Midwives' knowledge and use of partographs at Juba Teaching Hospital, South Sudan

Background:Evidence shows that good knowledge of partographs and proper application of this knowledge results in a remarkable reduction in prolonged and obstructed labour and reduces maternal mortality. Obstructed labour can be prevented by a simple and cost-effective health intervention tool, the partograph. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. This provides an opportunity for early identification of deviation from normal progress. Early detection of prolonged labour greatly contributes to prevention of obstructed labour and related complications.Objective:To assess midwives' knowledge and use of partographs in the maternity ward of Juba Teaching Hospital, South Sudan.Methods:A cross-sectional descriptive study was conducted to assess utilisation of partographs among healthcare providers in Juba Teaching Hospital. All providers working at the time of the study were included. An interviewer administered questionnaire prepared in English was used to assess socio-demographic and other related variables of respondents as well as knowledge and practice. Ethical procedures were followed at every step. Results:Only 20% of the 30 respondents were registered midwives, 67% knew the components -of a partograph, and 93% could differentiate between normal and abnormal labour with the use of a partograph. The factors affecting the use of partographs included; shortage of partographs in the ward, lack of protocols on partograph use, understanding semantics of the English language, absence of refresher training, late reporting of mothers to the ward, and a shortage of staff. Conclusions: Despite good knowledge of the partograph, about half of the providers do not use them. We recommend training and recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes

effect of counseling on post traumatic stress disorder after a traumatic childbirth

Adverse childbirth experiences as a trauma can evoke fear and post-traumatic stress disorder in some women. This study was conducted to investigate the effect of counseling on post traumatic stress disorder after a traumatic childbirth. This research was a clinical trial which was conducted at Kamaly hospital in Karaj. Samples [300 women] who had experienced a traumatic childbirth were selected by a convenient sampling method and were randomized into an intervention [n=150] and a control [n=150] group. The intervention group received face-to-face counseling within 72 hours of birth for forty to sixty minutes in a session. The control group just received usual care after childbirth. The data collection tool was questionnaire, which was completed via interview. The measuring variables were demographic characteristic, reproductive history, maternity social support, and post-traumatic stress disorder. Data were analyzed using descriptive statistics and inferential tests [Chi-square, Fisher's exact test, and generalized Fisher's exact test] by SPSS v.13 software. After 4-6 weeks of follow-up there was no significant difference regarding post-traumatic stress disorder between two groups [P=0.295]. At 3-month of follow-up, the intervention group reported less post-traumatic stress disorder comparing with the control group [P=0.001]. A midwife-led counseling plan is effective in reducing post-traumatic stress disorder during a long term

Maternal death and its causes - a challenge for achieving millennium goals

Maternal death is not the only death of a leady but it is in fact a death of a family. one of the millennium goal of WHO is to reduce maternal mortality by three quarters up to 2015. In order to achieve the role it is essential to have basic figure from worldwide. District head quarter women and children hospital DHQ [W and C], Dera Ismail Khan situated in southern areas of NWFP is providing as emergency obstetric care to this area and peripheral areas of Punjab and Bulochistan. Maternal mortality ratio and and its causes in Distt Headquarter setting of D.I Khan can serve as a baseline figures for planning the strategies for achieving millennium goals. The study was carried out in District Headquarter for women in Dera Ismail Khan. It was a seven year study starting from 15t January 1999- 31st December 2005. It is a descriptive retrospective hospital based study. The record was collected from admission Register, Labour Register. and maternal mortality register. In the seven years period total No of live birth were 11811 and there were 131 maternal deaths. Maternal mortality ratio was 1109/ 100,000 live births. Direct causes of maternal death contributed to 94.5% and indirect causes contributed to 5.35%. Hemorrhage, the leading cause of maternal death was responsible for 57.5% of maternal deaths. Antepartum [APH] and post partum [PPH] contributed equally. Obstructed labour killed 13.9% of the mothers, eclampsia killed 16.74% while infections killed 5.35% of the mothers. Indirect maternal deaths were hepatic coma, sever anaemia and cardiac failure. The challenge for achieving millennium goals is very high. The leading cause of death of the mothers is haemorrhage. The three delays i.e delayed decision, delayed transport, and delayed management are the virtual causes. To achieve the millenium goal we need to improve the first level health care facilities. We also need public awareness, rising the self determination and women's right and women empowerment and her role and decision maker

Effect of episiotomy on perineal lacerations in spontaneous vertex deliveries

To evaluate the effects of episiotomy on the frequency of perineal lacerations. Cross-Sectional analytical study. Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 [48.63%] of these women. There were 1095[37.53%] primiparae and 1823 [62.47%] multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 [9.2%] perineal tears were sustained by these women during vaginal delivery. Episiotomy was associated with 151 [10.6%] perineal tears compared to 116[7.7%] without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications

Evaluation of the effects of painless labor in mothers at Najmieh Hospital Tehran

Painless labor provides conditions for mother during painful contractions of uterus and dilatations of cervix. In addition to providing smooth progression of the process, the mother remains calm and pain free. Painlessness is produced by 3 methods A By systemic drugs, B By regional methods, C By non pharmacologic methods. Some of the complications of painless labor are: 1-sympathic block and hypotension, 2-motor nerve block, 3-nausea and vomiting, 4- urinary retention, 5-respiratory depression, 6-pruritis, 7- meningitis, 8-headache. This study was a cross - sectional descriptive study in which the complications of painless labor were assessed in 200 mothers during a 6 months period in Najmieh hospital. 200 mothers with painless labor were included in this study and 2 women [l%] were hospitalized, one woman was hospitalized for severe headache because of spinal anesthesia and another because of sympathic block, hypotension and headache probably because of drugs side effects. 2 women [1%] had respiratory depression. 5 women [2/5%] had nausea and vomiting, 3 of them had G.A and 2 women had regional anesthesia [1 spinal and 1 epidural]. 7 women [3.5%] had headache. 2 of them G.A and 5 women had regional methods. 3 women [1/5%] had pruritis and all of them had G.A anesthesia. 2 women [1%] had sympathic block and hypotension. One of them had G.A and another had regional anesthesia [spinal]. And in 1 case, Ketamine had been adminstered. 2 women [1%] had urinary retention. None of the patients had convulsion, meningitis and motor nerve block

Induction of labor with intracervical PGE2 in women with previous one cesarean section

Labor was induced with intracervical application of 1 mg PGE2 tablets in 42 term pregnat women with previous one cesarean section. 34 of them [81%] were delivered vaginally. Labor induction was considered failure in one woman [2.4%]. Repeat cesarean section was performed in 8 women [19%]. No neonatal deaths were reported. No uterine rupture or scar dehiscence were noted after vaginal delivery or at repeat cesarean section. In conclusion, intracervical application of PGE2 tables can reduce the need for cesarean section by inducing cervical ripening and labor induction in selected women with previous one cesarean section