BackgroundSurgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital.MethodsPatients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds.ResultsA total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%.ConclusionsIncidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecological surgeries. Multiple risk factors identified in the present study can be helpful for SSI risk stratification in low-middle income countries.

SUMMARYThis article addresses issues related to pregnancy anaemia and late referral by a village birth attendant in resource poor setting in a central state of India. A young anaemic woman had labour onset at her village, a birth attendant tried to deliver her but failed. When she came to our hospital, had established septicaemia and absolutely nonreassurable uterine tone leading to intractable atonic postpartum haemorrhage. She died after 5 days because of coagulopathy and multiorgan failure. Huge budgets are being spent for the promotion of institutional deliveries but still the maternal mortality ratio has not reduced. The epidemiology of childbirth, social awareness for safe labour and administrative lethargy towards implementation of government programmes have not changed. The tertiary care-blood and componentsmultidisciplinary approach could not prevent the death of an anaemic woman. Unless there is a grassroot level change in the healthcare delivery system at the village level, the scenario might not change. BACKGROUND

Background: Ovarian carcinoma is a silent killer because it presents in advanced stage. In India, it ranks third after carcinoma cervix and breast. Incidence of ovarian cancer is 5.4-8.0 per 100,000 in India. Various versions of risk of malignancy index have been studied to show its validity in different settings. We have studied third version of risk of malignancy index in a resource poor setting in India.Methods: In this prospective observational study 74 perimenopausal and postmenopausal women with ovarian mass were recruited. Menopausal score (M), Ultrasonography score (U) and CA-125 are components of Risk of Malignancy Index 3. Patients underwent preoperative ultrasonography and CA-125 level was assessed. Scores of M 1-3, U 1-3 and absolute value of CA-125 was multiplied. This product was value of Risk of Malignancy Index 3. If it is less than 250 it suggests absence of malignancy and more than 250 strongly suggests malignancy. Results were confirmed by histopathology.Results: Fifty six percent women were cancer positive. Ovarian malignancy was more common in postmenopausal age group. Ultrasonography and CA-125 had high sensitivity of 90% but poor specificity. Risk of malignancy index 3 had a sensitivity, specificity, positive predictive value and negative predictive value of 90%, 91%, 78% and 96% respectively at a cut off value of 250.Conclusions: Risk of malignancy index was concluded to be a multimodal approach with better diagnostic scoring index in preoperative stage in women of ovarian masses. It is simple and easily applicable clinical tool in resource poor setting.