Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis

Background Puerperal sepsis is a genital tract infection that can occur from amniotic fluid rupture to six weeks after birth. Maternal complication associated with puerperal sepsis includes prolonged hospital stay, septicemia, disseminated intravascular coagulation, pelvic inflammatory disease, infertility, and death. Even though, puerperal sepsis is the fourth leading cause of maternal morbidity and mortality in Ethiopia the overall prevalence of puerperal sepsis and its associated factors are not studied at the national stage. As a result, this systematic review and meta-analysis bring out the pooled prevalence of puerperal sepsis and its associated factors in Ethiopia. Methods A variety of data sources such as Pub Med, Web of Science, Science Direct, Embase, Google Scholar, HINARI, and Ethiopian universities online repositories were searched to identify the primary studies which were used for this systematic review and meta-analysis. The article search was conducted from February10/2021-March 10/2021. The quality of the selected primary studies was assessed using the Newcastle - Ottawa quality assessment Scale (NOS). Data extraction was done with Microsoft Excel and then exported to STATA 11 version statistical software for analysis. The Cochran (Q-test) and I2 test statistics were used to assess the heterogeneity of the studies. Publication bias was evaluated by the eggers regression test. Subgroup analysis was performed with region and sample size category. Result In this review, a total of 2222 respondents were involved from seven studies. The pooled prevalence of puerperal sepsis was 14.811% (95%CI; 8.46: 21.16; I2 = 94.2, P ≤ 0.001). Cesarean section delivery (CSD) (OR = 3.26, 95%CI: 1.90, 5.61), membrane rupture≥24 h (OR = 4.04, 95%CI: 2.54, 6.42), being multiparous mother (OR = 3.99, 95%CI: 1.82, 8.78), vaginal examination≥5 times (OR = 3.15, 95%CI: 1.17, 8.52), and anemia (OR = 5.68, 95%CI: 4.38, 7.36) were factors significantly associated with puerperal sepsis. Conclusion The prevalence of puerperal sepsis was high in Ethiopia. CSD, membrane rupture≥24 h, being multiparous mother, vaginal examination≥5, and anemia were factors associated with puerperal sepsis. Appropriate standard infection prevention techniques during CSD shall be practiced to reduce the maternal burden of puerperal sepsis. The unnecessary vaginal examination should be discouraged during the intrapartum period. Besides this, routine Iron sulfate supplementation and counsel on iron reach foods during ante partum and postpartum shall be considered for all mothers.

Comparative Study of Serum Profile in Bitches Treated for Transmissible Venereal Tumor by Autohaemotherapy

A total of 18 bitches in the period in the period of six month diagnosed for transmissible venereal tumor in Teaching Veterinary Clinical Complex, Nagpur by per vaginal examination and vaginal cytology. These bitches were divided randomly into three groups, viz., Group I (Inj. Vincristine @ 0.025mg/kg slow IV in DNS and Injection Botropase 1ml IM for 1st week), Group II (Inj. Vincristine @ 0.025mg/kg slow IV in DNS and Tab. Amoxycillin and Potassium Clavinate for first 7 days orally) and Group III (treated with autohaemotherapy@10 ml whole blood IM) for once in week and continue for 5 week. At the time of treatment, liver and kidney function tests were performed. During the course of treatment significant variation was noted in Group I and II in BUN values while creatinine values changes significantly in all treatment groups. In case of SGPT only significant changes observed in Group I. Rest of the changes in serum prolife found to be non significant. Also from recovery point of view we noted that, it was faster in Group I and II compare than Group III. Side effects observed only in Group I and II. From the study we concluded that autohaemotherapy will be an alternate option for treatment of TVT in bitches who shows the excessive side effects of Vincristine Sulphate.

Vaginal examinations and mistreatment of women during facility-based childbirth in health facilities: secondary analysis of labour observations in Ghana, Guinea and Nigeria

BackgroundPrevious research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts.MethodsA secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains).ResultsOf the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care; 233/1430 (16.4%) women had their private information shared; 397/1430 (27.8%) women had their genitalia exposed; and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9; Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9; Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9; Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7; Guinea: AOR 0.21, 95% CI 0.12 to 0.38).ConclusionOur results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.

The Assessment of Intrapartum Transperineal Ultrasonographic Parameters for their Effectiveness in Evaluation of Progress of Labor and Prediction of Mode of Delivery in Egyptian Women

Introduction: High fetal head station has been associated with prolonged labor and delivery outcomes. Although clinical assessment of fetal head station is both subjective and unreliable, women with prolonged labor are subjected to multiple digital vaginal examinations. The use of ultrasound has been proposed to aid in the management of labor since 1990s. Ultrasound examination is more accurate and reproducible than clinical examination in the diagnosis of fetal head station and in the prediction of arrest of labor. Ultrasound examination can, to some extent, distinguish those women destined for spontaneous vaginal delivery and those destined for operative delivery and may predict the outcome of instrumental vaginal delivery. Such a technique has the potential to reduce the frequency of intrusive internal examinations and associated infection and could be useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated. Intrapartum ultrasound not only provides objective and quantitative data in labor, but also helps to make more reliable clinical decisions aiming to improve obstetric outcomes of both the mother and fetus as a supplementary tool for active management. Aim of the work: This study aims at assessing the value of intrapartum transperineal ultrasonography as a quantitative and objective tool in the evaluation of progress of labor and prediction of mode of delivery. Subjects: This study was a prospective observational study conducted on 600 primiparous women in active first stage of labor admitted to Kasr Al Ainy maternity hospital from January 2017 to June 2018. The studied population was divided into two groups. Group A of 300 women with normal progress of labor and group B of 300 women with prolonged 1st stage of labor. Methods: Fetal head station(FHS) was assessed clinically by digital vaginal examination (dVE) and sonographically by transperineal ultrasound measurement of head perineal distance (HPD) and angle of progression (AOP). Intrapartum care of the patient continued as normal based only on digital vaginal examinations using the modified WHO partogram. (1). Statistical analysis was targeted towards assessing the potential of the intrapartum ultrasonography in the evaluation of progress of labor and prediction of mode of delivery. Results: All studied parameters for assessment of FHS (dVE, HPD, and AOP) significantly corelated with each other and with both progress of labor and mode of delivery with P value (<0.001). The highest sensitivity for prediction of progress of labor is observed using dVE (83%), the highest specificity is observed using AOP (78.3%). The highest sensitivity for prediction mode of delivery is for combined HPD & AOP (97.7%) while the highest specificity is for AOP (81%). When combining both HPD and AOP for prediction of mode of delivery, the assessment of both parameters was found to have a high sensitivity of 97.7% and a high positive predictive value of 86.63%. Conclusion: Intrapartum ultrasound examination is a valuable tool in the prediction of progress of labor and mode of delivery. The assessment of fetal head station by transperineal ultrasound measurement of HPD and AOP is much more informative of the progress of labor and the mode of delivery than digital assessment of fetal head station. Keywords: Labor, intrapartum ultrasound, Angle of progression, Head perineal distance, fetal head station, digital vaginal examination.

Partogram: an important tool in managing labour!

Background: Various types and designs of partographs are being used at various centers. WHO introduced simplified version of partogram, for the use by skilled birth attendant. Preprinted paper versions of the partograph are availableMethods: 100 antenatal women were selected for study. Patients with vertex presentation and singleton pregnancy were taken. Patients who came late in labour and those with cephalopelvic disproportion were not included in the study. Cervical Dilatation in cms was assessed by per vaginal examination every 2 hourly, fetal Heart Rate every ½ hourly, uterine contractions and maternal pulse measured every ½ hourly, maternal BP and temperature were measured every 4th hourly.Results: Using WHO simplified partogram, characteristics of labour and neonatal outcome was evaluated. Among the 100 women included in the study, 78 required augmentation of labour, here 6 of them crossed the alert line and underwent LSCS. Of the 22 women who did not require augmentation, 4 crossed the alert line and underwent LSCS.We didn’t find any difference in monitoring of labour using simplified version of WHO partogram compared with other partograms, apparently it’s more simpler to plot and easy to understand.Conclusions: An alert line on partogram should be based on lower 10th centile rate of cervical dilatation of the local population. We found this rate as 1cm/hr, which corresponds to the slope of alert lineon standard partogram. Based on this we conclude, simplified partogram is good enough for monitoring labour progress.

Advanced stage cervical carcinoma diagnosed one year after pregnancy: the importance of cervical cancer screening

<p class="abstract">Cervical cancer is the most common gynecological malignancy during pregnancy. The incidence of cervical cancer during pregnancy is 0.004-0.1%. Cervical cancer accompanied by pregnancy may have severe maternal and fetal consequences. In our case, our patient died approximately 1 year after giving birth and 2 months after being diagnosed with cervical cancer. Among the treatment options, chemotherapy, radiotherapy and surgical treatment options were available alone or in combination. Type of treatment needed to be individualized and depended on stage, type of histology and gestational age. The aim of our study was to emphasize the importance of vaginal examination and its method during pregnancy in the diagnosis of cervical cancer, which was among the preventable cancers in pregnancy.</p>

​Rejuvenating Effect of Mathan Thailam for a Wound Dehiscence following Caesarean Operation in a Kangayam Cow Affected with Uterine Torsion

Background: Kangayam is a popular and well known cattle breed from Tamil Nadu, known for its heat tolerance and work capacities. Postoperative wound gaping is a very traumatic and painful event for any patient including voiceless animal patient. The rejuvenating effect of herbal preparation from Oomathai (Datura metal); Mathan Thailam in a wound dehiscence following hysterotomy in a Kangayam cow affected with uterine torsion is reported. Methods: A full term pregnant Kangayam cow on its second parity was presented to the Large Animal Obstetrics Unit, Veterinary Clinical Complex (VCC), Veterinary College and Research Institute (VCRI), Namakkal with colic signs for two days. On general clinical examination, the animal was dull and depressed with recurrent kicking in the abdomen with tucked up udder. Vaginal examination revealed closed cervix and rectal examination revealed left side broad ligament crossing over the cervix towards right side. The case was diagnosed as pre-cervical right side uterine torsion and Schaffer’s method of detorsion of cervix failed to dilate. Thus, hysterotomy was performed to deliver the fetus. Postoperative wound dehiscence occurred as a complication which was treated with mathan thailam. Result: The owner was directed to apply the mathan thailam externally thrice daily after regular cleaning of wound. The result is significant that the mathan thailam showed excellent rejuvenation in the wound gaping.

Persistent Hymen in a Jersey Crossbred Heifer-A Novel Approach with Borescope

Background: Visualizing the internal genital organs in cattle using vaginoscope or endoscope is a costly affair and practically it is not possible to use this instrument in diagnosis of anatomical defects causing infertility under field conditions. An attempt was made to replace the costly instruments with low cost and easily available borescope in the diagnosis of persistent hymen in a Jersey crossbred heifer and the procedure has been reported for the benefit of field veterinarians and theriogenologists.Methods: A Jersey crossbred heifer with normal estrous cycle length and that failed to conceive even after 6 inseminations with fertile semen was presented to the Gynaecological ward. Rectal examination revealed a fluctuating swelling in the vagina. Vaginal examination revealed obstruction in the passage and the vaginal speculum could not be progressed into the vagina. Ultrasonographic examination revealed hypoechoic fluid in the vaginal cavity. A novel approach with borescope revealed a clear view of the membranous obstruction at the level of vagino-vestibular junction. Hence, the case was diagnosed as persistent hymen and hymenotomy was performed. Result: Upon hymenotomy, about two litres of thick, gummy, tenacious reddish brown colored mucus was evacuated from the vagina. The patency was checked and the animal was treated with antibiotics for three days. The animal was inseminated at the subsequent estrus on the 22nd day and pregnancy was confirmed on 45th day. The animal calved normally and delivered a live male calf. Thus, the borescope could be effectively used in the field of animal reproduction as an alternative tool for the diagnosis of developmental defects in the vagina.