Surgical site infections following caesarean sections in the largest teaching hospital in Ghana.

Background: Surgical site infections complicate up to 15% of all surgical procedures depending on surgery type and underlying patient status. They constitute 14-31% of all hospital-acquired infections, placing huge financial burdens on patients, healthcare institutions and the nation. Objective: To determine the incidence, risk factors, microbiological aetiology and antibiotic susceptibility patterns of surgical-site infections following caesarean sections (CSs) at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Methods: This prospective study involved 500 women who underwent CS from April to July 2017 at KBTH. Overall, 474 women completed the study with 26 women lost to follow-up or opting out of the study. Women were recruited on the first postoperative day and followed-up postnatally. Sociodemographic and obstetric data were obtained using a structured questionnaire. Swabs of infected surgical wounds were taken for culture and sensitivity testing using the Kirby-Bauer disk diffusion technique. Data was analysed using SPSS version 22. Results: Sixty-one (61/474) women (12.8%) had SSIs after CS. Of these, 41 (67.2%) were superficial, 18 (29.5%) were deep incisional and 2 (3.3%) were organ space SSIs. Significant risk factors for SSI were: emergency CS after 8 h of active labour, midline incisions, use of stored water for surgeon's pre-operative scrubbing, maternal status being single and alcohol consumption during pregnancy. Staphylococcus aureus was the commonest pathogen isolated with 6 (9.8%) being meticillin resistant (MRSA). Antibiotic susceptibility was mostly to quinolones. Conclusion: SSI occurred in 12.8% of CS wounds at the KBTH, commonly caused by S. aureus.

The impact of malaria parasites on the placenta and perinatal outcome at Korle Bu teaching hospital, Accra, Ghana: a case control study

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerable groups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies. Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test. Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had no history of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001). Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term

Cyclic mechanical stretching and interleukin-1alpha synergistically up-regulate prostacyclin secretion in cultured human uterine myometrial cells.

Prostacyclin (PGI2), a potent uterine smooth muscle relaxant, is postulated to be a major prostaglandin (PG) secreted from the human myometrium. PGI2 metabolite concentrations in the maternal plasma were reported to be elevated during pregnancy, especially during labor. Recently, we developed cultured human myometrial cells from pregnant women and reported that cyclic mechanical stretching mimicking labor increased PGI2 secretion from these cells by up-regulating PGI2 synthase promoter activities. Since elevation of cervical/vaginal interleukin-1alpha (IL-1alpha) concentrations is also a characteristic feature of delivery, and IL-1alpha is a known stimulator of PG synthesis, we investigated a possible synergistic effect of cyclic mechanical stretching and IL-1alpha on PGI2 production in cultured human myometrial cells. Treatment with IL-1alpha (10 ng/ml) significantly augmented (4- to 60-fold) the secretion of PGI2, prostaglandin E2 (PGE2), prostaglandin F2alpha (PGF2alpha) and thromboxane A2 (TXA2) from cultured human myometrial cells obtained from non-pregnant and pregnant women as well as in cultured human umbilical artery and cultured human coronary artery smooth muscle cells (p < 0.05 for all comparisons). However, labor-like cyclic mechanical stretching up-regulated IL-1alpha-augmented PGI2 secretion from myometrial cells obtained from non-pregnant and pregnant women 2.1- to 2.8-fold (p < 0.05 for all comparisons), but not PGE2, PGF2alpha nor TXA2. Moreover, such an augumentation of PGI2 secretion by cyclic mechanical stretching was not observed in cultured human umbilical artery nor in cultured human coronary artery smooth muscle cells. These results suggest that cyclic mechanical stretching by labor, in concert with IL-1alpha stimulation, contributes to the increase in myometrial PGI2 secretion during delivery.

Role of leptin in pregnancy--a review.

Leptin is an adipocyte-derived hormone that decreases food intake and body weight via its receptor in the hypothalamus. In rodents, it also modulates glucose metabolism by increasing insulin sensitivity. We previously reported that leptin is produced by human placental trophoblasts. We also revealed that leptin gene expression in the placenta was augmented in severe pre-eclampsia, and suggested that placental hypoxia may play a role in this augmentation. Maternal plasma leptin levels correlated well with mean blood pressure, but not with body mass index. Plasma leptin levels in pre-eclamptic women with IUGR were higher than those without IUGR (P< 0.05). We further examined the effects of hyperleptinemia on the course of pregnancy by using transgenic mice (Tg) overexpressing leptin. In pregnant Tg mice, food intake was significantly less than non-Tg, and the fetal body weights were reduced to approximately 70 per cent of those of non-Tg. Resistin is a novel adipocyte-derived hormone that decreases insulin sensitivity and increases plasma glucose concentration, thus contributing the development of obesity-related type II diabetes mellitus. We recently found that resistin gene is expressed in the human placenta as well as adipose tissue. In this review, possible roles of placental leptin and resistin are discussed.