Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study.

BACKGROUND: Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS: We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS: Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION: Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.

Outcome of cesarean section in asymptomatic HIV-1 infection in Kampala, Uganda.

AIM: Sepsis remains a major cause of morbidity and mortality in Mulago Hospital, Kampala, Uganda, following cesarean section (CS). The present study was designed to assess whether asymptomatic HIV infection could be contributing to the increased morbidity following emergency CS in the form of wound and genital tract infection (GTI) with consequent prolonged stay in the hospital. METHODS: Five hundred patients who had undergone emergency lower segment CS had their blood taken to check for HIV-1 serostatus on the first postoperative day. The patients were followed up for evidence of wound sepsis, defined as occult pus discharge on compression of the wound or removal of the closing stitches, GTI and duration of stay in the hospital after the operation. RESULTS: There were 98 (20.5%) HIV-1 seropositive patients. The incidence of postoperative wound sepsis (P = 0.948, 95% confidence interval [CI] 0.56-1.86), GTI (P = 0.339, 95% CI = 0.74-2.39) as well as hospital stay >8 days (P = 0.327, 0.78-2.09) was not statistically significantly different between the infected and non-infected groups. Significant predisposing factors to postoperative morbidity were poor general condition on admission, dehydration, preoperative clinical anemia, and ruptured membranes prior to the operation. CONCLUSION: Asymptomatic HIV-1 was not associated with increased postoperative morbidity following emergency lower segment cesarean section.

Knowledge; attitude and practice about sexually transmitted diseases among University students in Kampala

Background: Sexually transmitted diseases (STDs) remain an important cause of morbidity and mortality among women in the child-bearing age. In order to institute appropriate preventive measures there is need to establish the profile of knowledge of the predisposing factors and causation of STDs; attitude to sexual practice and sexual patterns among the susceptible young people; such as university students. Study population: Non medical university students; Makerere University. Methods: A detailed questionaire identifying socio-demographic characteristics; sexual patterns; knowledge of STDs as well as attitudes towards prevention of STDs was administered to 400 non-medical students of Makerere University. Results: Knowledge of the clinical features of gonorrhoea and AIDS was high; most knew the predisposing factors for STDs (multiple sexual partners 90; unprotected sexual intercourse 93; rape 81; sex outside marriage 78; and sex under the influence of alcohol 73) but not so for syphilis. males were three times more likely to contract STDs (27) than their female (9) counterparts. Whereas knowledge on methods of prevention was high (90) it was not followed by approproate behavioural patterns. More female (33.5) students had heard about Trichomonas vaginalis than males (23); (x2 = 17.1; 0.0001). This study has shown that more female than male students got information from their parents (x2

Malaria - The obstetrician's dilemma: malaria in pregnancy: treatment problems

Malaria in pregnancy is a common parasitic infection in Uganda and East Africa in general. The severity of infection depends on the patients immune status; and is worse in the primigravidae and the non-immune migrating to endemic areas. It may produce intrauterine growth retardation or complications in the mother such as cerebral malaria; acute pulmonary oedema; renal failure and in some cases is responsible for several autoimmune phenomena. A number of drugs have been used as the mainstay of treatment but the picture has become complicated by the emergence of resistant strains. Some drugs such as the sulphonamides and trimethoprim which would be useful in overcoming this resistance are unsuitable for use especially in late pregnancy because of adverse effects on the newborn. Newer drugs such as halofantrine and artemisinin (and other ginghaosu derivatives) have been tested and found to be effective against chloroquin resistant malaria. They have unfortunately been found to have either embryotoxic or gonadotoxic effects in laboratory animals. Ethical problems limit the ability of researchers to assess these adverse effects in clinical practice in obstetrics; thus presenting the obstetricians with a clinical dilemma in resistant forms of the disease