RESUMO
Background: Post-caesarean maternal infectious morbidity is still a big challenge despite prophylactic antibiotics use and other modalities adopted to prevent it. Pre-operative or post-operative vaginal cleansing with povidone-iodine may have effect on post-caesarean maternal infectious morbidity. Aim: The aim of this study was to compare the effectiveness of pre-operative vs. post-operative vaginal cleansing with povidone-iodine in reducing post-caesarean maternal infectious morbidities in a teaching hospital, South East Nigeria. Materials and Methods: This was a randomized controlled trial involving 244 pregnant women who underwent elective or emergency lower segment caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Recruited patients were randomized into two groups: Group 1 had pre-operative vaginal cleansing with 5% povidone-iodine, whereas group 2 had post-operative vaginal cleansing with 5% povidone-iodine. Post-operatively, patients were monitored for clinical symptoms and signs of endometritis, wound infection, and pyrexia daily till discharge and at 2 weeks post-partum visit. Both groups received same post-operative care. Data Analysis: Data were analysed using Statistical Package for Social Sciences (IBM SPSS) software (version 20, Chicago, IL, USA). Continuous variables were presented as mean and standard deviation (mean ± 2SD), whereas categorical variables were presented as numbers, frequencies, and percentages. The t-test was used for comparison between groups for quantitative variables, whereas the χ2 test was used to compare categorical variables. Relative risk and 95% confidence interval were calculated for outcome measures. P-value<0.05 was considered significant. Results: The overall infectious morbidity rate was 14.3% (34/239) in all the study participants. The rate was 1.7% (4/239) among women in the pre-operative vaginal cleansing group and 12.6% (30/239) among women in the post-operative vaginal cleansing group. This was statistically significant [(P < 0.05); relative risk (RR) 0.13, 95% confidence interval (CI) 0.05-0.36]. Endometritis occurred in 13/239 (5.4%) women with 0.8% in the pre-operative group and 4.6% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.009; RR 0.18, 95% CI 0.04-0.78). Wound infection occurred in 11/239 (4.6%) women with 0.8% in the pre-operative group and 3.8% in the post-operative vaginal cleansing group (P = 0.032; RR 0.22, 95% CI 0.05-0.98). Pyrexia occurred in 10/239 (4.2%) women with 0 (0%) in the pre-operative group and 4.2% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.0007; RR 0.01, 95% CI 0.007-0.16). These were commoners among women with ruptured foetal membranes (P =0.001; RR 0.22, CI 0.08-0.61) and those who had emergency caesarean delivery (P=0.0001; RR 0.14, CI 0.05-0.37). Conclusion: Pre-operative vaginal cleansing with povidone-iodine is more effective in the reduction of composite post-caesarean maternal infectious morbidity compared with immediate post-operative vaginal cleansing with povidone-iodine, especially in women with ruptured foetal membranes and those who had emergency caesarean section.
RESUMO
Tuberculosis (TB) is a common infectious pathology especially in low-income countries, which may complicate pregnancy. Although pulmonary TB is more common in pregnancy than extra pulmonary TB (EPTB), EPTB is becoming more common especially in those living with human deficiency virus (HIV) co infection or have other comorbidities. The diagnosis of TB may be delayed in pregnancy due to the masking of its symptoms by those of pregnancy. If diagnosed and treated on time both pulmonary TB and EPTB are associated with excellent maternal and perinatal outcome. If, however, there is delay in diagnosis and treatment then there could be adverse maternal and fetal consequences like preterm labour, fetal growth restriction and even stillbirths. Similarly severe forms of TB like disseminated disease (miliary TB) or multi drug resistant TB (MDR TB) are associated with poor outcome. Diagnosis and management is same as in non-pregnant patients. Both drug sensitive pulmonary TB and EPTB are treated with four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) orally daily for 2 months followed by three drugs (isoniazid, rifampicin and ethambutol) orally daily for 4 months. Drug resistant TB is treated with second line drugs with caution, as some of these drugs are teratogenic. Optimum antenatal care and nutrition therapy along with anti-tuberculosis drugs provide for optimum maternal and perinatal outcome. This review discusses maternal and perinatal outcomes, diagnosis and management of pulmonary TB and extrapulmonary TB as well as perinatal tuberculosis.