Background: Retroperitoneal hematomas during pregnancy arising from ovarian vessels are rare. Thiscondition is usually associated with hemorrhagic shock and can lead to serious maternal-fetal morbidityor mortality. Carrying a pregnancy to term when the condition is diagnosed in early pregnancy istherefore not guaranteed.Case presentation: A 39-year-old para 4+1 presented at 26 weeks of gestation with a 2-day history ofright lower abdominal pain after a fall on her farm two weeks before admission. She was anemic, andabdominal ultrasound revealed a hypoechoic mass in the right lower quadrant of the abdomen, which,upon explorative laparotomy, turned out to be a large nonexpanding zone III retroperitoneal hematoma.Conservative management without opening the hematoma was performed, and she was serially imagedto assess the etiology and to rule out any further bleeding. The patient carried the pregnancy to term anddelivered vaginally. Postpartum exploration of the abdomen during tubal ligation revealed resolution ofthe hematoma.Discussion: Retroperitoneal hematomas can occur spontaneously or can be caused by blunt orpenetrating trauma. Patients mostly present with abdominal pain, hypovolemia, or anemia. Fordescriptive purposes, the retroperitoneum is divided into three zones: central, perirenal, and pelvic. Forspontaneous or blunt trauma hematomas in the pelvic zone, conservative management without openingthe hematoma is advised.Conclusion: Retroperitoneal hematoma should be a differential diagnosis in a patient presenting with anacute abdomen during pregnancy. Although associated with morbidity and mortality during pregnancy,patients with this condition can still carry their pregnancy to term and deliver normally.
{"title":"Retroplacental hematoma: A case report","authors":"Tung'ani Muchiri, Grace Wanjiku, Lydia Mumenya, Esther Mutie","doi":"10.59692/jogeca.v36i1.142","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.142","url":null,"abstract":"Background: Retroperitoneal hematomas during pregnancy arising from ovarian vessels are rare. Thiscondition is usually associated with hemorrhagic shock and can lead to serious maternal-fetal morbidityor mortality. Carrying a pregnancy to term when the condition is diagnosed in early pregnancy istherefore not guaranteed.Case presentation: A 39-year-old para 4+1 presented at 26 weeks of gestation with a 2-day history ofright lower abdominal pain after a fall on her farm two weeks before admission. She was anemic, andabdominal ultrasound revealed a hypoechoic mass in the right lower quadrant of the abdomen, which,upon explorative laparotomy, turned out to be a large nonexpanding zone III retroperitoneal hematoma.Conservative management without opening the hematoma was performed, and she was serially imagedto assess the etiology and to rule out any further bleeding. The patient carried the pregnancy to term anddelivered vaginally. Postpartum exploration of the abdomen during tubal ligation revealed resolution ofthe hematoma.Discussion: Retroperitoneal hematomas can occur spontaneously or can be caused by blunt orpenetrating trauma. Patients mostly present with abdominal pain, hypovolemia, or anemia. Fordescriptive purposes, the retroperitoneum is divided into three zones: central, perirenal, and pelvic. Forspontaneous or blunt trauma hematomas in the pelvic zone, conservative management without openingthe hematoma is advised.Conclusion: Retroperitoneal hematoma should be a differential diagnosis in a patient presenting with anacute abdomen during pregnancy. Although associated with morbidity and mortality during pregnancy,patients with this condition can still carry their pregnancy to term and deliver normally.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"107 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963665","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.v36i1.146
Justus Wambugu, Khadija Warfa
Background: Vaginal foreign bodies (VFBs) in the pediatric population pose diagnostic and management challenges. This is due to the usual difficulty in obtaining an appropriate history, difficulty in conducting a vaginal examination, and the fallibility of conventional imaging modalities in picking most of the vaginal foreign bodies. In prepubertal who present with abnormal vaginal discharge or vaginal bleeding, the diagnosis of a vaginal foreign body should be considered, and appropriate care should be provided. Vaginoscopy is an excellent diagnostic and therapeutic modality for these cases. Case series: Between 2018 and 2023, 6 children aged between 3 and 6 years underwent vaginoscopy at our institution, having presented with diverse vaginal symptoms. The mean age was 4.5 years. Three presented with vaginal bleeding, two had recurrent vaginal discharge, and one had a history of trauma to the genitalia. There were no cases suspicious of sexual abuse. All except two had a normal external genital examination, with one having a small excoriation on the labia and the other having superficial perineal injuries due to trauma. All six cases had intact hymens. Vaginoscopy was performed using a 4-mm scope. Vaginal foreign bodies of varying size and consistency were retrieved from three patients. One patient had inflammatory changes on the proximal anterior vaginal wall. Two had normal findings. All 6 children tolerated the procedure well, with an excellent response to treatment. Conclusion: Correct diagnosis and management of pediatric vaginal foreign bodies is challenging compared with the adult population. A high index of suspicion is necessary for any young girl presenting with vaginal bleeding or abnormal vaginal discharge. Vaginoscopy is a safe and efficient diagnostic and therapeutic procedure for vaginal foreign bodies in the pediatric population.
{"title":"Vaginal foreign bodies in pediatric population - presentation, diagnostic challenges, and role of vaginoscopy: A case series","authors":"Justus Wambugu, Khadija Warfa","doi":"10.59692/jogeca.v36i1.146","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.146","url":null,"abstract":"Background: Vaginal foreign bodies (VFBs) in the pediatric population pose diagnostic and management challenges. This is due to the usual difficulty in obtaining an appropriate history, difficulty in conducting a vaginal examination, and the fallibility of conventional imaging modalities in picking most of the vaginal foreign bodies. In prepubertal who present with abnormal vaginal discharge or vaginal bleeding, the diagnosis of a vaginal foreign body should be considered, and appropriate care should be provided. Vaginoscopy is an excellent diagnostic and therapeutic modality for these cases. \u0000 \u0000Case series: Between 2018 and 2023, 6 children aged between 3 and 6 years underwent vaginoscopy at our institution, having presented with diverse vaginal symptoms. The mean age was 4.5 years. Three presented with vaginal bleeding, two had recurrent vaginal discharge, and one had a history of trauma to the genitalia. There were no cases suspicious of sexual abuse. All except two had a normal external genital examination, with one having a small excoriation on the labia and the other having superficial perineal injuries due to trauma. All six cases had intact hymens. Vaginoscopy was performed using a 4-mm scope. Vaginal foreign bodies of varying size and consistency were retrieved from three patients. One patient had inflammatory changes on the proximal anterior vaginal wall. Two had normal findings. All 6 children tolerated the procedure well, with an excellent response to treatment. \u0000Conclusion: Correct diagnosis and management of pediatric vaginal foreign bodies is challenging compared with the adult population. A high index of suspicion is necessary for any young girl presenting with vaginal bleeding or abnormal vaginal discharge. Vaginoscopy is a safe and efficient diagnostic and therapeutic procedure for vaginal foreign bodies in the pediatric population.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"113 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963734","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.v36i1.133
Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George osoti, Joan Mwende, Jennifer Okore, Jim Kelly Mugambi
Background: Results published from the E-MOTIVE trial concluded that for women undergoing vaginal delivery, early detection of postpartum hemorrhage (PPH), combined with bundled treatment of PPH, reduced severe PPH and associated adverse outcomes. Eighty hospitals across Nigeria, Kenya, Tanzania, and South Africa and over 210,000 women participated in the randomized trial, which was designed to assess the effect of implementing the E-MOTIVE intervention to detect and treat PPH. The results showed that the use of calibrated collection drapes dramatically increased the PPH detection rate, from 51% to 93%, and the use of the WHO-recommended bundle of treatments, from 19% to 91%. Moreover, implementing the E-MOTIVE approach to treat PPH resulted in a 60% reduction in severe PPH. The median blood loss, the need for postpartum blood transfusion, and the number of maternal deaths were also reduced. The E-MOTIVE trial trained a pool of PPH champions across the intervention facilities, including nurses, midwives, medical officers, and obstetrics and gynecology specialists. Their roles were to coordinate the training and practice activities of all relevant labor ward staff in their hospitals, observe labor ward staff practices, and provide specific feedback for targeted improvements in implementing the E-MOTIVE bundle correctly by reviewing regular performance indicators and outcome data from their hospitals to assess if improvements were needed. Methods: After the study findings, the Kenyan hub team continued tracking the performance of the facilities after the trial, without any active support. The PPH champions collected, discussed at the facility level, and shared data with the Kenyan hub team monthly. The data shared were included in the hub Project Management Information System and triangulated with data from DHIS, where it was analyzed by the Kenyan study team, and feedback was shared at the facility level. Results: Data analyzed from the last quarter (September-November) showed that seven E-MOTIVE implementing facilities maintained 5% PPH rates (blood loss >500 mls) and 2% severe PPH rates on moving averages. All components of the E-MOTIVE bundle were provided 100% to all PPH cases detected. During the same period, three maternal deaths were reported that had causes other than bleeding from PPH. Conclusion: Having PPH champions community of practice can help sustain best practices in the early detection and treatment of PPH beyond any project lifeline. It is a simple and cost-effective method that can prevent severe PPH and prevent maternal mortality arising from PPH.
{"title":"Postpartum hemorrhage champions: Sustaining gains beyond the E-MOTIVE Trial","authors":"Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George osoti, Joan Mwende, Jennifer Okore, Jim Kelly Mugambi","doi":"10.59692/jogeca.v36i1.133","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.133","url":null,"abstract":"\u0000Background: Results published from the E-MOTIVE trial concluded that for women undergoing vaginal delivery, early detection of postpartum hemorrhage (PPH), combined with bundled treatment of PPH, reduced severe PPH and associated adverse outcomes. Eighty hospitals across Nigeria, Kenya, Tanzania, and South Africa and over 210,000 women participated in the randomized trial, which was designed to assess the effect of implementing the E-MOTIVE intervention to detect and treat PPH. The results showed that the use of calibrated collection drapes dramatically increased the PPH detection rate, from 51% to 93%, and the use of the WHO-recommended bundle of treatments, from 19% to 91%. Moreover, implementing the E-MOTIVE approach to treat PPH resulted in a 60% reduction in severe PPH. The median blood loss, the need for postpartum blood transfusion, and the number of maternal deaths were also reduced. The E-MOTIVE trial trained a pool of PPH champions across the intervention facilities, including nurses, midwives, medical officers, and obstetrics and gynecology specialists. Their roles were to coordinate the training and practice activities of all relevant labor ward staff in their hospitals, observe labor ward staff practices, and provide specific feedback for targeted improvements in implementing the E-MOTIVE bundle correctly by reviewing regular performance indicators and outcome data from their hospitals to assess if improvements were needed.\u0000Methods: After the study findings, the Kenyan hub team continued tracking the performance of the facilities after the trial, without any active support. The PPH champions collected, discussed at the facility level, and shared data with the Kenyan hub team monthly. The data shared were included in the hub Project Management Information System and triangulated with data from DHIS, where it was analyzed by the Kenyan study team, and feedback was shared at the facility level.\u0000Results: Data analyzed from the last quarter (September-November) showed that seven E-MOTIVE implementing facilities maintained 5% PPH rates (blood loss >500 mls) and 2% severe PPH rates on moving averages. All components of the E-MOTIVE bundle were provided 100% to all PPH cases detected. During the same period, three maternal deaths were reported that had causes other than bleeding from PPH.\u0000Conclusion: Having PPH champions community of practice can help sustain best practices in the early detection and treatment of PPH beyond any project lifeline. It is a simple and cost-effective method that can prevent severe PPH and prevent maternal mortality arising from PPH.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"60 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964097","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.v36i1.294
Johnstone Miheso
Background: Assisted vaginal birth is an alternative to cesarean delivery where indicated and canreduce both maternal and fetal morbidity and mortality. There is a need to maintain and improve skillsthrough training, research, and mentorship, especially in where access to cesarean delivery remains achallenge.Objective: To determine the incidence and outcome of instrumental deliveries at a university teachinghospital in Nairobi.Methods: A retrospective study was conducted at the Aga Khan University Hospital between Januaryand November 2015. All files of patients who had an instrumental delivery during this period wereextracted, and data were collected on parity, indication, type of instrument, birth weight, perineal status,and Apgar scores.Results: Of 3000 women who delivered during this period, 132 had assisted vaginal birth (4.4%).Nulliparous formed 66.7%, and indication was only given in 12% of the cases. 11 percent of all caseswere forceps, whereas 89% were via vacuum. Trainees performed 36 (27%), instructors performed 10(7.5%), and obstetricians 73 (55.5%) of all instrumental deliveries. Two-thirds of the forceps wereperformed by obstetricians. Most (68.9%) babies weighed between 3 and 4 kg. The perineum was intactin 6%, 51.5% had episiotomy, and 6% had a third-degree tear; however, a fourth-degree tear was notreported. Two procedures failed, and patients underwent emergency cesarean delivery. 116 (87.8%)babies had Apgar scores of >6 at 5 minutes.Conclusion: Assisted vaginal delivery remains a safe and vital skill in the labor ward and has its place inmodern obstetric practice. The rate shown here is much lower than that in most high-income countries.There is a need to improve training and documentation of indications.
{"title":"Audit of assisted vaginal deliveries at Aga Khan University Hospital: A retrospective study","authors":"Johnstone Miheso","doi":"10.59692/jogeca.v36i1.294","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.294","url":null,"abstract":"Background: Assisted vaginal birth is an alternative to cesarean delivery where indicated and canreduce both maternal and fetal morbidity and mortality. There is a need to maintain and improve skillsthrough training, research, and mentorship, especially in where access to cesarean delivery remains achallenge.Objective: To determine the incidence and outcome of instrumental deliveries at a university teachinghospital in Nairobi.Methods: A retrospective study was conducted at the Aga Khan University Hospital between Januaryand November 2015. All files of patients who had an instrumental delivery during this period wereextracted, and data were collected on parity, indication, type of instrument, birth weight, perineal status,and Apgar scores.Results: Of 3000 women who delivered during this period, 132 had assisted vaginal birth (4.4%).Nulliparous formed 66.7%, and indication was only given in 12% of the cases. 11 percent of all caseswere forceps, whereas 89% were via vacuum. Trainees performed 36 (27%), instructors performed 10(7.5%), and obstetricians 73 (55.5%) of all instrumental deliveries. Two-thirds of the forceps wereperformed by obstetricians. Most (68.9%) babies weighed between 3 and 4 kg. The perineum was intactin 6%, 51.5% had episiotomy, and 6% had a third-degree tear; however, a fourth-degree tear was notreported. Two procedures failed, and patients underwent emergency cesarean delivery. 116 (87.8%)babies had Apgar scores of >6 at 5 minutes.Conclusion: Assisted vaginal delivery remains a safe and vital skill in the labor ward and has its place inmodern obstetric practice. The rate shown here is much lower than that in most high-income countries.There is a need to improve training and documentation of indications.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"540 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894404","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.v36i1.299
Susan A.D. Adongo, N. S. Omar, J. Azhary, Esther S.Y. Loh, Nur Azurah A. Ghani, A. A. Zainuddin
Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare urogenital anomaly, presents significant challenges to young girls and women in Africa. As we strive to break barriers and reposition Africa in the global health architecture, the timely recognition and management of OHVIRA becomes crucial. Usingt a retrospective case series approach, we examined OHVIRA cases managed by the Pediatric and Adolescent Gynecology Unit at a Tertiary Health facility in Malaysia, between June and November 2022. The study findings have relevance for Africa because the challenges faced by young girls and women in obtaining adequate healthcare are not confined by borders. Results: The age range of presentation, 11-25 years, mirrors the age group of concern for the African population. The time interval between symptom onset and diagnosis, spanning from 1 to 12 years, raises concerns about delayed identification. We observed that worsening dysmenorrhea, often unresponsive to analgesia, was the main presenting symptom, accompanied by complications, such as persistent vaginal discharge (12.5%), urinary retention (25%), constipation (12.5%), and pelvic masses (37.5%), which resonate with potential cases in Africa. Conclusion: The delayed diagnosis of OHVIRA syndrome emphasizes the pressing need for proactive healthcare interventions, particularly among young girls and women in Africa. By understanding the parallels between our study and the challenges faced by young women on the continent, we can identify opportunities to improve healthcare access and address the barriers that hinder timely diagnosis and management.
{"title":"Addressing the delayed diagnosis of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome for improved women health in Africa: A case series","authors":"Susan A.D. Adongo, N. S. Omar, J. Azhary, Esther S.Y. Loh, Nur Azurah A. Ghani, A. A. Zainuddin","doi":"10.59692/jogeca.v36i1.299","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.299","url":null,"abstract":"Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare urogenital anomaly, presents significant challenges to young girls and women in Africa. As we strive to break barriers and reposition Africa in the global health architecture, the timely recognition and management of OHVIRA becomes crucial. Usingt a retrospective case series approach, we examined OHVIRA cases managed by the Pediatric and Adolescent Gynecology Unit at a Tertiary Health facility in Malaysia, between June and November 2022. The study findings have relevance for Africa because the challenges faced by young girls and women in obtaining adequate healthcare are not confined by borders. \u0000Results: The age range of presentation, 11-25 years, mirrors the age group of concern for the African population. The time interval between symptom onset and diagnosis, spanning from 1 to 12 years, raises concerns about delayed identification. We observed that worsening dysmenorrhea, often unresponsive to analgesia, was the main presenting symptom, accompanied by complications, such as persistent vaginal discharge (12.5%), urinary retention (25%), constipation (12.5%), and pelvic masses (37.5%), which resonate with potential cases in Africa. \u0000Conclusion: The delayed diagnosis of OHVIRA syndrome emphasizes the pressing need for proactive healthcare interventions, particularly among young girls and women in Africa. By understanding the parallels between our study and the challenges faced by young women on the continent, we can identify opportunities to improve healthcare access and address the barriers that hinder timely diagnosis and management.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"175 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894514","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.v36i1.162
Carren Cheronoh Siele, M. Wafula
Background: Despite targeted efforts by the Ministry of Health and nongovernmental organizations, the maternal mortality ratio (MMR) was 673 in 100,000 live births in Migori County, Western Kenya. The first confidential investigation into maternal deaths was a detailed review of half of the maternal deaths reported across Kenya in 2014. Approximately 40% of maternal deaths were due to obstetric hemorrhage (OH), and 90% were attributed to substandard care. Objectives: To evaluate the use of a nonpneumatic anti-shock garment (NASG) and first response bundle in maternal survival following postpartum hemorrhage. Methods: An implementation team trained maternity care staff at 104 participating facilities (responsible for 85% of facility births for the county) to use the first-response bundle, NASG, and uterine balloon tamponade (UBT) combined with NASG for uterine atony. The study had two phases, beginning July 1, 2020, and ending September 30, 2021. Results: 63,580 deliveries were reported, giving an OH rate of 1.32%. Of 838 women with OH, 51.8% showed signs of hypovolemic shock (n=434). NASG was applied per protocol to 56.5% (n=267) of women and preventively to 146 (36.1%) of the 404 women with OH. For most women with OH who did not receive NASG, the provider stated that it was not necessary. In three cases, NASG was not applied due to lack of a trained provider, and in four cases, NASG was not available at the facility. The use of the complete first-response bundle increased from 37.3% to 42.3% over time. For tranexamic acid (TXA), 40.8% of eligible women who received TXA had received the other three interventions. 86 were managed with both the UBT and NASG (22.5%). Conclusion: This study demonstrated that the use of the NASG and PPH first-response bundle is feasible at tertiary and primary health facilities. The limitation to the use of a first-response PPH bundle is whether there is a local commitment to expand the availability of TXA.
{"title":"Use of nonpneumatic anti-shock garment and first response care bundle to improve maternal survival following obstetric hemorrhage in Migori County, Kenya","authors":"Carren Cheronoh Siele, M. Wafula","doi":"10.59692/jogeca.v36i1.162","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.162","url":null,"abstract":"Background: Despite targeted efforts by the Ministry of Health and nongovernmental organizations, the maternal mortality ratio (MMR) was 673 in 100,000 live births in Migori County, Western Kenya. The first confidential investigation into maternal deaths was a detailed review of half of the maternal deaths reported across Kenya in 2014. Approximately 40% of maternal deaths were due to obstetric hemorrhage (OH), and 90% were attributed to substandard care. \u0000Objectives: To evaluate the use of a nonpneumatic anti-shock garment (NASG) and first response bundle in maternal survival following postpartum hemorrhage. \u0000Methods: An implementation team trained maternity care staff at 104 participating facilities (responsible for 85% of facility births for the county) to use the first-response bundle, NASG, and uterine balloon tamponade (UBT) combined with NASG for uterine atony. The study had two phases, beginning July 1, 2020, and ending September 30, 2021. \u0000Results: 63,580 deliveries were reported, giving an OH rate of 1.32%. Of 838 women with OH, 51.8% showed signs of hypovolemic shock (n=434). NASG was applied per protocol to 56.5% (n=267) of women and preventively to 146 (36.1%) of the 404 women with OH. For most women with OH who did not receive NASG, the provider stated that it was not necessary. In three cases, NASG was not applied due to lack of a trained provider, and in four cases, NASG was not available at the facility. The use of the complete first-response bundle increased from 37.3% to 42.3% over time. For tranexamic acid (TXA), 40.8% of eligible women who received TXA had received the other three interventions. 86 were managed with both the UBT and NASG (22.5%).\u0000Conclusion: This study demonstrated that the use of the NASG and PPH first-response bundle is feasible at tertiary and primary health facilities. The limitation to the use of a first-response PPH bundle is whether there is a local commitment to expand the availability of TXA.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"166 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894611","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.v36i1.80
Franklin Munene, Philip Tonui, B.E Odongo
Background: The length of hospital stay after delivery is a major contributor to preventing postpartumcomplications and improving maternal and neonatal outcomes. Globally, the length of hospital stay afterdelivery has been reducing in recent times. However, there is limited understanding of the safety,outcomes, and complications of early discharge compared with late discharge in low- and middle-incomesettings. Objectives: To evaluate the outcomes of early versus late discharge from the hospital for post-spontaneous vaginal delivery low-risk parturient and healthy neonates in Moi Teaching and Referral Hospital, Eldoret, Kenya.Methods: A randomized controlled trial study design was employed. 744 mother-child dyads wererecruited into this study within the first hour postdelivery and were randomized into two groups: theintervention arm was those discharged within 24 hours and the control arm was those discharged after24 hours or more. The study participants were followed up over three months with over-the-phoneinterviews. The primary outcome was maternal rehospitalization.Results: Between July 2022 and October 2022, 744 mother-baby dyads were recruited and 372 wererandomly assigned to the intervention arm, and 372 to the control arm. There were 23 mothers in theintervention arm and 22 in the control arm who were lost to follow-up and subsequently excluded fromthe analysis. Baseline characteristics were similar between the study groups. There were 17 (4.9%)maternal readmissions in the intervention arm and 10 (2.9%) in the control arm (RR 2% (95%CI:-1.1%,5.2%; p-value=0.167).Conclusion: Early discharge for low-risk mothers and healthy neonates is noninferior to late discharge,with similar effects on maternal outcomes, neonatal outcomes, and breastfeeding patterns.
{"title":"Early versus late discharge from the hospital for low-risk parturients after spontaneous vaginal deliveries at Moi Teaching and Referral Hospital, Eldoret, Kenya: A randomized controlled trial.","authors":"Franklin Munene, Philip Tonui, B.E Odongo","doi":"10.59692/jogeca.v36i1.80","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.80","url":null,"abstract":"Background: The length of hospital stay after delivery is a major contributor to preventing postpartumcomplications and improving maternal and neonatal outcomes. Globally, the length of hospital stay afterdelivery has been reducing in recent times. However, there is limited understanding of the safety,outcomes, and complications of early discharge compared with late discharge in low- and middle-incomesettings.\u0000Objectives: To evaluate the outcomes of early versus late discharge from the hospital for post-spontaneous vaginal delivery low-risk parturient and healthy neonates in Moi Teaching and Referral\u0000Hospital, Eldoret, Kenya.Methods: A randomized controlled trial study design was employed. 744 mother-child dyads wererecruited into this study within the first hour postdelivery and were randomized into two groups: theintervention arm was those discharged within 24 hours and the control arm was those discharged after24 hours or more. The study participants were followed up over three months with over-the-phoneinterviews. The primary outcome was maternal rehospitalization.Results: Between July 2022 and October 2022, 744 mother-baby dyads were recruited and 372 wererandomly assigned to the intervention arm, and 372 to the control arm. There were 23 mothers in theintervention arm and 22 in the control arm who were lost to follow-up and subsequently excluded fromthe analysis. Baseline characteristics were similar between the study groups. There were 17 (4.9%)maternal readmissions in the intervention arm and 10 (2.9%) in the control arm (RR 2% (95%CI:-1.1%,5.2%; p-value=0.167).Conclusion: Early discharge for low-risk mothers and healthy neonates is noninferior to late discharge,with similar effects on maternal outcomes, neonatal outcomes, and breastfeeding patterns.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"119 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963489","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.v36i1.302
Polycarp Oyoo, Michael Waithaka, Assumpta Matekwa, Jane Kageha, Jane Wausi, Arthur Mboya, Njeri Nyamu
Background: Although there has been momentum in implementing sexual and reproductive health (SRH) services in most countries, young people typically remain underserved by these services despite their demonstrated need. This study aimed to determine the factors influencing access to and utilization of youth-friendly sexual and reproductive health (AYSRH) services in Isiolo County. This study was conducted under the Jhpiego-supported Accelerating Post pregnancy Family Planning Integration into Primary Healthcare (APIP) project that supports Isiolo. Methods: Mixed-methods qualitative and quantitative approach was used. Data were collected using the KOBO digital tool. and analysis was performed using NVivo and Stata for qualitative and quantitative data, respectively. Results: The baseline study found that 69% of the APIP-supported facilities offered YFSRHS, with 77% of the facilities conveniently located for ease of access by the youths. 69% of the facilities had AYSRH signages displayed outside the buildings, with 31% displaying the signages inside the building. 31% of the facilities had separate counseling and examination rooms to ensure privacy for the youths as they sought services. 54% of the facilities involved the youth in decision-making during the provision of the YFSRHS. The study also found that 31% of the facilities involved their communities and made them aware of the YFHS provided at the hospitals. Conclusion: Interventions focusing on implementing YFSRHS should aim at addressing challenges affecting quality services in health facilities to offer them according to the youth’s needs.
{"title":"Factors influencing access to and utilization of youth-friendly sexual and reproductive health services in Isiolo County, Kenya","authors":"Polycarp Oyoo, Michael Waithaka, Assumpta Matekwa, Jane Kageha, Jane Wausi, Arthur Mboya, Njeri Nyamu","doi":"10.59692/jogeca.v36i1.302","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.302","url":null,"abstract":"Background: Although there has been momentum in implementing sexual and reproductive health (SRH) services in most countries, young people typically remain underserved by these services despite their demonstrated need. This study aimed to determine the factors influencing access to and utilization of youth-friendly sexual and reproductive health (AYSRH) services in Isiolo County. This study was conducted under the Jhpiego-supported Accelerating Post pregnancy Family Planning Integration into Primary Healthcare (APIP) project that supports Isiolo. \u0000Methods: Mixed-methods qualitative and quantitative approach was used. Data were collected using the KOBO digital tool. and analysis was performed using NVivo and Stata for qualitative and quantitative data, respectively. \u0000Results: The baseline study found that 69% of the APIP-supported facilities offered YFSRHS, with 77% of the facilities conveniently located for ease of access by the youths. 69% of the facilities had AYSRH signages displayed outside the buildings, with 31% displaying the signages inside the building. 31% of the facilities had separate counseling and examination rooms to ensure privacy for the youths as they sought services. 54% of the facilities involved the youth in decision-making during the provision of the YFSRHS. The study also found that 31% of the facilities involved their communities and made them aware of the YFHS provided at the hospitals. \u0000Conclusion: Interventions focusing on implementing YFSRHS should aim at addressing challenges affecting quality services in health facilities to offer them according to the youth’s needs. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"120 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963613","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.v36i1.114
Christine Njeru, Cyrus Kimanthi
Background: Pregnancy is a normal phenomenon accompanied by physiological, psychological, andemotional changes. However, some changes negatively affect the health of mothers and babies,increasing maternal and neonatal mortality and morbidity. Obstetric danger signs show immediatehazards that, if not avoided, may lead to severe injuries or death to the pregnant mother or unborn child.However, data on the awareness of obstetric danger signs in Kenya are scarce. This study aimed toassess the knowledge of obstetric danger signs and associated factors among pregnant women in aselect Kenyan population.Methods: A descriptive cross-sectional study was conducted at the Kenyatta National Hospital antenatalcare clinic. Researcher-administered questionnaires were used in data collection. Quantitative data wereanalyzed using descriptive analysis; inferential statistics were used to determine the association betweenvariables. A p-value of <0.05 was considered statistically significant.Results: There were 193 responses in this study. Most respondents (51.3%) were aged 25-31 years. Ofthe respondents, 85.5% (n=165) indicated that they attended an antenatal clinic during their lastpregnancy. Most of the respondents 82.4% (n=159) had delivered at the health center, while theremaining 17.6% delivered at home. The mean average on the danger signs questions was 5.65. 102(53%) participants had good knowledge, while 46% (n=91) had poor knowledge of danger signs. Therespondent’s level of education and the number of deliveries was statistically significant to their level ofknowledge. Participants with secondary and tertiary education were more likely to have better knowledgethan those with informal education (AOR=3.91, 95% Confidence Interval 0.95-18.12).Conclusion: The results reveal an average level of knowledge of pregnancy danger signs among womenvisiting KNH. However, there is still a good percentage of women who have poor knowledge of thedanger signs experienced during pregnancy.
{"title":"Knowledge of obstetric danger signs and associated factors among pregnant women attending the antenatal care clinic at Kenyatta National Hospital: A cross-sectional study.","authors":"Christine Njeru, Cyrus Kimanthi","doi":"10.59692/jogeca.v36i1.114","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.114","url":null,"abstract":"Background: Pregnancy is a normal phenomenon accompanied by physiological, psychological, andemotional changes. However, some changes negatively affect the health of mothers and babies,increasing maternal and neonatal mortality and morbidity. Obstetric danger signs show immediatehazards that, if not avoided, may lead to severe injuries or death to the pregnant mother or unborn child.However, data on the awareness of obstetric danger signs in Kenya are scarce. This study aimed toassess the knowledge of obstetric danger signs and associated factors among pregnant women in aselect Kenyan population.Methods: A descriptive cross-sectional study was conducted at the Kenyatta National Hospital antenatalcare clinic. Researcher-administered questionnaires were used in data collection. Quantitative data wereanalyzed using descriptive analysis; inferential statistics were used to determine the association betweenvariables. A p-value of <0.05 was considered statistically significant.Results: There were 193 responses in this study. Most respondents (51.3%) were aged 25-31 years. Ofthe respondents, 85.5% (n=165) indicated that they attended an antenatal clinic during their lastpregnancy. Most of the respondents 82.4% (n=159) had delivered at the health center, while theremaining 17.6% delivered at home. The mean average on the danger signs questions was 5.65. 102(53%) participants had good knowledge, while 46% (n=91) had poor knowledge of danger signs. Therespondent’s level of education and the number of deliveries was statistically significant to their level ofknowledge. Participants with secondary and tertiary education were more likely to have better knowledgethan those with informal education (AOR=3.91, 95% Confidence Interval 0.95-18.12).Conclusion: The results reveal an average level of knowledge of pregnancy danger signs among womenvisiting KNH. However, there is still a good percentage of women who have poor knowledge of thedanger signs experienced during pregnancy.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"33 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963933","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.v36i1.97
S. Mutiso, Felix M Oindi, Debbie Mundia
Background: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, mostly because of catastrophic bleeding. First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding, such as an ectopic pregnancy. We present a case of first-trimester scar dehiscence and conduct a literature review of this rare condition. Case presentation: A 39-year-old patient with 4 previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. The patient had two previous histories of third-trimester uterine rupture in previous pregnancies with subsequent hysterotomy and repair. The patient underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently performed. Conclusion: This case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The outline risk factors, clinical presentation, diagnostic imaging, and management may help in the early identification and management of this rare but life-threatening condition.
{"title":"terine rupture in the first trimester: A case report and literature review","authors":"S. Mutiso, Felix M Oindi, Debbie Mundia","doi":"10.59692/jogeca.v36i1.97","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.97","url":null,"abstract":"Background: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, mostly because of catastrophic bleeding. First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding, such as an ectopic pregnancy. We present a case of first-trimester scar dehiscence and conduct a literature review of this rare condition.\u0000Case presentation: A 39-year-old patient with 4 previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. The patient had two previous histories of third-trimester uterine rupture in previous pregnancies with subsequent hysterotomy and repair. The patient underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently performed. \u0000Conclusion: This case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The outline risk factors, clinical presentation, diagnostic imaging, and management may help in the early identification and management of this rare but life-threatening condition. \u0000 ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"31 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963939","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：