OBJECTIVE

Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

METHODS

A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

RESULTS

Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission. 

CONCLUSION

The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

Human ; Female ; Infections ; Preterm Labor ; Obstetric Labor, Premature

OBJECTIVE

Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

METHODS

A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

RESULTS

Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission. 

CONCLUSION

The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

Human ; Female ; Infections ; Preterm Labor ; Obstetric Labor, Premature

BACKGROUND: Antimicrobial therapy is an integral part of an acceptable clinical practice in Obstetrics and Gynecology. However, in order for these antimicrobials to deliver the desired clinical outcome, the practice of judicious antibiotic stewardship should be observed. The objective of the study was 1.) To determine the proportion of pregnant women admitted at the Department of Obstetrics and Gynecology who received antibiotics from January 1, 2018 to December 31, 2018, 2.) To determine the proportion of indications for antibiotic administration, 3.) To determine if indications for antimicrobial usage is in accordance with the clinical case, policy guidelines, culture results and antibiogram report, 4.) To determine the percentage of cases not given antimicrobials that should have been started on antimicrobial therapy, 5.) To compare the association of the clinical outcomes among patients given and not given antimicrobials, 6.) To compare the association of the immediate neonatal outcomes among pregnant patients given and not given antimicrobials. METHODS: A retrospective cohort study was done covering a period of 1 year from January to December 2018. The study included all pregnant patients who were admitted and listed based from the master list of the Department of Obstetrics and Gynecology. Included are all the retrieval charts from the records sections whereas gynecologic and those cases with medical records not retrieved were excluded. A total of 3,495 obstetrics patients admitted from January to December 2018 were retrospectively studied. From this group, the complete medical records of 1,092 obstetrics patients were retrieved and included in this study. Detailed clinical information, antibiotics administered, diagnostic and other relevant investigations, and clinical outcomes were recorded from case sheets. After the data were collected from patients' medical records, datas were manually entered into an electronic spreadsheet file, and the data processing and analysis were then carried out using statistical software Stata 13. RESULTS: There were 1,092 women included in the current study with more than half of them administered or received antibiotics as part of their regimen (n = 663, 60.71 %) compared to those not administered antibiotics (n = 429, 39.29%). The results showed that the prevalence of obstetric patients (undelivered, delivered, ectopic pregnancy and abortion) prescribed and given antibiotics was between 57.75 to 63.62 per cent. There was no association between the comparison groups in terms of age (x 2 : 3.62, p: 0.31 ), marital status (x2 : 1.29, p: 0.26), body mass index classification (x 2 : 6.88, p: 0.08), hemoglobin level (x 2 : 1.74, p: 0.19), and number of prenatal consults (x2 : 3.13, p: 0.21 . There was a significantly higher proportion of women who delivered abdominally that were administered antibiotics (x 2 : 32.45, p<0.01) as compared to women who delivered vaginally (spontaneous or assisted), admitted due to ectopic pregnancy, abortion, and medical management. Cephalosporins are the most widely used antibiotics. Cefazolin (60.48%) followed by Cefuroxime (39.97%) were commonly used for pre-operative prophylaxis and urinary tract infection. Other commonly used antibiotics are Clindamycin (3.62%), Ampicillin (3.47%), Amikacin (2.56%), Ceftriaxone (2.11 %) and Doxycycline (1 .81 %). In 803 of cases (74.15%), reason for administration was not recorded in the chart and stated on working impression and final diagnosis. Majority of the antibiotics were empirically given (99.10%). The irrational use of antibiotics among those administered was observed in 564 cases (52.47%) (95% Cl: 49.46-55.47%). Rational use was only observed in 99 cases (19.08%). Among those not given antibiotics, 420 cases (80.92%) with adherence to antibiotic guidelines and 9 cases (52.47%) inappropriately not given antibiotics. It can also be noticed that there was an association between administration (and nonadministration) of antibiotics - and having an appropriate indication for such action (x2: 718.97, p<0.01 ). Maternal and neonatal outcomes showed that there was no noted association between the administration of antibiotics, and selected outcomes. Additional morbidity appeared to be slightly increased among those who were not given antibiotics than otherwise (z: -1.90, p: 0.60). CONCLUSION The study demonstrated that most of the antibiotic administration from January 1 to December 31, 2018

BACKGROUND: Adult vaccination is necessary in the prevention of many of the most common infectious diseases because immunity from infant vaccination typically wanes in adulthood In the female population the obstetrician gynecologist is placed at the forefront of health promotion and disease prevention In 2011 the Philippine Obstetrics and Gynecology Society POGS released a Clinical Practice Guideline on Immunization for Filipino Women but no study has been done to determine its impact
OBJECTIVE: This study determined the awareness and practices of OB GYN specialists on adult vaccination and their perceived hindrances to routine administration of the recommended vaccines METHODS: A self administered questionnaire was given to the POGS fellows through email phone and personal visits
RESULTS: Almost all of the respondents 95 were aware of Clinical Practice Guideline on Immunization but only 4 of the OB GYNs routinely administered all the vaccines The most common vaccinne administered was Human Papilloma Virus HPV vaccine 42 7 followed by Influenza virus vaccine 28 1 and Hepatitis B vaccine 27 3 There is no significant relationship between age of the respondent the number of years in practice place of practice affiliation with a teaching hospital or subspeciality training and vaccine recommendation and administration There is a significant positive relationship between awareness of the guidelines and the frequency of recommending the Tetanus Diphtheria Pertussis Tdap vaccine and the Influenza vaccine Similarly awareness of the guidelines was related to increased frequency of administering the Human Papilloma Virus HPV vaccine and the Influenza vaccine
CONCLUSION: Hence adult vaccination coverage may be promoted by increasing the awareness of the obstetrician gynecologists of the POGS Clinical Practice Guidelines on Immunization Although cost remains to be an issue identified by 93 of the respondents increasing awareness among OB GYNs on the importance of adult vaccination through the CPG on Immunization and or through attendance of the Vaccinology 101 Course through vaccinology courses may ultimately help decrease the incidence of some of the most coomon infectious diseases affecting the Filipino women and their children.

Human ; Male ; Female ; Middle Aged ; Adult ; Diphtheria-tetanus-pertussis Vaccine ; Influenza Vaccines ; Hepatitis B Vaccines ; Tetanus ; Diphtheria ; Vaccination ; Immunization ; Papillomavirus Vaccines ; Papillomaviridae

OBJECTIVE: The general objective of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for abdominal deliveries and exploratory laparotomy for ectopic pregnancy. The specific objective was to compare the incidence of fever and surgical site infection (551) between the povidone iodine group and chlorhexidine group.

STUDY DESIGN: This is a randomized controlled trial comparing 0.2% chlorhexidine digluconate and povidone iodine 7.5% scrub followed by 10% povidone iodine paint as surgical site antiseptics. Primary outcome measured were postoperative fever and surgical site infection (551). The wounds were inspected 1, 2, 3, 7 and 14 days postoperatively. The agent used during the pre-operative antisepsis was continued during the postoperative wound dressing.

RESULTS: A total of 552 patients were enrolled between March and August 2008. There were no differences between the povidone iodine (n=277) and chlorhexidine (n=275) groups with respect to age, gravidity, distribution of cases, presence of previous cesarean section/s, past medical history, presence of co-morbid illness, smoking and alcohol use, 8MI, number of internal examinations, length of labor, length of rupture of bag of waters, type of surgery, amount of adhesions, length of operation, amount of intraoperative blood loss, use of prophylactic antibiotic, presence of break in asepsis, year level of surgeons, pre- and postoperative anemia and leukocytosis. The only variable observed to be significantly different was place of operation with 92.4% of operation being performed at the 08 Admitting Section among the chlorhexidine group (vs 84.5% in povidone iodine group). Results on the analysis of intent to treat data were comparable with that of complete data. There was no significant difference in the incidence of fever on 3, 7 and 14 days postoperatively between the povidone iodine group and chlorhexidine group. Likewise, there was no significant difference in the incidence of surgical site infection on 3 and 14 days postoperatively between the two study groups. However, there was a significant difference in the incidence of 5517 days postoperatively, occurring in 7.63% and 2.75% under the complete data (P=.0132), 6.9% and 2.6% under the positive outcome assumption (P=.0168), and in 16.6% and 7.6% under the negative outcome assumption (P=.0013) for povidone iodine and chlorhexidine group, respectively.

CONCLUSION: It appears that chlorhexidine is superior to povidone iodine in the control of surgical site infection 7 days after abdominal delivery and exploratory laparotomy for ectopic pregnancy.

Human ; Female ; Povidone-iodine ; Chlorhexidine Gluconate ; Chlorhexidine ; Anti-infective Agents, Local ; Surgical Wound Infection ; Asepsis ; Leukocytosis ; Laparotomy ; Antisepsis ; Cesarean Section ; Pregnancy, Ectopic

A total of 270 women, all except 1 undergoing episiotomy and episiorrhaphy during vaginal delivery from June 17, 2005 until July 27, 2005 at the Philippine General Hospital, were randomly assigned to use either Chlorhexidine Digluconate, Povidone-lodine or Lactic Acid as antiseptic genital wash during and after the surgical procedure. All participants were asked to come back 1, 2, 4 and 6 weeks after discharge. Assessment was done comparing the efficacy, acceptability and safety of the three antiseptic solutions in preventing surgical site infection. Details of the surgical procedure that might have affected outcomes were also investigated. The results showed that all three antiseptic solutions were rated moderately to extremely acceptable by most of the participants. All three antiseptic solutions were equally safe. Adverse events were rare, mild and self limited. The three serious adverse events in the study were related to the pregnancy of the participants and not to the antiseptic solutions. Details of the surgical procedure that are not comparable among the 3 groups and thus seem to influence outcomes are the level of expertise of the surgeon, breaks in asepsis and severity of the accidental lacerations in the operative site. However, data on the eight participants who developed SSI did not confirm this-all these 8 cases were operated on by residents, did not have break in asepsis, and only one had laceration and the depth was reported to be subcutaneous. The duration of the operation, the amount of estimated blood loss, the type and amount of sutures used and the specific place where the surgery was performed are similar in the three groups. It appeared that oral systemic antimicrobials traditionally and commonly used for patients undergoing episiotomy and episiorrhaphy were unnecessary, and that generally good outcomes in terms of preventing surgical site infections can be obtained with the use of topical antiseptic solutions alone. Finally, compared to Povidone Iodine, and more so with lactic acid, the number of surgical site infections was found to be least in participants who used Chlorhexidine digluconate as antiseptic genital wash during and after the surgical operation. (Author)

Chlorhexidine ; Episiotomy ; Povidone-iodine ; Lactic Acid ; Anti-infective Agents, Local ; Women