Objectives: We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting organ dysfunctions and mortality in pregnancy associated sepsis (PAS). Methods: The study included 85 pregnant, post-abortal, and postpartum women with PAS, diagnosed using the quick Sequential Organ Failure Assessment criteria. Median interquartile range PCT levels were documented at admission and 48 hours later. Statistical comparisons were performed between the groups with non-severe and severe (≥1 organ failure) PAS, and between the survivor and mortality groups. The relationship between PCT and the number of organ failures was also assessed. Results: Most of the subjects with PAS were young and in the postpartum period (mean age 26 years; postpartum 55%). Sixteen (19%) patients died due to PAS. Sixty-two patients (74%) had severe PAS at presentation. Bacteria were isolated on culture in 64% of the subjects. PCT levels at admission were higher in patients with severe PAS than in those who did not have severe PAS. At 48 hours, this difference was significant (P=0.014; severe PAS 2.23 ng/mL vs. non-severe PAS 0.20 ng/mL). Furthermore, the number of organ failures increased at 48 hours. The PCT levels were significantly higher in the mortality group than in the survivors’ group at admission (8.31 ng/mL vs. 1.72 ng/mL), and the difference increased further at 48 hours (9.54 ng/mL vs. 1.37 ng/mL). Conclusion Repeat PCT estimation at 48 hours could complement the clinical findings and enhance the prognostic value for PAS.

The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Evidence-Based Medicine ; Female ; Guidelines as Topic ; Humans ; Infertility ; diagnosis ; therapy ; Male ; Practice Guidelines as Topic ; Primary Health Care ; methods ; standards ; Public Health ; standards ; Singapore