Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).

Tendance de la mortalité maternelle au Centre Hospitalo-Universitaire de Constantine entre 2012 et 2017 / Trend in maternal mortality at Constantine University Hospital between 2012 and 2017

Contexte et objectifs. Les données sur la tendance de la mortalité maternelle sont fragmentaires en Afrique Subsaharienne. La présente étude avait pour objectif de faire une analyse triennale de l'évolution du taux de mortalité maternelle et identifier les causes de décès. Méthodes : Il s'agissait d'une étude observationnelle documentaire, sur la mortalité maternelle enregistrée ; au Centre hospitalo universitaire de Constantine, entre le 1er Janvier 2012 et le 31 Décembre 2017. Résultats. Soixante-dix décès maternels ont été déplorés. Le taux de mortalité maternelle est de 101,3 décès pour 100 000 naissances vivantes. Les hémorragies obstétricales et les complications hypertensives de la grossesse sont les premières causes de mortalité. L'analyse des données triennales met en évidence une baisse importante de la mortalité par hémorragie et par complications de l'anesthésie. Conclusion. Cette étude a permis de dresser un profil des causes de la mortalité maternelle dont les niveaux restent inquiétants et requièrent une action globale.

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

BACKGROUND: Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district. METHODS: A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02­30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization. RESULTS: Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization. CONCLUSION: Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it

COVID-19 in pregnant women in South Africa: A retrospective review

Background. The majority of maternal deaths in South Africa (SA) occur as a result of non-pregnancy-related infections (NPRI). Pregnancy is a known risk factor in severe COVID-19, increasing the burden of NPRI in SA. In this study, we describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility.Objectives. To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, SA.Methods. We performed a retrospective review of all pregnant women with COVID-19 admitted to Charlotte Maxeke Johannesburg Academic Hospital between 6 March and 30 August 2020. Data collected included demographics, medical history, obstetric history, clinical findings and laboratory variables. Outcomes assessed were mortality, admission to intensive care unit (ICU), symptomatic v. asymptomatic disease, maternal and fetal outcome and mode of delivery.Results. A total of 204 pregnant women were included in the study. Of these, 33 (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. The median gestational age was 37 weeks and median birthweight 2 940 g. Sixty-seven women (33%) were HIV-positive, in keeping with national statistics regarding HIV in pregnancy. Caesarean section was the most common mode of delivery (n=105, 60%). However, no women underwent caesarean section for indications related to COVID-19. Conclusion. COVID-19-related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Background: Data-informed decision making is influenced by organizational, technical, and behavioral factors.Behavioral factors are the major contributing factors for data-informed decision-making practices. This study aimed to explore health workers' perceptions of data-informed decision making at primary health care units in Awi zone. Method: A cross-sectional qualitative study was undertaken to explore health workers' perceptions on the barriers of health data-informed decision-making practices. Eleven healthcare workers were purposively selected from primary hospitals, health centers and health posts. Medical doctors, nurses, midwifes and health extension workers were selected as key informants for the in-depth interview. The selected healthcare workers were asked about their perceptions that affect health data use practices. The data obtained was analyzed through thematic analysis using Open Code software. Analysis was performed using three themes namely, organizational, behavioral, and technical barriers of data-informed decision making. Results: All the health care workers including health extension workers utilized a data-informed decision-making practice at least once during their point of care. Five of the eleven key informants reported their data-informed decision-making practice as reviewing quality of facility data, while none of them reported data-informed decision-making practices for their monthly performance monitoring. Behavioral factors included negligence, workarounds, and skill gaps. Organizational factors included staff turnover and shortage of recording tools. Technical factors included high workloads which lead to data error and paper-based systems were considered major barriers to data-informed decision-making practices. Conclusion: Data-informed decision-making practices were low at primary health care units. Behavioral, organizational, and technical factors contributed to the decreased use of data. [Ethiop. J. Health Dev. 2022;36(2):000-000]

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Maternal mortality in Ethiopia is the highest in the world (412/100,000). Health facility delivery is the cornerstone in reducing maternal mortality. However, health facility delivery is low in Ethiopia, due to poor access and ill-equipped health facilities. Maternity waiting home(MWH)is one of the comprehensive packages of essential obstetric services, enabling women to access well-equipped health facilities. However, there are limited studies on maternal waiting home use in Ethiopia. This study aimedto use the integrated behavioral model, toassess maternal waiting home use and associated factors among mothers in the East Bellessa district, northwest Ethiopia.Method:A community-based cross-sectional study was conducted fromthe1-27 of March 2020. The multistage sampling technique was used to select a total of 624 mothers. Data was collected usingthe face-to-face interview technique. The reliability and validity of the itemswere checked using exploratory factor analysis. Multivariable logistic regressions wereconducted toidentify the factors associated with maternal waiting home use. Findings with a p-value <0.05 with a 95% confidence interval were considered statistically significant in the final model.Result.Overall, 20.5% (95% CI=17.3-23.7) of mothers used maternity waiting homes for the index of childbirth. Husband educational status (AOR=3.78, CI =1.44-9.93), the knowledge on maternitywaiting homes(AOR=3.97, CI=2.27-6.95), between 2 and 3antenatal care follow ups(AOR=0.14 CI=0.06-0.31), experiential attitude (AOR=2.37, CI=1.64-3.44), descriptive norms(AOR=0.66, CI=0.47-0.94), perceived behavioral control (AOR=1.07, CI=1.02-1.13) and behavioral intention (AOR=1.37, CI=1.1-1.71) were associated with maternity waiting home use.Conclusion:Maternity waiting home utilization was low. Husband's education status, antenatal care follow-up, knowledge on maternal waiting homes, experiential attitude, descriptive norms, perceived behavioral control and behavioralintention were positively significantly associated with MWH utilization. Therefore, strengthening the use antenatal care services, husbands'education, and developing a positive attitude towards MWH may improve the use of maternity waitinghomesamong women. [Ethiop. J. Health Dev. 2022; 36(2):000-000]Keyword:Maternity waiting home, mothers,integrated behavioral model, Ethiopia

Unplanned pregnancy among female students at universities in the Eastern Cape Province, South Africa

Unplanned pregnancy has adverse effects including unsafe and illegal abortions causing maternal morbidity and mortality. Despite the adverse impact of unplanned pregnancy on women's personal life, their families, and society, there is a dearth of knowledge on unplanned pregnancy in institutions of higher education and training in South Africa. As a result, the objective of this study was to assess unplanned pregnancy and underlying factors among unmarried female students in universities in Eastern Cape. This was a cross-sectional survey of 1269 unmarried female students from universities in Eastern Cape selected using multistage cluster sampling. The study found that the prevalence of unplanned pregnancy was 12.31%, Health Science student (AOR: 0.41, 95% CI [0.17, 0.99], p < 0.001) were less likely to experience unplanned pregnancy. Being financially supported by a family (AOR: 0.17, 95% CI: [0.07, 0.43], p< 0.001) and being aged less than or equal to 18 years during the first sexual intercourse (AOR: 6.32, 95% CI: [2.57, 15.54], p < 0.001) were associated with unplanned pregnancy. Rural residence (AOR=3.93; 95% CI: (1.21, 12.84), p <0.001), not using contraceptives (AOR=10.63; 95%CI: 5.29, 21.37, p < 0.001) and having divorced parents (AOR=1.99; 95%CI: 1.14, 3.94), p < 0.001) were associated with unplanned pregnancy compared to their counterparts, respectively. The prevalence of unplanned pregnancy is high among unmarried female students in universities in Eastern Cape. Unplanned pregnancy was influenced by age at first sexual intercourse, non-use of contraceptives, divorced parents, the field of study, and the source of financial support. Universities and stakeholders should work together to support reproductive health programmes to prevent unplanned pregnancy. (Afr J Reprod Health 2022; 26[7]: 29-37).

Implementation of assistance for one pregnant woman one cadre (OPOC) in Banjarnegara District, Central Java Province, Indonesia

The high maternal mortality rate caused by late detection of risk factors for pregnant women is a major health problem in Banjarnegara District. One of the efforts made to overcome this problem is the implementation of assistance for one pregnant woman by one cadre (OPOC). The application of OPOC consists of four mentoring activities, namely reminders about antenatal care schedule, detecting risk factors, monitoring fetal movements, and carrying out delivery planning and handling complications.Therefore, this study aims to describe the implementation of OPOC as well as to evaluate cadres' performance in Banjarnegara District. A quantitative cross-sectional design was used, where a total of 200 cadres were selected as respondents using a representative purposive sampling method. The results showed that reminding mothers about their antenatal care schedule,detecting risk factors, monitoring of fetal health through movements, and making commitments for birth planning and complications prevention were carried out by 199 (99.49%), 129 (64.84%), 138 (69.05%), and 159 (79.42%) respondents, respectively. More than 92% of them know their duties and responsibilities as companions for pregnant women, but only 28% have knowledge about the benefits of assisting. Furthermore, 93% often carry out OPOC assistance. The knowledge of cadres about OPOC assistance was good, but some of them are not knowledgeable about its benefits. These findings show that they need guidance, training, and motivation from public health centers. (Afr J Reprod Health 2022; 26[7]: 83-89).

Mortalité maternelle chez les adolescentes au service de Gynécologie-Obstétrique de l'Hôpital National Ignace Deen / Maternal mortality among adolescents in the Gynecology-Obstetrics department of Ignace Deen National Hospital

Introduction. L'objectif de cette étude était de contribuer à l'étude de la mortalité maternelle chez les adolescentes. Méthodes. Il s'agissait d'une étude retro-prospective descriptive et analytique cas témoin, d'une durée de trois ans. La collecte rétrospective avait porté sur deux (2) ans allant du 1er Janvier 2018 au 31 Décembre 2019 et celle prospective sur un (1) an allant du 1er Janvier 2020 au 31 Décembre 2020. Résultats. Durant la période d'étude nous avons enregistré 38 cas de décès maternels sur 16175 naissances vivantes soit un ratio de 235 décès pour 100000 naissances vivantes. Le décès concerne l'adolescente de 18-19 ans (65,8%), mariée (63,2%), non scolarisé (42,1%), et nullipare (65,8%). La majorité des adolescentes avait effectué 1-3 CPN (44,7%), et provenait d'une maternité périphérique (84,2%) et avait accouché par voie basse (78,4%). Le moyen de transport le plus utilisé était le transport en commun (63,2%). La cause de décès était dominée par l'hémorragie (44,7%). Le post-partum a été la période la plus pourvoyeuse de décès (52,6%). Conclusion. La mortalité maternelle constitue un problème de santé majeure dans notre pays, sa réduction nécessite la mobilisation de tous les acteurs de la société et implique une bonne éducation pour la santé, l'amélioration de la qualité du suivi prénatal et celle des soins obstétricaux d'urgence.

Introduction. The objective of this study was to contribute to the study of adolescent maternal mortality. Methods. This was a retrospective descriptive and analytical case-control study, lasting three years. The retrospective data collection covered two (2) years from January 1, 2018 to December 31, 2019 and the prospective one over one (1) year from January 1, 2020 to December 31, 2020. Results. During the study period we recorded 38 cases of maternal deaths out of 16,175 live births, ie a ratio of 235 deaths per 100,000 live births. The death concerns an adolescent girl aged 18-19 (65.8%), married (63.2%), out of school (42.1%), and nulliparous (65.8%). The majority of adolescent girls had performed 1-3 ANC (44.7%), and had come from a peripheral maternity hospital (84.2%) and had given birth vaginally (78.4%). The most used mode of transportation was public transit (63.2%) The cause of death was dominated by hemorrhage (44.7%). The postpartum period was the most significant period of death (52.6%). Conclusion: Maternal mortality is a major health problem in our country, its reduction requires the mobilization of all actors in society and involves good health education, improving the quality of prenatal care and that of obstetric care emergency

Macrosomie au Centre Hospitalier Universitaire de Libreville

La macrosomie constitue un problème de santé publique en Afrique subsaharienne, en raison de l'importance de sa morbidité et mortalité néonatales. Dans le monde, sa fréquence est en augmentation et peu d'études ont été réalisées au Gabon. Objectif : déterminer la fréquence, évaluer le pronostic materno-foetal et identifier les facteurs associés aux risques de la macrosomie. Patients et méthodes : il s'agissait d'une étude descriptive, analytique et prospective qui a été réalisée entre janvier et décembre 2017 au Centre Hospitalier Universitaire de Libreville. Les nouveaux nés de poids supérieur ou égal à 4 000 grammes ou supérieur au 90ème percentile des courbes de référence pour l'âge gestationnel ont été inclus. Les variables étudiées étaient sociodémographiques, les antécédents, le mode d'accouchement et les complications cliniques chez la mère. Pour le nouveau-né, elles concernaient, les paramètres anthropométriques, le score d'Apgar et le profil évolutif. Le test Khi 2 a été utilisé pour la comparaison des proportions avec un seuil de signification de p≤ 0,05. Résultats : la fréquence de la macrosomie était de 3,85%. L'âge moyen des mères était de 29,3 ± 6,1 ans. Un antécédent de macrosomie était retrouvé dans 47 cas (15,6%) et un de diabète gestationnel dans deux cas (0,7%). L'accouchement était par voie basse dans 247 cas (81,8 %) et en présentation céphalique dans 297 cas (98,3%). Une déchirure périnéale était notée dans 67 cas (22,2 %). Les nouveau-nés étaient à terme dans 182 cas (60,2%), de sexe masculin dans 201 cas (66,6%) et de sexe féminin dans 101 cas (33,4%). Ils avaient un poids moyen de 4257 ± 275,3 grammes, le score d'APGAR était ≥ 7 à la 1ère minute dans 253 cas (83,8%). Une élongation du plexus brachial était notée dans 22 cas (7,3%) et un décès dans neuf 9 cas (3,0%). Un poids de naissance supérieur à 4 500 grammes augmentait le risque de complications associé à la macrosomie. Conclusion : La macrosomie est peu fréquente dans notre contexte hospitalier mais la morbi-mortalité maternelle et néonatale qui en découle n'est pas négligeable. Le diagnostic précoce de macrosomie et une prise en charge multidisciplinaire permettrait de réduire la survenue de complications

Awareness of danger signs during pregnancy and post-delivery period among women of reproductive age in Unguja Island, Zanzibar: a qualitative study

Zanzibar is part of the United Republic of Tanzania with high levels of maternal mortality due to obstetric complications. Women's awareness on obstetric danger signs and early seeking of medical care is the first intervention in reduction of maternal deaths. This study explored awareness of danger signs among women of reproductive age in Unguja Island, Zanzibar. A community-based qualitative study using focus group discussions among women of reproductive age was conducted to explore awareness of danger signs between March and April 2016. Data was analyzed using thematic analysis. The study found that women were aware of danger signs during pregnancy but not during the post-delivery period. The mentioned danger signs during pregnancy included vaginal bleeding, fits, swelling of the legs and leaking of vagina fluid. Some women still believed that danger signs during pregnancy and post-delivery period were due to witchcraft leading to consultations with traditional healers and hence delays in seeking skilled medical care. In this context of misconceptions and cultural beliefs there should be investment in health education on danger signs to the community in general with involvement of traditional birth attendants and traditional healers who might play a role in advising and referring women with danger signs to the health facilities for care

"I have no choice": influences on contraceptive use and abortion among women in the Democratic Republic of the Congo

In 2015, the Democratic Republic of the Congo (DRC) recorded an estimated maternal mortality ratio of 693/100,000 live births. Strict abortion laws, high fertility rates, low contraceptive prevalence, and lack of emergency obstetric care all contribute to the high maternal mortality ratio. This study explored influences on contraceptive use and abortion in the DRC. Qualitative in-depth interviews were conducted with 32 women and 10 healthcare providers in four provinces. Participants were recruited at health centers and households in the study communities. Thematic analysis was used and identified that Congolese women's contraceptive decision-making was shaped by a range of external influences rather than their own independent decisions. Non-autonomous decisions and strict abortion laws influenced the methods used to abort a pregnancy, exposing risks of infection, complication, and fatality. These findings highlight that Congolese women's decisions about their fertility and family planning are constrained by policy and socio-cultural influences

Morphological patterns of anaemia among pregnant women from Sudan

Background: Morphological patterns of anaemia in pregnancy are considered essential for classification, diagnosis and management of patients, especially in regions with high maternal mortality like Sudan.Objectives: This study evaluated morphological patterns of anaemia among pregnant women in Sudan and morphological differences across characteristics of participants.Methods: This cross-sectional study was conducted from September 2016 to February 2017. A total of 200 women were selected according to specific criteria. Laboratory tests were performed for complete blood count, blood smears were performed for morphology and vitamin B12, folate and iron levels were measured. Participants were classified as: normochromic normocytic, microcytic hypochromic, macrocytic or dimorphic. Further classification based on haemoglobin levels was also performed.Results: A total of 116 participants (58%) had a dimorphic pattern, followed by 50 participants (25%) with a microcytic hypochromic pattern, 20 participants (10%) with a macrocytic pattern and 14 participants (7%) with a normochromic normocytic pattern. Participants with the dimorphic pattern also had low levels of iron and folate. The majority of dimorphic participants presented with mild anaemia, whereas the majority of participants with the microcytic hypochromic pattern presented with moderate or severe anaemia. A high percentage of participants in late pregnancy had the dimorphic pattern, and there were significant differences in the degree of anaemia by parity, gestational age and regular intake of haematinic supplements.Conclusion: The most frequent morphological pattern of anaemia in this study was dimorphic, followed by microcytic hypochromic, macrocytic and normochromic patterns. Morphological patterns appeared to predict types of vitamin and mineral deficiency and the degree of anaemia

Pregnancy induced hypertension and associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia

BACKGROUND: Disorders of pregnancy induced hypertensive are a major health problem in the obstetric population as they are one of the leading causes of maternal and perinatal morbidity and mortality. The World Health Organization estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy. The objective of this study is to assess pregnancy induced hypertension and its associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Gebretsadikshawo Hospital and Tepi General Hospital. METHODS: A health facility based cross-sectional study was carried out from October 01 to November 30/2016. The total sample size (422) was proportionally allocated to the three hospitals. Systematic sampling technique was used to select study participants. Variables with p-value of less than 0.25 in binary logistic regression were entered into the multivariable logistic regression to control cofounding. Odds ratio with 95% confidence interval was used. P-value less than 0.05 was considered as statistically significant. RESULTS: The prevalence of pregnancy induced hypertension was 33(7.9%); of which 5(15.2%) were gestational hypertension, 12 (36.4%) were mild preeclampsia, 15(45.5%) were severe preeclampsia and 1 (3%) eclampsia. Positive family history of pregnancy induced hypertension [AOR5.25 (1.39-19.86)], kidney diseases (AOR 3.32(1.04-10.58)), having asthma [AOR 37.95(1.41-1021)] and gestational age (AOR 0.096(0.04-.23)) were predictors of pregnancy induced hypertension. CONCLUSION: The prevalence of pregnancy induced hypertension among women attending delivery service was 7.9%. Having family history of pregnancy induced hypertension, chronic kidney diseases and gestational age were predictors of pregnancy induced hypertension

Compliance to maternal care guidelines is high in patients with complications compared to patients without complications. The tip of an iceberg? A retrospective case-control study

BACKGROUND: Rwanda achieved Millennium Development Goal Five (MDG5) and continues to register improvements in maternal health. Maternal death audit revealed that a great number of deaths were due to preventable causes in hospitals.OBJECTIVE: To identify preventable causes of severe maternal outcomes linked to poor guideline utilization in hospitals.METHODS: A retrospective case-control study was conducted. Data were collected for 196 controls (discharged without complications) and 100 cases with severe maternal outcomes (dead or discharged after complications) between 2016 to 2018 at Ruhengeri Referral Hospital in Musanze, Northern Province, Rwanda. Medical case files were reviewed, and outcomes were compared.RESULTS: Guideline utilization in diagnosis during ward rounds was 59% and 54% respectively. Correct guideline utilization [76% vs. 51%, OR: 3.21; 95% CI: 1.69-6.28)], noting of vital signs [65% vs. 22%, OR: 6.50, 95% CI: 3.55-11.96), lab results [76% vs. 48%, OR: 3.59, 95% CI: 2.09-6.21)] and regular ward rounds [76% vs. 39%, OR: 4.81 95% CI: 2.64-8.89)] were statistically different between the two groups.CONCLUSION: Guideline utilization was noted in complicated cases compared to patients without complications, post discharge mortality of 59% could be improved by putting guidelines in place, and attention to the details. There is a need for nationwide medical record review and implementation of a standardized guideline

Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital ­ a 4-year retrospective review

Background. Hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality and adverse outcomes. A previous study in the intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa, in 2000 found 10.5% mortality among eclampsia patients. Objectives. To describe the mortality and adverse neurological outcomes associated with HDP in a tertiary ICU, compare these with results from 2000 and describe factors associated therewith. Methods. The data of 85 patients admitted with HDP to ICU at King Edward VIII Hospital from 2010 to 2013 were retrospectively reviewed. Mortality and adverse neurological outcome (Glasgow Coma Scale (GCS) ≤14 on discharge from ICU) were assessed. Two sets of analyses were conducted. The first compared those alive on discharge from ICU with those who died in ICU. The second compared good neurological outcome with poor outcome (adverse neurological outcome, or death). Results. The mortality was 11.6%, and overall, 9% had adverse neurological outcomes. There was no significant difference in mortality between patients with eclampsia in 2010 - 2013 (11.0%) and those in 2000 (10.5%) (p=0.9). Factors associated with mortality were: intra- or postpartum onset of seizures; twins; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; respiratory failure; and lower respiratory tract infections. Factors associated with poor outcomes (adverse neurological outcome, or death) were: parity (better outcomes in primiparous patients); time of antenatal onset of hypertension (worse if earlier onset); HIV infection; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; use of anticonvulsants other than magnesium sulphate or benzodiazepines in eclampsia. Conclusion. The lack of improvement in ICU eclampsia mortality demonstrates a need to develop and implement a protocol for HDP management

Institutional delivery service utilization and its associated factors among women who gave birth during the past one year in Mizan Aman City Administration, Bench Maji Zone, South West Ethiopia, 2017

Background: Maternal mortality due to unsafe abortion, prolonged labour, eclampsia and other reasons has been the major problem across the globe especially in developing countries. This is because; most of those deliveries occur outside health care facilities and assisted with nonprofessionals. Aim: To assess magnitude and factors associated with institutional delivery practice and its determinants among mothers who gave birth during the past one year in Mizan Aman Town, Bench Maji zone, South West Ethiopia. Methods and Materials: Community based cross sectional study was conducted among mothers who gave birth during the past one year from April 10 to May 10, 2017. Structured and pretested questionnaire was used for data collection. Data was analyzed using SPSS version 20 software. Crude and adjusted Odds ratios were computed for selected variables and P-value less than 0.05 was considered to be statistical significant. Results: Only 54.2% of mothers gave birth at health facilities. Husbands educational level, decision about the cost related to health care/for referral or reaching health facility and place of antenatal care follow up were associated with institutional delivery service utilization. Conclusion: In contrast to studies conducted in other parts of the country and the Ethiopia Demographic health survey result of 2016, the number of women who had given birth at health care facilities in Mizan Aman city administration was higher. However, it was below the health sector transformation plan of the country that has a plan to raise institutional delivery supported by health personnel to 95%. Thus increasing awareness of mothers and their partners about the benefits of institutional delivery services are recommended

Césarienne à Lubumbashi, République Démocratique du Congo II: facteurs de risque de mortalité maternelle et périnatale

Introduction: l'objectif était d'analyser les facteurs de risque de mortalité maternelle et périnatale de la césarienne à Lubumbashi, République Démocratique du Congo (RDC).Méthodes: étude multicentrique de 3643 césariennes réalisées entre le 1er janvier 2009 et le 31 décembre 2013 sur un total de 34199 accouchements dans cinq formations hospitalières de référence à Lubumbashi (RDC). Les données sociodémographiques, les indications, l'environnement obstétrical et la morbi-mortalité maternelles et périnatales ont été analysés au logiciel Epi Info 2011. Les fréquences calculées sont exprimées en pourcentage et les moyennes avec leurs écart-types. Le test de Chi-carré et le test exact de Fisher lorsque recommandés ont été utilisés pour la comparaison des fréquences. L'odds ratio a été calculé avec l'intervalle de confiance de 95% de Cornfield grâce à un modèle de régression logistique pour déterminer la puissance de facteurs de risque. Le seuil de signification a été fixé à p < 0,05.Résultats: la fréquence de la césarienne était de 10,65%. L'âge moyen des césarisées était de 28,83±6,8 ans (extrêmes: 14 et 49 ans). La parité variait de 1 à 16 avec une moyenne de 2,6. De ces opérées, une sur neuf (10,9%) était porteuse d'un utérus cicatriciel de césarienne antérieure et 22,3% étaient des évacuées obstétricales. Les taux de létalité maternelle et périnatale étaient respectivement de 1,4% et 7,07% lors de la césarienne. L'analyse des facteurs de risque montre que la grande multiparité (≥5), l'absence de surveillance de la grossesse, le caractère urgent de l'indication opératoire influent significativement sur la mortalité maternelle. A ces facteurs s'ajoutent pour la mortalité périnatale l'âge maternel avancé (> 35 ans), l'évacuation comme mode d'admission et l'immaturité fœtale.Conclusion: cette étude montre que la césarienne dans nos conditions de travail est couplée à une forte mortalité maternelle et périnatale. Les facteurs de risque identifiés sont en grande partie évitables, surtout à tort ou à raison imputés à l'opération masquant ipso facto les circonstances souvent irrationnelles de sa pratique