Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report.

Background: We report on childbirth trauma resulting in a rare stretching and prolapsing of the anterior lip of the cervix beyond the vaginal introitus, and describe the management. Case Presentation: A 17-year-old primigravida who had normal antenatal care delivered a live normal male baby weighing 3600 g at 39 weeks of gestation. The patient sustained a birth trauma resulting in the anterior lip of the cervix becoming stretched and prolapsing outside the vagina. There was an associated uterovaginal prolapse (Pelvic Organ Prolapse Quantification System grade 2). The prolapse of the cervix recurred after the initial repositioning of the cervix into the vagina. Subsequently, a vaginal ring pessary was applied to reduce the uterus and cervix. The most distal part of the prolapsed cervix was necrotic, remained outside the vagina despite the application of the ring pessary, and was excised. The use of the ring pessary was discontinued at 6 weeks postpartum, the cervix healed without obvious defect, and there was no prolapse at 3-month follow-up. Conclusion: A stretched cervix that prolapses beyond the vaginal introitus and uterovaginal prolapse are rare complications of childbirth that may be amenable to treatment with a ring pessary and to surgical excision of non-viable cervical tissue.

Urinary bacterial profile and antibiotic susceptibility pattern among pregnant women in Rahima Moosa Mother and Child Hospital, Johannesburg.

BACKGROUND: Urinary tract infection (UTI) in pregnancy is associated with significant morbidity for both the mother and the foetus. The aim of this study was to determine the prevalence of UTI, urinary bacterial susceptibility, and resistance patterns among pregnant women with a possible UTI at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. METHODS: In this retrospective study, we analysed mid-stream urine culture and antibiotic susceptibility data from both inpatients and outpatients of pregnant women who attended RMMCH from January 2017 to December 2017. Data were collected from patients' files and then matched with urine microscopy, sensitivity and culture (MC&S) results from the National Health Laboratory Services (NHLS) data. RESULTS: Urine microscopy, cultures and sensitivities were performed on 1984 specimens belonging to pregnant women who presented with symptoms and/or signs of a UTI. A total of 333 patients (16.8%) had positive bacterial cultures. Escherichia coli (E. coli) was the commonest bacterial isolate (49.9%). Other microorganisms isolated included Klebsiella species (14.4%), Enterococcus faecalis (12.9%) and coagulase-negative staphylococci (CoNS); (8.9%). Approximately 98% of organisms were sensitive to cephalexin. Cefuroxime (95.2%), ceftriaxone/cefotaxime (94.4%) and nitrofurantoin (81.9%) demonstrated antimicrobial effectiveness as indicated. Most isolates were resistant to ampicillin/amoxicillin (84.4%), Trimethoprim/Sulfamethoxazole (55.6%) and amoxicillin-clavulanic acid (50.2%). CONCLUSION: E. coli was the commonest pathogen causing UTIs in pregnancy with Enterococcus faecalis increasing in prevalence. The choice of antimicrobial therapy in pregnancy should be determined according to sensitivity and resistance and foeto-maternal safety.