Planification familiale du postpartum à l'hôpital de district de la commune II de Bamako, Mali / Postpartum family planning at the district hospital of the commune II of Bamako, Mali

La planification familiale du postpartum est la prévention des grossesses durant les 12 mois qui suivent l'accouchement. Objectif : Etudier l'utilisation des méthodes contraceptives dans le postpartum dans le service de gynécologie obstétrique de l'hôpital de district de la commune II de Bamako. Matériels et Méthodes : Nous avons mené une étude transversale descriptive et analytique avec collecte prospective des données du 1er janvier 2019 au 31 décembre 2020. Ont été incluses, toutes les accouchées ayant choisi et bénéficié d'une méthode contraceptive. Le test statistique utilisé a été le test de Fisher avec un seuil de significativité fixé à 5%. Résultats : En 2 ans, la prévalence contraceptive dans le postpartum était de 26,1%. Plus des 2/3 des counselings (61%) ont été faits lors des consultations prénatales, 8% pendant la phase de latence, 26% dans le postpartum immédiat et 5% lors de la visite postnatale. Les méthodes les plus choisies ont été les implants (47,1%), le dispositif intra-utérin (29,6%), les pilules miro-progestatives (12,5%), les progestatifs injectables (8%) et les préservatifs (3,2%). Conclusion : La planification familiale du postpartum contribue à augmenter la prévalence contraceptive

Low-fidelity simulation for management of postpartum haemorrhage in a Ghanaian teaching hospital

We conducted a pre/post study of a post-partum hemorrhage (PPH) simulation exercise at Korle Bu Hospital, using a low-fidelity birthing simulator and questionnaires. We aimed to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in a low-resource setting. Knowledge and confidence in PPH management were measured before and after using 5-point Likert scales and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Statistically significant improvements in knowledge and confidence in managing PPH were evident following the simulation exercise. All participants agreed the simulation was educational, relevant and realistic, and 94% felt it could be incorporated into their training. (Afr J Reprod Health 2022; 26[4]: 57-64)

Maternal deaths due to eclampsia in teenagers: lessons from assessment of maternal deaths in South Africa

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014­2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014­2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia

Feasibility of a ketamine anesthesia package in support of obstetric and gynecologic procedures in Kenya when no anesthetist is available

The objective was to assess the feasibility and safety of the _Every Second Matters for Emergency and Essential Surgery ­ Ketamine' (ESM-Ketamine) package in support of obstetric and gynecologic emergency and essential surgery when no anesthetist is available. A consecutive case series was conducted in twelve hospitals across five severely resource-limited counties in Kenya. 530 women underwent obstetric or gynecological operative procedures supported by non-anesthetist clinicians using the ESM-Ketamine package between November 1, 2013 and September 30, 2017. Main outcomes included reasons for ESM-Ketamine activations and ketamine-related adverse events. There were two (0.4%) prolonged (>30 seconds) oxygen desaturations below 92%. Brief oxygen desaturations (<30 seconds) below 92% occurred in 15 (2.8%) cases and 113 (21.3%) were administered diazepam to treat hallucinations or agitation. There were no ketamine-related deaths or injuries. The ESM-Ketamine package appears feasible and safe for use in support of obstetric and gynecologic surgeries when no anesthetist is available

Determinants of preterm delivery in the central zone of Tigray, northern Ethiopia: a case-control study

Background. Preterm birth remains one of the most serious problems in obstetrics care globally. In Ethiopia preterm delivery is a direct cause of 28% newborn deaths. However, little is known about the risk factors of preterm birth.Objective. To determine risk factors of preterm birth in Tigray, Ethiopia.Methods. A hospital-based, unmatched case-control study was conducted among 288 respondents (cases=96; controls=192). Data were collected during individual interviews and through a chart review. Statistical analysis included descriptive statistics and bivariate and multivariate binary logistic regression analysis (significance level p<0.05). Results. The response rate was 100%. The mean (standard deviation) age of the respondents was 26.1 (5.9) years. Urban residence (adjusted odds ratio (aOR) 3.11; 95% confidence interval (CI) 1.181 - 8.168)), gynaecological problems (aOR 8.9; 95% CI 1.580 - 50.252), hard physical work during pregnancy (aOR 3.85; 95% CI 1.622 - 9.144), being younger than 18 (aOR 4.56; 95% CI 1.702 - 12.215) and being a first-time mother (aOR 4.66; 95% CI 1.635 - 13.254) were identified as statiscally significant risk factors of preterm delivery. Micronutrient supplementation (aOR 0.26; 95% CI 0.008 - 0.084) and nutritional counselling during pregnancy (aOR 0.24; 95% CI 0.067 - 0.862) were identified as protective factors against preterm birth. Conclusion. The study identified various factors associated with an increased risk of preterm birth and also some protective factors against preterm birth. Programmes to improve maternal and newborn healthcare are recommended to reduce the incidence of preterm births in this region

Involving male partners in maternity care in Burkina Faso: a randomized controlled trial

To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso. Methods:In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks' gestation at five primary health centres in Bobo-Dioulasso. The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum.Findings:The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confidence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3). Conclusion:Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

Effects of mother related factors on perinatal outcomes-a study of mothers seeking antenatal care at public and non-public health facilities in Kisii County, Kenya

The study sought to determine client level and facility-level factors that affect perinatal outcomes among women attending comparable public (government owned) and non-public health facilities (non-government owned) in Kisii County-Kenya in the context of free maternity care. A total of 365 pregnant mothers recruited in 4 health facilities during their ANC visit and followed up to 2 weeks post-delivery but only 287 attended all follow-up visits. Study subjects were recruited proportionate to number of deliveries each of the facilities had conducted in the preceding 6 months. The dependent variable was perinatal outcome; independent variables were demographic and clinical factors. Analysis was done using χ2, logistic regression, paired t and McNemar's tests. Maternal BMI and a mother's parity were statistically correlated with perinatal outcome (χ2= 8.900, d.f =3, P=0.031 and (χ2= 13.232, d.f =4, P=0.039) respectively. Mothers with 1 parity were 4.5 times more likely to have normal perinatal outcomes (OR =4.5, 95% CI 2.25-14.29, P=0.012). There was a significant relationship between a mother's knowledge of pregnancy-related issues and the baby's weight (t=-67.8 d.f. 213 P<0.001). Mothers' knowledge on pregnancy issues and spousal involvement influences perinatal outcomes. Dietary Diversity Score (DDS) of a mother does not have a direct influence on the outcome of a pregnancy. There is need to focus on maternal factors that affect perinatal outcomes besides free maternity care

Role of national blood transfusion service (NBTS) in promoting emergency obstetrics care (EMOC)

Background: Obstetrics haemorrhage is one of the leading cause of maternal mortality in our settings, this was compounded by the non availability to safe blood in situation of need. Hence the prompt access and availability of blood can avert this preventable cause of maternal death. Objectives: to highlight the benefits of effective collaboration with NBTS in ensuring prompt availability of blood for emergency obstetric services requiring blood for transfusion. Material And Method: All obstetrics cases requiring blood transfusion in FMC Nguru from 1st stJanuary 2006 ­ 31 December 2011 were retrospectively reviewed. Trends and pattern of the st strequest and source of blood were looked at within the two periods (from 1 January 2006 ­ 31 st stDecember 2008 and 1 January 2009 ­ 31 December 2011). Records of 1634 obstetric patients requiring blood transfusion or received blood transfusion in the maternity units were retrieved from the medical records, maternity ward record and blood bank. Information pertaining to their age, parity, indication for the transfusion or requests and source of blood was obtained for analysis. Data was analysed using simple percentage. st st Results: Between 1 January 2006 and 31 December 2008 only 513 (56%) of the units requested st st907 units of blood were supplied, while between 1 January 2009 and 1 December 2011 1367 ( 87%) of the 1567 units of blood requested were supplied. Within the earlier study period the only available source were from willing relatives and commercial blood donors, however between 2009 and 2011 more than 2/3 (64.2%) were supplied from the north east zonal NBTS office in Maiduguri. In 2006 through 2008, donation from relatives and commercial donors accounted for 53.22% and 46.78% respectively, but in 2009 and 2011 donation from relatives and commercial donors were recorded as 23.9% and 11.6% respectively. The commonest indication for the requests were anaemia, obstetrics haemorrhage (PPH, APH) and emergency C/S. Conclusion: Ready available source of blood will significantly improve timely availability of blood in our setting. There is the need to encourage this collaboration in other regions to ensure prompt availability of blood to attend to emergencies requiring blood transfusion

Barriers to Obstetric Care among Maternal Near Misses

Background. There are several factors in the healthcare system that may influence a woman's ability to access appropriate obstetric care.Objective. To determine the delays/barriers in providing obstetric care to women who classified as a maternal near-miss. Methods. This was a descriptive observational study at Steve Biko Academic Hospital; a tertiary referral hospital in Pretoria; South Africa. One hundred maternal near-misses were prospectively identified using the World Health Organization criteria. The 'three-delays model' was used to identify the phases of delay in the health system and recorded by the doctor caring for the patient.Results. One or more factors causing a delay in accessing care were identified in 83% of near-miss cases. Phase I and III delays were the most important causes of barriers. Lack of knowledge of the problem (40%) and inadequate antenatal care (37%) were important first-phase delays. Delay in patient admission; referral and treatment (37%) and substandard care (36%) were problems encountered within the health system. The above causes were also the most important factors causing delays for the leading causes of maternal near-misses - obstetric haemorrhage; hypertension/pre-eclampsia; and medical and surgical conditions.Conclusions. Maternal morbidity and mortality rates may be reduced by educating the community about symptoms and complications related to pregnancy. Training healthcare workers to identify and manage obstetric emergencies is also important. The frequency of antenatal visits should be revised; with additional visits in the third trimester allowing more opportunities for blood pressure to be checked and for identifying hypertension

Prediction of Successful Induction of Labour with Dinoprostone in a Homogeneous Group of Patients

Objectives. The aim of the present study was to compare the efficiency of transvaginal ultrasonography and the Bishop's scoring system in predicting the success of labour induction. Methods. Transvaginal ultrasonography for cervical evaluation and cervical palpation for Bishop scoring were performed in all patients by the same obstetrician. This prospective study was conducted in the Perinatology and Maternity Care Unit of Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital between September 2007 and February 2008. Eighty-four patients induced with prostaglandin E2 (dinoprostone) for medical indications were included in the study. Results. No significant association was found between transvaginal measurement of cervical length and the success of labour induction (p=0.201). We found no statistically significant difference between failure of labour induction and successful labour induction in terms of transvaginal measurement of cervical length (area under the curve (AUC) 0.583; 95 confidence interval (CI) 0.452 - 0.714). A significant association between the Bishop's score and failure of labour induction (p=0.029) was found. A statistically significant relationship was found between failure of labour induction and successful labour induction in terms of the Bishop's score (AUC 0.632; 95 CI 0.513 - 0.751). The best cut-off point for predicting successful labour induction was a Bishop's score of 2 or more. The sensitivity and specificity levels associated with this point were 82.4 and 44.9; respectively (positive predictive value 50.9 and negative predictive value 78.6). Conclusions. Bishop's scoring system was more successful than assessment of cervical length by ultrasound in predicting failed induction in a homogeneous group of patients in whom labour was induced with prostaglandin E2

Successful sex pre-selection using natural family planning

The objective of the study was to test the hypothesis that gender can be preselected by timing coitus in relation to ovulation, the marker of ovulation being the Peak symptom according to the Billings Method. A blind prospective study of 99 couples wishing to preselect the sex of their child was conducted in Nigeria, using the Post-Peak approach of Billings Method for males and Pre-Peak for females. Research co-ordinators examined the 'post-conception' form within four months of conception. This form recorded the timing of coitus prior to conception, and from this, the sex of child was predicted. 94 of the couples had a child of pre-selected sex showing a method success of 94.9%. 78 of 81 predicting a male were successful (96.3%) and 16 of the 18 predicting a female (88.9%). There was one user-failure, a couple who wanted a girl, timed coitus as for a boy, which they had. The study indicates that where comprehensive instruction is provided, the sex of a child can be preselected with a high degree of confidence by timing coitus, using the Post-Peak approach of Billings Method for males and Pre-Peak for females (Afr J Reprod Health 2011; 15[1]: 79-84)

Grand multiparity: Obstetric performance in Aminu Kano Teaching Hospital; Kano; Nigeria

Objective: The objective was to review the obstetric performance of booked grand multiparae. Design and Setting: A 5-year prospective observational study of cases between January 1; 2002; and December 31; 2006; was conducted in Aminu Kano Teaching Hospital; a tertiary institution; in Kano; Nigeria. Materials and Methods: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery); who delivered in our labor ward; were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. Outcome Measures: These were obstetric factors of maternal age and parity; antepartum hemorrhage; fetal malpresentations; and multiple pregnancy. Medical complications were gestational diabetes; hypertension; anemia; and heart disease. Pregnancy outcomes measured were gestational age at delivery; birth weight; mode of delivery; postpartum hemorrhage; and maternal and perinatal mortality. Results: The age range of the grand multiparae was between 22 and 43 years; with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15; with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55; CI = 6.72-23.91); hypertension (OR = 3.07; CI = 2.07-4.59); heart disease (OR = 2.01; CI = 0.70-6.08); anemia (OR = 3.16; CI = 1.42-7.24); antepartum hemorrhage (OR = 2.18; CI = 1.22-3.92); fetal malpresentations (OR = 3.04; CI = 2.38-3.88); cephalopelvic disproportion (OR = 2.09; CI = 1.33-3.29); and fetal macrosomia (OR = 2.27; CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care

Service Providers' Perception of the Quality of Emergency Obsteric Care Provided and Factors Indentified which Affect the Provision of Quality Care

Aim: The aim of the study was to investigate health workers' perception of the quality of; and factors which impact provision of quality emergency obstetric care. Methods: This exploratory; descriptive qualitative study was conducted at Mwanza district hospital in Malawi. Qualitative data was obtained through 14 individual in-depth interviews with the health workers involved in the management of women who experienced major obstetric complications. Results: The health workers' overall perception of the quality of emergency obstetric care provided was poor. The poor quality of care was identified as related to client related factors and facility/staff factors. Client factors which emerged as contributing to poor quality care were; the client delay in seeking care: reliance on TBAs; reliance on traditional medications; and lack of awareness regarding signs of an obstetric emergency. Facility/ staff themes which emerged as contributing to the poor care were; inadequate resources; inadequate staffing; poor teamwork; and inadequate knowledge/supervision. Conclusion: The findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were able to identify structure and process factors which contribute to this overall poor quality emergency obstetric care provided. These were attributed to health care system problems and client problems. Only through addressing the contributing factors will true improvement of management of obstetric emergencies occur

The Pattern of Cervical Cytology in Obstetrics and Gynaecology Clinics in Nnewi; South-Eastern Nigeria

Background: Cervical cytology screening has decreased the incidence of and mortality from invasive cervical cancer in developed and even some developing countries. The story is still different in Nigeria because there is no national screening programme in place.Objectives: The aim of this study was to evaluate the pattern of cervical cytology and relate it to some known risk factors such as age; parity; age at coitarche; number of sexual partners and clinical presentation.Subjects and Methods: A total of 100 women were seen at two Obstetrics and Gynaecology clinics in Nnewi over a three month period (May-July 2005) were screened. Conventional method of staining was used. The first fifty sexually active women that consented to completing the study questionnaire in the two clinics were included.Main Outcome Measures: The work noted the pattern of reports in relation to some known risk factors and adequacy of the sampling.Results: Sampling adequacy was 93; epithelial cell abnormality was reported in only one smear; 58 were reported as normal; 14 showed benign cellular changes (i.e. infective); and 18 reactive changes (i.e. atrophy). Conclusion: Now that infective aetiology has been established in cancer of the cervix; the co-factors may be some of these causes of benign cellular changes of the cervix

Obstetric Outcome of Teenage Pregnancy in Kano; North-Western Nigeria

BACKGROUND: Teenage pregnancies are regarded as high risk; because they often occur outside marriage. There is the need to evaluate the outcome of teenage pregnancies in a predominantly Islamic society like Kano where most occur within marriage; and timely prenatal care is usually available to most of them. OBJECTIVE: To review the obstetric outcome of teenage primigravida in Aminu Kano Teaching Hospital; Kano; Nigeria. METHODS: A retrospective case-control study of 500 booked teenage primigravidae; who delivered in our labour ward from January 2002 to December 2005 (study group) was performed. Their obstetric outcome was compared with that of an equal number of booked primigravidae aged 20-34 years; who met the recruitment criteria and delivered immediately after a selected teenage mother (control group). The study variables of interest were the demographic characteristics of the women in the two groups; antenatal/intrapartum complications and neonatal outcome. RESULTS: There were no significant differences in the mean birth weight; mean gestational age at delivery; mean height and perinatal mortality between the two groups; but mean maternal weight and body mass index (BMI) were higher among the older women. The teenage mothers had increased incidence of preterm labour and low birth weight infants (P 0.05). The incidence of caesarean section and instrumental deliveries were lower among the teenage mothers. CONCLUSION: The results of this study show that teenage mothers who receive good family and community support; timely quality antenatal care and deliver in the hospital; should expect similar obstetric outcome to that of their older peers

Evaluation of criteria-based clinical audit in improving quality of obstetric care in a developing country hospital

Study evaluated criteria­based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before (Phase I) and after (Phase II)' audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p=0.00), obstructed labour (81.7 to 93.5%, p<0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries (Afr J Reprod Health 2008; 12[3]:59-70)