Association of placenta praevia with repeat cesarean section in Omdurman Maternity Hospital, Sudan 2010- 2012

Several risk factors for placenta praevia exist, including previous cesarean section [C/S]. This association has been investigated long time ago, however in this hospital there is no documented evidence. This study was done to assess the risk of placenta praevia based on number of previous cesarean sections. A hospital-based study, at Omdurman maternity hospital- OMH during; January 2010- December 2012. Deliveries in OMH were reviewed by trained registrars. Patients diagnosed prenatally or during delivery as placenta praevia were included. All women operated were followed till discharge from hospital. Total number of deliveries during the study period is 94758.Of them 68415 [72.2%] delivered vaginally and 26343 [27.8%] by C/S.Of the latter 10643 [40.4%] underwent elective and 15700 [59.6%] emergency CS.448 [0.5%] were diagnosed as placenta praevia. Placenta praevia was more common in patients with scarred uterus being found a 250 out of 9853 CS [2.5%]. Its frequency increased with the number of uterine scars: one scar; [1.7%], [RR = 1.45, CI= 1.12- 1.88], 2-4 scars [2.8%], [RR = 2.32, CI= 1.87-2.87] and five or more scars; [12.7%], [RR = 10.54, CI= 7.34-15.13]. Nineteen patients [7.6%] had adherent placenta, [RR = 42.41, CI =5.69-315.83], 68[15.2%] had history of dilatation and curettage [D and C] or evacuation,[RR = 1.5, CI = 1.18- 1.94], 37 [8.3%] had previous history of placenta praevia, [RR= 8.30, CI = 6.17- 11.19]. Three maternal deaths were encountered [0.7%]. The frequency of placenta praevia in this study increased with increasing number of previous C/S, and was associated with adverse feto-maternal outcome. This study provides a reason to reduce primary C/S and encouraging vaginal birth after C/S [VBAC]

Impact of female genital mutilation on second stage of labour in primigravida at Omdurman Maternity Hospital, Sudan 2010

To find out the impact of female genital mutilation [FGM] on the second stage of labour at Omdurman Maternity Hospital [OMH]. A descriptive cross-sectional study, for primigravidae delivered vaginally in 2010. After an informed consent circumcised women, were included as study group and uncircumcised ladies as control group. Data was collected by trained registrars using a structured questionnaire to collect frequency of postpartum haemorrhage [PPH], perineal tear, birth asphyxia, neonatal death and hospital stay. A total of 1961 primigravidae, delivered in 2010 at OMH, 629[32.1%] were circumcised and 1332[67.9%] were uncircumcised. There was no significant difference in the mode of delivery and episiotomy. FGM places women at a greater risk during childbirth, endangering their health and their babies compared to uncircumcised.

Implementation of postabortion care [PAC] services in three states in eastern Sudan 2009-2010

This is an observational study done in three states in eastern Sudan, Red sea, Kassala and Gadarif states. It was conducted to determine number of patients presented for PAC, their socio-demographic characteristics and medical treatment they received. The study was carried in nine hospitals, in three states in eastern part of Sudan. Training of health care providers was done before embarking on the study together with renovation of health care centers. Patients presented for PAC, were included in the study after an informed consent, during 2009-2010. Data was collected by trained group of registrars in obstetrics and gynecology department. The study showed that, 3762 patients were admitted for PAC services during study period, accounting for 11.9% of the total hospitals admission, 3740 enrolled in the study. Abortion cases were classified as spontaneous 3463 [92.6%], while 277 [7.4%] were induced. Evacuation was done for 3548 [94.9%], the rest were spontaneous complete abortion, received uterotonics and antibiotics. Sharp curettage was done for 3065 [86.3%], manual vacuum aspiration-MVA, for 414 [11.7%] and 69 cases [2.0%] received misoprostol. Counseling and family planning provided to 301 cases [8.0%]. Pregnancy was intentional and wanted in 2647 cases [70.8%], wanted but unplanned in 553 [14.8%], and unwanted in 540 cases [14.4%]. Miscarriage [abortion] is prevalent even within desired pregnancy. Sharp curettage is still the method of practice. Family planning is not well integrated within PAC services. Health care providers need to know, practice and maintain full package of PAC