Low socioeconomic status, inadequate antenatal care and poor intrapartum care due to unskilled birth attendance are risk factors of IPPM.

No abstract

Background: Ascending infection is one of the most common etiologies in preterm premature rupture of membranes (PPROM). Antibiotics are used in PPROM to prolong the pregnancy and to prevent infection. But to prevent drug overuse and resistance, microorganism directed antibiotics should be used. So, this study was planned to evaluate vaginal flora in pregnant women with PPROM and their sensitivity to commonly used antibiotics. Methods: In this prospective cross-sectional study, 50 pregnant women (cases) preterm premature rupture of membranes and 28 pregnant women (controls) without complication were assessed for the type of vaginal flora and its sensitivity to commonly used antibiotics. Results: Among cases 18 (36%) women showed bacteria on Gram's staining of vaginal swabs with Gram-negative bacteria (10/18) being the most common. Among controls, 16 (57%) women showed bacteria on Gram's staining with Gram-positive bacteria being most common. Among cases Escherichia coli and Staphylococcus aureus were the commonest isolates. Of 8 (16%) positive bacterial cultures in cases, 6 (10%) were sensitive to Gentamicin and 2 (4%) to Ampicillin. Conclusion: Lower genital tract flora of pregnant women with PPROM predominantly consists of Gram-negative bacteria, which are sensitive to Gentamicin.

Doppler indices of MCA and Um A are significantly abnormal in preeclampsia. But on diagnostic statistical analysis they have good specificity but low sensitivity for detecting adverse perinatal outcome.

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.