Maternal factors and short-term outcome associated with episiotomy during vaginal delivery at the Women and Newborn Hospital, Lusaka, Zambia

Objective:To explore the maternal factors and short-term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital, Lusaka, Zambia.Materials and Methods:An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls.Asemi-structuredintervieweradministered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) werewithoutepisiotomy.Results:Atotal of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p<0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) deliveredbyamedicalofficer.Multivariateregression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p<0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3) Conclusion:Maternal factors associated with episiotomy includedage,parity,method of induction,and the personnel conducting the elivery. Shorttermmaternaloutcomesofepisiotomy were perineal tear extension, and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

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.

Preliminary study of seroprevalence and risk factors for hepatitis B infection in pregnant women in Lubumbashi, Democratic Republic of the Congo

Background: Hepatitis B virus (HBV) infection, defined as positivity for hepatitis B surface antigen (HBsAg), remains a public health problem nationally and globally. The objective of this study was to determine the seroprevalence and risk factors for HBV infection in pregnant women in the city of Lubumbashi.Methods: A Cross-sectional study of the 269 pregnant women received at Shalina Polyclinic in Lubumbashi was conducted. HBV screening was performed by the PCR technique (using the COBAS TaqMan 48 controller). The chi-square test and the calculation of the odds-ratios with 95% Confidence Intervals were used with the significance level set at p less than 0.05.Results: The mean age of pregnant women was 30.0 ± 5.34 years (range, 17 to 44 years). The majority of them were unemployed (98.51%) and married (99.25%). All pregnant women were unaware of their HBV serologic status and had not been vaccinated against HBV. Eighteen (6.69% [95% CI: 4.01-10.37%]) participants had HBsAg positive and four (1.48% [95% CI: 0.41-3.76%]) were HIV-positive. The highest prevalence of hepatitis B was observed in the age group between 31-40 (10.53%), single (50%), women with paying occupation (25%) and diabetes mellitus (14.29%) and a history of surgery (14.29%) with no statistically significant difference (p>0.05). However, HBV was significantly higher in HIV-positive pregnant women, who presented a risk of nearly 9-fold higher (50% versus 6.04%; OR adjusted: 8.89 [1.04-76.09]) compared to HIV-negative pregnant women.Conclusion: our study shows that hepatitis B is a public health problem among pregnant women in the city of Lubumbashi. The history of HIV infection is independently associated with HBV infection in this context