Aerobic Bacteria Associated with Septic Abortion

aerophilous Bacteria Associated with putrefacient AbortionAerobic bacteria associated with germy miscarriage among Sudanese womenYagoub Hamadt Allah Elhaj Abd Elseed1*, Mohamed, A E.M. Ibrahim2 Waled Amen Mohammed Ahmed3 thieveBackground pussy miscarriage is a common health problem with short- and long-term ramifications that affect the tincture of life of those fortunate enough to avoid death rate. Both spontaneous and induced stillbirth may closure in septic complications.Objective This ascertain aimed to seize and identify aerobic bacterial causative eonnts of septic abortion in Sudan.Method A descriptive study was conducted in the period from March 2013 till June 2013 in Gynecological Unit in Khartoum direction Hospital, Sudan. Thirty women with vaginal exhaust in the unit were included in the study. Thirty high vaginal swabs and cervical swabs were collected from the selected ladies admitted to the hospital with bleeding.Results The prevalence of abortion was a s fallows, in age group(20-25) abortion cases were (13.3%), in group(26-30) abortion cases were (33.3%), in group(31-35) cases were (20%), in group(36-40) cases were (33.3%) (P 0.05). apart(p) bacteria from those cases were Staphylococcus epidermidis (86.2%), Klebsiella ozaenae (6.9%), Proteus mirabilis (3.4%), Escherichia coli (3.4%) and Staphylococcus aureus (3.4%). The present study showed that induced abortion (73.3%) was insignificantly more than habitual abortion (26.3%), (P=0.07).Conclusion The major marooned organism was Staphylococcus epidermidis (86.2%), which was spaced from both consummate(a) and initial cases. But aerobic pathogenic bacteria isolated were Klebseilla ozaenae, Proteus mirabilis, Staphylococcus aureus and Escherichia coli.Keywords Septic abortion, vaginal swab, great(predicate) women, Stahpylococcus epidermidis.IntroductionSeptic abortions contribute significantly to maternal morbidity and mortality. Improving literacy aim in the female population and effective family planning should shrink its incidence 1. In 1900, the rationale of therapy of the sketchy septic abortion was divided into a medical or surgical approach. Medical therapy comprising oxytocic, bed suspire and supportive measures theoretically decreased the incidence of sepsis, while increasing the problem of blood loss and draw out hospitalization. The surgical approach classified by some as controlled blood loss but theoretically increased the incidence of sepsis 1.In 1973, a report described an adolescent admitted to a large capital of Massachusetts Teaching Hospital with what proved to be incomplete septic abortion 2. Deaths from illegal abortion argon mainly due to infection2,3.Additional to that At 1990 a review of deaths due to abortion in the united states say that 62 percent of the deaths from illegal abortion and 51 percent of deaths from spontaneous abortion were due to infection, as comp atomic pattern 18d which only 21 percent of death from lega l abortion 4 . Mccormick (I944) estimated that 3,500 women died annually in America from this complication of pregnancy and a recent estimate in Turkey suggested that 10,000 women a year died from this cause in that country5.A recent publication by Sedgh et al. (2007) estimated that a total of 42 million abortions were performed in 2003, shine from 46 million estimated for 1995 using the same methods. The same study showed that 20% of all pregnancies, including miscarriages and stillbirths, terminate in abortion each year. This means that one out of every five pregnancies worldwide is voluntarily modify annually, a statistic that illustrates its enormous dimensions. Expressed an separate way, the worldwide rate of induced abortion was approximately 29 per 1000 women between ages 15 and 44 years in 2003, down from 35 per 1000 in 1995. This means that globally one out of every 34 women within that age range has an abortion each year 6.On the basis of verbal autopsy data and hospital records it is estimated that approximately 25% of maternal deaths are caused by hemorrhage, 15% by infection,12% by pregnancy-induced hypertension, and 8% by obstructed labor7. At the last years it has been observed that there is an increase in the prevalence of septic abortion among pregnant women, and its complication upon community. Septic abortion is considered nowadays one of the most important issues concerning Maternal health .There are not much studies traced in Sudan investigating the septic abortion prevalence and its causative agent. Therefore, this study aimed to isolate and identify aerobic bacterial causative agents of septic abortion in Khartoum, Sudan.Material and MethodThis is a descriptive study. It had been conducted among pregnant women in age of (20 40 ) years, who are being admitted to the Gynecology bleeding exigency room of Khartoum Teaching Hospital, Sudan, in the period from March 2013 till June 2013.High vaginal swabs by and by the introduction of the s peculum, the swab should be rolled firmly over the surface of the vaginal vault. The swab should consequently be placed in Amies transport medium with charcoal or/and Stuarts transport medium.Cervical swabs afterwards introduction of the speculum to the vagina, the swab should be rotated inside the endocervix. The swab should then be placed in Amies transport medium with charcoal or Stuarts transport medium. Then all collected specimens were inoculated on rail line agar (aerobic 370c), chocolate agar (aerobic 370c and 5-10% co2) and Macconkey agar (aerobic 370c). Incubated for overnight based on report done by Fawad A. et al 20088, when puerperal sepsis or septic abortion is suspected inoculate the specimen on two plates of blood agar and report aerobically at 35370C overnight. Inoculate the specimen on Macconkey agar and incubate the plate aerobically at 35370c overnight 8.Examine the colonies for Gram stained smearIt is done to psychoanalyze the smear for pus cells and bacteri a (8).Identification tests done to identify the pathogenic bacteria include Catalase test, Coagulase test, Deoxyriboneuclease test, Kligler weightlift agar, Citrate utilization test, Simmons citrate agar, Urease test, Indole test, Sugar fermentation test and Methyl Red test.ResultsThe total number of 30 samples were collected from pregnant women suffering from bleeding, out of these 11 specimens (36.67%) were collected after complete abortion, whilst 19 (63.33%) samples were collected at initial cartridge clip of bleeding, as referd in prorogue (1) .Table (1) The collected specimens era from women with bleeding in Khartoum Teaching Hospital.ParameterNumberPercentageSpecimens collected after complete abortion1136.67%Specimens collected at initial time of bleeding1963.33%Total cases30100%According to demographic characters, septic abortion appearing more frequently at the age of 26-30 and 36-40 and most cases were induced abortion (73.3%) as shown in Table (2).Table (2) Demograph ic characteristics of women attending with bleeding Khartoum Teaching HospitalDemographic characterFrequencyPercentageAge categories20-25413.34%26-301033.33%31-35620%36 401033.33%Total30100%Type of abortionHabitual826.67%Induced2273.33%Total30100%Types of aerobic bacteria isolated from specimens collected at complete stage of abortion were Staphylococcus epidermidis, Klebseilla ozaenae, Staphylococcus aureus, Escherichia coli and Proteus mirabilis. Staphylococcus epidermidis was isolated from both initial stage and complete stage of abortion. It was isolated from 14 specimens out of 19 specimens, Table (3).Table (3) Number of different bacteria isolate from septic abortion cases from women attending to Khartoum Teaching Hospital.ParameterOrganism isolatedFrequencyPercentageOrganism isolated from complete stage of abortionStaphylococcus epidermidis654.5%Klebsiella ozaenae218.2%Staph. aureus19.1%Escherichia coli19.1%Proteus mirabilis19.1%Total11100%Organism isolated from initial stag e of abortionStaphylococcus epidermidis1473.68% no yield526.32%Total19100%Table(4) Relationship between the age of women, and type of abortion and the time of specimens in Khartoum Teaching HospitalDemographic characterComplete abortionn(%)Initial abortionn(%)p-valueAge categories20-251 (9.1%)3 (15.8%)0.0826-304 (36.3%)6 (31.6%)31-352 (18.2%)4 (21.1%)36 405 (45.4%)5 (26.3%)Type of abortionHabitual3 (27.27%)5 (26.32%)0.07Induced8 (72.73)14(73.68%)Discussion come to the fore of 30 cases involved in this study 11 (36.67%) cases were caused by aerobic bacteria which may indicate that abortion may be caused by other causative agents than aerobic bacteria. The Percentage of septic abortion have been notably decreased , this is mostly because health care provider contribute significantly to reduce the expose of woman to septic complication by providing surfaces in a safe environment, this is un consistent with other published reviews9.The highest incidence were in age group 26-30 also in group36-40 (P 0.05) the incidence were high , which is in inconsistent with other published reviews in other countries 9 ,but its consistent with the research of (Fawad, et al 2008) who found that the legal age of patient were of middle age8. Also habitual abortion occupied nearly (27.3%) (P 0.05) and induced abortion about (72.7%) (P 0.05).Earlier published review showed that most isolated organism was Escherichia coli (20%) ,either alone or in conspiracy with other bacteria ,which is inconsistent with our study (9.1%). Also the reviewer isolate Proteus mirabilis in combination with Escherichia coli (6%), in our study we found Proteus mirabilis (9.1%) 5.The percentage of Klebsiella ozaenae isolate was (18.2%) which is higher than pervious study (Isibor, et.al 2011) with percentage of (4.4%) among pregnant woman 10Staphylococcus aureus isolate percentage was (9.1%) in disagree with study done by (Isibor, et al 2011), which found that Staphylococcus aureus occupies about (26.7% ). this may be attributed to immune emplacement of the individual, personal hygiene and the proximity of the vagina to urethra 11.ReferencesAtrash H.K., Lawson H.W., Smith J.C., Legal abortion in the US trends and mortality . Contemp Ob/Gyn, 1990p35(2)58-69.jewett J.F., septic induce abortion . N Engl J Med,1973,p2899-748.Cates W .Jr. , Rochat R.W. , Smith J.C. , Taylor C.W. 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