Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.270
Lauryn Mengesa, Daki Dido, D. Muchiri, Philomena Owende
Background: Phyllodes tumors account for <1% of all breast neoplasms with a median age ofpresentation of the fourth decade. It is a fibroepithelial neoplasm that presents as a morphologiccontinuum from benign to malignant. The use of hormone replacement therapy has been linked to thedevelopment of breast cancer. The risk is increased with longer periods of use and with hormonalreplacement therapy. Phyllodes tumor is associated with Li-Fraumeni syndrome, a rare autosomaldominant condition characterized by the development of multiple tumors. Surgery is the preferred modeof treatment and involves wide local excision.Case presentation: A 37-year-old nulliparous presented with a left breast lump on self-examination. Shewas on follow-up for ovarian dysgerminoma when she first presented to a peripheral facility at the age of12 years with abdominal swelling. Hysterectomy and right oophorectomy were performed, followed by 10courses of chemotherapy with vincristine, actinomycin, and cyclophosphamide. She has also been onhormonal replacement therapy with on-and-off cyclical spotting and postcoital bleeding. She also hashypertension, diabetes, and dilated cardiomyopathy since 2016, and in 2018, she was diagnosed withchronic obstructive hydronephrosis. She then presented with a left breast lump in September 2023, andan ultrasound-guided core biopsy revealed a spindle cell neoplasm of malignant phyllodes tumor.Mastectomy was performed in December 2023, followed by radiotherapy, and hormonal replacementtherapy was stopped.Conclusion: Malignant phyllodes tumors differ from the more common type of breast cancer becausethey are less likely to respond to hormonal therapy and chemotherapy. Therefore, there is need for closefollow-up and monitoring.
{"title":"Phyllodes breast tumor in a patient on hormonal replacement therapy for primary ovarian failure with chronic kidney disease, hypertension with dilated cardiomyopathy and diabetes mellitus: A case report","authors":"Lauryn Mengesa, Daki Dido, D. Muchiri, Philomena Owende","doi":"10.59692/jogeca.v36i1.270","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.270","url":null,"abstract":"Background: Phyllodes tumors account for <1% of all breast neoplasms with a median age ofpresentation of the fourth decade. It is a fibroepithelial neoplasm that presents as a morphologiccontinuum from benign to malignant. The use of hormone replacement therapy has been linked to thedevelopment of breast cancer. The risk is increased with longer periods of use and with hormonalreplacement therapy. Phyllodes tumor is associated with Li-Fraumeni syndrome, a rare autosomaldominant condition characterized by the development of multiple tumors. Surgery is the preferred modeof treatment and involves wide local excision.Case presentation: A 37-year-old nulliparous presented with a left breast lump on self-examination. Shewas on follow-up for ovarian dysgerminoma when she first presented to a peripheral facility at the age of12 years with abdominal swelling. Hysterectomy and right oophorectomy were performed, followed by 10courses of chemotherapy with vincristine, actinomycin, and cyclophosphamide. She has also been onhormonal replacement therapy with on-and-off cyclical spotting and postcoital bleeding. She also hashypertension, diabetes, and dilated cardiomyopathy since 2016, and in 2018, she was diagnosed withchronic obstructive hydronephrosis. She then presented with a left breast lump in September 2023, andan ultrasound-guided core biopsy revealed a spindle cell neoplasm of malignant phyllodes tumor.Mastectomy was performed in December 2023, followed by radiotherapy, and hormonal replacementtherapy was stopped.Conclusion: Malignant phyllodes tumors differ from the more common type of breast cancer becausethey are less likely to respond to hormonal therapy and chemotherapy. Therefore, there is need for closefollow-up and monitoring.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"75 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.183
Gichangi Peter, Mercylyn Mokeira, Eric Wefukho, Patricia Owira, Edward Serem
Background: Maternal and neonatal morbidity and mortality remain public health concerns. A study onmortality in Kenyan hospitals found that neonates comprise two-thirds of deaths in the pediatric agegroup (0–13 years). These deaths are caused by preventable conditions or those, which can bemanaged better if diagnosed early, such as placenta insufficiency, placenta previa, severe fetal growthrestriction, congenital abnormalities, multiple pregnancies, and breech presentation; these can all beidentified using point-of-care ultrasound (POCUS). Obstetrical ultrasound availability is limited to level 4and higher facilities, yet most women access lower levels of health care. Implementation of POCUS iscurrently limited because of a lack of appropriate training, limited scope of practice for frontline workers,and legal framework.Objective: The POCUS project is being undertaken to develop national guidelines to facilitate the roll outand scale-up of obstetrical POCUS.Methods: A collaborative participatory approach is planned for the development of the national POCUSguidelines. The key in this process is the identification of suitable frontline workers who, with adjustmentto their scope of practice, appropriate training, implementation of a supervision/referral system, canundertake obstetrical POCUS and gain buy-in from regulatory bodies, the inclusion of voices of relevantstakeholders, and leadership from government. A landscape and stakeholders analysis will also beundertaken as part of the process of the guideline development.Results: Narrative literature review shows that the WHO recommends effective and reliable antenatalultrasound services to be available to all pregnant women to optimize maternal and newborn healthoutcomes and at least one ultrasound scan up to 24 weeks of pregnancy. That there are deliberateefforts in Kenya to introduce POCUS with pilot training and implementation. Where obstetrical POCUS isimplemented, it is useful in diagnosing fetal malpresentation, placenta previa, congenital malformations,or multiple pregnancies. Appropriate interventions, such as reduction of cesarean delivery, induction oflabor, reduction of small for gestational age, low birthweight, preterm birth, and stillbirths, can improve thehealth outcome of the mother and neonate. There is a need to develop national POCUS guidelines.Conclusions: Implementation of POCUS may be riddled with difficulties, particularly where frontlineworkers’ current scope of practice may not allow them to perform such procedures, regulatoryframework, lack of knowledge, awareness, negative attitude, or behavior. The proposed guidelines willaddress these barriers.
{"title":"Point-of-care ultrasound, today, tomorrow, and the future – the place for task sharing","authors":"Gichangi Peter, Mercylyn Mokeira, Eric Wefukho, Patricia Owira, Edward Serem","doi":"10.59692/jogeca.v36i1.183","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.183","url":null,"abstract":"Background: Maternal and neonatal morbidity and mortality remain public health concerns. A study onmortality in Kenyan hospitals found that neonates comprise two-thirds of deaths in the pediatric agegroup (0–13 years). These deaths are caused by preventable conditions or those, which can bemanaged better if diagnosed early, such as placenta insufficiency, placenta previa, severe fetal growthrestriction, congenital abnormalities, multiple pregnancies, and breech presentation; these can all beidentified using point-of-care ultrasound (POCUS). Obstetrical ultrasound availability is limited to level 4and higher facilities, yet most women access lower levels of health care. Implementation of POCUS iscurrently limited because of a lack of appropriate training, limited scope of practice for frontline workers,and legal framework.Objective: The POCUS project is being undertaken to develop national guidelines to facilitate the roll outand scale-up of obstetrical POCUS.Methods: A collaborative participatory approach is planned for the development of the national POCUSguidelines. The key in this process is the identification of suitable frontline workers who, with adjustmentto their scope of practice, appropriate training, implementation of a supervision/referral system, canundertake obstetrical POCUS and gain buy-in from regulatory bodies, the inclusion of voices of relevantstakeholders, and leadership from government. A landscape and stakeholders analysis will also beundertaken as part of the process of the guideline development.Results: Narrative literature review shows that the WHO recommends effective and reliable antenatalultrasound services to be available to all pregnant women to optimize maternal and newborn healthoutcomes and at least one ultrasound scan up to 24 weeks of pregnancy. That there are deliberateefforts in Kenya to introduce POCUS with pilot training and implementation. Where obstetrical POCUS isimplemented, it is useful in diagnosing fetal malpresentation, placenta previa, congenital malformations,or multiple pregnancies. Appropriate interventions, such as reduction of cesarean delivery, induction oflabor, reduction of small for gestational age, low birthweight, preterm birth, and stillbirths, can improve thehealth outcome of the mother and neonate. There is a need to develop national POCUS guidelines.Conclusions: Implementation of POCUS may be riddled with difficulties, particularly where frontlineworkers’ current scope of practice may not allow them to perform such procedures, regulatoryframework, lack of knowledge, awareness, negative attitude, or behavior. The proposed guidelines willaddress these barriers.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.190
Maryanne Mwangi, S. Wanyonyi
Background: Fetal lower urinary tract obstruction (LUTO) is a rare occurrence that is usually associatedwith major morbidity and mortality after birth. It has an incidence of 2.2 in 10000 pregnancies. In males,the most common cause is persistent posterior urethral valves (50-60%). Other causes include urethralatresia with a poor prognosis. Most fetuses that survive to term with LUTO need dialysis or renaltransplant.Case presentation: A 35-year-old gravida 3 presented for routine antenatal follow-up. Her antenatalfollow-up remained normal until she underwent a growth scan at 33 weeks. Ultrasound revealed a fetuswithin normal growth centiles, but the renal system had features of obstruction. Renal calyces weredilated with hyperechoic renal parenchyma. The bladder was also markedly distended and had athickened wall, and a keyhole sign was present. There was a multicystic lesion in the sacral regionwithout blood flow on Doppler imaging. There was oligohydramnios. She had fetal vesicocentesis, whichrevealed normal kidney function. She had serial fetal vesicocentesis, and renal ultrasound showedimprovement in the corticomedullary differentiation of the kidney. At 38 weeks, the patient underwent acesarean delivery. Imaging studies showed a sacrococcygeal teratoma that was causing pressure on therenal system. This was excised, and the patient was allowed to return home on physiotherapy. Renalfunction test after delivery remained normal.Conclusion: Fetal lower urinary tract obstruction in males is mostly managed using the placement ofvesicoamniotic shunts or stents. In male fetuses with posterior urethral valves, ablation is performed inutero using cystoscopy. In this case report, LUTO was managed by serial vesicocentesis, whichpreserved renal function. In low-resource settings where surgery is not available, serial vesicocentesiscan be performed to relieve obstruction.
{"title":"Fetal lower urinary tract obstruction caused by sacrococcygeal teratoma: A case report","authors":"Maryanne Mwangi, S. Wanyonyi","doi":"10.59692/jogeca.v36i1.190","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.190","url":null,"abstract":"Background: Fetal lower urinary tract obstruction (LUTO) is a rare occurrence that is usually associatedwith major morbidity and mortality after birth. It has an incidence of 2.2 in 10000 pregnancies. In males,the most common cause is persistent posterior urethral valves (50-60%). Other causes include urethralatresia with a poor prognosis. Most fetuses that survive to term with LUTO need dialysis or renaltransplant.Case presentation: A 35-year-old gravida 3 presented for routine antenatal follow-up. Her antenatalfollow-up remained normal until she underwent a growth scan at 33 weeks. Ultrasound revealed a fetuswithin normal growth centiles, but the renal system had features of obstruction. Renal calyces weredilated with hyperechoic renal parenchyma. The bladder was also markedly distended and had athickened wall, and a keyhole sign was present. There was a multicystic lesion in the sacral regionwithout blood flow on Doppler imaging. There was oligohydramnios. She had fetal vesicocentesis, whichrevealed normal kidney function. She had serial fetal vesicocentesis, and renal ultrasound showedimprovement in the corticomedullary differentiation of the kidney. At 38 weeks, the patient underwent acesarean delivery. Imaging studies showed a sacrococcygeal teratoma that was causing pressure on therenal system. This was excised, and the patient was allowed to return home on physiotherapy. Renalfunction test after delivery remained normal.Conclusion: Fetal lower urinary tract obstruction in males is mostly managed using the placement ofvesicoamniotic shunts or stents. In male fetuses with posterior urethral valves, ablation is performed inutero using cystoscopy. In this case report, LUTO was managed by serial vesicocentesis, whichpreserved renal function. In low-resource settings where surgery is not available, serial vesicocentesiscan be performed to relieve obstruction.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"435 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.197
R. Achapa, R. Kosgei, A. Osoti, F. Odawa, A. Pulei, M. Masinde, M. Kilonzo, A. Kihara, O. Ogutu, P. M. Ndavi
Background: Cervical cancer is the leading cause of mortality among reproductive women in resource constrained countries especially among the HIV infected group. HIV infection accelerates the transition of cervical dysplasia to invasive cervical cancer. An overview of the risk factors among the HIV infected women in this county is significant despite the paucity of data in this setting. Objective: To determine the risk factors of invasive cervical cancer in HIV-infected women in Kisumu County. Methodology Study design: An unmatched 5 year case control study from 2012-2016. Study setting: Jaramogi Oginga Odinga Teaching and Referral Hospital, largest hospital in Western Kenya. Study population: A total of 200 patient records, 100 cases and controls each. Data collection and analysis : A structured questionnaire was used as a standard tool for extraction of data from both cases and controls. The determinants of invasive cervical cancer were analyzed using univariate and multivariate analysis. Relevant tests to determine statistical significance were also carried out, p-value of <0.05 was considered statistically significant. Results: HIV-infected women with invasive cervical cancer had poor socio-economic status, lower education level (p=0.028), a higher parity (p=0.001), they also lived far away from the hospital facility (p=<0.0001,OR 4.6,C.I 1.62-12.9) and had a lower CD4 count (OR 18.6,C.I4.0-86.6) than those without invasive cervical cancer. Conclusion: Majority of the HIV-infected women with invasive cervical cancer had poor socio-economic status, lived far away from the hospital facility, had done more prior pap smears and had a lower CD4 count than those without.
{"title":"RISK FACTORS FOR INVASIVE CERVICAL CANCER AMONG WOMEN LIVING WITH HIV/AIDS AT JARAMOGI OGINGA ODINGA TEACHING & REFERRAL HOSPITAL IN KISUMU COUNTY: A 5-YEAR HOSPITAL BASED CASE-CONTROL STUDY.","authors":"R. Achapa, R. Kosgei, A. Osoti, F. Odawa, A. Pulei, M. Masinde, M. Kilonzo, A. Kihara, O. Ogutu, P. M. Ndavi","doi":"10.59692/jogeca.v32i1.197","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.197","url":null,"abstract":"Background: Cervical cancer is the leading cause of mortality among reproductive women in resource constrained countries especially among the HIV infected group. HIV infection accelerates the transition of cervical dysplasia to invasive cervical cancer. An overview of the risk factors among the HIV infected women in this county is significant despite the paucity of data in this setting. \u0000Objective: To determine the risk factors of invasive cervical cancer in HIV-infected women in Kisumu County. Methodology \u0000Study design: An unmatched 5 year case control study from 2012-2016. \u0000Study setting: Jaramogi Oginga Odinga Teaching and Referral Hospital, largest hospital in Western Kenya. Study population: A total of 200 patient records, 100 cases and controls each. \u0000Data collection and analysis : A structured questionnaire was used as a standard tool for extraction of data from both cases and controls. The determinants of invasive cervical cancer were analyzed using univariate and multivariate analysis. Relevant tests to determine statistical significance were also carried out, p-value of <0.05 was considered statistically significant. \u0000Results: HIV-infected women with invasive cervical cancer had poor socio-economic status, lower education level (p=0.028), a higher parity (p=0.001), they also lived far away from the hospital facility (p=<0.0001,OR 4.6,C.I 1.62-12.9) and had a lower CD4 count (OR 18.6,C.I4.0-86.6) than those without invasive cervical cancer. \u0000Conclusion: Majority of the HIV-infected women with invasive cervical cancer had poor socio-economic status, lived far away from the hospital facility, had done more prior pap smears and had a lower CD4 count than those without. \u0000 ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.203
G.N Wanjiku
Introduction: Vaginal metastasis in choriocarcinoma complicates about 30% of patients with choriocarcinoma. The commonest site of metastatic is the lungs and is seen in a majority of patients with choriocarcinoma. Vaginal metastasis of choriocarcinoma can be misleading at the time of presentation resulting in misdiagnosis and delay in initiation of life saving treatment. The case is presented of a 30-year-old, para1+1 with history of a slow growing, painful and easily bleeding vaginal mass that was initially thought to be uterine prolapse or a prolapsed leiomyoma.
{"title":"VAGINAL METASTASIS OF CHORIOCARCINOMA IN A 3O YEAR OLD FEMALE INITIALLY DIAGNOSED AS UTERINE PROLAPSE.","authors":"G.N Wanjiku","doi":"10.59692/jogeca.v32i1.203","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.203","url":null,"abstract":"Introduction: Vaginal metastasis in choriocarcinoma complicates about 30% of patients with choriocarcinoma. The commonest site of metastatic is the lungs and is seen in a majority of patients with choriocarcinoma. \u0000Vaginal metastasis of choriocarcinoma can be misleading at the time of presentation resulting in misdiagnosis and delay in initiation of life saving treatment. \u0000The case is presented of a 30-year-old, para1+1 with history of a slow growing, painful and easily bleeding vaginal mass that was initially thought to be uterine prolapse or a prolapsed leiomyoma. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 63","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.199
W.P Flora, R.K Kamau, M.M James, O. Ogutu, J. Karanja, A. Osoti, O. Kireki, A. Kihara, R. Kosgei, M. Obimbo, A. Bosire, P.K Koigi, P. M. Ndavi
Background/Objectives: Perinatal mortality rates are highest in Africa where it is more than five times higher than in developed regions. South Sudan has some of the worst health outcome indicators globally, in spite of modest improvements over the last five years. The aim of this study is to determine the magnitude and characteristic of women with early perinatal mortality at Juba Teaching Hospital, South Sudan. Methodology Study design: A cross-sectional study. Study site/setting: Juba Teaching Hospital maternal word. Study population: Comprised of mothers and their newborn babies delivered at JTH during the study period. Sampling: Consecutive sampling techniques was most appropriate for the selection of mothers who delivered their babies during the study period. Data collection & management: Data was analyzed using SPSS, version 23. Descriptive analysis was conducted to summarize characteristics of participants. Multivariable analysis conducted using binary logistic regression analysis to identify the predictors of EPNM. Statistical significance based on a p value of 0.05. Result: Early perinatal mortality rate was 122.3 per 1000 total birth with stillbirth rate of 82.7 per 1000 total births with majority attributable to fresh still births 14(41%). Factors associated with early perinatal mortality: Non-formal education ( OR=5; 95% CI 2.1-10.1 P val. <0.000) , pervious history of stillbirth, (OR = 2.6; 95% CI 1.1-6.3; p val. 0.04), ANC < 4 visit (OR=3.2, 95% CI 1.5-7.0; p val, 0.0005) and gestation age ≤ 36 weeks (OR= 5.1; 95% CI 2.4-11; p val. 0.0001), were associated with increased risk of EPNM. While parity of ≥ 4 (OR= 0.4; 95% CI 0.2-0.09; p val. 0.04), appeared to significantly, reduce EPNM among women delivered at JTH during the study period. Conclusions: The lack of formal education, younger maternal age, previous history of stillbirth, low antenatal clinic attendance and pre-term gestation increased the risk of early perinatal mortality among mothers delivered in JTH.
背景/目标：非洲的围产期死亡率最高，是发达地区的五倍多。南苏丹的一些健康结果指标在全球最差，尽管在过去五年中略有改善。本研究旨在确定南苏丹朱巴教学医院围产期早期死亡妇女的数量和特征。方法 研究设计：横断面研究。 研究地点/环境：朱巴教学医院的产妇。研究人群：包括研究期间在朱巴教学医院分娩的母亲及其新生儿。抽样：连续抽样技术最适合选择在研究期间分娩的母亲。数据收集与管理：数据使用 SPSS 23 版本进行分析。对参与者的特征进行了描述性分析。使用二元逻辑回归分析进行多变量分析，以确定 EPNM 的预测因素。统计意义以 p 值 0.05 为基础。结果早期围产期死亡率为每 1 000 例新生儿中有 122.3 例死亡，死胎率为每 1 000 例新生儿中有 82.7 例死亡，其中 14 例（41%）为死胎。与围产期早期死亡相关的因素有非正规教育（OR=5；95% CI 2.1-10.1；P 值 <0.000）、死胎史（OR=2.6；95% CI 1.1-6.3；P 值 0.04）、ANC < 4 次（OR=3.2；95% CI 1.5-7.0；P 值 0.0005）和孕龄小于 36 周（OR=5.1；95% CI 2.4-11；P 值 0.0001）与围产期早期死亡风险增加有关。而在研究期间，在 JTH 分娩的妇女中，奇数≥ 4（OR= 0.4；95% CI 0.2-0.09；P 值 0.04）似乎可显著降低 EPNM。结论缺乏正规教育、产妇年龄较小、曾有死胎史、产前门诊就诊率低以及早产等因素增加了在 JTH 分娩的产妇围产期早期死亡的风险。
{"title":"Early Perinatal Mortality and characteristic of mothers delivered at Juba Teaching Hospital, South Sudan: A Cross Sectional Study","authors":"W.P Flora, R.K Kamau, M.M James, O. Ogutu, J. Karanja, A. Osoti, O. Kireki, A. Kihara, R. Kosgei, M. Obimbo, A. Bosire, P.K Koigi, P. M. Ndavi","doi":"10.59692/jogeca.v32i1.199","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.199","url":null,"abstract":"Background/Objectives: Perinatal mortality rates are highest in Africa where it is more than five times higher than in developed regions. South Sudan has some of the worst health outcome indicators globally, in spite of modest improvements over the last five years. The aim of this study is to determine the magnitude and characteristic of women with early perinatal mortality at Juba Teaching Hospital, South Sudan. \u0000Methodology \u0000Study design: A cross-sectional study. \u0000Study site/setting: Juba Teaching Hospital maternal word. \u0000Study population: Comprised of mothers and their newborn babies delivered at JTH during the study period. \u0000Sampling: Consecutive sampling techniques was most appropriate for the selection of mothers who delivered their babies during the study period. \u0000Data collection & management: Data was analyzed using SPSS, version 23. Descriptive analysis was conducted to summarize characteristics of participants. Multivariable analysis conducted using binary logistic regression analysis to identify the predictors of EPNM. Statistical significance based on a p value of 0.05. \u0000Result: Early perinatal mortality rate was 122.3 per 1000 total birth with stillbirth rate of 82.7 per 1000 total births with majority attributable to fresh still births 14(41%). Factors associated with early perinatal mortality: Non-formal education ( OR=5; 95% CI 2.1-10.1 P val. <0.000) , pervious history of stillbirth, (OR = 2.6; 95% CI 1.1-6.3; p val. 0.04), ANC < 4 visit (OR=3.2, 95% CI 1.5-7.0; p val, 0.0005) and gestation age ≤ 36 weeks (OR= 5.1; 95% CI 2.4-11; p val. 0.0001), were associated with increased risk of EPNM. While parity of ≥ 4 (OR= 0.4; 95% CI 0.2-0.09; p val. 0.04), appeared to significantly, reduce EPNM among women delivered at JTH during the study period. \u0000Conclusions: The lack of formal education, younger maternal age, previous history of stillbirth, low antenatal clinic attendance and pre-term gestation increased the risk of early perinatal mortality among mothers delivered in JTH. \u0000 ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.202
F. Odera, J. Karanja, J. Kinuthia, O. Kireki, M. Kilonzo, A. Pulei, A. Kihara, M. Masinde, F. Odawa, R. Kosgei, O. Ogutu
Background: Polycystic ovary syndrome (PCOS) is the commonest endocrinological condition associated with anovulatory infertility in women. Worldwide, the prevalence is highly variable, ranging from 2.2% to as high as 26%. Similarly, the prevalence of PCOS is variable in Africa, occurring in about 1 in 6 infertile Nigerian women and 32% of infertile women in Tanzania. The variable prevalence could be attributable to multiplicity of diagnostic criteria, and similarity in presentation with other syndromes that present with amenorrhea and the population studied. Objectives: To determine the prevalence by criterion basis of PCOS among women with amenorrhea and oligomenorrhea attending the Kenyatta National Hospital in 2018. Methodology: This was a descriptive cross sectional study. The study population comprised of 131 women recruited at Kenyatta National Hospital gynecology department. Those enrolled, gave an informed consent, filled a questionnaire, had their anthropometric measurements taken, then underwent a pelvic ultrasound scan and a blood sample for serum free testosterone levels was taken. PCOS was determined using the Rotterdam 2003, the NIH 1990 and the AE-PCOS 2006 criteria. Results: PCOS was diagnosed in 49(37%) using the Rotterdam criteria, 26(20%) using the NIH 1990 criteria and 15(12%) using the AE-PCOS 2006 criteria. Conclusion: When the Rotterdam criteria is used, the prevalence is highest, followed by the NIH 1990 and lastly the AE-PCOS 2006. Recommendation: The Rotterdam criteria for diagnosis of PCOS should be used as it more representative.
{"title":"PREVALENCE BY CRITERION BASIS FOR POLYCYSTIC OVARY SYNDROME AMONG WOMEN PRESENTING WITH AMENORRHEA AND OLIGOMENORRHEA AT THE KENYATTA NATIONAL HOSPITAL IN 2018","authors":"F. Odera, J. Karanja, J. Kinuthia, O. Kireki, M. Kilonzo, A. Pulei, A. Kihara, M. Masinde, F. Odawa, R. Kosgei, O. Ogutu","doi":"10.59692/jogeca.v32i1.202","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.202","url":null,"abstract":"Background: Polycystic ovary syndrome (PCOS) is the commonest endocrinological condition associated with anovulatory infertility in women. Worldwide, the prevalence is highly variable, ranging from 2.2% to as high as 26%. Similarly, the prevalence of PCOS is variable in Africa, occurring in about 1 in 6 infertile Nigerian women and 32% of infertile women in Tanzania. The variable prevalence could be attributable to multiplicity of diagnostic criteria, and similarity in presentation with other syndromes that present with amenorrhea and the population studied. \u0000Objectives: To determine the prevalence by criterion basis of PCOS among women with amenorrhea and oligomenorrhea attending the Kenyatta National Hospital in 2018. \u0000Methodology: This was a descriptive cross sectional study. The study population comprised of 131 women recruited at Kenyatta National Hospital gynecology department. Those enrolled, gave an informed consent, filled a questionnaire, had their anthropometric measurements taken, then underwent a pelvic ultrasound scan and a blood sample for serum free testosterone levels was taken. PCOS was determined using the Rotterdam 2003, the NIH 1990 and the AE-PCOS 2006 criteria. \u0000Results: PCOS was diagnosed in 49(37%) using the Rotterdam criteria, 26(20%) using the NIH 1990 criteria and 15(12%) using the AE-PCOS 2006 criteria. \u0000Conclusion: When the Rotterdam criteria is used, the prevalence is highest, followed by the NIH 1990 and lastly the AE-PCOS 2006. \u0000Recommendation: The Rotterdam criteria for diagnosis of PCOS should be used as it more representative. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.201
M.A Okango, O.W Gachuno, H. Tamooh, P.K Koigi, A. Bosire, A. Osoti, M. Obimbo, C.B Wekesa, R. Kosgei, A. Kihara, O. Ogutu
Background: The World Health Organization (WHO) defines Early Pregnancy Loss (EPL) as termination of pregnancy before 20 weeks gestation or with a fetal weight of below 500grams. EPL occurs in 10% of all clinically recognized pregnancies, 80% of which occurs in the first trimester. About 50% of EPLs are due to chromosomal abnormalities. Other factors implicated include: immunologic; anatomic; endocrine; hematologic and micronutrient factors, including folic acid deficiency. This study aimed at assessing the association between serum folic acid levels and EPL among patients attending Ante natal services at the Kenyatta National Hospital (KNH). Methodology: This was a case control study where cases were women aged 18 to 40 years presenting with EPL (below 16 weeks of gestation) while the controls were women with viable pregnancy matched for gestation age. Consecutive sampling was used to identify 82 women with EPL and 95 women with normal pregnancy.2mls of blood was collected from the ante cubital fossa for assessment of folic acid levels. Results: There was a statistically significant difference in the median folic acid level between the EPL group and the normal pregnancy group (17.3ng/ml and 19.7ng/ml respectively) (p, 0.022). Using the KNH normal reference range for serum folic acid levels in pregnancy of 12.9 – 20ng/ml, there was no significant association between folate levels and EPL. Two-thirds in the EPL group (69.5%) and majority (89.5%) of the pregnant group were married. Pregnancy loss was significantly associated with marital status (p, 0.001), education level (p, 0.042), number of previous miscarriages (p, 0.003) and antenatal clinic attendance (p,0.016). Conclusion and recommendations: From our study we concluded that normal serum folate levels do not seem to confer protection against EPL in this population. Supplementation is essential to high risk population i.e. those with low education level, single status and those not attending antenatal clinics.It is recommended that WHO levels for normal serum folic acid be used as the normal and then conduct further studies using this standard.
{"title":"ASSOCIATION BETWEEN SERUM FOLATE LEVELS AND EARLY PREGNANCY LOSS AT KNH. A CASE CONTROL STUDY","authors":"M.A Okango, O.W Gachuno, H. Tamooh, P.K Koigi, A. Bosire, A. Osoti, M. Obimbo, C.B Wekesa, R. Kosgei, A. Kihara, O. Ogutu","doi":"10.59692/jogeca.v32i1.201","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.201","url":null,"abstract":"Background: The World Health Organization (WHO) defines Early Pregnancy Loss (EPL) as termination of pregnancy before 20 weeks gestation or with a fetal weight of below 500grams. EPL occurs in 10% of all clinically recognized pregnancies, 80% of which occurs in the first trimester. About 50% of EPLs are due to chromosomal abnormalities. Other factors implicated include: immunologic; anatomic; endocrine; hematologic and micronutrient factors, including folic acid deficiency. This study aimed at assessing the association between serum folic acid levels and EPL among patients attending Ante natal services at the Kenyatta National Hospital (KNH). \u0000Methodology: This was a case control study where cases were women aged 18 to 40 years presenting with EPL (below 16 weeks of gestation) while the controls were women with viable pregnancy matched for gestation age. Consecutive sampling was used to identify 82 women with EPL and 95 women with normal pregnancy.2mls of blood was collected from the ante cubital fossa for assessment of folic acid levels. \u0000Results: There was a statistically significant difference in the median folic acid level between the EPL group and the normal pregnancy group (17.3ng/ml and 19.7ng/ml respectively) (p, 0.022). Using the KNH normal reference range for serum folic acid levels in pregnancy of 12.9 – 20ng/ml, there was no significant association between folate levels and EPL. Two-thirds in the EPL group (69.5%) and majority (89.5%) of the pregnant group were married. Pregnancy loss was significantly associated with marital status (p, 0.001), education level (p, 0.042), number of previous miscarriages (p, 0.003) and antenatal clinic attendance (p,0.016). \u0000Conclusion and recommendations: From our study we concluded that normal serum folate levels do not seem to confer protection against EPL in this population. Supplementation is essential to high risk population i.e. those with low education level, single status and those not attending antenatal clinics.It is recommended that WHO levels for normal serum folic acid be used as the normal and then conduct further studies using this standard.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 91","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.198
Ogutu Omondi
{"title":"Editorial: Perinatal mortality in the region, are we prepared for this persistent matter in our midst?","authors":"Ogutu Omondi","doi":"10.59692/jogeca.v32i1.198","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.198","url":null,"abstract":"","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-31DOI: 10.59692/jogeca.v32i1.200
A.H Nima, R. Kosgei, A. Osoti, P.K Koigi, M. Obimbo, O. Ogutu, J. Karanja, A. Bosire, A. Kihara
Background: Antenatal care (ANC) ensures the best health conditions for both the mother and baby during pregnancy. Globally during the period 2007-2014 only 64% of pregnant women attended WHO recommended minimum of the four contacts for ANC. Somalia lacks local data on utilization of the ANC services yet this is important in maternal and newborn healthcare planning. The aim of this study was to determine the prevalence of early versus late attendance at antenatal clinic and describe the factors associated with the specified attendance at Medina Hospital, Somalia. Methodology: This is a comparative cross-sectional study conducted among early versus late antenatal attendees at Medina Hospital, Somalia between December 2018 to February 2019. 247 women who meet the inclusion criteria were seen at the clinic. Data was analyzed using IBM statistic SPSS version 23. Structured questionnaire was used to collect data. Statistical significance of association between variables was tested by the use of chi square or fisher’s exact test, with the T-test used to determine whether continuous data were significantly associated with late attendance. Results: Out of the 247 women, 149(60%) attended ANC early i.e.<12 weeks and 98(40%) attended late (≥12weeks). The average age was 28.4 (SD±7.17) years. Maternal age ≥ 26 years (OR 0.39, 95% CI 0.23 – 0.69, p<0.001), higher number of residents in the household (OR 3.11, 95% CI 1.75-5.52, p<0.001), distance >5km from the nearest health facility (OR 2.85, 95% CI 1.17-6.99, p=0.022) and lack of easy access to antenatal care service (OR 4.76; 95% CI 2.17-10.5; p =0.003). were associated with late attendance. On the contrary, urban residence (OR 3.26, 95%CI 1.33 – 0.82, p <0.001) and higher educational attainment (OR 0.40, 95% CI 0.23-0.67, p<0.001) were associated with early attendance. Although more than half of the participants were unemployed and had a monthly household income <200USD, these did not significantly influence the timing of antenatal attendance. Conclusion: Sociodemographic and reproductive factors influence the timing of seeking antenatal care. Three key strategies that can improve uptake of early antenatal care are: health education strategies to improve health-seeking behavior, increase the number of clinics in order to enhance access and provide free maternity care. Recommendation: Creating awareness and increasing sensitization of the importance of early attendance will help in early detection of complications and hence reduce the maternal morbidity and mortality.
{"title":"FACTORS ASSOCIATED WITH TIMING OF ANTENATAL CLINIC ATTENDANCE AT MEDINA HOSPITAL, SOMALIA","authors":"A.H Nima, R. Kosgei, A. Osoti, P.K Koigi, M. Obimbo, O. Ogutu, J. Karanja, A. Bosire, A. Kihara","doi":"10.59692/jogeca.v32i1.200","DOIUrl":"https://doi.org/10.59692/jogeca.v32i1.200","url":null,"abstract":"Background: Antenatal care (ANC) ensures the best health conditions for both the mother and baby during pregnancy. Globally during the period 2007-2014 only 64% of pregnant women attended WHO recommended minimum of the four contacts for ANC. Somalia lacks local data on utilization of the ANC services yet this is important in maternal and newborn healthcare planning. The aim of this study was to determine the prevalence of early versus late attendance at antenatal clinic and describe the factors associated with the specified attendance at Medina Hospital, Somalia. \u0000Methodology: This is a comparative cross-sectional study conducted among early versus late antenatal attendees at Medina Hospital, Somalia between December 2018 to February 2019. 247 women who meet the inclusion criteria were seen at the clinic. Data was analyzed using IBM statistic SPSS version 23. Structured questionnaire was used to collect data. Statistical significance of association between variables was tested by the use of chi square or fisher’s exact test, with the T-test used to determine whether continuous data were significantly associated with late attendance. \u0000Results: Out of the 247 women, 149(60%) attended ANC early i.e.<12 weeks and 98(40%) attended late (≥12weeks). The average age was 28.4 (SD±7.17) years. Maternal age ≥ 26 years (OR 0.39, 95% CI 0.23 – 0.69, p<0.001), higher number of residents in the household (OR 3.11, 95% CI 1.75-5.52, p<0.001), distance >5km from the nearest health facility (OR 2.85, 95% CI 1.17-6.99, p=0.022) and lack of easy access to antenatal care service (OR 4.76; 95% CI 2.17-10.5; p =0.003). were associated with late attendance. \u0000On the contrary, urban residence (OR 3.26, 95%CI 1.33 – 0.82, p <0.001) and higher educational attainment (OR 0.40, 95% CI 0.23-0.67, p<0.001) were associated with early attendance. Although more than half of the participants were unemployed and had a monthly household income <200USD, these did not significantly influence the timing of antenatal attendance. \u0000Conclusion: Sociodemographic and reproductive factors influence the timing of seeking antenatal care. Three key strategies that can improve uptake of early antenatal care are: health education strategies to improve health-seeking behavior, increase the number of clinics in order to enhance access and provide free maternity care. \u0000Recommendation: Creating awareness and increasing sensitization of the importance of early attendance will help in early detection of complications and hence reduce the maternal morbidity and mortality.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141219985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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