Journal articles on the topic 'Hospitals, Gynecologic and obstetric Victoria'

Background: Thyroid gland is the power house of human body. It provides energy for the various biochemical processes of the body and helps to maintain basal metabolic rate. Objective: To estimate the prevalence of thyroid dysfunction in pregnancy and to evaluate the obstetric and perinatal outcomes in such pregnancies Setting: Department of Obstetrics & Gynecology, Bahawal Victoria Hospital Bahawalpur from 15 January 2021 to 15 JUNE 2021 Study Design: A Descriptive Case Series. Materials and Methods: A total of 292 cases of antenatal patients, irrespective of their period of gestation were enrolled in this study by random sampling method. Patients with multiple pregnancies and having bad obstetrical history were excluded. Detailed history and obstetrical examination, routine blood test and serum TSH were performed. These patients were followed during labour, delivery and puerperium and maternal outcome and neonatal outcomes were noted. Results: In this study we enrolled two hundreds and ninety two (292) antenatal women. Out of total 292 patients only 61 (20.9%) were nulliparous and rest of the patients were multiparous. The prevalence of thyroid dysfunction in pregnancy was 8.2%. Out of this, 2.74 % patients had sub clinical hypothyroidism (SCH). Overt hypothyroidism (OH) was seen in 2.40%, sub clinical Hyperthyroidism in 1.71% & the incidence of overt hyperthyroidism was 1.37%. Maternal complication included: abortion (5.5%), pre-eclampsia (3.4%), abruption-placentae (4.1%), preterm labour (4.5%), PPH (4.2%) and puerperal sepsis (2.8%). Neonatal outcomes included: preterm births (5.4%),LBW (5.1 %), IUGR (6.2%), still birth (4.4%), neonatal death (5.1%), low APGAR score ( <7 at 5 minutes ) (6.9%). Conclusion: Thyroid dysfunction in pregnancy, though has a low incidence, but is associated with adverse maternal and fetal complications. Thus thyroid screening should be done in antenatal period to improve fetomaternal outcome. Keywords: Thyroid dysfunction, Hypothyroidism, Hyperthyroidism, Fetomaternal outcome, Overt Hypothyroidism, Subclinical Hypothyroidism.

Objective: The objective of study was to find out serum uric acid level in normal andpreeclamptic pregnant women of third trimester visiting outpatient department of obstetrics and gynecology of Bahawal Victoria Hospital, Bahawalpur. Methodology: It was a cross sectional descriptive study conducted form July 2018 to June 2019. All primigravida women of age 18-35 years in third trimester of singleton pregnancy attending in Obstetrics and Gynecology Outpatient Department of Bahawal Victoria Hospital in study duration were included in the study. Statistical analysis was performed by using SPSS version 14. Chi-square test was performed to find the statistical difference regarding uric acid distribution between groups and ‘p’ value <0.05 was considered as a lowest level of significance. Results: Out of total 1212 women 84.6% were normal and 15.4% had preeclampsia. In our study out of 187 preeclamptic women, 63.6% had raised serum uric acid level and out of 268 normal pregnant women uric acid level was raised in only 39.5%. Results were found statistically significant. Conclusion: Results of our study suggest that serum uric acid level in pregnant women can be used as a useful and inexpensive marker in prediction of preeclampsia and preventive measures can be taken accordingly.

Objective: To determine the transmission of Hepatitis B virus from infectedmother to their newborns. Design: Cross-sectional descriptive study. Setting: Pediatrics Ward-2 and Gynecology &Obstetric Department Bahawal Victoria Hospital/Quaid-e-Azam Medical College Bahawalpur. Period: From August2004 to December 2005 Material and Methods: A total of 300 pregnant ladies admitted in the gynecological andobstetric department for delivery were screened for HBsAG, HBeAG, HBcAB, HBsAB, and HBeAB. The newborns ofthe mothers with HBsAG and HBeAG were tested for the same antigens at the time of birth and the ones who werepositives for the antigens were labeled as having “vertical infection” through placenta. Results were tabulated; incidenceof hepatitis was calculated. RESULTS: HBsAG was positive in 37(12.3%) out of the 300 enrolled mothers. Out of the37 babies born to 37 hepatitis B positive mothers, 4(21%) newborns were positive for HBsAG.In the mothers of theseinfected newborns, HBeAG was present in 3 while one mother did not have HBeAG. CONCLUSION: Universal prenatalscreening for hepatitis B in all the pregnant women and protection of their off springs should be provided both by activeand passive prophylaxis immediately after birth depending upon their serological status.

Objective: To review the management and outcome of postoperative complications after common obstetric and gynecologic surgeries performed in outside nonacademic private hospitals (clinics) and peripheral public hospitals (districts hospitals) and later admitted in Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital (RMCH). RMCH is a tertiary referral hospital where all complicated patients were referred for better management from surrounding hospital.Methodology: This Quasi-experimental study was carried out in the Department of Obstetrics and Gynecology at Rajshahi Medical College Hospital, Rajshahi, Bangladesh between July 1, 2015 and June 30, 2017. All patients admitted with post operative complications following common obstetric and gynecologic surgeries during this period were included. Patients admitted with post operative complications, where primary surgery was done in this hospital were excluded. The common obstetric and gynaecological surgeries were caesarean sections (LUCS), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) performed outside Rajshahi Medical College Hospital.Result: During this period a total of 39,929 patients were admitted through emergency way in obstetrics and gynecology department of Rajshahi Medical College Hospital. Among them 675 patients were admitted with the complaints of post operative complications following common obstetric and gynecologic surgeries with rate being 1.7%. In 560(83%) cases surgery was done in clinics and 115(17%) cases surgery was done in district hospitals. Among the patients 580(85.9%) cases primary operation was done by non-gynaecologic surgeon and 95(14.1%) cases by gynaecologic surgeon. Caesarean section was the primary obstetric surgery in 405(60%) cases .Gynecologic surgeries included TAH in 185(27.4%) cases and VH in 85(12.6%) cases. We found 25(3.7%) patients died from these complications. Repeat surgery was done in 90(13.33%) cases. Genitourinary fistula repair was done in 41 cases (45.55%). Rests were improved by conservative management.Conclusion: Any surgical procedure carries risk of complications. Careful selection of patients with suitable indications for operations, expertise of the surgeon, good surgical technique, proper knowledge of pelvic anatomy and careful postoperative follow up can minimize recognized complications.TAJ 2017; 30(2): 7-12

Objectives: Determination of the relationship among the peritoneal adhesions, cesarean scar and striae gravidarum. Study Design: Cross sectional Study. Settings: Gynecology and Obstetrics Department of Bahawal Victoria Hospital, Bahawalpur. Period: June 2018 to May 2018. Material & Methods: A total of 150 cases of cesarean section which presented at gynecology and obstetrics department of Bahawal Victoria Hospital, Bahawalpur were involved in this study. Davey scoring system was applied in order to determine the severity of striae gravidarum. Intraperitoneal adhesions were classified into five subcategories on the basis of Modified Blauer classification. Grouping was done on the random basis. Three groups were made. Group 1 consisted of the women with no striae gravidarum, group 2 had women with number of striae gravidarum from mild to moderate and group 3 had women of severe number of striae gravidarum. Comparison between different groups was done using the Mann-Whitney and student T test. Mean and standard deviation were calculated for quantitative variables while qualitative variables were assessed by their frequency and percentage. Statistically significant P value was 0.05 or less. Results: Intraperitoneal adhesions of grade 2-4, pigmentations and keliods were frequent in group 2 and 3 but the difference between these groups was not statistically significant (p-value 0.517, 0.427 and 0.372, respectively). There was no difference present among the group regarding the appearance of scar as well (p=0.541). As far as the length and width of the scar was concerned, the length was relatively more in patients of group 3 while width was relatively more in patients of group 1 but there were no statistically significant differences (Table-II) (p=0.289 and p=0.248 respectively). Conclusion: It can be concluded that there is no association between intraperitoneal adhesions and striae gravidarum but correlation between scar characteristics and striae gravidarum are evident.

The influence of Queen Victoria on the acceptance of obstetric anesthesia has been overstated, and the role of John Snow has been somewhat overlooked. It was his meticulous, careful approach and his clinical skills that influenced many of his colleagues, Tyler-Smith and Ramsbotham and the Queen's own physicians. The fact that the Queen received anesthesia was a manifestation that the conversion of Snow's colleagues had already taken place. This is not to say that this precipitated a revolution in practice. Medical theory may have changed, but practice did not, and the actual number of women anesthetized for childbirth remained quite low. This, however, was a reflection of economic and logistical problems, too few women were delivered of newborn infants during the care of physicians or in hospitals. Conversely, it is important to recognize that John Snow succeeded in lifting theoretical restrictions on the use of anesthesia.

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..

Objectives: To compare the frequency of wound infection between subcuticular stitches versus interrupted mattress sutures after cesarean section. Setting: Obstetrics & Gynecology Department, Bahawal Victoria Hospital, Bahawalpur. Study duration: 21st July 2019 to 20th December 2020 Study design: Randomized controlled Clinical trial Materials & Methods: In this clinical trial study, A sum-total of 60 women, 18-40 yrs of age, scheduled for planned elective cesarean section through Pfannenstiel incision were enrolled. In Group I women, subcuticular sutures were placed while in group II women, interrupted mattress sutures were placed. All women were discharged on tablet Augmentin 1gram x twice a day for 7 days at which wound infection was noted. Results: The mean age of women in group I was 27.60 ± 5.16 years and was 27.40 ± 3.99 years in group II. My study has shown the wound infection in group I (sub-cuticular stitches) as 01 (3.33%) and in group II (interrupted mattress sutures) as 08 (26.67%) respectively with p-value of 0.011. Conclusion: The inference from my study shows that the wound infection after cesarean section is less after sub cuticular stitches as compared to interrupted mattress sutures. Keywords: cesarean section, sub cuticular stitches, wound infectio

Objective: To compare maternal and perinatal outcome in cases of PROM at term, following induction with vaginalmisoprostol (PGE1) to shorten the duration of labour with those managed expectantly. Design: Quasi Experimental study. Setting: Thestudy was carried out in department of obstetrics and gynecology labour room unit-1, Bahawal Victoria Hospital, Bahawalpur.Population: Term pregnancies (37-42 wks) with PROM and cephalic alive fetuses. Methods: Sixty patients with confirmed diagnosis ofPROM were randomized into two groups i.e, A&B. Group A comprising 30 patients were induced with tab. Misoprostol 25 ug at 6 hrlyinterval max of four doses and group B was managed expectantly for 24 hrs followed by induction with intravenous oxytocin. OutcomeMeasures: Total duration of labour, mode of delivery, maternal infection rates and, APGAR score at 1 and 5 min. Results: It was found thatboth groups had similar characteristics, but the misoprostol group had a significantly shorter time interval from PROM to delivery (18.9 vs27.5 hours) i.e total duration of labour. Caesarean section rates were 20% in the misoprostol group and 30.7% in the other. There were nodifferences between them regarding fetal well being, complications during labour and delivery and neonatal or postpartum maternalmorbidity. Within 24 hours, 44% of women had delivered in the expectant group against 73.3% in the misoprostol group. Conclusion:Immediate labour induction with misoprostol in cases of term PROM shortens the total duration of labour, and the time of maternalhospitalization without any maternal and perinatal outcomes disadvantages.

HIGHLIGHTS 1. Serum calcium concentration in pregnant women who took prenatal appointments in the general hospital and its satellite hospitals were evaluated.2. It was found that serum calcium concentration in those pregnant women who made the prenatal appointments were normal. ABSTRACT Objectives: This study aimed to evaluate serum calcium concentration in pregnant women who made prenatal appointments to Obstetric and Gynecologic Outpatient Clinics at Adam Malik General Hospital, Medan, Indonesia, and its satellite hospitals. Materials and Methods: This study was a descriptive study with a case series approach. The case series of the study included 35 pregnant women in their second or third trimester chosen by consecutive sampling method. Results: The mean calcium serum level of pregnant women in the second and third trimester was 9.12±0.49 mg/dl and 8.97±0.26 mg/dl, respectively. The mean calcium level of pregnant women aged <20, 20-35, and >35 years old were 9.0±0.28 mg/dl, 9.07±0.44 mg/dl, and 8.96±0.06 mg/dl, respectively. Conclusion: This study found that the mean calcium serum level of pregnant women who took prenatal appointments in Haji Adam Malik General Hospital, Medan, Indonesia, was normal.

Study Design: Cross-sectional descriptive study. Setting: Department of Obstetrics & Gynecology, Bahawal Victoria Hospital, Bahawalpur. Period: 05 August 2016 to 05 Feb 2017. Material & Methods: A total of 228 suspected patients of cervical carcinoma and age of 20-50 years were included. Patients with acute cervicitis, pregnant females, h/o abnormal cytology and obvious lesion on cervix were excluded. All the patients were underwent papanicoloau (PAP) smear and visual inspection using acetic acid. The results of papanicoloau (PAP) smear and visual inspection using acetic acid (VIA) were compared with cervical biopsy report. Results: In 110 papanicoloau (PAP) smear positive patients, 97 were True Positive and 13 were False Positive. Among, 118 papanicoloau (PAP) smear negative patients, 18 were False Negative whereas 100 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of papanicoloau ( PAP )smear in screening of cervical carcinoma was 84.35%, 88.50%, 88.18%, 84.75% and 86.40% respectively. In 114 visual inspection using acetic acid (VIA) positive patients, 95 were True Positive and 19 were False Positive. Among, 114 visual inspection using acetic acid (VIA) negative patients, 20 were False Negative whereas 94 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of visual inspection using acetic acid ( VIA) in screening of cervical carcinoma was 82.61%, 83.19%, 83.33% 82.46% and 82.89% respectively. Conclusion: This study concluded that papanicoloau ( PAP) smear and visual inspection using acetic acid (VIA) in screening of cervical carcinoma are highly sensitive, accurate and having almost equal diagnostic accuracy.

Objectives: To compare efficacy of extra-amniotic Foley’s catheter balloon aloneversus combined use of Foley’s catheter balloon and extra-amniotic instillation of prostaglandinF2-alpha in therapeutic termination of second trimester pregnancy. Study Design: Randomizedcontrolled trial. Setting: Department of Obstetrics & Gynecology, Bahawal Victoria Hospital,Bahawalpur. Period: Two years. July 2014 to June 2016. Sample Technique: Non-probability,consecutive sampling technique. Patients & Methods: A total of 256 patients, 16 to 38 years ofage with fetal death or missed abortion on ultrasonography in 2nd trimester (14-24 gestationalweeks) of pregnancy were included in the study. Patients with previous uterine surgery, multiplepregnancies and parity>3 were excluded. Then selected patients were placed randomly intotwo groups i.e. Group A (extra-amniotic Foley’s catheter balloon alone) & Group B (Foley’scatheter balloon along with extra-amniotic instillation of prostaglandin F2-alpha), by using lotterymethod. Outcome variables like efficacy i.e. expulsion of fetus within 24 hours of induction, werenoted. Results: The mean age of women in group A was 24.51 ± 4.77 and in group B was 24.29± 4.48 years. The mean gestational age in group A was 21.65 ± 2.01 weeks and in group Bwas 21.28 ± 1.93 weeks. Efficacy was 103 (80.47%) in group A (extra-amniotic Foley’s catheterballoon alone) and 119 (92.97%) in group B (combined use of Foley’s catheter balloon andextra-amniotic instillation of prostaglandin F2-alpha) with p-value of 0.003. Conclusion: Thisstudy concluded that combined use of Foley’s catheter balloon and extra-amniotic instillationof prostaglandin F2-alpha is better and more efficacious than extra-amniotic Foley’s catheterballoon alone in therapeutic termination of second trimester pregnancy.

Objective: The objective of this study is to evaluate diagnostic performance of total bile acids and transaminases in intrahepatic cholestasis of pregnancy (ICP). Material and Methods: This observational cross-sectional study was conducted at Gynecology & Obstetrics ward, Bahawal Victoria Hospital and Pathology Laboratory of Quaid-e-Azam Medical College, Bahawalpur. Thirty pregnant females with intrahepatic cholestasis of pregnancy were included in the study. Thirty age, parity and gestational age matched controls were selected. Total bile acids and alanine transaminases (ALT) were measured in each study subject. Results: The sensitivity and specificity for both total bile acids and ALT were calculated. Our study results showed a comparable sensitivity and specificity for both tests in patients with ICP. The rise in bile acids and ALT was statistically significant in ICP. The level of transaminases increased in proportion to total bile acids. Also, our study found an increased risk of preterm delivery, low birth weight and delivery by cesarean section in patients with ICP. Conclusion: It is concluded that ALT can be used alternatively to total bile acids for the diagnosis of intrahepatic cholestasis of jaundice. Total bile acids are expensive and only a few laboratories in Pakistan are offering this service, making its access limited to general population. Whereas ALT is a cost effective and common test, its results are readily available with an additional benefit that no fasting sample is required. Hence, it is a more appropriate diagnostic test for ICP in our resource constraint setup. Key Words: Bile acids, Liver enzymes, Cholestasis, Pregnancy, Aminotransaminase

Termination of Pregnancy (TOP), in our country is carried out only when considerable danger to a fetus due to congenital abnormalities, intrauterine fetal loss or when maternal life is under threat. The principle concerns in providing second trimester termination include safety, efficacy, simplicity, low-cost, and fast acting with minimal side effects. Objectives: To compare the efficacy in term of complete abortion within 48 hours between protocol-I (200 µg misoprostol 4 hourly) versus protocol-II (200 µg misoprostol 6 hourly) for second trimester (14-24 weeks) medical termination of pregnancy. Study Design: Randomized controlled trial. Settings: Gynecology & obstetrics unit-II, Bahawal Victoria Hospital (BVH) Bahawalpur. Period: From 1st July 2017 to 30th June 2018. Material & Method: A total of 182 patients meeting the inclusion criteria were included in study. Ninety one patients were included in group-A and 91 patients were included in group-B. Women allocated to group-A was given misoprostol 200µg every 4 hour. Similar drug and dose were administered to women of group-B intra-vaginally, 6 hourly. Patients in both groups were monitored up to 48. If abortion occurred within 48 hours of induction, it was labeled as effective abortion otherwise it was regarded as failed abortion. Results: The mean age in group-A was 26.71 years 25.49 years in Group-B. In group-A, 89 (97.8%) patients showed efficacy (abortion within 48 hours) and in group-B, 74 (81.32%) patients showed efficacy to misoprostol. Conclusion: The regimen of using 200μg of vaginal misoprostol 4 hourly is more efficacious and quick for 2nd trimester TOP with fewer side effects when compared to 200μg of vaginal misoprostol 6 hourly.

Objectives: The hypertensive disorders of pregnancy (HDP), especially severe preeclampsia are most common cause of neonatal and maternal mortality and morbidity. Alteration in metabolism of calcium and magnesium during pregnancy is considered to be one of etiological factor for pre-elampsia. Study Design: Case-control study. Settings: Departments of Pathology and Gynecology and Obstetrics, Bahawal Victoria Hospital. Period: September 2018 to June 2019. Material & Methods: To compare whether serum levels of calcium or magnesium showed significant change in mild and severe preeclamptic patients as compared to control group. Research population consisted of pregnant females that were divided into three groups. The mild and severe preeclamptic groups comprised of 55 and 26 participants respectively and 45 were included in control group. The serum calcium and magnesium levels were measured in these groups. Results: Maximum numbers of preeclamptic cases were presented at 28-32 week of gestation while severe pre-eclamptic group showed most cases in 33-36 weeks. In both groups, most of cases occurred in multiparous women as compared to nulliparous women. The normotensive group showed serum calcium and magnesium levels of 9.08±0.63 and2.12±0.22mg/dl while mild preeclamptic (mPE) had mean value of 7.91±0.64 and 1.58±0.42mg/dl and measurement were 7.67±0.48 and 1.26±0.44 in cases of severe pre eclampsia (sPE). Serum magnesium levels were significantly lower in sPE as compared to mPE (<0.0001) while difference was not statistically significant for serum calcium level (0.14). Conclusion: Both decrease level of serum calcium and magnesium might be risk factor in development of preeclampsia with more emphasis on role of low magnesium as a prognostic marker in severe preeclamptic cases.

This study aimed to investigate (1) pregnant women’s level of knowledge of lifestyle-related risk factors during pregnancy and their potential health impact on their offspring, and (2) the factors affecting women’s knowledge of lifestyle-related risk factors during pregnancy. A cross-sectional observational study of pregnant women was carried out in obstetric and gynecologic care settings at three hospitals in Southern Germany. Data from 209 pregnant women revealed large knowledge gaps on lifestyle-related risk factors during pregnancy and their potential health impact. Factors affecting women’s knowledge of lifestyle-related risk factors during pregnancy were specifically associated with socioeconomic status, e.g., lower household net income, middle educational level, and statutory health insurance status. Women who had received information from their gynecologist had a higher level of knowledge of lifestyle-related risk factors during pregnancy. This study showed that health promotion regarding lifestyle-related risks during pregnancy specifically needs to address women from the low-to-middle socioeconomic status group. Gynecologists seem particularly effective in providing this information.

Abstract Objective: To describe the implementation and results of a perioperative antibiotic prophylaxis (PAP) program. Design: A protocol for correct use of PAP was implemented in December 1994. For selected months we measured the PAP protocol compliance of a random sample of clean and clean-contaminated procedures and calculated the cost of incorrect use of PAP. Setting: A 180-bed general hospital in Ribeirão Preto, Brazil. Results: The cost of unnecessary PAP in the obstetric and gynecologic, cardiothoracic, and orthopedic services dropped from $4,224.54 ($23.47/procedure) in November 1994 to $1,147.24 ($6.17/procedure, January 1995), $544.42 ($3.58/procedure, May 1995), $99.06 ($0.50/procedure, August 1995), and $30 ($0.12/procedure, March 1996). In November 1994, only 13.6% of all surgical procedures were done with correct use of PAP, compared to 59% in January 1995, 73% in August 1995, 78% in March 1996, 92% in November 1996, and 98% in May 1997. Conclusions: Incorrect PAP use wastes resources, which is a particular problem in developing countries. Our program is simple and can be implemented without the use of computers and now is being adopted in other hospitals in our region. We credit the success of our program to the commitment of all participants and to the strong support of the hospital directors.

AbstractObjective:To investigate how many nosocomial infections would be missed if surveillance activities were restricted to patients having either microbiology reports or antibiotic administration.Design:Analysis of data from a large prevalence study on nosocomial infections (Nosocomial Infections in Germany— Surveillance and Prevention).Setting:A total of 14,966 patients were investigated in medical, surgical, obstetric-gynecologic, and intensive-care units of 72 German hospitals representatively selected according to size. Five hundred eighteen patients (3.5%) had at least one nosocomial infection. Microbiology reports were available for 56.6% of these patients on the prevalence day, and 86.3% received antibiotics.Results:Only 31 nosocomially infected patients (6%) would have been missed by using either microbiology reports or antibiotic treatment as an indicator. These indicators of nosocomial infections had a high diagnostic sensitivity for nosocomial pneumonia (98.8%), urinary tract infections (96.3%), and primary bloodstream infections (95.3%), but a lower sensitivity for wound infections (85.4%). Thus, 97.4% of all nosocomial infections were found with this method in intensive-care units and 96.1% in medicine units, but only 89.7% in surgical departments. In 9 (12.5%) of 72 hospitals, the overall sensitivity would have been &lt;80% using a combination of the two indicators. For this reason, the situation in one's own hospital should be checked before using this method.Conclusions:After checking the situation in one's own hospital, the “either-or” approach using the two indicators “microbiology report” and “antibiotic administration” can be recommended as a time-saving measure to diagnose pneumonia, urinary tract, and primary bloodstream infections. For wound infections, additional information obtained by changing dressings or participating in ward rounds is necessary to achieve satisfactory sensitivity in the surveillance of nosocomial infections. Of course, it is necessary that the surveillance staff discard all false positives to ensure a satisfactory specificity.

Purpose Even at the early stage endometriosis, may be associated with infertility, whose treatment, which is not always straightforward, is often controversial. This study intends to determine the effectiveness of laparoscopic ablation of lesions at an early stage. Methods The charts of 250 women suffering from infertility, admitted from July 1998 to December 2008 to the obstetric and gynecologic departments of Vittorio Emanuele and Santo Bambino hospitals in Catania were reviewed. Among these women, 97 patients (38.8%) affected by stage 1 and 2 endometriosis were found and divided into 2 groups of 53 (A) and 44 (B) patients. According to the approach of the surgeon, group A patients underwent laparoscopic ablation of endometriotic lesions with or without adesiolysis, while group B patients only had diagnostic laparoscopy. Cumulative pregnancy rate, cumulative live birth rate, monthly fertility rate and outcome of pregnancies (miscarriages and live birth), developed within the first year soon after laparoscopy, were determined in each group. Results This study shows that, according to the literature, laparoscopic systematic destruction of minimal and mild stage endometriotic lesions, improves the cumulative pregnancy rate (49.1% in group A versus 22.7% in group B) and cumulative live birth rate (39.6% in group A versus 18.2% in group B) in selected patients. However, this type of intervention, by itself, does not normalize the monthly fertility rate that remains low in both groups (4.1% in group A and 1.9% in group B). Conclusions This study suggests that laparoscopic treatment of minimal-mild endometriotic lesions is a valid therapeutic option because it improves the fertility rate, even if it does not completely resolve the reduced fertility.

Background. Preterm birth refers to a birth of a baby before 37 completed weeks of gestation and after fetal viability. It is now the leading cause of new born deaths. Although identifying its common risk factors is mandatory to decrease preterm birth and thereby neonatal deaths, there was a dearth of studies in the study area. Objective. The aim of this study was to identify determinants of preterm birth among women who gave birth in Amhara region referral hospitals, Northwest Ethiopia, 2018. Method. An institutional based case-control study was conducted from September 01 to December 01/2018. A total of 405 mothers (135 cases and 270 controls) were included in the study. Multistage sampling technique was employed. Data were collected using structured questionnaire through face to face interview and checklist via Chart review. Data were entered into Epi Info version 7 and export to Statistical Package for Social Sciences (SPSS) version 20 for analysis. Descriptive statics like mean, frequency and percentage was used to describe the characteristics of participants. Both bivariable and multivariable analyses were carried out. Variable having p-value <0.05 in binary logistic regression were the candidate for multivariable analyses. Finally, the statistical significance of the study was claimed based on the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) and its p-value <0.05. Result. The result of multivariable analysis show that mothers with no formal education (AOR = 2.24; 95% CI: 1.28, 3.91), history of abortion (AOR = 2.92; 95% CI: 1.3, 6.4), multiple gestation (AOR = 4.1; 95% CI: 1.7, 9.8), hemoglobin level <11 gm/dl (AOR = 2.75; 95% CI: 1.11, 7.31), premature rupture of membrane (AOR = 6.4; 95% CI: 3.23, 12.7) and pregnancy induced hypertension (AOR = 4.74; 95% CI: 2.49, 9.0) had statistically significant association with experiencing preterm birth. Conclusion and Recommendation. Most of the determinants of preterm birth found to be modifiable. Thus, putting emphasis for prevention of obstetric and gynecologic complications such as anemia, premature rupture of membrane and abortion would decrease the incidence of preterm birth. Moreover, strengthening Information Communication Education about prevention of preterm birth was recommended.

AbstractObjective:To determine the incidence of, and risk factors for, surgical-site infections (SSIs).Design:Prospective observational study of all patients undergoing surgery during a 3-month period.Setting:Two urban hospitals in Hanoi, Vietnam.Patients:All 697 patients admitted for emergent and elective surgery.Methods:Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model.Results:During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46;P&lt;.01) and wound class IV (OR, 5.67;P&lt;.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene.Conclusions:There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.

Abstract Background The use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth. Methods This was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed. Results In total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome. Conclusion Common intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Objectives: To Compare metformin and regular insulin in blood sugar control and neonatal outcome in patients with gestational diabetes mellitus. Material and Method:… Study Design: Randomized control trial. Place of the Study: Department of Gynecology and Obstetrics, Bahawal Victoria hospital Bahawalpur. Duration of the study.1 year 1st January 2017- 31st December 2017. Sample Size: N=200, one half (group A) receiving Metformin and other half (group B) receiving regular insulin. Results: Blood sugar control depicted by fasting, 2 hr post parandial levels and HbA1c % was similar in both group.coexisting hypertensive complications were seen more in insulin group. Weight gain was also significantly more in insulin group 17 kg on an average as compared to metformin group where average weight gain was 13 kg.Convenience and satisfaction regarding their treatment,more number of patients were satisfied in metformin group. There were significant increase in the mean birth weight of the newborns, need for admission in NICU and Neonatal hypoglycemia in insulin group as compared to metformin group. Conclusion: Metformin when compared to insulin has equal efficacy in controlling maternal blood sugar levels but better neonatal outcome, patient satisfaction and convenience in treatment of gestational Diabetes Mellitus.

Cesarean section is the most commonly performed abdominal operations on women worldwide. Its rate has increased markedly in recent years in most developed countries. Due to insufficient available data regarding the best suture materials for cesarean skin closure, we conducted a study “to compare the efficacy of 2 suture materials non absorbable prolene 2-0 and absorbable suture vicryl (2-0), brand Ethicon as subcuticular skin stitches in women undergoing elective cesarean section. Study Design: Prospective, observational study. Setting: Department of Obstetrics and Gynecology, Bahawal Victoria Hospital Bahawalpur. Period: 6 months. Materials and Methods: A total of 200 women fulfilling inclusion and exclusion criteria as above were enrolled for the present study. They were divided into 2 groups of 100 each by systematic sampling technique. Results: There is statistically significant difference related to post-operative wound complication parameters between non absorbable vs absorbable suture material on day 8, 15, 30 and 45. More number of patients having absorbable suture had pain, tenderness swelling and indurations. Maximum number of participants, that is, 86 (86%) and 93 (93%) from Group 1 showed excellent wound healing at day 30 and day 45 of caesarean section as compared to 63 (63%) and 66 (68%) from Group 2. Conclusion: The non-absorbable suture (prolene) was better in terms of wound healing and cosmesis as compared to absorbable suture used in our study (vicryl).

Abstract Background Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown. Methods In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria’s 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test. Results Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p < 0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1–11.0%), 15.6% (95% CI 12.2–19.0%), and 19.5% (95% CI 15.3–23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings. Conclusions Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.

Abstract Introduction Even though the Pelvic organ prolapse (POP) is outstanding gynecologic problem, most private and asymptomatic nature of the illness makes it the “hidden epidemic.” The aim of this study was to identify the determinants of POP. Methods Facility based unmatched case control study was conducted from June 15 to September 10, 2020. All cases diagnosed with POP were enrolled in the study by using consecutive random sampling method by assuming that patient flow by itself is random until the required sample size was obtained. Then 1:2 cases to control ratio was applied. A structured interviewer-administered questionnaire and chart review for type and degree of prolapse was used. Epi-data was used for data entry and SPSS were used for analysis. Chi square test and binary and multivariable logistic regression analysis was employed. Multicollinearity was checked. Result On multivariate logistic regression, heavy usual work load(AOR = 2.3, CI(1.066–4.951), number of pregnancy ≥ 5(AOR = 3.911, CI(1.108–13.802), birth space of < 2 years(AOR = 2.88, CI(1.146–7.232), history of fundal pressure (AOR = 5.312, CI(2.366–11.927) and history of induced labor (AOR = 4.436, CI(2.07–9.505) were significantly associated with POP with P value < 0.05 and 95% CI after adjusting for potential confounders. Conclusion Heavy usual work load, having pregnancy greater than five, short birth space, history of induced labor, and history of fundal pressure are independent predictors of pelvic organ prolapse. Hence the responsible body and obstetric care providers should counsel the women about child spacing, minimizing heavy usual work load and effect of multigravidity on POP. Incorporation of health education on those risk factors related to POP on antenatal and postnatal care should be considered. The obstetric care providers also avoid fundal pressure and labor induction without clear indication and favorability, and the hospital officials set a law to ban fundal pressure during labor.

ABSTRACT Introduction Obstetric fistulae are a leading scourge for women in developing countries resulting, in severe individual suffering and devastating socio-economic repercussions for her family and community. The underlying causes of obstetric fistula stem from multiple factors to include poor nutrition, early marriage, insufficient education and inferior social status of women as well as substandard medical care. The US Agency for International Development (USAID) has invested more than $100 million globally since 2004 to address these factors as well as support women suffering with fistulae. The ultimate goal is to eradicate obstetric fistula in Bangladesh in the next 20 years. Despite these efforts, nearly 20,000 women in Bangladesh, still suffer with this malady. Methods To close this gap, USAID and the Department of Defense (DOD) developed a novel Interagency Agreement (IAA) leveraging the surgical skills of military health professionals to scale-up the ongoing fistula care program. The agreement outlined three lines of effort: (1) treat existing fistulae by bolstering surgical capacity of the existing USAID fistula care program; (2) promote fistula mitigation with lectures and hands-on teaching of obstetric care as well as safe gynecologic surgery; and (3) assist with advocacy at higher levels of the Bangladesh government. A Bangladesh Fistula Mission Partnership working group was formed to design and implement this IAA. Critical partners from the US Embassy in Dhaka included USAID (Health, Legal, Contracting), the DOD (Office of Defense Cooperation), and Department of State (Regional Security Officer). Partners from the US Army included United States Army-Pacific Command (Surgeon, Legal, Finance, Security Cooperation, Contracting), Regional Health Command-Pacific (Operations, Legal, Public Affairs), and Tripler Army Medical Center (Department of OBGYN, Operations, Public Affairs). Institutional Review Board approval was not required as the treatments offered were standard of care. Results The Tripler Army Medical Center (TAMC) health professionals executed the IAA with one pre-deployment site survey and two surgical missions in 2016–2017. The military team supported the surgical repair of 40 pelvic fistulae and perineal tears and provided operative management for an additional 25 patients with pelvic organ prolapse. Furthermore, the team conducted 19 professional lectures and multiple educational forums at hospitals in Kumudini, Khulna and the premier medical university in Dhaka for over 800 attendees including physicians, nurses and students to help prevent obstetric and surgical fistulae. Importantly, the team assisted USAID as subject matter experts in its advocacy to the Bangladesh Ministry of Health for improved maternity care and regulatory oversight. During the missions, the team enhanced their readiness by exercising individual and collective tasks while exposing personnel to the cultural context of the region. Conclusion This IAA was the first USAID funded and DoD-executed health mission in the US Indo-Pacific Command Area of Responsibility. Direct participation in the IAA enabled TAMC to support the US Indo-Pacific Command Theater Campaign Plan, the Department of Defense Instruction 2000.30 on Global Health Engagements, the USAID Country Development Cooperation Strategy, and the US Ambassadors Integrated Country Strategy Objectives in Bangladesh. This effort can serve as a model for future cooperation between USAID and the DoD.

Abstract Study question What is the reproductive outcome from ovarian tissue transplantation (OTT) from a single, experienced center. Summary answer The overall delivery rate was 41% (16/39) per woman and a total of 20 children to 39 women is expected. What is known already Ovarian tissue cryopreservation (OTC) is a well-established procedure for fertility preservation in girls and young women prior to gonadotoxic treatment and has shown to be a safe and promising method to restore fertility, with more than 200 healthy children born worldwide. Initial recovery of endocrine function is very high, although the longevity of the grafted tissue varies. The success of OTT is multifactorial, and important factors such as high age and poor ovarian reserve at OTC, as well as pelvic radiation are known to impair the chances of success. Study design, size, duration This is a single center, combined retro- and prospective cohort study including 40 women undergoing a total of 53 OTTs from the Fertility Clinic at Rigshospitalet University Hospital of Copenhagen, Denmark between 2003 and 2021. Participants/materials, setting, methods All women, who underwent OTT, were included in the study. End of follow up was December 31st, 2021. Information about diagnoses, gonadotoxic treatment, gynecologic (incl. endocrine parameters) and obstetric history was retrieved from medical records. Permission to obtain retrospective data from 1999 to 2020 was given by the Danish Patient Safety Authorities (jrn 3-3013-2790/1) and prospective data-collection was given by informed consent from the patients from 2020 and onwards. Main results and the role of chance Mean age at OTC was 28.5+5.5 years. Indications for OTC were malignant (n = 34) or benign diseases (n = 6). Mean time to first OTT was 4.2 years and mean age 33.0+5.4 years. At OTT, 19 women had POI (FSH&gt;25 IU/L and amenorrhea), 10 were perimenopausal (intermittent FSH &gt;25 IU/L) and 11 were low responders (AMH&lt;5pmol/L), with normal endocrine parameters but signs of infertility. Minimal follow up was 11 months and maximum 17 years from OTT. From 39 women with a pregnancy wish, 11 (28%) gave birth to a total of 15 children. In addition, 5 pregnancies are currently ongoing in the last trimester. The overall delivery rate was 51% (20/39) (including 5 ongoing) and 41% (16/39) per woman. Of 20 deliveries, 60% were conceived naturally and 40% from ART. Nineteen children were delivered following the first OTT. Four women had 2 children, of whom one had her second child following the second OTT. Initial activation of the grafted tissue, defined by a drop of FSH to &lt; 25 IU/L within 6 months, was seen in 18/19 (95%) women with POI prior to OTT. One woman experienced total graft failure. Data on endocrine function of the grafted tissue will be presented at the meeting. Limitations, reasons for caution This study is based on information from medical records in public Danish hospitals, where information of all deliveries in Denmark is available. Pregnancies and deliveries outside Denmark might therefore not be included, why the total number could be slightly underestimated. Wider implications of the findings OTC with OTT is an efficient and encouraging way to restore fertility in a selected group of young women with a high risk of infertility following gonadotoxic treatment. Further, our data, from a specialized and experienced center, shows a good chance of livebirth and initial recovery of endocrine function. Trial registration number 3-3013-2790/1

This single and critical case study evaluated a faith-based natural family planning program's salient features using a framework on implementation fidelity. Multiple focus group discussions were conducted, with three groups of stakeholders (n=100), to gather qualitative data on their knowledge and experience of the program. Overall, the findings showed that the program primarily adhered to the essential elements of implementation fidelity, such as content, frequency, duration, and coverage prescribed by its designers. Three lessons were drawn to address some issues that have influenced the degree of fidelity in which the program was implemented. The first is the need to secure adequate and sustained human and financial resources. The second is the need to strengthen its partnership with government and non-government organizations that have provided them with much-needed assistance. Finally, there is also the need to provide extensive training, materials, and support to its service providers to preserve their morale and interest. Other faith-based organizations may hold this case as an indicator of how and why an NFP program works and the extent to which the need for family planning can be met adapted to their local conditions and needs. References Arbuckle, Gerald A. Refounding the Church: Dissent for Leadership. Quezon City: Claretian Publications. 1993. Arevalo, Marcos. "Expanding the Availability and improving the delivery of natural family planning services and fertility awareness education: providers' perspectives. Adv Contracept. Jun-Sep 1997; 13(2-3):275-81. Arévalo, Marcos, Victoria Jennings, and Irit Sinai. "Efficacy of a new method of family planning: the Standard Days Method." Contraception 65, no. 5 (2002): 333-338.Arévalo, Marcos, Irit Sinai, and Victoria Jennings. 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