et l'endométrite clinique. Les données ont été analysées avec la version 23 de SPSS. RÉSULTATS: Les caractéristiques sociodémographiques et cliniques étaient comparables dans les deux groupes. Il n'y avait pas de différences statistiques dans l'incidence de la morbidité fébrile dans les groupes d'étude et de contrôle (0% contre 1,3%, P = 1000) et l'infection des plaies (12,2% contre 12,8%, P = 0,902, RR = 0,902, 95% CI 0,409-2,203). Il n'y a eu aucun cas d'endométrite clinique dans les deux groupes. La différence de coût des antibiotiques était cependant statistiquement significative (P= 0,001). CONCLUSION: Les antibiotiques de courte durée ont une efficacité comparable aux antibiotiques de longue durée dans la prévention de la morbidité infectieuse post-césarienne. MOTS CLÉS: Antibiotiques, prophylaxie, césarienne, infection.

A randomized controlled study comparing Prostaglandin E2 vaginal suppository with intra-cervical Foleys catheter balloon for preinduction cervical ripening at term.

BACKGROUND: Pre-induction ripening of an unfavourable cervix reduces the incidence of failed induction and associated maternal and perinatal morbidity and mortality. OBJECTIVE: The aim of this study is to compare the effectiveness of prostaglandin E2(PGE2) vaginal suppository with intra-cervical Foley's catheter balloon for pre-induction cervical ripening. METHODS: It is a prospective randomized study. Clients with unfavourable cervix (Bishop score<5) were randomly allocated into two groups. One group received 3mg PGE2 vaginal suppository and the second group had intra cervical Foley catheter insertion and balloon inflated with 30mls of sterile water. RESULTS: There were 38 patients in each arm.There was no difference in age, parity and educational level, p=0.9157, 0.8054 and 0.7568 respectively, in the two groups. There were significant changes in the Bishop scores following the application of Foley's catheter and Prostaglandin E2 (p= 0.0214 and 0.0105) respectively. The cervix became ripened (Bishop score e"5) in 92.1% of clients. There was no significant difference in cervical ripening effectiveness in the two groups (p=1.0000). The average time to onset of labour (latency interval) was 12.48±3.36 hours and was significantly shorter with the PGE2 group (p=0.0494). The mean induction to delivery interval for the women was 16.33±8.25hours. There was no significant difference between the two groups (p=0.7418). There were no differences between the two groups in mode of delivery, apgar sores and neonatal admission rate. CONCLUSIONS: PGE2 and Foley catheter balloon are equally effective as cervical ripening agents.

Current management and prevention of malaria in pregnancy: a review.

BACKGROUND: Pregnant women suffer more frequent and severe malaria than non-pregnant women. Malaria in pregnancy contributes to the high maternal and perinatal morbidity and mortality in Africa. OBJECTIVE: To review the burden and highlight the current management and prevention strategies for control of malaria in pregnancy in Africa. METHODS: Papers for this review were identified by searches of PubMed and Google, and references from relevant articles. Search terms were "malaria", "malaria in pregnancy", "Malaria during pregnancy" and "antimalarial drug". Only papers published in English between 1983 and 2013 were included. RESULTS: In malarial endemic areas, acquired partial malarial immunity is not effective during pregnancy. Pregnant women are prone to frequent malaria infections which may be severe or asymptomatic but associated with placental parasitization. Malaria contributes 2-15% to maternal anaemia, 13-70% to intrauterine growth restriction, 8-14% to low birth weight, 8-36% to prematurity, 3-8% to infant deaths and 2.9-17.6% to maternal mortality. The control of malaria in pregnancy is currently predicated on three main strategies: 1) Prompt and effective case management of malaria; 2).Use of Insecticide-treated nets; and 3).Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine. Artemisinin-based combined therapy is the recommended treatment for uncomplicated malaria in the second and third trimesters of pregnancy, while quinine is used in the first trimester and for severe cases of malaria at any gestational age. CONCLUSION: The control of malaria during pregnancy should be an integral part of efforts to reduce maternal and perinatal morbidity and mortality in Africa.

Gynaecological and reproductive health issues in HIV-positive women.

BACKGROUND: Women constitute over 60 percent of the HIV-infected population in sub-Saharan Africa. Highly active antiretroviral therapy (HAART) has improved the life span of people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Advances in scientific knowledge and management of the HIV-positive pregnant woman have also led to reduction in the risk of mother-to- child transmission (MTCT) of HIV. The gynaecological and reproductive health needs and care of the HIV-positive woman are poorly appreciated, suboptimal and largely neglected, with potential to negatively affect their quality of life and efforts at control of the HIV epidemic. OBJECTIVE: To review the contemporary gynaecological and reproductive health problems and management of the HIV-positive woman. METHODS: A review of local and international publications on gynaecology / reproductive health and HIV from indexed / online journals and relevant websites using Pubmed and Google search in the period between 1980 and March 2009. RESULTS: The HIV-positive woman suffers increased frequency and severity of pelvic infections and cervical premalignant and malignant lesions. Relapses and treatment failures of these conditions are common among these patients. Infertility and contraception are also challenges to the HIV-positive woman. Gynaecological and reproductive health care is an integral part of the comprehensive health care needs of the HIV-positive woman. CONCLUSION: In addition to antiretroviral treatment, HIV positive women should be provided regular screening for sexually transmitted infections (STIs), cervical cytology, counselling and services for infertility and contraception. Appropriate attention to the gynaecological and reproductive health needs of the HIV-positive woman will improve her general health status and quality of life and contribute to reduction in the incidence of HIV infection.

Stevens-Johnson syndrome associated with nevirapine use in an HIV-positive pregnant woman: a case report.

BACKGROUND: Stevens-Johnson syndrome (SJS) is a rare but potentially life threatening condition which has been associated with infections, neoplasm and drug use. OBJECTIVE: To report a case of nevirapine-induced SJS in an HIV-positive pregnant woman on antiretroviral therapy for prevention of mother-to-child transmission (PMTCT) of HIV. METHODS: Clinical and laboratory evaluation of a 31-year old HIV-positive primigravida who presented at 20 weeks gestation with fever and generalized skin rash with bullae. She was admitted and managed conservatively as a case of SJS. RESULTS: There was history of use of nevirapine-containing highly active antiretroviral therapy (HAART) for six weeks prior to presentation. Physical findings included a generalized skin rash with bullae, oral mucosa blisters/ulcerations and purulent conjunctivitis. She was managed as a case of SJS. Antiretroviral drugs were temporarily withdrawn. A skin biopsy confirmed the diagnosis of a drug-induced dermatosis (erythema multiforme). She recovered satisfactorily with significant improvement of her dermatologic, oral mucosal and eye conditions and was discharged after 35 days of hospitalization. She was recommenced on antiretroviral therapy but with substitution of nevirapine in place of saquinavir. She carried the pregnancy to term and was delivered of a live baby through caesarean section. CONCLUSION: Practitioners managing HIV-positive patients on nevirapine-containing antiretroviral therapy should be aware of the potential for SJS. A high index of suspicion is required to be able to promptly diagnose, refer and/or institute appropriate management to avoid severe morbidity and fatality associated with this condition.