No abstract

Acute abdomen in pregnancy due to nonobstetric causes is accompanied by a high incidence of poor fetal outcome and maternal morbidity.1,2 Delay in surgical intervention, together with the operative maneuvers, are the main causes of the poor outcome. [3][4][5] Fear of the complication of a negative laparotomy in a pregnant female makes surgeons hesitant to interfere surgically, leading them to await clear-cut symptoms and signs of acute abdomen. 5,6 In pregnancy, these symptoms and signs are blunted by the anatomical displacement of the pregnant uterus 7 and the masking effect of the physiological symptoms of normal pregnancy, such as nausea, vomiting, mild abdominal pain and constipation. 8,9 Ironically, this delay, when prolonged, carries a high risk to the mother and fetus. 4 In acute abdomen in pregnancy, some have advocated aggressive early surgical intervention, 10-11 while others have adopted an initial trial of conservative treatment before resorting to surgery in case of failure. 4,12 Tocolytics are thought to calm the uterus from the insult of acute abdomen during conservative management or surgery, but this is controversial.13,14 The purpose of this article is to discuss the high incidence of acute abdomen, the effect of early surgical intervention on the maternal fetal health, and to evaluate the effect of tocolytics on pregnancy outcome. Subjects and MethodsAll cases of acute abdomen in pregnancy due to non-obstetric causes that were admitted to Asir Central Hospital (the main referral hospital in the region) from January 1991 to December 1993 were studied and analyzed. The parameters examined included the gestational age, acute abdomen symptoms and their duration before admission, signs, results of investigations, including ultrasound scanning, provisional diagnosis, the initial management plan (whether conservative or surgery and the criteria for either), tocolytic used, its nature, dose, side effects and its effects on the. fetal outcome, and whether abortion, preterm or term labor. Maternal morbidity was assessed by the duration of hospital stay, recurrent hospital admission, body temperature, nature of operation, postoperative complications and maternal health after delivery or abortion. The results of ultrasound scan and histopathology were compared to operative findings. The newborn charts were reviewed and any neonatal abnormality recorded.The chi-squared test, Fisher's exact test, and unpaired Student's t-test were used as tests of significance at the 5% level. For this purpose the software Statistical Package for Social Sciences (SPSS) was used. ResultsDuring the study period, there were 15,562 deliveries, of which 60 cases were provisionally diagnosed and admitted as having acute abdomen with pregnancy. The symptoms were severe abdominal pain, vomiting, constipation and signs of abdominal distension, rigidity, tenderness, abdominal mass, high temperature and rapid pulse. Table 1 summarizes the frequency of symptoms and signs.Depending on the severity of the above symptoms, patients were ei...

Background: There is an overwhelming concern around the world regarding the increasing number of resistant strains of microorganisms in all sorts of wounds. There is hardly any information about the prevalence and incidence of such resistance pattern in our local hospitals Methods: This study was done to probe into the common microorganisms and their culture sensitivities to antibiotics in surgical wound infections in general surgery wards of Mayo hospital. The study material included the pus specimens sent to pathology lab from general surgical wards. There culture sensitivity results were interpreted to find out the prevalence of individual microorganisms in surgical wounds and sensitivities and resistance to different antibiotics. Results: Staphylococcus aureus was the most common organism cultured (54.87%), followed by E.Coli (10%), pseudomonas(10%), proteus (7.9%) and kleibsiella (5.3%). 20 percent of wounds had mixed growth of organisms. Mixed growth of microorganisms was seen in 20% of cases. Conclusion: Most of the bacteria cultured were resistant to routinely used antibiotics.

Over a three-year period 49 cases were admitted to our hospital with an acute abdomen in pregnancy due to cholecystitis. In this article we compare surgical treatment with medical treatment and consider the aetiology of the high prevalence. Out of the 49 cases admitted, 15 cases (31%) had emergency cholecystectomy within the first week and 34 cases (69%) were treated conservatively of whom 24 relapsed many times and had to be readmitted to the hospital (mean number of admissions was 4 +/- 1.4 and the mean hospital stay was 8 +/- 2.3 days) and of the remaining 10 on conservative management, three had emergency cholecystectomy and seven reached term safely. The maternal morbidity is significantly less in the surgically treated group (P < 0.0001) but the perinatal outcome failed to show any significant difference. The frequency of acute cholecystitis in pregnancy (0.33%) is high in comparison with other studies. Although tocolytics were used in 13 cases they did not improve the fetal outcome significantly and had maternal and fetal side effects. In conclusion early surgical intervention is recommended and the use of tocolytics did not improve the perinatal outcome.