ABSTRACT
BACKGROUND: Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans Frontières supports a referral maternity ward in the capital, Bangui. OBJECTIVES: To describe the prevalence, associated factors and fatality of one of the most severe complications, uterine rupture, as well as the effect of a history of uterine surgery. METHODS: This is a cross-sectional study based on retrospectively collected data between January 2018 and December 2021 for women who delivered new-borns weighing over 1,000 g. RESULTS: Of 38,782 deliveries, 229 (0.6%) cases of uterine rupture were recorded. Factors associated with uterine rupture were parity ⩾5 (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 4.6-12.2), non-occipital foetal presentation (aOR 2.8, 95% CI 2.1-3.7) and macrosomia (OR 4, 95% CI 2.6-6.4). The fatality rate was 4.4%, and the stillbirth rate was 64%. Uterine rupture occurred in non-scarred uterus in 150 (66.1%) women. Adverse outcomes were more common in cases of uterine rupture on non-scarred uterus compared to scarred uterus, with higher maternal mortality (6% vs. 0%, P = 0.023) and lower Apgar scores (<2) for new-borns (69.1% vs. 45.8%, P < 0.001). CONCLUSION: Uterine rupture remains a major issue for maternal and perinatal health in the CAR, and efforts are needed to early detect risk factors and increase coverage of the comprehensive emergency obstetric and neonatal care.
ABSTRACT
OBJECTIVES: Thyroid disorders are highly prevalent in patients with schizophrenia. Changes in the levels of thyroid hormones cause the occurrence of psychiatric disorders and affect the response to treatment. The aim of this study was to investigate the changes in thyroid hormone levels in patients with chronic schizophrenia, and to demonstrate any association between psychiatric symptoms and hormones. METHODS: Sixty-three patients with schizophrenia and 53 controls were included in this study. The serum levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in patients and controls were tested by using the chemiluminescence immunoassay. Symptoms were assessed via the Positive and Negative Syndrome Scale (PANSS). RESULTS: The level of FT4 in the schizophrenia group was statistically significantly lower than the control group (p = 0.045). There was no significant difference between the clinical subtypes of schizophrenia and thyroid hormone levels. There was a mild negative correlation between PANSS negative subscale scores and levels of TSH (p = 0.023). CONCLUSION: These findings suggest that the subclinical hypothyroidism observed in the chronic schizophrenic patients may be associated with the treatment of neuroleptics. The possible alterations of thyroid hormones should be considered in chronic schizophrenic patients for treatment with neuroleptics.
