Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.128
D. Matheka, James Wachira, S. Masheti, G. Githemo, Sachita Shah, Matthew S. Haldeman, Mena Ramos, Kevin Bergman
Background: Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to the increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low- and middle-income countries (LMICs) is limited. Despite the World Health Organization’s (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health has not been widely used in LMICs. We describe the implementation of obstetrics POCUS training for high-risk conditions in rural public health care facilities in Kenya. Methods: As part of the initiation of a large-scale implementation study of obstetrics-POCUS, clinician trainees were recruited from rural Kenyan hospitals to participate in a series of five-day POCUS workshops. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for five obstetrics POCUS applications. Instructor-observed assessments of students’ scanning and image interpretation were performed during the training period. Assessment of knowledge and confidence was performed via an online pretest and posttest and objective structured clinical examinations. Results: 514 midlevel health care providers were trained over three months, with a trainer: trainee ratio of 1:5. Of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. Obstetrics POCUS topics covered included malpresentation, multiple gestation, fetal cardiac activity, placenta, and amniotic fluid volume. There was a marked improvement in the posttraining test scores. Conclusion: Our implementation description serves as a guide for the successful rapid dissemination of obstetrics POCUS training for midlevel providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound during pregnancy through accessible obstetrics POCUS training programs.
{"title":"A training program for obstetrics point-of-care ultrasound to rural health care providers in Kenya","authors":"D. Matheka, James Wachira, S. Masheti, G. Githemo, Sachita Shah, Matthew S. Haldeman, Mena Ramos, Kevin Bergman","doi":"10.59692/jogeca.v36i1.128","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.128","url":null,"abstract":"Background: Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to the increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low- and middle-income countries (LMICs) is limited. Despite the World Health Organization’s (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health has not been widely used in LMICs. We describe the implementation of obstetrics POCUS training for high-risk conditions in rural public health care facilities in Kenya. \u0000Methods: As part of the initiation of a large-scale implementation study of obstetrics-POCUS, clinician trainees were recruited from rural Kenyan hospitals to participate in a series of five-day POCUS workshops. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for five obstetrics POCUS applications. Instructor-observed assessments of students’ scanning and image interpretation were performed during the training period. Assessment of knowledge and confidence was performed via an online pretest and posttest and objective structured clinical examinations. \u0000Results: 514 midlevel health care providers were trained over three months, with a trainer: trainee ratio of 1:5. Of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. Obstetrics POCUS topics covered included malpresentation, multiple gestation, fetal cardiac activity, placenta, and amniotic fluid volume. There was a marked improvement in the posttraining test scores. \u0000Conclusion: Our implementation description serves as a guide for the successful rapid dissemination of obstetrics POCUS training for midlevel providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound during pregnancy through accessible obstetrics POCUS training programs.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"100 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964075","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.v36i1.164
Elias Wakoli, G. Gwako, Philomena Owende, O. Ogutu, Elly Odongo, Joseph Karanja
Background: Blood and blood component transfusion plays a pivotal lifesaving role. Adequate amounts significantly reduce maternal morbidity and mortality. This study aimed to assess the prevalence and pattern of blood and blood component utilization among women managed at the Kenyatta National Hospital (KNH) maternity unit in 2022-2023. Methods: This was a cross-sectional study targeting women admitted to the KNH maternity unit. Participants were recruited through consecutive sampling. A data abstraction chart was used for data collection. The study variables included proportions of patients who required blood or blood components, indications for transfusion, number of units availed against those requested, and outcomes of the participants. To determine the prevalence of transfusion, the proportion of participants who received blood or blood components was calculated over the admissions. To determine the percentage per indication for transfusion, a particular indication was calculated over the total number of indications and expressed in percentages, and the need was calculated as the total need per blood request generated. Continuous data were analyzed for mean and standard deviation. Frequencies and percentages were calculated for variables with categorical data. Results: Among 5567 admissions, 344 participants who needed blood and blood components were sampled over 7 months from October 2022. This represented a prevalence of 6.2%. Of this prevalence, cesarean deliveries made up 3%, SVD 1.4%, and miscarriages accounted for 0.5% among others. Postpartum hemorrhage was the most common indication (34.5%), with 65.4% of participants having their need for blood/blood components met. The deficit in blood units ordered was 12.4%. The majority (98%) were discharged home. While mortality was recorded at 2%. Conclusion: The prevalence of blood/blood components transfusion was 6.2%. Postpartum hemorrhage remains the most common indication for blood transfusion. The need for blood and its components remains unmet both for the number of units and the type of component.
{"title":"Prevalence and pattern of blood and blood component utilization at the Kenyatta National Hospital maternity unit in 2022-2023: A cross-sectional study","authors":"Elias Wakoli, G. Gwako, Philomena Owende, O. Ogutu, Elly Odongo, Joseph Karanja","doi":"10.59692/jogeca.v36i1.164","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.164","url":null,"abstract":"Background: Blood and blood component transfusion plays a pivotal lifesaving role. Adequate amounts significantly reduce maternal morbidity and mortality. This study aimed to assess the prevalence and pattern of blood and blood component utilization among women managed at the Kenyatta National Hospital (KNH) maternity unit in 2022-2023.\u0000Methods: This was a cross-sectional study targeting women admitted to the KNH maternity unit. Participants were recruited through consecutive sampling. A data abstraction chart was used for data collection. The study variables included proportions of patients who required blood or blood components, indications for transfusion, number of units availed against those requested, and outcomes of the participants. To determine the prevalence of transfusion, the proportion of participants who received blood or blood components was calculated over the admissions. To determine the percentage per indication for transfusion, a particular indication was calculated over the total number of indications and expressed in percentages, and the need was calculated as the total need per blood request generated. Continuous data were analyzed for mean and standard deviation. Frequencies and percentages were calculated for variables with categorical data. \u0000Results: Among 5567 admissions, 344 participants who needed blood and blood components were sampled over 7 months from October 2022. This represented a prevalence of 6.2%. Of this prevalence, cesarean deliveries made up 3%, SVD 1.4%, and miscarriages accounted for 0.5% among others. Postpartum hemorrhage was the most common indication (34.5%), with 65.4% of participants having their need for blood/blood components met. The deficit in blood units ordered was 12.4%. The majority (98%) were discharged home. While mortality was recorded at 2%.\u0000Conclusion: The prevalence of blood/blood components transfusion was 6.2%. Postpartum hemorrhage remains the most common indication for blood transfusion. The need for blood and its components remains unmet both for the number of units and the type of component.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894262","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.v36i1.292
J. Miheso
Background: Pregnancy in patients with end-stage renal disease is a rare condition that requires multidisciplinary care. Severe preeclampsia can lead to severe maternal and fetal morbidity and mortality, including kidney failure and intrauterine growth restriction. Case presentation: A 31-year-old para 1 gravida 2 presented to KNH Othaya at 29 weeks of gestation with elevated blood pressure and generally feeling unwell. She had been transferred from a different facility where she had been found to have a small for gestational age pregnancy. She had been started on methyldopa and nifedipine. Her admission blood pressure was 166/102mmHg, and urinalysis revealed severe proteinuria (+++). She denied any severe features. On examination, the patient was sick-looking, and her feet were swollen. Her abdomen was soft, and her fundal height was 24 weeks. An obstetric ultrasound scan showed an estimated fetal weight of 200g and gestational age of 24 weeks. Her biophysical profile was 6/8 with a reduced amniotic fluid index. Her hemoglobin was 10g/dL, platelets of 132x10^9/L, normal liver function test, urea 30 mg/dL, and creatinine 700 umol/L. She was admitted and started on magnesium sulfate and corticosteroids. She was also reviewed by a nephrologist and started on hemodialysis. Despite twice-weekly dialysis, there was no recovery of renal function and no significant change in fetal growth with fortnightly obstetric scans. Her general condition remained the same and her blood pressure labile, requiring constant adjustment of antihypertensives. After six weeks, a multidisciplinary decision was taken to terminate the pregnancy to save the mother’s life. This was discussed with her parents and her partner, and prostaglandin induction was successfully undertaken. Her kidneys recovered subsequently, dialysis was stopped, and she was discharged home. Conclusion: This case illustrates the importance of a multidisciplinary team in the management of antenatal renal failure secondary to preeclampsia.
{"title":"Renal failure in a patient with preeclampsia requiring hemodialysis and subsequent termination of pregnancy: A case report","authors":"J. Miheso","doi":"10.59692/jogeca.v36i1.292","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.292","url":null,"abstract":"Background: Pregnancy in patients with end-stage renal disease is a rare condition that requires multidisciplinary care. Severe preeclampsia can lead to severe maternal and fetal morbidity and mortality, including kidney failure and intrauterine growth restriction. \u0000Case presentation: A 31-year-old para 1 gravida 2 presented to KNH Othaya at 29 weeks of gestation with elevated blood pressure and generally feeling unwell. She had been transferred from a different facility where she had been found to have a small for gestational age pregnancy. She had been started on methyldopa and nifedipine. Her admission blood pressure was 166/102mmHg, and urinalysis revealed severe proteinuria (+++). She denied any severe features. On examination, the patient was sick-looking, and her feet were swollen. Her abdomen was soft, and her fundal height was 24 weeks. An obstetric ultrasound scan showed an estimated fetal weight of 200g and gestational age of 24 weeks. Her biophysical profile was 6/8 with a reduced amniotic fluid index. Her hemoglobin was 10g/dL, platelets of 132x10^9/L, normal liver function test, urea 30 mg/dL, and creatinine 700 umol/L. She was admitted and started on magnesium sulfate and corticosteroids. She was also reviewed by a nephrologist and started on hemodialysis. Despite twice-weekly dialysis, there was no recovery of renal function and no significant change in fetal growth with fortnightly obstetric scans. Her general condition remained the same and her blood pressure labile, requiring constant adjustment of antihypertensives. After six weeks, a multidisciplinary decision was taken to terminate the pregnancy to save the mother’s life. This was discussed with her parents and her partner, and prostaglandin induction was successfully undertaken. Her kidneys recovered subsequently, dialysis was stopped, and she was discharged home. \u0000Conclusion: This case illustrates the importance of a multidisciplinary team in the management of antenatal renal failure secondary to preeclampsia. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"410 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894710","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.v36i1.280
Odipo Erick, Cynthia Muhambe, Paul Odila, Alinda Ndenga, Hassan Nyawanga, Dan Rambo, Veronica Musiega
Background: Family planning (FP) integration in other services is essential to address unmet FP needs among postpartum women and reduce the risks of short pregnancy intervals. Immediate postpartum family planning (PPFP) is an established high-impact practice. This study aimed to assess the uptake of immediate PPFP utilization before and after implementation in various project interventions. Methods: Capacity building of 276 health care providers was conducted in 100 facilities by 32 established FP mentors through facility-based mentorship, emphasizing quality counseling. PPIUCD sets were procured and distributed to 80 facilities. 165 health care workers were oriented on facility consumption data reports and requests (FCDRR) to improve commodity availability. Monthly FP dashboard meetings were held at the subcounty level. FP registers were availed in postnatal wards, and messaging and FP referrals were performed by community health volunteers. For voluntarism, FP compliance sessions were conducted with service providers, and PPFP quality improvement approaches were implemented in eight facilities. Results: 927 and 542 women received immediate PPFP in Homa Bay and Vihiga Counties, respectively, accounting for 11% and 17% of women who delivered in the facilities. The proportion of women who delivered in the facilities received PPFP within 48 hours changed one year later, with 397 women or 3.8% of deliveries between October and December 2021. Health facility baseline assessment demonstrated gaps in the uptake of contraceptives in the immediate postpartum period, including inadequate counseling during antenatal care, lack of postpartum intrauterine device (IUD) insertion skills, lack of PPIUD kits, and lack of commodities and of reporting tools. Conclusion: The untapped demand for immediate PPFP can be met through targeted interventions to improve access and quality of the service.
{"title":"Utilization of immediate postpartum family planning among women in Homabay and Vihiga Counties","authors":"Odipo Erick, Cynthia Muhambe, Paul Odila, Alinda Ndenga, Hassan Nyawanga, Dan Rambo, Veronica Musiega","doi":"10.59692/jogeca.v36i1.280","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.280","url":null,"abstract":"Background: Family planning (FP) integration in other services is essential to address unmet FP needs among postpartum women and reduce the risks of short pregnancy intervals. Immediate postpartum family planning (PPFP) is an established high-impact practice. This study aimed to assess the uptake of immediate PPFP utilization before and after implementation in various project interventions. \u0000Methods: Capacity building of 276 health care providers was conducted in 100 facilities by 32 established FP mentors through facility-based mentorship, emphasizing quality counseling. PPIUCD sets were procured and distributed to 80 facilities. 165 health care workers were oriented on facility consumption data reports and requests (FCDRR) to improve commodity availability. Monthly FP dashboard meetings were held at the subcounty level. FP registers were availed in postnatal wards, and messaging and FP referrals were performed by community health volunteers. For voluntarism, FP compliance sessions were conducted with service providers, and PPFP quality improvement approaches were implemented in eight facilities.\u0000Results: 927 and 542 women received immediate PPFP in Homa Bay and Vihiga Counties, respectively, accounting for 11% and 17% of women who delivered in the facilities. The proportion of women who delivered in the facilities received PPFP within 48 hours changed one year later, with 397 women or 3.8% of deliveries between October and December 2021. Health facility baseline assessment demonstrated gaps in the uptake of contraceptives in the immediate postpartum period, including inadequate counseling during antenatal care, lack of postpartum intrauterine device (IUD) insertion skills, lack of PPIUD kits, and lack of commodities and of reporting tools. \u0000Conclusion: The untapped demand for immediate PPFP can be met through targeted interventions to improve access and quality of the service.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"84 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894559","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.v36i1.180
Bruce Semo, Dennis Mureithi, Misheck Njukia
Background: Access to quality gynecological surgery in low- and middle-income communities has beengreatly hampered by logistical and socioeconomic challenges. These challenges can be overcomethrough the provision of mobile laparoscopic surgery. Endoscopic surgery reduces the rate of infection,duration of hospital stay, and the need for blood transfusion, which are factors attributable to surgicaldisease burden due to poverty. A team comprising gynecologists, nurses, and theater technicians hasbeen providing laparoscopic surgery to patients in low-income communities in Kiambu, Nairobi, and Merucounties in Kenya. This initiative was undertaken by pooling resources to procure basic laparoscopicequipment, a regional needs assessment for gynecological surgery, and logistical planning for outpatientclinical services. This was followed by the provision of laparoscopic surgery to patients diagnosed withvarious gynecological conditions. We present programmatic data of the clinical profile and outcomes ofpatients who benefited from the program.Results: A total of 175 women benefited from the program from January 2023 to December 2023. Themost common surgery undertaken was laparoscopic hysterectomy due to symptomatic uterine fibroids.Other procedures included diagnostic hysteroscopy and laparoscopy for chronic pelvic pain. Most womenwere under the national health insurance fund scheme.Conclusion: The program has improved the quality of services provided and demonstrated the feasibilityof mobile surgical workshops as an intervention to improve the quality of services in low-incomecommunities.
{"title":"Clinical profile and outcomes of endoscopic surgery patients during a mobile gynecological surgery program in low- and middle-income communities in Kenya","authors":"Bruce Semo, Dennis Mureithi, Misheck Njukia","doi":"10.59692/jogeca.v36i1.180","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.180","url":null,"abstract":"Background: Access to quality gynecological surgery in low- and middle-income communities has beengreatly hampered by logistical and socioeconomic challenges. These challenges can be overcomethrough the provision of mobile laparoscopic surgery. Endoscopic surgery reduces the rate of infection,duration of hospital stay, and the need for blood transfusion, which are factors attributable to surgicaldisease burden due to poverty. A team comprising gynecologists, nurses, and theater technicians hasbeen providing laparoscopic surgery to patients in low-income communities in Kiambu, Nairobi, and Merucounties in Kenya. This initiative was undertaken by pooling resources to procure basic laparoscopicequipment, a regional needs assessment for gynecological surgery, and logistical planning for outpatientclinical services. This was followed by the provision of laparoscopic surgery to patients diagnosed withvarious gynecological conditions. We present programmatic data of the clinical profile and outcomes ofpatients who benefited from the program.Results: A total of 175 women benefited from the program from January 2023 to December 2023. Themost common surgery undertaken was laparoscopic hysterectomy due to symptomatic uterine fibroids.Other procedures included diagnostic hysteroscopy and laparoscopy for chronic pelvic pain. Most womenwere under the national health insurance fund scheme.Conclusion: The program has improved the quality of services provided and demonstrated the feasibilityof mobile surgical workshops as an intervention to improve the quality of services in low-incomecommunities.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"142 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894636","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.v36i1.136
Jonathan Wawire, Olvia Chesikaw
Background: The incidence of endometrial carcinoma is rising worldwide, partly due to the risingprevalence of obesity. From a diagnostic pathology perspective, it is a heterogeneous disease with avaried range of histomorphological features and is prone to poor interobserver reproducibility. This oftenhas downstream effects on treatment protocols and patient outcomes. The current WHO Classification ofTumors of the Female Genital Tract recommends the incorporation of histology, immunohistochemistry,and molecular testing where possible in the classification of endometrial carcinoma into clinically relevantsubtypes. In Kenya, access to ancillary testing is limited and prohibitively expensive, negatively affectingaccurate tumor classification. In addition, there are limited local data on the various histologic subtypes ofendometrial carcinoma and their respective clinical outcomes.Objectives: To review the classification of endometrial carcinoma as defined by the current WHOClassification contextualized with local clinical, demographic, pathology, and outcome data from twotertiary referral centers in Kenya.Methods: Formalin-fixed paraffin-embedded blocks (FFPE) of 123 cases of endometrial carcinomasbetween 2012 and 2020 were retrieved from the Aga Khan University and Moi Teaching and ReferralHospitals. The clinical history and follow-up data were abstracted. Hematoxylin and eosin sections werereviewed and 11 immunohistochemical markers (MLH1, MSH2, MSH6, PMS2, ER, PR, ARID1A, P16,PTEN, napsin A, and p53) were determined, and analyzed to arrive at a consensus diagnosis.Results: Six endometrial carcinoma subtypes: endometrioid (68 cases, 55%), serous (32 cases, 26%),carcinosarcoma (15 cases, 12%), clear cell (5 cases, 4%), mixed carcinoma (2 cases, 1.5%), anddedifferentiated carcinoma (1 case, <1%) were reported. The median age of presentation was 63 years(range of 34-90 years) and the median body mass index (BMI) was 27.4 kg/m2. Staging data wereavailable in 95 cases, of which 64 (67%) were in the early stage at presentation. Follow-up data wereavailable in 70 patients with a median follow-up time of 18 months. Recurrences were reported in 11cases, 5 of which were of the serous subtype. Of the 26 patients whose status was known at the time ofthe conclusion of the study, 7 died of the disease.Conclusion: To our knowledge, this is the first comprehensive review of the clinical and pathologicalprofiles of various subtypes of endometrial cancer in Kenya with follow-up and outcome data using awide array of immunohistochemical markers for accurate classification as per the WHO classification.
{"title":"A snapshot of the landscape of endometrial cancer in Kenya: Implications of recent updates in pathological classification","authors":"Jonathan Wawire, Olvia Chesikaw","doi":"10.59692/jogeca.v36i1.136","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.136","url":null,"abstract":"Background: The incidence of endometrial carcinoma is rising worldwide, partly due to the risingprevalence of obesity. From a diagnostic pathology perspective, it is a heterogeneous disease with avaried range of histomorphological features and is prone to poor interobserver reproducibility. This oftenhas downstream effects on treatment protocols and patient outcomes. The current WHO Classification ofTumors of the Female Genital Tract recommends the incorporation of histology, immunohistochemistry,and molecular testing where possible in the classification of endometrial carcinoma into clinically relevantsubtypes. In Kenya, access to ancillary testing is limited and prohibitively expensive, negatively affectingaccurate tumor classification. In addition, there are limited local data on the various histologic subtypes ofendometrial carcinoma and their respective clinical outcomes.Objectives: To review the classification of endometrial carcinoma as defined by the current WHOClassification contextualized with local clinical, demographic, pathology, and outcome data from twotertiary referral centers in Kenya.Methods: Formalin-fixed paraffin-embedded blocks (FFPE) of 123 cases of endometrial carcinomasbetween 2012 and 2020 were retrieved from the Aga Khan University and Moi Teaching and ReferralHospitals. The clinical history and follow-up data were abstracted. Hematoxylin and eosin sections werereviewed and 11 immunohistochemical markers (MLH1, MSH2, MSH6, PMS2, ER, PR, ARID1A, P16,PTEN, napsin A, and p53) were determined, and analyzed to arrive at a consensus diagnosis.Results: Six endometrial carcinoma subtypes: endometrioid (68 cases, 55%), serous (32 cases, 26%),carcinosarcoma (15 cases, 12%), clear cell (5 cases, 4%), mixed carcinoma (2 cases, 1.5%), anddedifferentiated carcinoma (1 case, <1%) were reported. The median age of presentation was 63 years(range of 34-90 years) and the median body mass index (BMI) was 27.4 kg/m2. Staging data wereavailable in 95 cases, of which 64 (67%) were in the early stage at presentation. Follow-up data wereavailable in 70 patients with a median follow-up time of 18 months. Recurrences were reported in 11cases, 5 of which were of the serous subtype. Of the 26 patients whose status was known at the time ofthe conclusion of the study, 7 died of the disease.Conclusion: To our knowledge, this is the first comprehensive review of the clinical and pathologicalprofiles of various subtypes of endometrial cancer in Kenya with follow-up and outcome data using awide array of immunohistochemical markers for accurate classification as per the WHO classification.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"102 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963674","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.v36i1.95
Wangeci Kihara
A multidisciplinary approach to maternal health signifies the integration of diverse healthcare professionals working collaboratively to address the complex needs of expectant and postpartum women. This approach acknowledges the intricate interplay between physical health and mental well-being during pregnancy, childbirth, and the postpartum period. In this framework, a team comprising obstetricians, midwives, psychologists, psychiatrists, nurses, social workers, and other specialists works together to provide holistic care. This teamwork ensures a comprehensive assessment of the physical and psychological aspects of maternal health. For instance, obstetricians focus on the physical health of the mother and baby, while mental health professionals assess and manage conditions, such as perinatal depression, anxiety, or postpartum mood disorders. Lactation consultants and nutritionists are also able to identify mental health concerns based on the time and anatomy of their consultations. The multidisciplinary team approach discussed will suggest the employment of early screening tools to detect mental health concerns by obstetricians and midwives, allowing for timely interventions and personalized care plans. This approach not only addresses immediate mental health issues but also prevent long-term complications that might affect both the mother and child. Furthermore, this collaborative model promotes education and support for mothers and their families. It empowers women with information about mental health during pregnancy and postpartum, equipping them to recognize symptoms and seek assistance when needed. In addition, it provides social and emotional support, reducing the stigma often associated with maternal mental health challenges. By engaging the expertise of various professionals, the multidisciplinary approach enhances the quality of care, leading to improved maternal mental health outcomes. It contributes to healthier pregnancies, reduces the risk of postpartum mental health issues, and fosters an environment where mothers receive comprehensive support, positively influencing the well-being of both the mother and child eventually.
{"title":"Role of a multidisciplinary approach in maternal health and mental health outcomes","authors":"Wangeci Kihara","doi":"10.59692/jogeca.v36i1.95","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.95","url":null,"abstract":"A multidisciplinary approach to maternal health signifies the integration of diverse healthcare professionals working collaboratively to address the complex needs of expectant and postpartum women. This approach acknowledges the intricate interplay between physical health and mental well-being during pregnancy, childbirth, and the postpartum period. In this framework, a team comprising obstetricians, midwives, psychologists, psychiatrists, nurses, social workers, and other specialists works together to provide holistic care. This teamwork ensures a comprehensive assessment of the physical and psychological aspects of maternal health. For instance, obstetricians focus on the physical health of the mother and baby, while mental health professionals assess and manage conditions, such as perinatal depression, anxiety, or postpartum mood disorders. Lactation consultants and nutritionists are also able to identify mental health concerns based on the time and anatomy of their consultations. \u0000The multidisciplinary team approach discussed will suggest the employment of early screening tools to detect mental health concerns by obstetricians and midwives, allowing for timely interventions and personalized care plans. This approach not only addresses immediate mental health issues but also prevent long-term complications that might affect both the mother and child. Furthermore, this collaborative model promotes education and support for mothers and their families. It empowers women with information about mental health during pregnancy and postpartum, equipping them to recognize symptoms and seek assistance when needed. In addition, it provides social and emotional support, reducing the stigma often associated with maternal mental health challenges. By engaging the expertise of various professionals, the multidisciplinary approach enhances the quality of care, leading to improved maternal mental health outcomes. It contributes to healthier pregnancies, reduces the risk of postpartum mental health issues, and fosters an environment where mothers receive comprehensive support, positively influencing the well-being of both the mother and child eventually.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"71 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963877","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.v36i1.103
Mjahid Hassan, Joan Okemo
Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low- andmiddle-income countries. Uterine atony accounts for 70–80% of PPH cases. Management of PPH isusually based on a cascade beginning with the use of uterotonics and eventually hysterectomy in casesof refractory PPH. Different compression suture techniques have been described and used for themanagement of uterine atony where medical management is insufficient and preservation of fertility isdesired.Case presentation: This is a series of four patients who presented to our facility and consequentlydeveloped uterine atony that was unresponsive to medical management during cesarean delivery despitethe use of multiple uterotonics. All four patients had established risk factors for uterine atony, includinginduction of labor, augmentation of labor, chorioamnionitis, or fetal macrosomia. Hayman compressionsutures were performed in all four patients with success. Estimated blood loss in the series ranged from400 to 1200 mls. All patients recovered well with no complications reported during the postpartum period.Conclusion: Hayman compression sutures offer an alternative to the more ubiquitous B-Lynch suturewith several advantages, including ease of placement and no need for a hysterotomy in PPH post vaginalbirth or placement post repair of hysterotomy in cesarean cases. Thus, the may be easier to perform forjunior health care professionals as well as in stressful situations.
{"title":"HAYMAN COMPRESSION SUTURES : AN UNDERUTILIZED TOOL FOR MANAGEMENT OF UTERINE ATONY AND POSTPARTUM HAEMORRHAGE.","authors":"Mjahid Hassan, Joan Okemo","doi":"10.59692/jogeca.v36i1.103","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.103","url":null,"abstract":"Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low- andmiddle-income countries. Uterine atony accounts for 70–80% of PPH cases. Management of PPH isusually based on a cascade beginning with the use of uterotonics and eventually hysterectomy in casesof refractory PPH. Different compression suture techniques have been described and used for themanagement of uterine atony where medical management is insufficient and preservation of fertility isdesired.Case presentation: This is a series of four patients who presented to our facility and consequentlydeveloped uterine atony that was unresponsive to medical management during cesarean delivery despitethe use of multiple uterotonics. All four patients had established risk factors for uterine atony, includinginduction of labor, augmentation of labor, chorioamnionitis, or fetal macrosomia. Hayman compressionsutures were performed in all four patients with success. Estimated blood loss in the series ranged from400 to 1200 mls. All patients recovered well with no complications reported during the postpartum period.Conclusion: Hayman compression sutures offer an alternative to the more ubiquitous B-Lynch suturewith several advantages, including ease of placement and no need for a hysterotomy in PPH post vaginalbirth or placement post repair of hysterotomy in cesarean cases. Thus, the may be easier to perform forjunior health care professionals as well as in stressful situations.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"65 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963892","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.v36i1.290
Faiza Nassir, Rehema Omar Shee, Abdul lavingia, Nawal Alyan
Background: Human papillomavirus (HPV) infection is associated with oropharyngeal and anogenitalcancers in men and women. Approximately 90% of all cervical cancers are attributed to high-risk HPVinfections, and 60% of squamous cell carcinomas (SCC) of the vulva, vagina, anus, and penis are due toHPV infection.Case presentation: We present the case of a 26-year-old with retroviral disease managed for locallyadvanced vulva cancer on external beam radiotherapy followed by wide excision of the residual tumorand bilateral inguino femoral nodal dissection. She later presented with a history of foul-smelling vaginaldischarge. A biopsy confirmed moderately differentiated squamous cell carcinoma of the cervix clinicallyand radiologically staged at 2B and 3B, respectively. She was scheduled to start chemotherapy withcarboplatin and paclitaxel after blood transfusion due to anemia.Discussion: Field cancerization was coined by Slaughter et al. to describe the existence of generalizedcarcinogen-induced early genetic changes in the epithelium from which multiple independent lesionsoccur, leading to the development of multifocal tumors. In some cases, multiple contiguous tumor focicoalesce, hence the lateral spread of squamous cell cancers. It was also observed that normal-lookingcells near malignant cells were histologically abnormal and therefore were part of the transformed cells ina particular tumor field and consequently were responsible for the occurrence of local tumorrecurrences.Conclusion: Field cancerization is a well-known and well-documented process of malignanttransformation. Several studies have confirmed the importance of this phenomenon in tumordevelopment. Surveillance is the key to detecting early recurrence and secondary malignancies.
{"title":"Secondary malignancy in a vulva cancer patient – HPV-induced field cancerization: A case report","authors":"Faiza Nassir, Rehema Omar Shee, Abdul lavingia, Nawal Alyan","doi":"10.59692/jogeca.v36i1.290","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.290","url":null,"abstract":"Background: Human papillomavirus (HPV) infection is associated with oropharyngeal and anogenitalcancers in men and women. Approximately 90% of all cervical cancers are attributed to high-risk HPVinfections, and 60% of squamous cell carcinomas (SCC) of the vulva, vagina, anus, and penis are due toHPV infection.Case presentation: We present the case of a 26-year-old with retroviral disease managed for locallyadvanced vulva cancer on external beam radiotherapy followed by wide excision of the residual tumorand bilateral inguino femoral nodal dissection. She later presented with a history of foul-smelling vaginaldischarge. A biopsy confirmed moderately differentiated squamous cell carcinoma of the cervix clinicallyand radiologically staged at 2B and 3B, respectively. She was scheduled to start chemotherapy withcarboplatin and paclitaxel after blood transfusion due to anemia.Discussion: Field cancerization was coined by Slaughter et al. to describe the existence of generalizedcarcinogen-induced early genetic changes in the epithelium from which multiple independent lesionsoccur, leading to the development of multifocal tumors. In some cases, multiple contiguous tumor focicoalesce, hence the lateral spread of squamous cell cancers. It was also observed that normal-lookingcells near malignant cells were histologically abnormal and therefore were part of the transformed cells ina particular tumor field and consequently were responsible for the occurrence of local tumorrecurrences.Conclusion: Field cancerization is a well-known and well-documented process of malignanttransformation. Several studies have confirmed the importance of this phenomenon in tumordevelopment. Surveillance is the key to detecting early recurrence and secondary malignancies.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"38 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964013","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.v36i1.175
J. Miheso, Doreen Osoro
Background: Interstitial cystitis is a debilitating condition with a rising prevalence due to increasedresearch and diagnostic criteria. Interstitial cystitis falls under the category of urologic chronic pelvic painsyndrome and is a diagnosis of exclusion. Interstitial cystitis or bladder pain syndrome (BPS) ischaracterized by chronic inflammation. Common symptoms include chronic pelvic pain, pressure, ordiscomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, suchas persistent urge to void or urinary frequency in the absence of confusable diseases (hypersensitivebladder symptoms). The true burden of interstitial cystitis is underestimated, and the economic burden ofthe disease is due to multiple office visits and an increase in direct medical costs.Case presentation: A 59-year-old para 2+0 (2 previous scars) postmenopausal with a 1-year history offrequency (up to eight episodes) nocturia with low abdominal pain. Her urinalysis profile, urea,electrolytes and creatinine, and ultrasound and computed tomography of the kidneys, ureters andbladder, pap smear, and random blood sugar tests were unremarkable. Cystoscopy was hemorrhagicwith biopsy histology showing ulcerated bladder mucosa with numerous plasma cells, eosinophils, andneutrophils in the lamina propria no atypia, with fibrosis and dilated capillaries in the lamina propria. Onfollow-up she had a recurrence of pain symptoms with a cystoscopy biopsy, seven months later showingplasma cell infiltrate with ulceration of the overlying urothelium, and congestion of the blood vessels. Shewas not neoplastic and was put on antihistamine, nonsteroidal antiinflammatory drugs, and solifen.Conclusion: Prompt diagnosis and treatment of interstitial cystitis will reduce the burden of diseaseassociated with multiple outpatient visits and unnecessary use of antibiotics. The mainstay ofmanagement is oral and intravesical treatment with surgery in refractory cases.
{"title":"Interstitial cystitis – a diagnostic dilemma: A case report","authors":"J. Miheso, Doreen Osoro","doi":"10.59692/jogeca.v36i1.175","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.175","url":null,"abstract":"Background: Interstitial cystitis is a debilitating condition with a rising prevalence due to increasedresearch and diagnostic criteria. Interstitial cystitis falls under the category of urologic chronic pelvic painsyndrome and is a diagnosis of exclusion. Interstitial cystitis or bladder pain syndrome (BPS) ischaracterized by chronic inflammation. Common symptoms include chronic pelvic pain, pressure, ordiscomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, suchas persistent urge to void or urinary frequency in the absence of confusable diseases (hypersensitivebladder symptoms). The true burden of interstitial cystitis is underestimated, and the economic burden ofthe disease is due to multiple office visits and an increase in direct medical costs.Case presentation: A 59-year-old para 2+0 (2 previous scars) postmenopausal with a 1-year history offrequency (up to eight episodes) nocturia with low abdominal pain. Her urinalysis profile, urea,electrolytes and creatinine, and ultrasound and computed tomography of the kidneys, ureters andbladder, pap smear, and random blood sugar tests were unremarkable. Cystoscopy was hemorrhagicwith biopsy histology showing ulcerated bladder mucosa with numerous plasma cells, eosinophils, andneutrophils in the lamina propria no atypia, with fibrosis and dilated capillaries in the lamina propria. Onfollow-up she had a recurrence of pain symptoms with a cystoscopy biopsy, seven months later showingplasma cell infiltrate with ulceration of the overlying urothelium, and congestion of the blood vessels. Shewas not neoplastic and was put on antihistamine, nonsteroidal antiinflammatory drugs, and solifen.Conclusion: Prompt diagnosis and treatment of interstitial cystitis will reduce the burden of diseaseassociated with multiple outpatient visits and unnecessary use of antibiotics. The mainstay ofmanagement is oral and intravesical treatment with surgery in refractory cases.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"94 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964159","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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