The magnitude of episiotomy among women who gave birth in Ethiopia: Systematic review and meta-analysis

Episiotomy is one of the most common obstetric procedures done by health providers putting the client at high risk of developing complications and lacerations. These days, episiotomy has been done at an alarming rate in Ethiopia as compared to the slant set by World Health Organization. Be that as it may, there is a need for nationally representative data. This study aimed to determine the pooled prevalence of episiotomy practice among women who gave birth at public health institutions in Ethiopia. We accessed PubMed, Web of Science, Google Scholar, EMBASE, and manual search was used to retrieve articles. The extractions of the data were done by using Microsoft Excel and analyzed by STATA version 11 statistical software. The publication bias was checked by funnel plot visually and Egger's test and Begg's test, with P < 0.05 considered indicating potential publication bias. I2 was used to check the presence of heterogeneity of the studies. Overall estimated analysis was done. Subgroup analysis was done by region. We carried out a leave-one-out sensitivity analysis. The Joanna Briggs Institute risk of bias assessment tool was used. Out of 254 articles retrieved, 9 studies met the eligibility criteria and are thus included in this study. The overall episiotomy practice in Ethiopia was 45.01% (95% CI: 36.288, 53.741). Based on the sub-group analysis, prevalence of episiotomy practice was 49.32% (95%CI: 12.67, 85.97), 46.92% (95%CI: 29.47, 64.37), 44.23 (95%CI: 37.77, 50.99) and 38.29 (95%CI: 32.38, 44.20) among South region, Addis Ababa, Amhara region and Tigray region respectively. The findings revealed that the prevalence of episiotomy practice in Ethiopia was high (45.01%). Therefore, it is better to have periodic training for birth attendants on the indication of episiotomy and the appropriate use of guidelines to reduce the rate of episiotomy. (Afr J Reprod Health 2022; 26[4]: 98-109).

Consensual coital vaginal laceration in hypovolaemic shock: A report of two cases

Background:Certain life-threatening complications and morbidities may occur following consensual sexual intercourse which may not be commonly experienced in clinical practice. One of such complications is hypovolaemic shock resulting from profuse bleeding.AbstractMethods:Two cases of vaginal laceration complicated by hypovolaemic shock following consensual sexual intercourse are presented.Results:Both patients had resuscitation with intravenous fluid, blood transfusion and subsequent examination under anaesthesia with repair of laceration in theater. Post-operative recovery period was uneventful and they were both discharged after proper counselling. Conclusion:Bleeding from coital laceration could be life threatening. Prompt treatment should be instituted in such cases

Life Threatening Vaginal Haemorrhage from Coital Laceration in a Post-Menopausal Woman

Background: Life threatening coital laceration from consensual intercourse in the postmenopausal period is unusual without any predisposing factors(s). The usual site of occurrence is the right side of the posterior fornix. Aim: To report a case of haemorrhagic shock from coital laceration. Design: Case report : A 55-year-old woman who presented as an emergency with haemorrhagic shock following vaginal bleeding from consensual coitus is presented. She was resuscitated with intravenous fluids and blood transfusions. The vaginal laceration of about 5 cm on the right side of the posterior fornix was sutured following examination under anaesthesia. Conclusion: Coital laceration should be considered a differential diagnosis in any postmenopausal vaginal bleeding while prompt recognition and treatment are important to avoid morbidity and even mortality

Major trauma : from the grand surgical rounds: a presentation in the Makerere University Medical School Davies Lecture Theatre; August 1st 1996

A case was presented of a 60 year old male patient from Mubende who had met with the bonnet of a fast moving vehicle and sustained injuries to both lower limbs (with an open fracture of the right tibia). Primary suture of the pretibial laceration had been done. On the second day; he had been found to be tender in the epigastrium; and there was some swelling and pain under the rib margin on the left; so; with a diagnosis of rupture of the spleen; he was referred from Mityana Hospital to Mulago; after emergency splinting of the lower limb. At Mulago; he was found to be dehydrated; apyrexial; with a rapid pulse but a normal blood pressure. The wound just above the right ankle was dirty with a crusting of blood over it. His abdomen was distended; with guarding; dullness and tenderness in the left hypochndrium. Accordingly; he was diagnosed as having a ruptured spleen; and the injured organ was removed totally as he had an accessory spleen; so splenic conservation was not indicated. He made a reasonably straightforward post-operative recovery apart from an infection of the right tibial fracture. The article includes highlights on pathophysiology; complications; prognostic factors and lessons which include the danger of missing a rupture of an internal organ when there is an obvius fracture; and the danger of doing immediate primary suture of a tibial fracture in a case with multiple injuries