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

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

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

Césarienne en urgence absolue: risque anesthésique et pronostic foeto-maternel

Introduction : Le pronostic maternel et foetal des cesariennes en urgence absolue est severe dans les pays en developpement comme le notre. Il existe peu d'etudes sur l'epidemiologie; l'influence respective des facteurs obstetricaux et anesthesiques. Patients et methodes : Nous avons etudie les deux facteurs anesthesiques et obstetricaux dans une etude retrospective de 51 parturientes d'age moyen de 27;1 ans cesarisees en urgence absolue sur une periode d'une annee a l'Hopital General de Reference de Panzi. Ces urgences absolues ont ete groupees en deux classes; I et II selon la classification de LUCAS. Les donnees ont ete enregistrees sur le logiciel Excel. L'interpretation des resultats a ete faite a l'aide du pourcentage et du test de Chi carre de Pearson. Resultats : La couverture de la consultation prenatale (CPN) etait faible avec 45;1 de parturientes n'ayant realise aucune CPN. Les indications de la cesarienne etaient dominees par la rupture uterine a 22;2 pour la classe I et la souffrance foetale aigue 41;7 pour la classe II. 86;2 de cesariennes de la classe I etaient sous anesthesie generale et seules 10 des patients ont ete intubees. Le choc hemorragique constituait la complication la plus frequente dans 25;9 des cas suivi du syndrome de Mendelson 7;4 des cesarisees pour la classe I. Le taux de mortalite etait de 2. 17;6 des nouveaux nes presentaient un tableau d'asphyxie neonatale avec un score d'Apgar entre 0 et 3. Conclusion : L'anesthesie pour cesarienne en urgence absolue reste un probleme majeur de sante publique dans nos milieux. Le pronostic maternel et fotal est severe. Une formation continue des anesthesistes et des obstetriciens est utile pour la prise en charge des grossesses a risque

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Intern's experiences with episiotomy and its repair

Background: Episiotomy ­an incision of the perineum at the time of vaginal delivery is a common obstetric procedure. If the repair is inadequately done, it may leave the woman suffering from perineal pain and other long term conditions with serious impact on the woman's health and social wellbeing. The importance of skill in the obstetric procedure of episiotomy and its repair cannot be over emphasized. Objectives: The study aims to determine the interns' training and experience with episiotomy and its repair. Materials and Methods: A questionnaire study of medical interns' who had their houseman ship at the Federal Medical Centre Owerri, over a period of two years between 2003 and 2005. Results were analyzed with the SPSS version 10. Results: 70 (77.7%) of the 90 interns to whom the questionnaire was administered responded correctly. They had an average age of 28.81 ±3.36 years. 44 (62.9%) had a formal demonstration on episiotomy repair done at their medical training institution. 56 (80%) of the interns were comfortable with episiotomy repair while 14 (20%) were not. 10 (45.45%) of the females and 4 (8.33%) of the males were not comfortable with episiotomy repair. 30% of those who got their skill on episiotomy repair at the period of houseman ship were not comfortable with the procedure as opposed to 4.3% of those who had a formal training at their medical training institution. Discussion: A formal demonstration at the medical school of training does not appear to be a constant event in the medical schools as only 62.9% of the interns in this study accepted receiving such. However, despite the above, 80% of these interns' were comfortable with the repairs of episiotomy. Conclusions: It would be preferred if a formal demonstration is given on this procedure while a student is still in training

A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary Hospital

Background: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques; caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus; the current emphasis is to limit the rising rate of caesarean section to as much as possible. Objective: To determine the rate of caesarean section; pregnancy out-come; major indications and complications of caesarean section. Methods: A five year (January 1st 2005 to December 31st 2009) retrospective analysis of clinical data from the ward admissions and discharge books; patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital; Ituku Ozalla; Enugu. Results: Out of the 3;554 deliveries during the study period; 980 cases were by caesarean section; giving a rate of 27.6. Most cases 918 (93.7) were by emergency caesarean sections; with elective procedure accounting only for 6.3of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5) were primigravidae; 503(51.4) were between para one and para four; while 70 (7.1) were grand-multipara. The rate of caesarean section was higher amongst the booked patients; 563 (57.5) than the unbooked patients 355 (36.2). Two previous caesarean section was the commonest indication for caesarean section 211(21.5); followed by cephalopelvic disproportion 198 (20.2); and foetal distress188 (19.2). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91) were delivered by emergency procedure. More than half of the babies 582(57.7) had birth asphyxia and there were 39 (3.9) perinatal deaths. All the cases of perinatal deaths and 549 (94.3) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7. Conclusion: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital

Five Years Experience of Ureterovaginal Fistulae Following Obstetric or Gynecological Intervention in Ethiopia

To study the etiology; presentation and outcome of women presenting to the Addis Ababa Fistula Hospital with an ureterovaginal fistula. Patients and Methods Women presenting with ureterovaginal fistulae following obstetric or gynecological intervention. The operating register from June 2004 to July 2009 was studied to identify women who had undergone ureteric re-implantation. Patient files were reviewed and only women with fistulae resulting from iatrogenic injury were included. Results Ureterovaginal fistulae were found in 89 women; 64 after Caesarean section; of which 43 were for a stillborn baby; 12 women have uterine rupture; 6 with instrumental delivery and only 7 with abdominal hysterectomy. The left ureter was most frequently injured (54). The number of patients seen has doubled over the past two years. Using one of four methods of repair; 88 women were continent at discharge from hospital. One died from a suspected pulmonary embolism. conclusion The incidence of iatrogenic ureteric injury is increasing in Ethiopia and most result from Caesarean section. The reasons should be studied. Using a variety of repair techniques; all patients can be cured. However; surgeons undertaking this surgery should have a wide range of urological training

Deux cas de grossesses heterotopiques spontanees au Centre Hospitalier de Soavinandriana Antananarivo

La grossesse heterotopique spontanee est une pathologie rare mais aussi une urgence chirurgicale souvent passee inapercue. Le but de cet article est d'en rapporter deux cas a travers lesquels nous relatons la difficulte diagnostic devant la mise en evidence premiere de la grossesse intra-uterine. Cette situation retarde la prise en charge et met en danger la vie des patientes

Anesthesie en obstetrique au centre Hospitalo-univesitaire de kamenge; a L'hopital Prince Regent Charles et a L'hopital de Nyanza-Lac (Etude prospective sur 9 mois)

Notre etude porte sur 652 patientes enceintes operees a l'Hopital de Nyanza-Lac; au Centre Hospitalo-Universitaire de Kamenge et a l'Hopital Prince Regent Charles du 1er avril au 31 decembre 2008. A l'Hopital de Nyanza-Lac; 123 patientes enceintes ont ete operees sur un total de 162 soit 75;9. Plus du tiers des patientes (33.3) ont un age compris entre 14 et 20 ans. Au Centre Hospitalo-Universitaire de Kamenge; 327 interventions obstetricales ont ete realisees sur un total de 365 patientes operees soit 89;5. A l'Hopital Prince Regent Charles; 202 patientes enceintes ont ete operees sur un total de 249 soit 81;1. Nous avons constate que 95;5des cas etaient des cesariennes. La rachianesthesie dans ces trois hopitaux est devenue l'anesthesie de choix pour la cesarienne en raison de ses avantages. La complication principale de cette technique est l'hypotension arterielle au Centre Hospitalo-Universitaire de Kamenge est de 17;5; a l'Hopital Prince Regent Charles est de 21et a l'Hopital de Nyanza-Lac est de 61;4. Les differences de survenue s'expliquent par les mesures preventives utilisees. Dans les deux hopitaux de Bujumbura; l'anesthesie generale est utilisee en cas d'urgence tandis que a l'hopital de Nyanza-Lac la rachianesthesie reste l'anesthesie la plus utilisee meme en cas d'urgence faute de moyen logistiques pour faire une bonne anesthesie generale. En plus; cet hopital ne dispose pas d'un laboratoire pour faire les tests de coagulation

Anesthesie en obstetrique au centre Hospitalo-univesitaire de kamenge; a L'hopital Prince Regent Charles et a L'hopital de Nyanza-Lac (Etude prospective sur 9 mois)

Notre etude porte sur 652 patientes enceintes operees a l'Hopital de Nyanza-Lac; au Centre Hospitalo-Universitaire de Kamenge et a l'Hopital Prince Regent Charles du 1er avril au 31 decembre 2008. A l'Hopital de Nyanza-Lac; 123 patientes enceintes ont ete operees sur un total de 162 soit 75;9. Plus du tiers des patientes (33.3) ont un age compris entre 14 et 20 ans. Au Centre Hospitalo-Universitaire de Kamenge; 327 interventions obstetricales ont ete realisees sur un total de 365 patientes operees soit 89;5. A l'Hopital Prince Regent Charles; 202 patientes enceintes ont ete operees sur un total de 249 soit 81;1. Nous avons constate que 95;5des cas etaient des cesariennes. La rachianesthesie dans ces trois hopitaux est devenue l'anesthesie de choix pour la cesarienne en raison de ses avantages. La complication principale de cette technique est l'hypotension arterielle au Centre Hospitalo-Universitaire de Kamenge est de 17;5; a l'Hopital Prince Regent Charles est de 21et a l'Hopital de Nyanza-Lac est de 61;4. Les differences de survenue s'expliquent par les mesures preventives utilisees. Dans les deux hopitaux de Bujumbura; l'anesthesie generale est utilisee en cas d'urgence tandis que a l'hopital de Nyanza-Lac la rachianesthesie reste l'anesthesie la plus utilisee meme en cas d'urgence faute de moyen logistiques pour faire une bonne anesthesie generale. En plus; cet hopital ne dispose pas d'un laboratoire pour faire les tests de coagulation

Obstetric hysterectomy in rural Democratic Republic of the Congo : an analysis of 40 cases at Katwa Hospital

The objective of this study was to determine the incidence, indication, and outcome of obstetric hysterectomy at an Eastern DRC rural hospital. This was a seven year retrospective study. The incidence was 0.28%. Mean age and parity of patients was 35.8 and 7 respectively. Trend to have Obstetric Hysterectomy increased with an age of = 35 years and parity of = 5. The main indications were Post-Partum Hemorrhage (PPH) (40%) and Ruptured Uterus (27.5%). Maternal mortality was 5% compared to 0.18% for Caesarean practiced at the same study period; and perinatal mortality 35.5%. Most indications could be avoided by improvement of Obstetric care. (Afr Reprod Health 2008; 12[1]:60-66)

Etude des besoins obstetricaux non couverts au centre de sante de reference de Niono

Notre etude transversale et retrospective s'est deroulee au centre de sante de reference de Niono dans la 4eme region du Mali du 1er janvier 2003 au 28 fevrier 2005. L'objectif principal est d'evaluer les besoins obstetricaux non couverts au CSRef de Niono. Au cours de cette etude nous avons enregistre 422 parturientes ayant subi des inter- ans. Les deficits en BONC evoluaient de maniere negative avec un excedent d'IOM. La cesarienne a ete l'intervention la plus pratiquee suivie de la laparotomie; alors que les DFP ont domine les IMA. Tous les cas de deces maternels observes apres les IOM/IMA ont ete attribues aux hemorragies severes

Besoins obstetricaux non couverts : les interventions obstetricales majeures pour indications maternelles absolues a l'Hopital General d'Anyama

BUT: nous avons a l'instar de certains hopitaux generaux d'Afrique realise une etude prospective couvrant l'annee 2002 sur les besoins obstetricaux non couverts. A travers cette etude; qui a concerne l'hopital general d'Anyama; on a recherche a savoir dans quelles mesures les problemes obstetricaux majeures de la population d'Anyama etaient pris en charge.OBJECTIFS: Determiner les B.O.N.C dans les indications maternelles absolues pour les interventions obstetricales majeures l'Hopital General d'Anyama.Calculer le taux de reference des 10M pour indication maternelle absolue (IMA) proposer une strategie de reduction des B.0.N.C dans les IMA Methodologie : C'est une etude prospective realisee a l'hopital general d'Anyama dans le courant du 1er janvier 2002 au 31 decembre 2002.Les criteres d'inclusion ont concerne toutes les interventions obstetricales majeures; les indications maternelles absolues et enfin toutes les femmes decedees a l'hopital sans avoir subi d'interventions alors qu'elles en avaient besoin.RESULTATS : Il ressort de notre etude que sur une periode d'un an; 18 cas de cesariennes ont ete realises soit 0;6pour cent dont 10 cas d'IOM soit 0;3pour cent. Le taux de reference est de 0;35pour cent c'est a dire que 0;35pour cent des femmes enceintes a Anyama devaient beneficier d'une IOM pour etre sauvees. Ce taux est largement inferieur aux normes exigees par l'OMS (1;5pour cent) ; pourtant le ratio de cet hopital pour les SOUC est de 3;33 pour 500.000 habitants; valeur nettement superieur aux normes de L'OMS qui preconise un centre de SOUC pour 500.000 habitants.. Au niveau des ressources humaines et materielles; on note la mauvaise repartition du personnel et l'eloignement de la banque de sang. Ceci constitue un handicap majeur. On comprend aisement la lethalite de 9;5pour cent qui liee aux complications obstetricales majeuresConclusion : L'hopital general d'Anyama malgre ses capacites de prise en charge des urgences obstetricales possede de gros handicaps au niveau des ressources humaines et materielles.Aussi; une meilleure utilisation des ressources humaines et materielles ameliorerait sans aucun doute les performances de cet hopital. La carte sanitaire a un role important a jouer

Comparison of the Process and Outcome of Spinal Anaesthesia and General (Ether) anaesthesia for caesarean section in Mulago Hospital

Objective: To compare the process and outcome of Spinal Anaesthesia (SA) with that of General Anaesthesia (GA) for Cesarean Section (c/s). The study was prompted by the current virtually exclusive utilization; but unacceptable standard and safety of GA in Mulago Hospital. There is also a wide knowledge gap on implications of the use of both GA and SA in general; but as applied to our setting in particular. Setting: Mulago Hospital Obstetrics and Gynaecology Theatre and all Obstetrics wards. Methods: This was a prospective randomised; unblinded clinical trial in which 142 ASA physical status 1 and 2 mothers at term scheduled for c/s and gave written consent to take part in the study were randomly allocated to receive one of the two techniques (SA/GA). the intra-operative course using the induction time; surgeons waiting time and total anaesthesia time; adequacy of anaesthesia intra-operative blood loss and the mean falls of blood pressure were comapred. The outcome was done using the Apgar Scores of the delivered babies; associated complications; rating of the technique by the Anaesthesists/surgeon/mother and the final outcome of the mother plus her baby. The mean cost of the drugs and materials used for the anaesthetic was also compared. The Arcus statistical soft ware was used for analysis; statistical significance was achieved at p0.05. Results: For c/s where mother and fetus are normal in Mulago hospital; SA compared to GA was associated with similar operating conditions (97.2) as compared to 95.8 had good operative conditions) and fetal outcome (p:ns); lower blood loss (550+- 112.4 comapred to 802+-126.4) mls; less undesired intra and post operative sequalae. It was cheaper (US$14.26 +-3.8 comapred to 37.14 +-2.9); enabled earlier return to independent living conditions and was highly appreciated by the mothers. However it had a longer preparation time (p0.0001) and bigger drop in BP (13+-7.7 compared to 8 +-7.9) mmHG