BackgroundAntibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7–10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months.MethodsAfter root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts.ResultsSSAP increased from a baseline 2.1%–67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%–90% for more than 2 years without any increase in SSI rate.ConclusionQI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.

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Objectives: To assess the predictive value of Swede score with VIA as the screening method and identify a cut-off score that predicts high grade CIN. Methods: Records of 324 women who were VIA positive and had acetowhite lesion on colposcopy graded according to Swede score followed by biopsy/excisional procedure were included in the analysis. Sensitivity, Specificity, PPV & NPV for each Swede score were calculated and area under the ROC curve (AUROC) for score predicting high grade histopathology (≥ CIN 2) was estimated. A p value less than 0.05 was considered statistically significant. Results: As the swede score increased from 0 to 10, the sensitivity decreased and specificity increased i.e. sensitivity of score < 6 was high whereas specificity of score > 6 was high. At a cut-off of Swede Score ≥6, it predicted high grade histology with a sensitivity of 51%, and a speci-ficity of 79%. The highest diagnostic accuracy was at swede score cut off >6 i.e. 64.6%. Conclusion: We recommend biopsy at a Swede score of 5 or less and treatment by excision at a Swede score of 6 or more.

Background: Pregnancy provides a good time for opportunistic screening of our women who rarely attend for cervical screening. The prevalence of abnormal PAP smear in pregnant women in developed countries was 5-6%, however, no literature was available from India. Aim: To determine the prevalence of abnormal PAP smears in antenatal women presenting to our antenatal clinic. Methods: Women attending the antenatal clinic with gestation of <28 weeks were recruited after an informed consent and had a PAP smear by Ayre spatula and cytobrush or a broom type of cytobrush. The comfort level during smear taking & any problems noted were recorded using a pain score. The smears were stained using the PAP stain, were categorized as adequate or inadequate & classified as per Bethesda classification. Results: We had 150 women participating, the mean age was 24.2 yrs, the mean period of gestation was 17 weeks; 43.9% were nulliparous. Smear adequacy rate was 71.5% overall. Pain during procedure was reported in 2.9% of women, 18.3% had minor discomfort; 78.6% were comfortable. Minor bleeding during smear taking was noted in 15%; this was more with the cytobrush & broom than the Ayre spatula alone. Abnormal smears were seen in three women; two had AGC & one had LSIL. Conclusions: Opportunistic cervical screening during pregnancy is safe and well tolerated. Abnormal Cervical smears were seen in 2% of our pregnant women.