Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.137
Dr. Mary Kiria Koigi, Prof. R. Koigi Kamau, Dr. Paul Kamau Koigi
Infertility affects at least 15% of couples worldwide, and its prevalence is higher in low- and middle-income countries (LMICs). Although expensive, especially in LMICs, the uptake of assisted reproductive technology (ART) services is on the rise. The cohort of patients who utilize these services tend to be older and prone to pregnancy-related complications, such as hypertension and early pregnancy loss. Aspirin is not only affordable and accessible but also widely used for its antithrombotic and anti-inflammatory effects, which may counteract implantation failure or miscarriage. Although this sounds logical, sufficient evidence has not been adduced. In addition, there is currently no consensus on the dosage of aspirin. It is important to consider the therapeutic advantages of aspirin in pregnancies conceived through ART to optimize pregnancy outcomes. There is a need for more research on the benefits that may be accrued using aspirin in ART and other high-risk pregnancies.
全世界至少有 15%的夫妇患有不孕症，而中低收入国家（LMICs）的不孕症发病率更高。虽然费用昂贵，但辅助生殖技术（ART）服务的使用率却在不断上升，尤其是在中低收入国家。使用这些服务的患者往往年龄较大，容易出现妊娠相关并发症，如高血压和早孕反应。 阿司匹林不仅价格低廉、容易获得，而且因其抗血栓和消炎作用而被广泛使用，可预防着床失败或流产。 虽然这听起来合乎逻辑，但还没有足够的证据。此外，目前对阿司匹林的用量还没有达成共识。重要的是要考虑阿司匹林对通过 ART 受孕的孕妇的治疗优势，以优化妊娠结局。有必要对 ART 和其他高危妊娠使用阿司匹林可能带来的益处进行更多研究。
{"title":"Value of aspirin in assisted reproductive technology","authors":"Dr. Mary Kiria Koigi, Prof. R. Koigi Kamau, Dr. Paul Kamau Koigi","doi":"10.59692/jogeca.v36i1.137","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.137","url":null,"abstract":"Infertility affects at least 15% of couples worldwide, and its prevalence is higher in low- and middle-income countries (LMICs). Although expensive, especially in LMICs, the uptake of assisted reproductive technology (ART) services is on the rise. The cohort of patients who utilize these services tend to be older and prone to pregnancy-related complications, such as hypertension and early pregnancy loss. Aspirin is not only affordable and accessible but also widely used for its antithrombotic and anti-inflammatory effects, which may counteract implantation failure or miscarriage. Although this sounds logical, sufficient evidence has not been adduced. In addition, there is currently no consensus on the dosage of aspirin. It is important to consider the therapeutic advantages of aspirin in pregnancies conceived through ART to optimize pregnancy outcomes. There is a need for more research on the benefits that may be accrued using aspirin in ART and other high-risk pregnancies.\u0000","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"263 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139893854","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.v36i1.297
Rafique Parkar
For 35 years, there has been a rapid spread and evolution of laparoscopic surgery in the developed world, where this modality is now regarded as a safe and first choice for up to 98% of all surgical interventions by adequately trained surgeons. The advantages of laparoscopic surgery are now well established. Surgeons must be encouraged to undergo the required training to provide safe laparoscopic surgery. Having pursued my Master’s in Obstetrics and Gynecology at the University of Nairobi, I was posted to Kilifi District Hospital where I served for nine years. I later moved back to Mombasa and ventured into private practice. I developed an interest in and pioneered minimal access surgery in 1994. I developed an immense interest and passion in minimal access surgery and initially pursued a Diploma in Laparoscopic Surgery at the Coimbatore Institute of Gastrointestinal Endosurgery (CIGES). Subsequently, I attended dedicated workshops and additional training in Kiel, Hamburg (Germany), Clermont-Ferrand and Strasbourg (France), and various institutions in Asia and Europe, attending over 40 dedicated workshops, including advanced laparoscopic and hysteroscopic procedures. In 2000, I moved my practice to Nairobi and worked at various private institutions. To increase the awareness of laparoscopic surgery in Kenya. I organized workshops and encouraged many gynecologists and general surgeons to embrace change. I was later fortunate to be invited to several African countries where I trained and mentored numerous surgeons. In conclusion, laparoscopic surgery faces many challenges but is a safe and effective alternative to the traditional open modalities of surgery. The training of surgeons and support staff should be made a priority. I pray that my journey will be an inspiration and encouragement to many in our fraternity in the years ahead.
{"title":"Laparoscopic surgery: My Journey","authors":"Rafique Parkar","doi":"10.59692/jogeca.v36i1.297","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.297","url":null,"abstract":"For 35 years, there has been a rapid spread and evolution of laparoscopic surgery in the developed world, where this modality is now regarded as a safe and first choice for up to 98% of all surgical interventions by adequately trained surgeons. The advantages of laparoscopic surgery are now well established. Surgeons must be encouraged to undergo the required training to provide safe laparoscopic surgery. Having pursued my Master’s in Obstetrics and Gynecology at the University of Nairobi, I was posted to Kilifi District Hospital where I served for nine years. I later moved back to Mombasa and ventured into private practice. I developed an interest in and pioneered minimal access surgery in 1994. I developed an immense interest and passion in minimal access surgery and initially pursued a Diploma in Laparoscopic Surgery at the Coimbatore Institute of Gastrointestinal Endosurgery (CIGES). Subsequently, I attended dedicated workshops and additional training in Kiel, Hamburg (Germany), Clermont-Ferrand and Strasbourg (France), and various institutions in Asia and Europe, attending over 40 dedicated workshops, including advanced laparoscopic and hysteroscopic procedures. In 2000, I moved my practice to Nairobi and worked at various private institutions. To increase the awareness of laparoscopic surgery in Kenya. I organized workshops and encouraged many gynecologists and general surgeons to embrace change. I was later fortunate to be invited to several African countries where I trained and mentored numerous surgeons. In conclusion, laparoscopic surgery faces many challenges but is a safe and effective alternative to the traditional open modalities of surgery. The training of surgeons and support staff should be made a priority. I pray that my journey will be an inspiration and encouragement to many in our fraternity in the years ahead.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"39 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964010","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.v36i1.138
Justus Wambugu, Bob Achila
Background: Urinary tract endometriosis (UTE) is the presence of endometriotic implants in the bladder,ureter, kidneys, or urethra. It affects ~1% of women with endometriosis and occurs more commonlyamong those with deep infiltrative endometriosis. Bladder endometriosis is the most commonpresentation, comprising 85% of cases. Concomitant involvement of the bladder and ureter is rare,comprising 1.4% of all cases. The clinical presentation involves lower urinary tract symptoms, thatworsen during menses. Timely diagnosis and treatment are crucial in ameliorating symptoms andpreventing complications, such as obstructive nephropathy. This is a case of bladder endometriosis withureteral involvement, outlining management challenges, reviewing evidence on managementapproaches, and highlighting the experience gained from this case in managing complex UTE.Case presentation: A 38-year-old female presented with a longstanding history of pelvic pain, dysuria,and new-onset voiding difficulty. She had undergone two prior surgical procedures for endometriosis,including a total abdominal hysterectomy. Her physical examination was normal. Ultrasound revealed a3-cm intracavitary bladder mass, which was described as likely endometriosis on magnetic resonanceimaging. On cystoscopy the mass was noted to be larger, encasing the left ureteric meatus. Alaparoscopic cystostomy was performed, with partial resection of the mass and placement of a temporaryureteric stent. After three months of medical treatment with dienogest, cystoscopy revealed a significantreduction in size with sub-centimeter residual avascular tissue. This was resected avoiding the ureter andureteric meatus. A new ureteric stent was placed. A repeat cystoscopy three months later revealed goodhealing with no residual endometriosis. The stent was removed, and a retrograde pyelogram confirmedno meatal stenosis or ureteric obstruction. She has remained symptom-free.Conclusion: Medical and surgical options are available for bladder endometriosis, with partialcystectomy being the gold standard. The initial approach is dependent on the size of the lesion and theextent of ureteric involvement. A staged approach that combines medical or surgical management canensure optimal outcomes while reducing surgery-associated morbidity in complex cases.
{"title":"Bladder endometriosis – diagnostic and management challenges: A case report","authors":"Justus Wambugu, Bob Achila","doi":"10.59692/jogeca.v36i1.138","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.138","url":null,"abstract":"Background: Urinary tract endometriosis (UTE) is the presence of endometriotic implants in the bladder,ureter, kidneys, or urethra. It affects ~1% of women with endometriosis and occurs more commonlyamong those with deep infiltrative endometriosis. Bladder endometriosis is the most commonpresentation, comprising 85% of cases. Concomitant involvement of the bladder and ureter is rare,comprising 1.4% of all cases. The clinical presentation involves lower urinary tract symptoms, thatworsen during menses. Timely diagnosis and treatment are crucial in ameliorating symptoms andpreventing complications, such as obstructive nephropathy. This is a case of bladder endometriosis withureteral involvement, outlining management challenges, reviewing evidence on managementapproaches, and highlighting the experience gained from this case in managing complex UTE.Case presentation: A 38-year-old female presented with a longstanding history of pelvic pain, dysuria,and new-onset voiding difficulty. She had undergone two prior surgical procedures for endometriosis,including a total abdominal hysterectomy. Her physical examination was normal. Ultrasound revealed a3-cm intracavitary bladder mass, which was described as likely endometriosis on magnetic resonanceimaging. On cystoscopy the mass was noted to be larger, encasing the left ureteric meatus. Alaparoscopic cystostomy was performed, with partial resection of the mass and placement of a temporaryureteric stent. After three months of medical treatment with dienogest, cystoscopy revealed a significantreduction in size with sub-centimeter residual avascular tissue. This was resected avoiding the ureter andureteric meatus. A new ureteric stent was placed. A repeat cystoscopy three months later revealed goodhealing with no residual endometriosis. The stent was removed, and a retrograde pyelogram confirmedno meatal stenosis or ureteric obstruction. She has remained symptom-free.Conclusion: Medical and surgical options are available for bladder endometriosis, with partialcystectomy being the gold standard. The initial approach is dependent on the size of the lesion and theextent of ureteric involvement. A staged approach that combines medical or surgical management canensure optimal outcomes while reducing surgery-associated morbidity in complex cases.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"99 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964112","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.v36i1.122
Joel Ooko Ojwando, Dorcas Waithira Maina, Esther Nafula, Eunice Cheserem
Background: Cervical cancer is the leading cause of cancer-related deaths among women in Kenya.Patients present late when the cure is unattainable and have an impaired quality of life (QoL). Pain is theworst and most common cause of impaired QoL. Poor control is due to a focus on the physical aspect ofpain only rather than the holistic approach that also considers the nonphysical factors, includingpsychological, social, spiritual, economic, and information needs aspects of pain. Information need isdefined as a state in which one perceives a gap between information and knowledge available to solve aproblem. There is inadequate information exchange between health care providers and cervical cancerpatients in Kenya, with such patients reporting that inadequate information prolonged their suffering asthey sought diagnosis and treatment. There have been recommendations that communication guidelinesbe developed, and communication training skills be developed in a culturally relevant way. Differences incultural and socioeconomic contexts may impede this goal.Objective: To explore information needs factors among patients with cervical cancer stages III and IV atthe Kenyatta National Hospital.Methods: Qualitative research using a descriptive phenomenological study involving fifteen in-depthinterviews and five focus group discussions was conducted.Results: This study revealed poor methods of breaking bad news, conflicts in the disclosure of bad newsto patients, inadequate information on the investigations and procedures needed, and doctors’unavailability to provide detailed information, especially those that require seeking money from relatives.Conclusion: Information needs remain a gap affecting pain experienced by cervical cancer patients.
背景：宫颈癌是肯尼亚妇女因癌症死亡的主要原因。患者在无法治愈的情况下很晚才就诊，生活质量（QoL）受到影响。疼痛是导致生活质量下降的最严重和最常见的原因。疼痛控制不佳的原因在于只关注疼痛的生理方面，而没有采取整体方法来考虑非生理因素，包括疼痛的心理、社会、精神、经济和信息需求方面。信息需求被定义为一种状态，在这种状态下，人们认为解决问题所需的信息和知识之间存在差距。在肯尼亚，医疗服务提供者与宫颈癌患者之间的信息交流不足，这些患者表示，信息不足延长了他们在寻求诊断和治疗时的痛苦。有人建议制定沟通指南，并以文化相关的方式发展沟通培训技能。文化和社会经济背景的差异可能会阻碍这一目标的实现：探讨肯雅塔国立医院宫颈癌 III 期和 IV 期患者的信息需求因素：方法：采用描述性现象学研究方法进行定性研究，包括 15 次深入访谈和 5 次焦点小组讨论：结果：研究显示，告知坏消息的方法不当，向患者披露坏消息时存在冲突，关于所需的检查和程序的信息不足，医生无法提供详细信息，尤其是那些需要向亲属要钱的信息：结论：信息需求仍然是影响宫颈癌患者疼痛的一个缺口。
{"title":"Information needs factors affecting pain experience among patients with cervical cancer stages III and IV at the Kenyatta National Hospital: A descriptive phenomenology study","authors":"Joel Ooko Ojwando, Dorcas Waithira Maina, Esther Nafula, Eunice Cheserem","doi":"10.59692/jogeca.v36i1.122","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.122","url":null,"abstract":"Background: Cervical cancer is the leading cause of cancer-related deaths among women in Kenya.Patients present late when the cure is unattainable and have an impaired quality of life (QoL). Pain is theworst and most common cause of impaired QoL. Poor control is due to a focus on the physical aspect ofpain only rather than the holistic approach that also considers the nonphysical factors, includingpsychological, social, spiritual, economic, and information needs aspects of pain. Information need isdefined as a state in which one perceives a gap between information and knowledge available to solve aproblem. There is inadequate information exchange between health care providers and cervical cancerpatients in Kenya, with such patients reporting that inadequate information prolonged their suffering asthey sought diagnosis and treatment. There have been recommendations that communication guidelinesbe developed, and communication training skills be developed in a culturally relevant way. Differences incultural and socioeconomic contexts may impede this goal.Objective: To explore information needs factors among patients with cervical cancer stages III and IV atthe Kenyatta National Hospital.Methods: Qualitative research using a descriptive phenomenological study involving fifteen in-depthinterviews and five focus group discussions was conducted.Results: This study revealed poor methods of breaking bad news, conflicts in the disclosure of bad newsto patients, inadequate information on the investigations and procedures needed, and doctors’unavailability to provide detailed information, especially those that require seeking money from relatives.Conclusion: Information needs remain a gap affecting pain experienced by cervical cancer patients.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"118 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963626","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.v36i1.121
Dr. Poli Philippe Amubuomombe, Kosgei Wycliffe, K. T. Philip, M. M. Richard, Sarah K. Esendi, Ngeleche Ruth, Nyongesa Paul, Irene Koech, Jignesh K Jesanii, Esther Wanjama, Rajshree K Hirani, Emily Chesire, Audrey K. Chepkemboi, Deborah V. Makasi, Vahista J. Shroff, Bett C.Kipchumba, Pallavi Mishra, Philip Kirwa, Wilson K. Aruasa, Ann Mwangi, Elkannah O. Orang'o
BACKGROUND: Hydrops fetalis is a fetal condition associated with higher perinatal and neonatal mortality and morbidity. The overall survival rate from the diagnosis is today estimated to be 27% despite advanced intrauterine and neonatal care. Factors that contribute to poor perinatal and neonatal outcomes have been identified; however, little is known about the existing specific predictor tool of perinatal outcome by mode of delivery. OBJECTIVE: the study aimed to determine whether cesarean section does improve the perinatal outcomes of hydrops fetalis infants. STUDY DESIGN: This was a retrospective cohort study that retrieved 102 medical records of pregnancies complicated by hydrops fetalis. For all those women, the transabdominal ultrasound was performed during pregnancy as part of the standard diagnostic modality of intrauterine hydrops fetalis. All pregnant women’s and their newborn’s medical records were retrieved and reviewed to collect information related to the outcomes as per the mode of delivery either by cesarean section or vaginal delivery. Based on the severity of fetal disease as described by obstetric ultrasound findings, pregnant women were divided into 4 groups: mild, moderate, moderately severe, and severe hydrops fetalis. The significance of the obtained data was set at two-tailed p<0.05. The chi-squared test was used to compare categorical between groups based on outcomes. Fisher’s exact test or Monte Carlo correction was used for chi-squared analysis when more than 20% of the cells had an expected count <5. The odds ratio and 95% confidence interval for perinatal adverse outcomes were calculated using logistic regression. RESULTS: The incidence of hydrops fetalis was estimated to be 1.1% in this cohort study. The non-immune hydrops fetalis was the common type, accounting for 75.6% of all cases. Perinatal mortality occurred in 55.9% and the 7-day survival was estimated at 44.1%. The mortality rate was 66.1% in non-immune hydrops fetalis. There was a statistically significant association between the mode of delivery and the overall survival (pv-0.04). However, survival was increased in class I and class II (55.0%), while survival was equally observed in classes III and IV (22.5%). There was a statistically significant association between the class and survival (pv <.001). Birth weight of ≥3000 grams was associated with reduced poor perinatal outcomes at 0.3% (pv-0.02, 95% CI=0.14 -0.85). Similarly, admission to the newborn unit was associated with reduced mortality by 2.5% (pv-0.04, 95% CI=1.0 - 6.4). CONCLUSION: Cesarean section delivery does not improve the perinatal outcomes of hydrops fetalis newborns and it should be considered only for maternal concerns. The predictor tool of perinatal outcomes of hydrops fetalis infant per mode of delivery is a useful tool to assist in decision-making and predict the perinatal outcome of hydrops fetalis per mode of delivery.
{"title":"Predictors of Hydrops Fetalis Infants by Mode of Delivery","authors":"Dr. Poli Philippe Amubuomombe, Kosgei Wycliffe, K. T. Philip, M. M. Richard, Sarah K. Esendi, Ngeleche Ruth, Nyongesa Paul, Irene Koech, Jignesh K Jesanii, Esther Wanjama, Rajshree K Hirani, Emily Chesire, Audrey K. Chepkemboi, Deborah V. Makasi, Vahista J. Shroff, Bett C.Kipchumba, Pallavi Mishra, Philip Kirwa, Wilson K. Aruasa, Ann Mwangi, Elkannah O. Orang'o","doi":"10.59692/jogeca.v36i1.121","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.121","url":null,"abstract":"BACKGROUND: Hydrops fetalis is a fetal condition associated with higher perinatal and neonatal mortality and morbidity. The overall survival rate from the diagnosis is today estimated to be 27% despite advanced intrauterine and neonatal care. Factors that contribute to poor perinatal and neonatal outcomes have been identified; however, little is known about the existing specific predictor tool of perinatal outcome by mode of delivery. \u0000OBJECTIVE: the study aimed to determine whether cesarean section does improve the perinatal outcomes of hydrops fetalis infants. \u0000STUDY DESIGN: This was a retrospective cohort study that retrieved 102 medical records of pregnancies complicated by hydrops fetalis. For all those women, the transabdominal ultrasound was performed during pregnancy as part of the standard diagnostic modality of intrauterine hydrops fetalis. All pregnant women’s and their newborn’s medical records were retrieved and reviewed to collect information related to the outcomes as per the mode of delivery either by cesarean section or vaginal delivery. Based on the severity of fetal disease as described by obstetric ultrasound findings, pregnant women were divided into 4 groups: mild, moderate, moderately severe, and severe hydrops fetalis. The significance of the obtained data was set at two-tailed p<0.05. The chi-squared test was used to compare categorical between groups based on outcomes. Fisher’s exact test or Monte Carlo correction was used for chi-squared analysis when more than 20% of the cells had an expected count <5. The odds ratio and 95% confidence interval for perinatal adverse outcomes were calculated using logistic regression. \u0000RESULTS: The incidence of hydrops fetalis was estimated to be 1.1% in this cohort study. The non-immune hydrops fetalis was the common type, accounting for 75.6% of all cases. Perinatal mortality occurred in 55.9% and the 7-day survival was estimated at 44.1%. The mortality rate was 66.1% in non-immune hydrops fetalis. There was a statistically significant association between the mode of delivery and the overall survival (pv-0.04). However, survival was increased in class I and class II (55.0%), while survival was equally observed in classes III and IV (22.5%). There was a statistically significant association between the class and survival (pv <.001). Birth weight of ≥3000 grams was associated with reduced poor perinatal outcomes at 0.3% (pv-0.02, 95% CI=0.14 -0.85). Similarly, admission to the newborn unit was associated with reduced mortality by 2.5% (pv-0.04, 95% CI=1.0 - 6.4). \u0000CONCLUSION: Cesarean section delivery does not improve the perinatal outcomes of hydrops fetalis newborns and it should be considered only for maternal concerns. The predictor tool of perinatal outcomes of hydrops fetalis infant per mode of delivery is a useful tool to assist in decision-making and predict the perinatal outcome of hydrops fetalis per mode of delivery. \u0000 \u0000 ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"112 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963643","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.v36i1.189
Dorcas Muchiri
Background: Menopause is a retrospective diagnosis defined by the World Health Organization as thepermanent cessation of menstruation resulting from the loss of ovarian follicular activity. With morewomen living longer, all those above the age of 50 years will experience menopause, with a smallernumber experiencing this before 40 – 49 years without their knowledge. Menopause contributes tosignificant public health conditions, such as cardiovascular, bone, cognitive, and mental healthconditions. The Menopause Rating Scale (MRS) is an internationally validated tool for measuring theseverity of menopausal symptoms. The WHO notes a challenge in awareness and access tomenopause-related information and treatment for women and health care providers in most countries.Little is known about the experience of menopause in African women, and the MRS scale has limited usein the Kenyan setting, presenting gaps in research and practice.Objectives: To raise awareness of menopause and test the usability and local context of MRS in theassessment of menopausal symptoms in African women.Methods: 304 of 403 attendees on an urban community health education day voluntarily completed asurvey adapted from the MRS.Results: While 80% of women globally report hot flushes as the commonest symptom, only 41% ofwomen over 50 years if age had hot flushes. The most common symptoms were musculoskeletal painand mood swings at 74.1% and 45.8%, respectively.Conclusion: Work is needed to streamline the use and adaptability of the MRS for Swahili-speakingcountries. More community health awareness, research, and advocacy are needed to address thepublic health concerns arising from menopause in Africa.
{"title":"A Spotlight on Menopause in Africa","authors":"Dorcas Muchiri","doi":"10.59692/jogeca.v36i1.189","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.189","url":null,"abstract":"Background: Menopause is a retrospective diagnosis defined by the World Health Organization as thepermanent cessation of menstruation resulting from the loss of ovarian follicular activity. With morewomen living longer, all those above the age of 50 years will experience menopause, with a smallernumber experiencing this before 40 – 49 years without their knowledge. Menopause contributes tosignificant public health conditions, such as cardiovascular, bone, cognitive, and mental healthconditions. The Menopause Rating Scale (MRS) is an internationally validated tool for measuring theseverity of menopausal symptoms. The WHO notes a challenge in awareness and access tomenopause-related information and treatment for women and health care providers in most countries.Little is known about the experience of menopause in African women, and the MRS scale has limited usein the Kenyan setting, presenting gaps in research and practice.Objectives: To raise awareness of menopause and test the usability and local context of MRS in theassessment of menopausal symptoms in African women.Methods: 304 of 403 attendees on an urban community health education day voluntarily completed asurvey adapted from the MRS.Results: While 80% of women globally report hot flushes as the commonest symptom, only 41% ofwomen over 50 years if age had hot flushes. The most common symptoms were musculoskeletal painand mood swings at 74.1% and 45.8%, respectively.Conclusion: Work is needed to streamline the use and adaptability of the MRS for Swahili-speakingcountries. More community health awareness, research, and advocacy are needed to address thepublic health concerns arising from menopause in Africa.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894493","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.v36i1.178
Rukia Gang'ombe, Rosa Chemwey
Background: Rhesus alloimmunization is a significant cause of perinatal morbidity in sub-SaharanAfrica.Case presentation: A 28-year-old para 2+2 gravida 5, rhesus-negative mother with no living childpresented to the Kenyatta National Hospital (KNH) antenatal clinic at 20 weeks of gestation as a referralbecause of a bad obstetric history secondary to rhesus D alloimmunization following a positive indirectCoombs test. She was started on methylprednisolone, and serial middle cerebral artery peak systolicvelocity (MCA-PSV) monitoring was performed until 32 weeks of gestation when the fetus developedhemolytic disease of the newborn diagnosed via cordocentesis. She underwent two sessions ofintrauterine transfusion and had a successful cesarean delivery at 34 weeks and 1 day of gestation. Theneonate was admitted to the KNH neonatal intensive care unit where he was managed for hemolyticdisease of the newborn, 33 days after which he was successfully discharged home.Conclusion: The role of maternal-fetal specialists in the diagnosis, antenatal follow-up, and timelymanagement of rhesus D alloimmunization is key in the prevention of adverse perinatal outcomes.
{"title":"Rhesus alloimmunization in pregnancy. A Tertiary Care Center Experience in Kenya. A Case Report","authors":"Rukia Gang'ombe, Rosa Chemwey","doi":"10.59692/jogeca.v36i1.178","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.178","url":null,"abstract":"Background: Rhesus alloimmunization is a significant cause of perinatal morbidity in sub-SaharanAfrica.Case presentation: A 28-year-old para 2+2 gravida 5, rhesus-negative mother with no living childpresented to the Kenyatta National Hospital (KNH) antenatal clinic at 20 weeks of gestation as a referralbecause of a bad obstetric history secondary to rhesus D alloimmunization following a positive indirectCoombs test. She was started on methylprednisolone, and serial middle cerebral artery peak systolicvelocity (MCA-PSV) monitoring was performed until 32 weeks of gestation when the fetus developedhemolytic disease of the newborn diagnosed via cordocentesis. She underwent two sessions ofintrauterine transfusion and had a successful cesarean delivery at 34 weeks and 1 day of gestation. Theneonate was admitted to the KNH neonatal intensive care unit where he was managed for hemolyticdisease of the newborn, 33 days after which he was successfully discharged home.Conclusion: The role of maternal-fetal specialists in the diagnosis, antenatal follow-up, and timelymanagement of rhesus D alloimmunization is key in the prevention of adverse perinatal outcomes.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"69 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894526","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.v36i1.293
Michael Maina, Hassan Mjahid, Joan Okemo
Background: The incidence of ovarian cysts in pregnancy is postulated to be approximately 3%. Most ofthese cysts are benign, with 6% of them being benign. Most of these masses are diagnosed incidentallyduring routine ultrasound. The most common are functional cysts. Most of these cysts do not havesymptoms and are managed conservatively. For persistent symptomatic cysts, medical and surgicalmanagement is a viable option.Case series: We present cases of three patients, two of whom were managed conservatively. One of thepatients with a corpus luteum cyst was managed surgically and did well, whereas the other two patientswere noted to have asymptomatic dermoid cysts. Pregnancy outcomes for the two who delivered wereunaffected, including their modes of delivery.Conclusion: Adnexal masses are common during pregnancy. There is a need to evaluate andcharacterize these masses even during pregnancy. Management options for adnexal masses areprimarily conservative, but for masses that meet the criteria for surgical management, surgery is safe,especially in the second trimester. A laparoscopic approach for abdominal surgery in the second trimesteris feasible and relatively safe, as demonstrated in the present case. Modification of entry and surgicalapproaches and preoperative planning are important when considering surgery during pregnancy. Reliefof pain symptoms during pregnancy will lead to a positive pregnancy experience.
{"title":"Approaches to the management of ovarian cysts in pregnancy: A case series","authors":"Michael Maina, Hassan Mjahid, Joan Okemo","doi":"10.59692/jogeca.v36i1.293","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.293","url":null,"abstract":"Background: The incidence of ovarian cysts in pregnancy is postulated to be approximately 3%. Most ofthese cysts are benign, with 6% of them being benign. Most of these masses are diagnosed incidentallyduring routine ultrasound. The most common are functional cysts. Most of these cysts do not havesymptoms and are managed conservatively. For persistent symptomatic cysts, medical and surgicalmanagement is a viable option.Case series: We present cases of three patients, two of whom were managed conservatively. One of thepatients with a corpus luteum cyst was managed surgically and did well, whereas the other two patientswere noted to have asymptomatic dermoid cysts. Pregnancy outcomes for the two who delivered wereunaffected, including their modes of delivery.Conclusion: Adnexal masses are common during pregnancy. There is a need to evaluate andcharacterize these masses even during pregnancy. Management options for adnexal masses areprimarily conservative, but for masses that meet the criteria for surgical management, surgery is safe,especially in the second trimester. A laparoscopic approach for abdominal surgery in the second trimesteris feasible and relatively safe, as demonstrated in the present case. Modification of entry and surgicalapproaches and preoperative planning are important when considering surgery during pregnancy. Reliefof pain symptoms during pregnancy will lead to a positive pregnancy experience.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"59 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894533","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.v36i1.185
Martin Odhiambo, Wanyonyi Sikolia, Maina Michael
Background: Twin-to-twin transfusion syndrome (TTTS) affects up to 20% of monochorionic pregnancies and has a mortality rate as high as 90% without timely intervention. The underlying mechanism is believed to be unbalanced placental blood flow via arteriovenous anastomoses. Early diagnosis and prompt management are crucial. Case series: This study presents four cases of TTTS managed at Aga Khan University Hospital Nairobi, highlighting the challenges faced. Case 1: We diagnosed stage 2 TTTS and selective fetal growth restriction in a 21-year-old with a monochorionic diamniotic (MCDA) twin pregnancy. TTTS progressed to Stage 5 despite undergoing serial amnioreduction. Financial constraints and religious beliefs complicated continued care, necessitating transfer to another facility. Case 2: A 28-year-old with a MCDA twin pregnancy presented with abdominal discomfort. We diagnosed stage 1 TTTS and opted for expectant management. The patients was lost to follow-up despite presenting later with symptoms of worsening TTTS, increased abdominal discomfort, and reduction in fetal movements. Case 3: We diagnosed stage 2 TTTS in a 30-year-old with MCDA twin pregnancy. The patient opted for the termination of pregnancy, highlighting the complex ethical considerations involved in TTTS management. Case 4: A 24-year-old with an MCDA twin pregnancy and stage 2 TTTS at 24 weeks of gestation was scheduled for amnioreduction but experienced prelabor rupture of membranes a priori. She eventually experienced the neonatal demise of both twins. Discussion: These cases illustrate the challenges faced in managing TTTS in a resource-limited setting. Delayed diagnosis due to inadequate prenatal care, limited access to specialist centers, and financial constraints are significant obstacles. The unavailability of fetal laser ablation, the gold standard treatment, necessitates reliance on palliative measures, such as serial amnioreduction, with limited effectiveness. Conclusion: Expanding access to prenatal care through telemedicine in rural areas can enable an early diagnosis. Upgrading healthcare infrastructure and addressing financial barriers are crucial to facilitate regular follow-up and access to advanced interventions, such as laser coagulation, thus improving the prognosis of TTTS.
{"title":"Twin-to-twin transfusion syndrome – challenges in management: A case series","authors":"Martin Odhiambo, Wanyonyi Sikolia, Maina Michael","doi":"10.59692/jogeca.v36i1.185","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.185","url":null,"abstract":"Background: Twin-to-twin transfusion syndrome (TTTS) affects up to 20% of monochorionic pregnancies and has a mortality rate as high as 90% without timely intervention. The underlying mechanism is believed to be unbalanced placental blood flow via arteriovenous anastomoses. Early diagnosis and prompt management are crucial. \u0000Case series: This study presents four cases of TTTS managed at Aga Khan University Hospital Nairobi, highlighting the challenges faced. \u0000Case 1: We diagnosed stage 2 TTTS and selective fetal growth restriction in a 21-year-old with a monochorionic diamniotic (MCDA) twin pregnancy. TTTS progressed to Stage 5 despite undergoing serial amnioreduction. Financial constraints and religious beliefs complicated continued care, necessitating transfer to another facility. \u0000Case 2: A 28-year-old with a MCDA twin pregnancy presented with abdominal discomfort. We diagnosed stage 1 TTTS and opted for expectant management. The patients was lost to follow-up despite presenting later with symptoms of worsening TTTS, increased abdominal discomfort, and reduction in fetal movements. \u0000Case 3: We diagnosed stage 2 TTTS in a 30-year-old with MCDA twin pregnancy. The patient opted for the termination of pregnancy, highlighting the complex ethical considerations involved in TTTS management. \u0000Case 4: A 24-year-old with an MCDA twin pregnancy and stage 2 TTTS at 24 weeks of gestation was scheduled for amnioreduction but experienced prelabor rupture of membranes a priori. She eventually experienced the neonatal demise of both twins. \u0000Discussion: These cases illustrate the challenges faced in managing TTTS in a resource-limited setting. Delayed diagnosis due to inadequate prenatal care, limited access to specialist centers, and financial constraints are significant obstacles. The unavailability of fetal laser ablation, the gold standard treatment, necessitates reliance on palliative measures, such as serial amnioreduction, with limited effectiveness. \u0000Conclusion: Expanding access to prenatal care through telemedicine in rural areas can enable an early diagnosis. Upgrading healthcare infrastructure and addressing financial barriers are crucial to facilitate regular follow-up and access to advanced interventions, such as laser coagulation, thus improving the prognosis of TTTS.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"502 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894692","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.v36i1.148
Gathoni Muriithi, A.B Kihara, P. Kigamwa
Background: Postpartum depression (PPD) is a depressive episode that occurs in women within 6 weeks of parturition. It has a global prevalence of 13-19%. Long-term consequences include a high likelihood of experiencing depression in mothers, suicide, and infanticide. There is currently no routine screening for postpartum depression at the postnatal clinic. Objectives: To determine the prevalence of postpartum depression among adolescent mothers, characteristics, and associated determinants in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH). Methods: This was a cross-sectional study, involving 162 consenting postnatal adolescent mothers (14-19 years) at Kenyatta National and Pumwani Maternity hospitals. Consecutive sampling was employed. Data were collected using a structured sociodemographic questionnaire and the Edinburg Postpartum Depression Scale (EPDS). Data were analyzed using SPSS version 25. Results: Of all participants, 77.2% were from PMH and 22.8% were from KNH. Most participants were 18–19 years old, had primary education as the highest entry level, were single, depended on their parents for financial support, and were Christians. For obstetric characteristics, the majority had no history of miscarriage, were primipara, had unintended pregnancy, had amenorrhea as the first symptom, had an initial antenatal clinic (ANC) visit during the first trimester, had at least four ANC visits, and delivered via spontaneous vaginal birth. The prevalence of postpartum depression was 22.2%. The most prominent characteristics of PPD were feeling overwhelmed, sadness, anxiety, and crying episodes. Associated determinants of PPD in adolescent mothers were age <18 years, starting ANC visits after the second trimester, less than four ANC visits, being HIV-positive, unsupportive partner, and having a post-delivery illness for the mother. Conclusion: This study established that approximately one in four adolescent mothers are likely to suffer from postpartum depression.
{"title":"Prevalence, characteristics, and associated determinants of postpartum depression among adolescent mothers in Kenyatta National Hospital and Pumwani Maternity Hospital from March to July 2023: A prospective, cross-sectional study","authors":"Gathoni Muriithi, A.B Kihara, P. Kigamwa","doi":"10.59692/jogeca.v36i1.148","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.148","url":null,"abstract":"Background: Postpartum depression (PPD) is a depressive episode that occurs in women within 6 weeks of parturition. It has a global prevalence of 13-19%. Long-term consequences include a high likelihood of experiencing depression in mothers, suicide, and infanticide. There is currently no routine screening for postpartum depression at the postnatal clinic.\u0000Objectives: To determine the prevalence of postpartum depression among adolescent mothers, characteristics, and associated determinants in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH).\u0000Methods: This was a cross-sectional study, involving 162 consenting postnatal adolescent mothers (14-19 years) at Kenyatta National and Pumwani Maternity hospitals. Consecutive sampling was employed. Data were collected using a structured sociodemographic questionnaire and the Edinburg Postpartum Depression Scale (EPDS). Data were analyzed using SPSS version 25. \u0000Results: Of all participants, 77.2% were from PMH and 22.8% were from KNH. Most participants were 18–19 years old, had primary education as the highest entry level, were single, depended on their parents for financial support, and were Christians. For obstetric characteristics, the majority had no history of miscarriage, were primipara, had unintended pregnancy, had amenorrhea as the first symptom, had an initial antenatal clinic (ANC) visit during the first trimester, had at least four ANC visits, and delivered via spontaneous vaginal birth. The prevalence of postpartum depression was 22.2%. The most prominent characteristics of PPD were feeling overwhelmed, sadness, anxiety, and crying episodes. Associated determinants of PPD in adolescent mothers were age <18 years, starting ANC visits after the second trimester, less than four ANC visits, being HIV-positive, unsupportive partner, and having a post-delivery illness for the mother.\u0000Conclusion: This study established that approximately one in four adolescent mothers are likely to suffer from postpartum depression. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"111 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963651","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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