Double cervical cerclage for cervical insufficiency: Case report.

Recurrent pregnancy loss devastates parents and frustrates doctors, especially when the pregnancy progresses to the second trimester. Cervical insufficiency is the most common cause of second-trimester pregnancy loss. Abdominal cerclage is the treatment option for women with failed vaginally applied cervical cerclage. We report a 33-year-old para 0 with a history of nine second-trimester pregnancy losses. She had six failed transvaginal cerclages using McDonald's procedure. A vaginal double cervical cerclage was placed in her index pregnancy. Two mersilene tape purse-string sutures were placed in the submucosal layer of the cervix; the first 1cm below and the second at the level of the internal os. Both sutures were knotted at the 12 O'Clock position on the cervix. She carried her pregnancy to almost term and delivered a healthy baby girl weighing 2.5kg. We recommend a transvaginal double cervical cerclage with mersilene tape using a modified McDonald's technique as a viable alternative to abdominal cervical cerclage. (Afr J Reprod Health 2024; 28 [6]: 117-125).

Les fausses couches récurrentes sont dévastatrices pour les parents et frustrent les médecins, surtout lorsque la grossesse progresse jusqu'au deuxième trimestre. L'insuffisance cervicale est la cause la plus fréquente de fausse couche au deuxième trimestre. Le cerclage abdominal est l'option de traitement pour les femmes dont le cerclage cervical appliqué par voie vaginale a échoué. Nous rapportons une para 0 de 33 ans avec des antécédents de neuf fausses couches au deuxième trimestre. Elle a eu six cerclages transvaginaux selon la procédure McDonald's qui ont échoué. Un double cerclage vaginal vaginal a été placé lors de sa grossesse index. Deux fils de suture en bourse en ruban de mersilène ont été placés dans la couche sous-muqueuse du col de l'utérus ; le premier 1cm en dessous et le second au niveau de l'os interne. Les deux sutures ont été nouées à la position 12 heures sur le col. Elle a mené sa grossesse presque à terme et a donné naissance à une petite fille en bonne santé pesant 2,5 kg. Nous recommandons un double cerclage cervical transvaginal avec du ruban de mersilène en utilisant une technique McDonald's modifiée comme alternative viable au cerclage cervical abdominal. (Afr J Reprod Health 2024; 28 [6]: 117-125).

An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana.

BACKGROUND: Antenatal care (ANC) is imperative to decreasing adverse pregnancy outcomes and their related maternal mortality. However, in sub-Saharan Africa, increases in ANC coverage have not correlated well with improved maternal and fetal outcomes suggesting the quality of ANC received could be the missing link. This study assessed ANC quality and its effect on adverse pregnancy outcomes among women who delivered at Komfo Anokye Teaching Hospital. METHODS: A cross-sectional study was conducted among women who delivered at Komfo Anokye Teaching Hospital within the study period. Women were selected through systematic sampling and interviewed using a pretested structured questionnaire as well as review of their medical records. Data were collected on their sociodemographic and reproductive characteristics, care provided during ANC and delivery outcomes. Categorical variables were compared using the χ2 test. Factors associated with quality of ANC and adverse pregnancy outcomes were assessed using univariate and multivariate logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical analyses were performed using SPSS and GraphPad Prism. P-values of < 0.05 were considered statistically significant. RESULTS: 950 women were recruited into the study with mean age of 30.39±5.57 years. Less than one-tenth (7.6%) of the women received good quality ANC, 63.4% had average quality ANC, and 29.0% received poor quality ANC. Increasing educational level and initiating ANC in the first trimester [aOR 0.2; 95%CI 0.08-0.68; p<0.001] increased the odds of receiving good quality ANC while being unemployed decreased the odds of receiving good quality ANC [aOR 0.3; 95% CI 0.12-0.65; p = 0.003]. Receiving poor and average quality of ANC were significantly associated with increased likelihood of developing anaemia during pregnancy, preeclampsia with severe features or delivering a low birth weight baby. CONCLUSION: Most women did not receive good quality ANC. High quality ANC should be provided while the women are encouraged to comply with the recommendations during ANC.

Postpartum contraceptive choices among women attending a well-baby clinic in Ghana.

OBJECTIVE: To assess postpartum contraceptive choices among women attending a well-baby clinic in Ghana. METHODS: From April 1 to May 31, 2011, a descriptive cross-sectional survey was conducted among women who attended the well-baby clinic of Komfo Anokye Teaching Hospital, Kumasi, at 6-24 months after delivery. Participants were consecutively recruited and interviewed using semi-structured questionnaires. Data were collected on demographics, exposure to family planning counseling, message content, and postpartum contraceptive choices. Differences between the profiles of women who did or did not take up postpartum family planning were assessed. RESULTS: Of the 200 women enrolled, 44 (22.0%) wanted no more children and the last pregnancy was unintended among 88 (44.0%). In all, 110 (55.0%) women took up postpartum contraception, with the calendar method (n=57; 51.8%) and injectable contraceptives (n=22; 20.0%) cited as popular choices. Family planning counseling was received at the prenatal clinic by 47 (23.5%) women, with 12 (6.0%) given written referrals on the postnatal ward. More previous contraceptive users than previous non-users chose long-acting or permanent postpartum methods (P<0.001). CONCLUSION: Inadequate postpartum family planning counseling and referrals during maternity care were recorded, suggesting that a comprehensive educational intervention is required to improve uptake.