Obstetrics And Gynecology Department Research Articles

To study the awareness of needle stick injuries among healthcare workers in an area select of tertiary care hospital

Background: Needle stick injuries, or NSIs, refer to injuries produced by several types of needles, including hypodermic needles, blood collection needles, intravenous stylets, and needles used for connecting components of intravenous administration systems. Aims and Objectives: The study aimed to study the awareness of NSIs among healthcare workers (HCWs) in a selected area of a tertiary care hospital. Materials and Methods: A cross-sectional study was undertaken within the department of obstetrics and gynecology (OBG). The study’s target group was all HCWs of varied experience levels (n=272). This study employed a meticulously crafted questionnaire in the English language. The survey includes 22 items covering a variety of NSI-related topics. Subgroup analysis was conducted using the Pearson Chi-square test. Results: It was found that most of them were in the 20–30 age group (75%), the majority were females (72%), unmarried (61%), and from an urban background (85%). Almost all the participants (96%) were aware that NSIs are preventable. Similarly, 90% of the participants were aware that NSIs may cause the transmission of diseases, and 77% of the participants reported that they have training on biomedical waste management and its disposal. About 74% of the respondents stated that they had been exposed to NSIs. Conclusion: This study sheds light on the awareness levels and experiences of HCWs regarding NSIs in the OBG department. While a high level of awareness was observed, the study identified areas for improvement in the implementation of preventive measures, reporting practices, and post-exposure management.

Natural Methods for Relieving Labor Pain and Anxiety during the First Stage among Primigravida Mothers

Labor pain is a universal experience among primigravida during pregnancy. Failure to manage labor pain may lead to abnormal labor. There are many complementary nonpharmacological methods used to cope with labor pain such as back massage and breathing exercises. Aim: To evaluate the effect of natural methods for relieving labor pain and anxiety during the first stage of labor among primigravida mothers. Design: A quasi-experimental design was utilized to accomplish this study. Sample: A Purposive sample included 80 primigravida mothers were recruited and divided into two equal groups as a group (A) refers to the back massage group (n=40) and group (B) which refers to the breathing exercises group (n=40). Setting: The study was applied in the Obstetrics and Gynecology Department at Sohag University Hospital. Three tools were used for data collection (1) A structured interviewing questionnaire, (2) a visual analog pain scale, (3) a State-Trait Anxiety Inventory scale. Results: Revealed that there was a highly significant difference between mean and SD of pretest level and posttest regarding labor pain level in back massage and breathing exercises groups at P=0.001 level. There was a highly significant difference between mean and SD of pretest level and posttest regarding anxiety level in back massage and breathing exercises groups at P=0.001 level. Conclusion: Back massage and breathing exercises were effective in relieving and reducing the intensity of pain and reduce anxiety during the first stage of labor among primigravida mothers. Recommendation: Applying back massage and breathing exercises are recommended to relieve pain and reduce anxiety

Early detection and primary prevention system in COVID-19 transmission to staff and residents in the department of obstetrics and gynecology

COVID-19 is currently a global pandemic because of its fast transmission in humans. The disease can be symptomatic or asymptomatic. Patients with the disease can transmit the infection to the medical team who are exposed without proper protection. Prevention of transmission is our main focus of attention as well as early recognition of exposed medical teams among obstetrics and gynecology residents and consultants in our hospital. This article aimed to describe the COVID-19 early detection and primary prevention system among staff and residents in the Obstetrics and Gynecology (OBSGYN) Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr. Sardjito General Hospital from April to June 2020. The data were acquired from the reports of the COVID-19 taskforce from the OBSGYN Department. In order to prevent the transmission of COVID-19 infection, actions taken by the OBSGYN Department are as follows: a) arrangement of staff and residents watch schedules, b) usage of PPE (Personal Protective Equipment) according to protocol, c) contact tracing, and d) early detection. Resident watch schedule arrangement is done by withdrawing residents from affiliated hospitals so that the division of daily duty schedules at Dr. Sardjito General Hospital is divided into 2 shifts of 12 hours each. The PPE usage policy is adjusted according to the risk of COVID-19 exposure in different environments and in accordance with established standards. A total of 65 out of 74 residents (88%) had been exposed to suspected COVID-19 cases, and among the exposed residents, 12 residents (18%) were self-isolated because of the occurrence of symptoms, exposure to patients with positive COVID-19 rapid antibody test, or exposure to patients with positive COVID-19 Polymerase Chain Reaction (PCR) test. The department also conducted early detection of COVID-19 infection among all staff members and residents. As many as 13 out of 27 staff (48%) underwent COVID-19 rapid antibody test with 100% negative results, 66 of the 74 residents (89%) also underwent COVID-19 rapid antibody test with 100% negative results. In conclusion, the OBSGYN Department has implemented several measures to prevent transmission of COVID-19 among its staff and residents with adequate satisfactory results.

Serious Workplace Violence Against Healthcare Providers in China Between 2004 and 2018.

Introduction: Workplace violence (WPV) against healthcare providers has severe consequences and is underreported worldwide. The aim of this study was to present the features, causes, and outcomes of serious WPV against healthcare providers in China.Method: We searched for serious WPV events reported online and analyzed information about time, location, people, methods, motivations, and outcomes related to the incident.Result: Serious WPV reported online in China (n = 379) were mainly physical (97%) and often involved the use of weapons (34.5%). Doctors were victims in most instances (81.1%). Serious WPV mostly happened in cities (90.2%), teaching hospitals (87.4%), and tertiary hospitals (67.9%) and frequently in Emergency Department (ED), Obstetrics and Gynecology Department (OB-GYN), and pediatric departments; it was most prevalent in the months of June, May, and February. Rates of serious WPV increased dramatically in 2014 and decreased after 2015, with death (12.8%), severe injury (6%), and hospitalization (24.2%) being the major outcomes. A law protecting healthcare providers implemented in 2015 may have helped curb the violence.Conclusion: Serious WPV in China may stem from poor patient–doctor relationships, overly stressed health providers in highly demanding hospitals, poorly educated/informed patients, insufficient legal protection, and poor communication. Furthering knowledge about WPV and working toward curtailing its presence in healthcare settings are crucial to increasing the safety and well-being of healthcare workers.

Prevalence and Factors of Urinary Incontinence among Postmenopausal Women Attending the Obstetrics and Gynecology Outpatient Service in a Tertiary Health Care Center in Kochi, Kerala.

Introduction:Urinary incontinence has an immense impact on the social and mental health, and the quality of life of a person. Women neither come forward seeking medical consultation nor do they discuss about their incontinence openly, and the condition remains underestimated in the society. Hence, this study was undertaken to assess the type of urinary incontinence in postmenopausal women visiting obstetrics and gynecology (OBG) outpatient in a tertiary health care sector and to determine the risk factors of urinary incontinence.Materials and Methods:All postmenopausal women of age 45–90 years visiting the OBG Department of Amrita Institute of Medical Sciences in the months of May and June 2018 were assessed for urinary incontinence. QUID questionnaire - a six item urinary incontinence diagnostic questionnaire to diagnose and differentiate stress, urge and mixed incontinence - was used.Results:The prevalence of urinary incontinence was 26.47%, stress urinary incontinence contributing 13.9%, mixed urinary incontinence 7.2%, and urge urinary incontinence 5.4%. Chronic cough, recurrent urinary tract infections (UTI), and prolonged duration of labor were independent risk factors associated with urinary incontinence in postmenopausal women.Conclusion:Stress incontinence was found to be the major type of urinary incontinence in the postmenopausal women. Those having history of chronic cough, prolonged duration of labor, and recurrent UTI should be screened regularly for urinary incontinence.

A study to analyze the pattern, causality, severity, predictability, and preventability of adverse drug reactions among patients attending department of obstetrics and gynecology at a tertiary care hospital

Background: Adverse drug reactions (ADRs) in women demand a special care due to altered physiology. Despite lingering safety questions, studies on vulnerable groups such as pregnancy, lactation, peri- and post-menopausal women are lacking. Hence, the assessment of ADRs is essential for early risk detection and its management. Aims and Objectives: To analyze the pattern, causality, severity, predictability and preventability of occurrence of ADRs in the Obstetrics and Gynecology (OBG) Department. Materials and Methods: An observational study was conducted from June 2012 to 2016 to analyze the ADRs reported spontaneously from the Department of OBG to ADR Monitoring Center, Bangalore Medical College and Research Institute. Causality of each ADR was assessed by the WHO-ADR scale, severity by Hartwig and Siegel scale and preventability by modified Schumock and Thornton scale. Results: A total of 100 ADRs were reported over 48 months; a maximum number of ADRs were observed in the age group of 21–40 years (81%) and majority of them during pregnancy (62%). The highest number of ADRs was associated with iron therapy (42%) followed by antimicrobials (31%). Gastrointestinal system (51%) was affected predominantly. Gastritis (25%) followed by allergic reactions (18%) was most commonly observed ADRs. The WHO-UMC criteria showed that 61% were “probable” and 57% were “mild” in nature. Preventability assessment showed that 56% were “probably preventable” ADRs. Furthermore, 72% of the ADRs were predictable in nature. 43% of the ADRs required additional medical treatment, while causative drug was withdrawn in 44% of cases. Conclusion: This study provides a database of ADRs in the OBG Department and most of the ADRs were predictable and probably preventable with no severe ADRs, which highlights the appropriate management of ADRs at our center.

Sexual Assault in the Department of Obstetrics and Gynaecology of the Bamako’s 5th Municipality Medical Center

Background: The authors report cases of sexual assault reported to the obstetrics and gynecology department of the Bamako’s 5th municipality medical center during a prospective study of eight months from 1st January to 31st August 31st, 2012. Results: Twenty-one cases of assault were reported out of a total of 13,482 consultations, representing a frequency of 0%, 15%. Most victims were represented by students and accounted 43% of the study population. In 76% of cases the victims knew their assailant. The type of sexual contact was genito-genital vaginal penetration in 67% of cases and the condom was used in only one case. The average time before consultation was 3 days. The preventive ARV treatment was administered in 24% of cases and emergency contraception in 43% of cases. Conclusion: Sexual assault is common in Bamako. The reality is probably underestimated because many cases are not reported. The victims are mostly children and adolescents. The risk of transmission of STIs and HIV is very high during the sexual assault. Education and awareness of the population are essential for early consultation. Training of health workers to care for victims of sexual assault is needed.

Knowledge, attitude, and behavior of pregnant women on early initiation of breastfeeding

Background Infant mortality rate is an indicator of the degree ofhealth in society. In Indonesia, the infant mortality rate remainshigh, with most deaths occurring in the first 24 hours of life.Breastfeeding has been shown to reduce infant mortality, especiallyif undertaken in the first hour of life. This practice is knownas early initiation of breastfeeding (EIB). According to variousstudies, EIB implementation may be influen ced by many factorssuch as knowledge, attitude, behavior, and health care facilities.Objective To assess the level of knowledge, attitude, and behaviorof pregnant women towards EIB.Methods We conducted a descriptive study using questionnaireson 74 pregnant women in the outpatient clinic of Obstetrics andGynecology Department, Dustira Hospital, Cimahi, West Java,Indonesia from November to December 2012.Results Out of 74 respondents, 21 % had a good level of knowledgeon EIB, 23% had an adequate knowledge, and 56% had less thanadequate knowledge on EIB. A positive attitude towards EIBwas found in 65% of the respondents, while 35% had a negativeattitude. With regards to behavior conducive to EIB, 8% ofrespondents had good behavior, 57% had moderate behaviot; and35%had less than adequate behavior.Conclusion Majority of pregnant women have less than adequateknowledge on EIB, a positive attitude towards EIB, and moderateto less than adequate behavior conducive to EIB.

Knowledge, attitude, and behavior of pregnant women on early initiation of breastfeeding

Background Infant mortality rate is an indicator of the degree ofhealth in society. In Indonesia, the infant mortality rate remainshigh, with most deaths occurring in the first 24 hours of life.Breastfeeding has been shown to reduce infant mortality, especiallyif undertaken in the first hour of life. This practice is knownas early initiation of breastfeeding (EIB). According to variousstudies, EIB implementation may be influen ced by many factorssuch as knowledge, attitude, behavior, and health care facilities.Objective To assess the level of knowledge, attitude, and behaviorof pregnant women towards EIB.Methods We conducted a descriptive study using questionnaireson 74 pregnant women in the outpatient clinic of Obstetrics andGynecology Department, Dustira Hospital, Cimahi, West Java,Indonesia from November to December 2012.Results Out of 74 respondents, 21 % had a good level of knowledgeon EIB, 23% had an adequate knowledge, and 56% had less thanadequate knowledge on EIB. A positive attitude towards EIBwas found in 65% of the respondents, while 35% had a negativeattitude. With regards to behavior conducive to EIB, 8% ofrespondents had good behavior, 57% had moderate behaviot; and35%had less than adequate behavior.Conclusion Majority of pregnant women have less than adequateknowledge on EIB, a positive attitude towards EIB, and moderateto less than adequate behavior conducive to EIB.

Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751; of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Effect of Interventions on Prescribing of Antimicrobials for Prophylaxis in Obstetric and Gynecologic Surgery

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.

Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.