Annular cervical detachment during caesarean section

Annular cervical detachment is a rare complication mostly associated with prolonged labour and the resultant vascular impairment. Although a remote possibility, such a complication is not unheard of with caesarean section. Here is one such case of annular detachment of cervix during caesarean section due to difficult delivery of fetus which was managed by repair of cut edges.

Review on Prasramsini Yonivyapad (Pelvic Organ Prolapse)

Laxity of vaginal canal and uterine descent is one of the conditions commonly seen in peri-menopausal age with predominance of vata dosha, also seen as a complication of prolonged labour. syandana-prolapse, kshobhana-irritation, dushprasuta-difficult labour and other features of vitiation of pitta dosha are seen in prasramsini yonivyapad. Local therapy play an important role in these conditions. The descent of an organ is called Sramsana and condition called Prasramsini. Prasramsini yonivyapad is enumerated in pittaja yonivyapad by Sushruta which may be co-related with 1st and 2nd degree uterine prolapse. This condition is seen in peri-menopausal or postmenopausal period although young age group with distress during labour is no exemption. Prasramsini is a vatanubandhi, pittaja yonivyapad, the drugs with the properties of vata and pitta doshahara, kashaya rasa, balya and agnideepana can be selected. Vaginal tamppon is helpful to strengthen the vagina and cervix. In Ayurveda, local treatment of Prasramsini yonivyapad is sthanapavartana, pichu dharana and veshavara pinda with gophana bandha.

Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.

Pregnancy outcomes in women with excessive gestational weight gain in Dschang health district of Cameroon

<p class="abstract"><strong>Background:</strong> Excessive gestational weight gain (EGWG) during pregnancy can lead to adverse outcomes for the mother and/or the new-born. The aim of the study was to determine the prevalence of EGWG as well as its effect on pregnancy outcomes amongst pregnant women at the health district of Dschang in Cameroon. </p><p class="abstract"><strong>Methods:</strong> This was a cross sectional study conducted from January to June 2019 and targeting all consenting pregnant women in Dschang District Hospital. They were administered a prepared questionnaire followed by their body mass index measurements for times at the beginning and the end of gestation to measure GWG. Logistic regression was used to determine the association of the EGWG to some particular pregnancy outcomes, adjusting for other factors with significance set at 5%. </p><p class="abstract"><strong>Results:</strong> A total of 400 women were included in this study with a mean age of 27±5years, 59.2% being married and 34.8% still being students. Also it was noted that 24.8% of these women were obese while 25.3% had EGWG. Furthermore, EGWG was independently associated to prolonged labour (aOR=2.4; CI: 1.3-4.6; p value=0.007), genital tract laceration (aOR=2.0; CI: 1.0-3.8; p value=0.036) and foetal macrosomia (aOR=7.3; CI: 3.5-15.2; p value&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> The prevalence of EGWG was high and it was associated with prolonged labour, genital tract laceration and foetal macrosomia. There is thus the need to improve the awareness of these women on EGWG as well as a constant follow up all through gestational period so as to regulate their GWG. The above measures will help to reduce occurrence of these complications, and consequently reduce maternal and neonatal mortality.</p><p class="abstract"> </p>

SURGICAL SITE INFECTIONS AFTER OPERATIVE DELIVERY AT THE TERTIARY CARE HOSPITAL IN RAJASTHAN, THEIR MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND CLINICAL RISK FACTORS

Introduction: Surgical site infections (SSI) are common problem in developing country like India. There are so many factors are responsible for SSI like low immunity, prolonged labour, production of hematoma presence of gestational diabetes Anaemia, multiparaty, heavy blood loss during delivery. Methods: It is a case-control study undertaken for a period of one year in a tertiary care hospital of Rajasthan state, India. The study population included patients suffering from SSIs in the various unit of obstetrics ward of our hospital. Result: in our study we found a lot of factor affecting prevalence of SSIs like anaemia, premature rupture of membrane, prolonged labour, multiparity and obesity. Common organism are Escherichia coli, staphylococcus and pseudomonas. Most of the organism are susceptible with carbapenems vancomycin and amikacin. Conclusion: Even though the total number of Cesarean delivery has increasing consistently, wound infection should be has remained less constant. This may be achieved by high compliance among the infection control practices by health care workers in the hospital

Incidence of uterine rupture and associated factors in Ethiopia: A systematic review and Meta-analysis

Background: Globally, maternal morbidity and mortality a major public health challenge. Uterine rupture is a life-threatening obstetrical emergency with life-threatening complications for both the mother and her infant. In developing countries, it is the leading cause of maternal and fetal morbidity and mortality. Therefore, this systematic review and meta-analysis aimed to assess the incidence of uterine rupture and its associated factors among mothers managed for obstetric cases in Ethiopia.Method: for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. This search included all published and unpublished observational studies written only in English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) used for data analysis.Result: A total of 21 studies with 33,303 mothers managed for obstetric cases were included. The pooled incidence of uterine rupture among mothers managed for obstetric cases in Ethiopia was 3.25% (95%CI: 2.6–3.89, I2=97.4%, P<0.001). Rural residency (adjusted odds ratio (AOR):5.44; 95% confidence interval (CI): 95%CI: 3.17–9.34, I2 =59.5%, P=0.03), grand multiparty (AOR = 2.38; 95%CI: 1.32–4.29, I2=0.0%, p=0.002), not having antenatal care (AOR =4.05(; 95% CI: 1.90–8.64 I2=89.4%, P<0.001), having previous cesarean section scar (AOR =7.10; 95% CI: 5.40–9.34, I2=26.3%, P=0.254), having Prolonged labour (AOR=6.71; 95%CI: 4.04–11.15, I2=84.6%, P<0.001), having obstructed labour (AOR=7.22; 95%CI: 2.86–18.28, I2=97.4%, P<0.001), no partograph utilization for labour monitoring (AOR=3.43; 95%CI: 1.62–7.29, I2=66.6%, P=0.05) were the determinant factors for the incidence of uterine rupture in Ethiopia.Conclusion: This systematic review and meta-analysis showed that the incidence of uterine rupture was high in Ethiopia. Being from the rural area, prolonged labour, having cesarean section scar, not using partograph for labour monitoring, not having ante natal care, and obstructed labour increased the risk of uterine rupture.

Give Time or Take Action? Clinical Challenges of Prolonged Labour: Perspectives from Tanzania

Background: Globally, some evidence suggests that up to one third of nulliparous women experience delay in the first stage of labour. Diagnosing prolonged labour is complicated by uncertainty related to the definition of both onset of labour and normal labour progression.Prolonged labour inhabits an increased risk of poor neonatal and maternal outcomes. To our knowledge, few studies have assessed the clinical challenges of prolonged labour from a health care professional perspective. In this study we aim to improve understanding of how clinical challenges related to prolonged labour are perceived by doctors and nurse-midwives in Tanzania. Methods: A qualitative study with group interviews of either doctors (2 interviews) or nurse-midwives (7 interviews). A qualitative content analysis was performed. The study setting comprised one zonal consultant university hospital and one regional referral hospital in Northern Tanzania. Results: A total of 37 respondents, among them 32 registered nurse-midwives and 5 doctors, all with experience from labour ward. Five categories emerged. Challenges were expressed in relation to 1) various ways of understanding prolonged labour, 2) assessing progress in labour, 3) monitoring foetal heart rate, 4) appropriate intervention at the appropriate time and 5) working as a team. Conclusions: The study provides a broader understanding of the clinical challenges encountered by nurse-midwives and doctors when managing prolonged labour. The grounds on which decisions are made, are somewhat inconsistent. The respondents request clear guidelines and frequent training.

Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study

Background Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden on parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia. Methods A facility based cross-sectional study was conducted between 1 August 2015 and 30 July 2016. We randomly selected medical records of pregnant women from a hospital delivery registry. Bivariate analysis was employed to assess the association between independent and dependent variables using chi-square with significant p-value. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding variables. Results Of 374 reviewed records of pregnant women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Fifteen (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (< 2500grams) (adjusted odds ratio (AOR): 10.70, 95% CI 3.18–35.97) than normal birth-weight babies (2500-<4000). Pregnant women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76–84.12) more likely to have stillbirths than pregnant women without a prolonged labour. Pregnant women with obstetric complications were 18.9 times more likely to have stillbirths than pregnant women without obstetric complications. Similarly, pregnant women with at least two pregnancies were more likely to have stillbirths than pregnant women with less than two pregnancies (AOR: 4.39, 95% CI 1.21–15.85). Conclusions We found a high burden of stillbirths in the study setting. Modifiable risk factors contributed to a higher risk of stillbirths; therefore, tailored interventions such as early identification and management of prolonged labour and obstetric complication at each level of health system could avert preventable stillbirths.