Access to postpartum tubal ligation services in Cape Town, South Africa - an observational study

Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

Mort in utero tardive: fréquence, facteurs associés et méthodes de déclenchement du travail à Kisangani, République Démocratique du Congo / Late fetal death: frequency, associated factors and methods of labor induction in Kisangani, Democratic Republic of Congo

La mort fœtale tardive fait référence à la mort in utéro (MIU) de survenue spontanée à partir de 22 semaines d'aménorrhée (SA), mais avant tout début du travail d'accouchement, ce qui constitue une tragédie pour la mère, les membres de la famille et du personnel soignant. La présente étude a déterminé l'ampleur, les facteurs associés et les méthodes de déclenchement artificiel du travail d'accouchement sur MIU. Méthodes : Il s'est agi d'une étude transversale descriptive, multicentrique menée dans 3 hôpitaux de Kisangani, pendant une période de 3 ans. La collecte des données était rétrospective, des cas de MIU à partir de 28 SA. Résultats : La fréquence de MIU tardive était de 6,48%. Les principaux facteurs associés étaient l'infection urinaire (35,4%), le paludisme sur grossesse (27,5%) et l'hypertension artérielle gravidique (27,5%). Le taux de participation aux consultations prénatales (CPN) n'était que de 63,5 %. Les méthodes de déclenchement artificiel du travail d'accouchement utilisées étaient le Misoprostol (42,7%), l'ocytocine (17,7%) soit les deux combinées (25%). La césarienne était indiquée à un taux de 26,4%. Conclusion : la fréquence de MIU tardive est élevée à Kisangani. L'infection urinaire, le paludisme et l'hypertension artérielle en constituaient les principaux facteurs associés. Le Misoprostol était la méthode de déclenchement du travail les plus utilisées. Un suivi régulier des CPN pourrait réduire le taux de MIU.

Decision-to-delivery interval and obstetric outcomes of emergency caesarean sections in a Nigerian teaching hospital

Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients' relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foetomaternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutesas a benchmark.

Facteurs associés à la césarienne en salle de travail chez les patientes à bas risque périnatal, "cas de l'hôpital général de référence Bonzola" à Mbujimayi (RDC) / Associated factors of cesarean section in workroom in patients with Low perinatal risk "case of the Bonzola Reference General Hospital

Contexte et objectifs : La césarienne est une intervention de plus en plus pratiquée en obstétrique pour sauver les vies. Les objectifs de cette étude étaient d'identifier les facteurs associés à la décision de césarienne en salle de travail et de déterminer les conduites thérapeutiques et obstétricales qui peuvent augmenter la probabilité d'accoucher par voie haute. Méthodes : Il s'agissait d'une étude castémoins réalisée dans le service de gynéco-obstétrique de l'Hôpital Général de Bonzola (HGR) à Mbujimayi du premier Mai 2020 au 30 Avril 2021. La population cible était constituée de toutes les parturientes à bas risque. Le modèle de régression logistique sur logiciel épi-info 7 a été utilisé pour la détermination des facteurs prédictifs d'indication de la césarienne chez les parturientes. Résultats : Les indications de la césarienne étaient dominées parla dilatation stationnaire avec 56,2% de cas et l'ARCF avec16,7% de cas ; un Apgar≤ 3 et un poids de naissance ≥ 4000g ont été retenus comme caractéristiques néonatales essentielles de la césarienne en cours de travail. Après analyse multivariée par régression logistique, un score de Bishop ˂ 6 avec col défavorable, unedilatation ˂ 3 cm à l'admission et une thérapeutique faite à l'ocytocine, rupture artificielle des membranes et G10% pendant le travail étaient des éléments identifiés comme facteurs de risque de la césarienne en cours du travail. Conclusion : Certains facteurs permettent de prédire le risque de césarienne chez les parturientes à faible risque obstétrical. La connaissance de ces facteurs de risque peut permettre aux praticiens de le prévenir ou de mieux préparer les patientes à affronter cette intervention.

Background and Objectives: Cesarean section is an increasingly common life-saving procedure in obstetrics. The objectives of this study were to identify the factors associated with the decision to perform a cesarean section in the labor room and to determine the therapeutic and obstetric practices that can increase the probability of giving birth by high way. Methods: This was a case-control study conducted in the gynecology-obstetrics department of the General Hospital of Bonzola (HGR) in Mbujimayi from May 1, 2020 to April 30, 2021. The target population consisted of all low-risk parturients. The logistic regression model on epi-info 7.2.0 software was used to determine the predictive factors for the indication of caesarean section among parturients. Results: Indications for cesarean section were dominated by stationary dilatation with 56.2% of cases and ARCF with16.7% of cases; an Apgar≤ 3 and a birth weight ≥ 4000g were retained as essential neonatal characteristics for cesarean section in labor. After multivariate analysis by logistic regression, a Bishop score ˂ 6 with unfavorable cervix,dilatation ˂ 3 cm on admission, and therapy done with oxytocin, artificial rupture of membranes, and G10% during labor were identified as risk factors for cesarean section in labor. Conclusion: Certain factors predict the risk of cesarean section in parturients at low obstetrical risk. Knowledge of these risk factors may allow practitioners to prevent it or to better prepare patients for this procedure.

Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH. Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio-demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma. Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%) Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study

Facteurs favorisant la douleur postopératoire aiguë après césarienne au Centre Hospitalier Universitaire Androva, Mahajanga, Madagascar / Risk factors for acute postoperative pain after caesarean section at the Androva University Hospital, Mahajanga, Madagascar

Une douleur aiguë postopératoire peut être source de complications à court voire à long terme si elle est sous-évaluée et sous traitée. Plusieurs facteurs interviennent à l'exacerbation de cette douleur. Notre objectif était de déterminer les facteurs cliniques influençant la sévérité de la douleur post opératoire immédiate après une césarienne. Méthodes : Une étude type cas-témoin portant sur les patientes césarisées était réalisée en salle de soins post-interventionnels du Centre Hospitalier Universitaire Professeur Zafisaona Gabriel Mahajanga allant de janvier 2019 au décembre 2019. L'étude statistique a été réalisée avec le logiciel Epi-Info® 3.5.4 de l'Organisation Mondiale de la Santé Genève et CDC Atlanta. Les mesures d'association ont été mesurées par le calcul d'Odds ratio. Le seuil de signification statistique (p) a été fixé à une valeur < 0,05. Résultats : Nous avons retenu 32 cas pour 64 témoins. La population d'étude était jeune et la majorité appartenait dans la tranche d'âge de 16 à 29 ans. Les facteurs qui interviennent sur l'intensité de la douleur postopératoire étaient surtout des facteurs liés à la patiente tels que le jeune âge (OR= 3,46 [1,17 - 10,18]; p=0,009), la gestité en l'occurrence la primigestité et la paucigestité (OR=2,77 [1,33 - 5,79]; p=0,002), la primiparité et la pauciparité (OR=5,67 [2,16 - 14,94]; p=< 0,001), l'anxiété préopératoire (OR=5,04 [1,99 - 12,74]; p=0,0003) et l'appartenance à la classe 2 selon la classification de l'American Society ofAnesthesiologists (OR=4,2 [1,49 - 11,76]; p=0,004). Conclusion : La connaissance de ces fac

Satisfaction de la prise en charge de la douleur après césarienne au Centre Hospitalier Universitaire de Gynécologie Obstétrique Befelatanana, Madagascar / Satisfaction of the pain management after caesarean section at the Befelatanana University Hospital of Gynecology and Obstetrics, Madagascar

L'évaluation de la satisfaction des patientes est une composante essentielle de l'amélioration de la qualité des services en anesthésie. Notre objectif était de déterminer les bénéfices/risques de la Lidocaïne par rapport à la gestion de la douleur post-césarienne et son coût dans le but d'améliorer la prise en charge des patientes douloureuses. Méthodes : Nous avons procédé à une d'une étude prospective comparative randomisée sur une période de dix mois au sein du Centre Hospitalier Universitaire Gynécologie Obstétrique de Befelatanana. La population d'étude a concerné les femmes opérées pour césarienne sous rachianesthésie. Nous avons évalué la douleur avec la règle EVA (0 à 100 mm) à H1, H2, H3, H4, H8, H12 postopératoire. Résultats : Nous avons inclus 40 patientes pour le groupe A avec Lidocaïne, et 40 patientes pour le groupe B sans Lidocaïne. L'intensité moyenne de la douleur à H12 postopératoire, est de 17,6 ± 11,5 mm pour le groupe A et 29,1 ± 7,4 mm pour le groupe B, avec une différence statistique significative entre les deux groupes (p = 0,008). Conclusion : L'infiltration pariétale de Lidocaïne en peropératoire, pour la prise en charge de la douleur post-césarienne, est bénéfique, comparée au traitement standard seul

Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review

Background: The upward trend of caesarean section and its associated morbidity/mortality especially in low- and middle-income areas make regular appraisal of the procedure necessary. Objective: To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba. Methods: A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018, and June 31, 2020. Data was analyzed using SPSS version 20. Results: There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%. There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P<0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anemia (140 (19.9%) while caesarean section case fatality was 0.6%. Conclusion: This study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality

Effect of video-based information on preoperative State trait anxiety inventory scores in adult patients presenting for elective caesarean section: a randomized controlled trial

Background: Preoperative anxiety is a common occurrence in patients presenting for surgery with a reported incidence of up to 80%. Increased preoperative anxiety has been associated with increased morbidity. Provision of information relating to surgery and anesthesia to patients has been proven to have benefit in allaying anxiety. However, the best format of information dissemination remains unknown. Objective: To determine the effect of video information in addition to the pre-anesthetic review on the mean preoperative State anxiety inventory (STAI-S) score in adult patients presenting for elective caesarean section under spinal anesthesia at Aga Khan University Hospital, Nairobi (AKUHN), and to determine the prevalence of preoperative anxiety in the obstetric population presenting for elective caesarean section at AKUHN. Methods: Thirty-seven adult patients booked for elective caesarean section under spinal anesthesia were randomly assigned to one of two groups. In the study arm, a video was shown to the participants in addition to the standard pre-anesthetic review. In the control arm the participants only had a standard pre-anesthetic review. Results: The mean STAI-T score in the sampled population was 45.64 (SD 5.625). The mean baseline STAI-S score was 46.32 (SD 4.911). There was no statistically significant difference in change in STAI score between the video and control arms (p>0.05). Conclusion: On the basis of this study among this population, there was no benefit demonstrated from the use of an information video about spinal anesthesia on anxiety levels in obstetric patients presenting for a first time spinal

Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managedata Teaching Hospital in Zambia: A Retrospective Cross-Sectional Study

BackgroundThe obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and, in most cases, treatable. Surgicalrepairis themainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia. Methods: Aretrospective review of medical records for all women who underwent obstetric fistula repair surgeryat Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer's exact test was used to measure association between surgical outcomes and variables in the model.: ResultsIn total,18 out of 29 records of patients who underwentfistularepairwereretrievedandanalyzed. Ages ranged from 15 to 47 years, mean age 29years.Overtwothirds(72.23%)weremultiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83%at 2 weeks post-operative.Study findings were inadequate to show a significant association between successful repair and factors in the model. Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by caesarean section and poor birth outcomes. Success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.:

Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

Context and objectives. In Ghana, CS rates have increased by 2% since 2014 even though the World Health Organization has called for the procedure only for medically justifiable cases. Provider payment mechanisms such as capitation have been used to moderate CS rates in some settings. We explored the effects of the withdrawal of the capitation policy on the Cesarean Surgery (CS) rate in public primary care hospitals together with vaginal delivery (VD) and antenatal care for women with 4+ visits (ANC4+) rates. Methods. An interrupted time-series analytical design was used to assess the effects of the withdrawal of capitation on selected variables from the secondary District Health Information Management System (DHIMS 2) of public hospitals between January 2015 and December 2019. Results: The results show that after the policy withdrawal, the trend and level of provision of CS and VD were not significantly altered. Significant declining trends of ANC4+ reversed with significant positive trends after the policy removal. Conclusion. We conclude that the withdrawal of the capitation policy may not have impacted the CS rate significantly in public hospitals. Enhanced capitation payment mechanisms and specific policies aimed at limiting CS are needed to curtail the rise in Ghana.

Facteurs prédictifs de l'issue de l'accouchement sur utérus cicatriciel, service de gynécologie obstétrique EHS Batna, Algérie / Predictive factors of the outcome of delivery on scar uterus in the department of obstetrics - gynecology EHS Batna, Algeria

Introduction. La pratique de césariennes est en augmentation constante dans le monde, soulevant la problématique de la gestion des femmes enceintes ayant un utérus cicatriciel. L'objectif de notre travail était d'identifier les facteurs significativement associés au succès de l'épreuve utérine au sein de notre service, afin de réaliser une sélection rigoureuse des candidates à la tentative de voie basse. Méthodes. Nous avons mené une étude épidémiologique descriptive, rétrospective, mono centrique au niveau de l'EHS mère ­ enfant Batna du 1er janvier 2018 au 31 décembre 2019 ayant intéressé les femmees porteuses d'un utérus cicatriciel d'origine obstétricale avec un âge de grossesse supérieur à 22 SA. Résultats. Au cours de notre étude nous avons recensé 3002 accouchements sur utérus cicatriciel. Le taux de tentatives de voie basse après césarienne était de 46,84 % avec un taux de succès de 89,19 %. Les principaux facteurs qui favorisent le succès de la tentative de voie basse après césarienne étaient : un antécédent d'accouchement par voie vaginale après la césarienne (p <0,001) la multiparité (p=0,0002), une césarienne précédente pour présentation podalique (p<0,001), un intervalle inter génésique de 12 mois et plus (p <0,001), des conditions locales favorables (dilatation du col supérieure à 4 cm ; p=0,02 et la p=0,02 et la rupture artificielle des membranes ; p =0,02 et la rupture artificielle des membranes ; p=0,03). Les facteurs qui défavorisent le succès de la TVBAC étaient : un antécédent de césarienne pour stagnation ou non-engagement à dilatation complète (p<0,001), un terme d'accouchement supérieur à 40 SA (p=0,002), un poids de naissance supérieur à 4000 g (p<0,001). Les facteurs qui ne semblent pas influencer l'issue de l'épreuve utérine étaient : l'âge maternel, l'âge de réalisation de la première césarienne, la présence de pathologies maternelles et la réalisation de radiopelvimétrie Conclusion. Les facteurs de succès et d'échec d'une TVBAC sur utérus cicatriciel sont importants à relever pour les décisions ultérieures de la voie d'accouchement, la situation obstétricale doit être soigneusement évaluée et en cas de doute, faire appel à une décision collégiale.

Troubleshooting obstetric spinal anaesthesia at district hospital level

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.Keywords: anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Neonatal outcomes in twin pregnancies with the first twin in breech presentation according to the mode of delivery: A cohort study from Dakar Senegal

The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).

A retrospective identification of risk factors associated with fetal macrosomia

Despite extensive work on macrosomia, it is impossible to predict women at risk. Current prediction strategies which include clinical examination and ultrasound are imprecise. This study aims to determine the risk factors associated with macrosomia. It was a descriptive, retrospective chart review of women delivered of macrosomic neonates over a two-year period from 2015-2016. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (version 25.0 IBM, Armonk, New York, USA). Of 22 244 singleton deliveries, 415 were macrosomic infants (1.9%). The mean birth weight for macrosomic infants was 4.39 ± 0.43 (range 4-5.15) kg and males were more in number and weight. Macrosomic infants occurred more in age groups 25-29 years and peaked with BMI ≥30 kg/m2 . Majority were cesarean sections compared to vaginal deliveries (56.6% vs 43.4%; p=0.006) respectively. Vaginal delivery of macrosomic infants was associated with complications. Significant differences were found between fetal macrosomia and clinical characteristics such as body mass index, parity, advanced maternal age, and male fetal sex. Hypoglycaemia was most frequent in infants born to non-diabetic mothers (98.1%). Antenatal risk factors are important in the prediction of macrosomia, but fetal and maternal outcome depends on labour management. (Afr J Reprod Health 2022; 26[7]: 127-134).

Human error causing inappropriate management of pregnancy associated breast cancer, literature review and experience in Niger delta university teaching hospital, Okolobiri, Bayelsa state, Nigeria

Breast cancer is the commonest cancer in women in Nigeria. Pregnancy Associated Breast Cancer (PABC) is breast cancer occurring in pregnancy up to one year after delivery. Due to some misconceptions, mistakes occur in the management of these patients leading to poor outcomes. There may be difficulties in the diagnosis of PABC due to the clinical features being mistaken for the normal physiologic changes of pregnancy. The physiologic changes may interfere with radiological and pathological interpretations. Fine needle aspiration cytology (FNAC) or a trucut biopsy confirms the diagnosis. There have been debates on maternal versus foetal wellbeing in PABC. Chemotherapy is safe after 10 weeks of pregnancy when organogenesis is complete. Delaying chemotherapy till after pregnancy worsens the prognosis. Hormonal treatment is contraindicated in PABC. Method: This is a retrospective observational study of cases of PABC at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria, from January 2019 to January 2021. Results: Seven cases were seen with ages ranging from 28 to 37. All patients presented with breast lumps. Diagnosis was by FNAC and trucut biopsy. None of the patients received care for the cancer during pregnancy as they were advised by their doctors not to and to present after delivery due to the percermived haful effects of treatment on the foetus. All seven patients presented with advanced stage disease after delivery. They all received chemotherapy and hormonal therapy. Eventually all patients were lost to follow up. Conclusion: Patients diagnosed with PABC in peripheral hospitals should be referred for specialist care. Treatment modalities like surgery and chemotherapy are feasible in PABC and should not be unduly delayed. Continuing education on the topic and feedback to colleagues at peripheral hospitals should be ensured

The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital

Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Chi-square test and Fisher's exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects

Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased.Objective. To investigate four treatment methods, based on each patient's clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP.Methods. CSEP cases (N=30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage (n=12), embryo reduction with local methotrexate injection (n=12), laparoscopic excision (n=3) and excision through laparotomy (n=3). Serum levels of beta-human chorionic gonadotrophin (ß-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values.Results. There was a significant positive correlation between gestational age in weeks and the CSEP management strategy employed. ß-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later.No cases required a hysterectomy, and no maternal complications were reported in this study.Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of ß-hCG levels and ultrasonographic examinations, is recommended after CSEP management