Spinal anesthesia for cesarean delivery at two teaching hospitals in Addis Ababa, Ethiopia

Introduction: Either regional or general anesthesia is an acceptable approach to providing anesthesia for cesarean delivery. However, regional anesthesia is the widely preferred option considering its multiple benefits. The aim of this study was to assess the prevalence of spinal anesthesia use, attitude of mothers towards spinal anesthesia, and magnitude of its complications.Methods: This is a hospital-based cross-sectional study conducted from April-June 2014 at Tikur Anbessa Specialized Hospital and Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Data was collected using a pre-tested questionnaire and analyzed using SPSS version 21 statistical software.Result: During the study period, there were 1,713 deliveries, with overall cesarean section delivery prevalence of 32.5%. The overall proportion of cesarean delivery with spinal anesthesia was 68.2%. Only two mothers were given spinal anesthesia in left lateral position. The experience of the anesthetist was the only factor significantly associated with the occurrence of hypotension in a multivariable analysis. Postdural puncture headache after cesarean section with spinal anesthesia was reported in 34.2% of the cases. After the operation, 90.3% of the mothers were happy with the type of anesthesia administration.Conclusion: The rate of spinal anesthesia for cesarean delivery in this study is significantly lower than reports from the developed as well as sub-saharan countries implying a need to increase use of this procedure to achieve the recommended 90-95% target and avail epidural anesthesia as an option for those in need. The current practice in administering spinal anesthesia needs to be revised to minimize such side effects

OUTCOME OF PREGNANCY WITH CLINICALLY VISIBLE/PALPABLE MYOMA AMONG WOMEN WHO UNDERGO CAESARIAN SECTION IN THREE TEACHING HOSPITALS, ADDIS ABABA, ETHIOPIA: A CROSS SECTIONAL STUDY.

Introduction: Myoma is the most common pelvic tumor and an enormous healthcare concern in women. Complications occur in approximately 10-40% of pregnancies with myomatous uterus. This study is conducted to determine the prevalence and obstetric outcome of grossly visible and/or palpable myoma among women who gave birth by caesarean section. Methods: A cross sectional study conducted in three teaching hospitals in Addis Ababa, Ethiopia. Data was collected using a pre-tested questioner. Results: A total of 404 cases were included in the study. The prevalence of myoma was 15.3% (62/404). Only 9.7% (6/62) of the myoma cases were diagnosed preoperatively with ultrasound. The number of myoma per case ranged from 1-to-14 with mean number of 3 ±2.7. The mean diameter of largest single myoma per case was 5.2cm ± 3.4. The commonest location of myoma was subserous being the location in 58.1% (36/62). There was significant association between presence of myoma and age of the woman (P<0.05). The adjusted prevalence of myoma increases as women's age increases, and gestational age and birth weight decreases. In addition, the prevalence of myoma was about two times higher in low (≤6) first and fifth minute APGAR score groups with adjusted prevalences of 22.2% (Vs 14.1% in ≥7 group) and 31.8% (Vs 14.4% in ≥7 group) respectively. Conclusions: The prevalence of myoma during pregnancy in this study is higher than prior reports from similar setups. But, no statistically significant association was observed between the presence of myoma and maternal out come.

Outcome of pregnancy with clinically visible/palpable myoma among women who undergo caesarian section in three teaching hospitals, Addis Ababa, Ethiopia: a cross sectional study

Introduction: Myoma is the most common pelvic tumor and an enormous healthcare concern in women. Complications occur in approximately 10-40% of pregnancies with myomatous uterus. This study is conducted to determine the prevalence and obstetric outcome of grossly visible and/or palpable myoma among women who gave birth by caesarean section.Methods: A cross sectional study conducted in three teaching hospitals in Addis Ababa, Ethiopia. Data was collected using a pre-tested questioner.Results: A total of 404 cases were included in the study. The prevalence of myoma was 15.3% (62/404). Only 9.7% (6/62) of the myoma cases were diagnosed preoperatively with ultrasound. The number of myoma per case ranged from 1-to-14 with mean number of 3 ±2.7. The mean diameter of largest single myoma per case was 5.2cm ± 3.4. The commonest location of myoma was subserous being the location in 58.1% (36/62). There was significant association between presence of myoma and age of the woman (P<0.05). The adjusted prevalence of myoma increases as women's age increases, and gestational age and birth weight decreases. In addition, the prevalence of myoma was about two times higher in low (≤6) first and fifth minute APGAR score groups with adjusted prevalences of 22.2% (Vs 14.1% in ≥7 group) and 31.8% (Vs 14.4% in ≥7 group) respectively.Conclusions: The prevalence of myoma during pregnancy in this study is higher than prior reports from similar setups. But, no statistically significant association was observed between the presence of myoma and maternal out come

PATTERNS OF NEURAL TUBE DEFECTS AT TWO TEACHING HOSPITALS IN ADDIS ABABA, ETHIOPIA A THREE YEARS RETROSPECTIVE STUDY.

BACKGROUND: Neural tube defects (NTDs), one of the most common congenital malformations, are potentially preventable cause of perinatal morbidity and mortality. OBJECTIVES: To give baseline description of NTDs and their outcome at two teaching hospitals in Addis Ababa, Ethiopia. MATERIALS AND METHODS: A retrospective cross sectional descriptive study conducted from September 2009 to August 2012. RESULTS: During the study period out of 28,961 deliveries 177 cases of NTDs were identified, giving an overall NTD prevalence of 6.1/1000. Only 12% (21/177) were diagnosed before 28 weeks of gestation. The mean gestational age at diagnosis of NTDs was 33.8 weeks (±5.5). Majority, 93.2% (165/177), had antenatal care (ANC) follow-up. Most, 72% (127/177), were diagnosed by ultrasound before delivery while 28% (50/177) were identified at the time of delivery or expulsion. Majority, 85.3% (151/177), never received folic acid supplementation. Only less than 1% (2/177) of the mothers started taking folic acid supplementation pre-conceptionally. Only a third, 33.3% (59/177), of the fetuses were born alive while only 13.6% (24/177) were discharged alive. Myelomeningocele, identified in 51.4% (91/177), was the commonest NTD in this study. CONCLUSION AND RECOMMENDATIONS: The proportion of NTDs in this study is among the highest globally reported rates. The practice of periconceptional folic acid supplementation is negligible. And although most had ANC follow-up the vast majority of NTDs were diagnosed late in the third trimester. It is, therefore, highly recommended to consider implementing national preventive strategies to reduce the prevalence of NTDs in Ethiopia.

MATERNAL AND PERINATAL OUTCOME OF PREGNANCIES WITH PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) AT TIKUR ANBESSA SPECIALIZED TEACHING HOSPITAL, ADDIS ABABA, ETHIOPIA.

INTRODUCTION: Preterm premature rupture of membranes is a common complication of pregnancy associated with significant maternal, fetal and neonatal risks. An understanding of its magnitude and consequences is critical in providing appropriate intervention to prevent poor pregnancy outcomes. OBJECTIVE: To describe maternal and perinatal outcomes of preterm premature rupture of membranes at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. METHODOLOGY: A Retrospective cross-sectional descriptive study done at Tikur Anbessa Hospital from June, 2010 G.C. to June, 2013 G.C. RESULTS: The prevalence ofpreterm premature rupture of membranes in this study was 1.4%. Intra-amniotic infection, seen in 31.5% (35/111), was the commonest maternal complication. The mean latency period from rupture of membranes to delivery was 6.6 days. Twenty-six (23.2%) neonates were delivered by cesarean section. There were a total of 12 perinatal deaths, 4 (3.6%) stillbirths (2 antepartum and 2 itrapartum) and 8 (7.1%) early neonatal deaths, making the gross perinatal mortality rate to be 107 per 1000 live births. Prematurity was the commonest cause of neonatal death. CONCLUSION AND RECOMMENDATIONS: Although the prevalence of preterm premature rupture of membranes in this study appears lower than many prior reports, the level of maternal and perinatal morbidity is high compared to many prior reports from similar setups. Especially the proportion of mothers presenting with established chorioamnionitis is high. Therefore, it is important that women be well informed regarding maternal, fetal and neonatal complications ofpremature rupture of membranes so that proper and timely management is provided.