Perinatal outcome of oligohydramnios in academic hospitals in a low resource setting.

Oligohydramnios has been a topical issue in obstetrics. The prevalence of oligohydramnios ranges from 1 to 5%. Conflicting data exists concerning its effects on adverse perinatal outcome. This study aims to assess perinatal outcomes of oligohydramnios at the Mekelle Public Hospitals from April 1, 2018 - March 31, 2019. This was a cross-sectional study and a total population purposive sampling method was employed to collect data prospectively. During the study period, there were a total of 10,451 deliveries in both hospitals. Oligohydramnios complicated 332 pregnancies (3.2%, 95%CI: 2.9%, 3.5%) across all gestations and 273 pregnancies (2.6%, 95% CI: 2.3%, 2.9%) at term. The composite adverse perinatal outcome rate was 29.7% (95% CI, 24.5, 35.4). Primigravidity and presenting at post-term gestation were associated with adverse perinatal outcome. Nearly 70% of mothers gave birth via Cesarean delivery. Oligohydramnios was found to be associated with a significant increase in adverse newborn and maternal outcomes in the study setting. Although a significant proportion of mothers underwent Cesarean delivery for a perceived increased complications associated with vaginal delivery in this population of patients, Cesarean delivery was found to not improve perinatal outcome. Primigravids and postdated pregnancies must receive increased surveillance to detect oligohydramnios early and to institute appropriate and timely interventions. Indications for Cesarean delivery in patients complicated by oligohydramnios must be carefully examined to balance the benefit on the perinatal outcome on the one hand and to avoid unnecessary major surgery with potential fatal maternal complications on the other.

Heterotopic Pregnancy with Ipsilateral Adnexal Cyst Causing a Diagnostic Dilemma: A Case Report.

Background: Heterotopic pregnancy is the coexistence of intrauterine and extrauterine (ectopic) pregnancies. This is a relatively rare phenomenon with an incidence of 1 in 30,000 in spontaneously conceived pregnancies and 1 in 100 pregnancies achieved through assisted reproduction. Due to its relative rarity, diagnosis can be challenging. The presence of adnexal cystic masses complicating pregnancies can obscure the examination of the pelvis to rule in/out heterotopic pregnancy further adding to the complexity of the diagnosis. Case Presentation: In this study, we present a 26-year-old primigravid, ethnic Tigrayan lady from the Tigray region of Ethiopia. She presented to our hospital with the complaint of progressively worsening abdominal pain of three days duration. She also had a subjective period of amenorrhea of 2 months duration. Pregnancy test was positive a few days prior to her current presentation. She reported that she had a history of treatment for pelvic inflammatory disease three months prior to her current conception. At presentation to our hospital, she was acutely ill-looking in pain, tachycardic, and hypotensive. Pelvic ultrasound showed an adnexal mass, hemoperitoneum, and an intrauterine pregnancy at 7 weeks + 5 days gestation. With the impression of ruptured ovarian cyst to rule out heterotopic pregnancy emergency, an explorative laparotomy was done which was pertinent for significant hemoperitoneum, ruptured left tubal ectopic pregnancy, and intact left ovarian cyst. Conclusion: Physicians should consider a broad range of differential diagnosis in pregnant mothers who present with acute abdominal pain. Moreover, in the presence of an adnexal mass and hemoperitoneum, there is a need to maintain a low threshold for rare but life-threatening complications such as heterotopic pregnancy. The presence of an intrauterine gestation does not rule out extrauterine gestation. Thus, the presence of a viable intrauterine gestation should not stop physicians from carefully examining patients for the coexistence of an ectopic pregnancy.