Factors Associated with Neural Tube Defects among Women Who Gave Birth at Adama Hospital Medical College, Adama, Ethiopia: A Case Control Study.

Background: Neural tube defects (NTDs) occur as a result of incomplete closure of the neural tube by the embryonic age of 26 to 28 days. Addressing factors associated with NTDs would help to identify and prioritize high-risk women, which in turn guides the preventive strategy. The study aimed to identify factors associated with NTDs among women who gave birth or had a second-trimester abortion at Adama Hospital Medical College, from January 1st to December 31st, 2019. Methods: Hospital based unmatched case-control study was conducted on 344 women. Data were analyzed with SPSS 20. Descriptive statistics were computed. Binary logistic regression analysis was performed to determine factors associations with NTDs. Results: The odds of having a fetus with NTDs were 2.19 times higher among women who are not in a marital relationship (AOR = 2.19; 95% CI: 1.13, 4.25). Women with a previous history of Abortion or stillbirth had 3 fold increased risk of having a fetus with NTDs (AOR = 3.05; 95% CI: 1.58, 5.88). Inadequate housing condition nearly doubles the odds of having a fetus with NTDs (AOR = 1.91; 95% CI: 1.20, 3.04). Folic acid or multivitamin supplementation early in pregnancy reduced the odds of having a fetus with NTDs by 43% (AOR = 0.57; 95% CI: 0.35, 0.91). Conclusion: Being not in a marital relationship, previous history of abortion or stillbirth, and living in inadequate housing conditions were risk factors for NTDs, while multivitamins or folic acid supplementation was a protective factor.

Laparotomy for Advanced Abdominal Ectopic Pregnancy.

Background: Abdominal pregnancy is the rarest and the most serious type of extrauterine pregnancy. The mainstay of treatment for advanced abdominal pregnancy is surgery. The fetus can be delivered easily, and there are two options for the management of the placenta: removal of the placenta and leave the placenta in situ. Case Presentation. This is a 26-year-old primigravida lady who does not recall her first day of last normal menstrual period (LNMP) but claimed to be amenorrhic for the past 9 months. She had antenatal care (ANC) follow-up at a private hospital and had obstetric ultrasound two times and told that the pregnancy was normal. Currently, she presented with absent fetal movement of one week and vaginal bleeding of 3 days duration. She had history of abdominal pain with fetal movement before one week. Upon examination, the abdomen was 34 weeks sized, with easily palpable fetal parts; fetal heartbeat was negative, with mild abdominal tenderness. The cervix was closed and uneffaced. She was investigated with ultrasound which reveals 3rd trimester abdominal ectopic pregnancy with negative fetal heartbeat. Laparotomy was done to deliver a 2000 gm female stillborn with GIII maceration from the peritoneal cavity. Placenta was removed after releasing adhesion from the bowel and omentum. She had smooth postoperative course and discharged on her 5th postoperative day. Conclusion: Abdominal ectopic pregnancy could be missed despite having repeated ultrasound scanning and may continue to third trimester. High index of suspicion and correlation of patient's sign and symptom is very important to make early diagnosis.

Successful Management of Intraoperatively Diagnosed Ruptured Spontaneous Sub-Capsular Liver Hematoma in a Woman with Preeclampsia.

BACKGROUND: Ruptured subcapsular hematoma of the liver is one of the rare life-threatening complications of pregnancy and its incidence varies between 1/45,000 and 1/225,000 births. CASE PRESENTATION: A 32-year-old woman who claimed 9 months amenorrhea, presented to our hospital with elevated blood pressure and pushing down pain. After evaluation she was admitted to the labor ward with a diagnosis of latent first stage of labor and preeclampsia with severe features. She gave birth by outlet vacuum. Immediately following delivery she developed hypotension with signs of intra-abdominal fluid collection. Surgical exploration revealed massive hemoperitoneum with ruptured subcapsular hepatic hematoma. She was managed conservatively with pressure packing and drainage tube. The patient improved and was discharged after 12 days of hospital stay. CONCLUSION: Timely surgical intervention, multidisciplinary team, on-time availability of blood products, and proper postoperative follow up are crucial to optimize the patient outcome.