Determinants of Pelvic Organ Prolapse at Public Hospitals in Hawassa City, Southern Ethiopia, 2020: Unmatched Case Control Study

Introduction: Even though the Pelvic organ prolapse (POP) is outstanding gynecologic problem, most private and asymptomatic nature of the illness makes it the “hidden epidemic.” The aim of this study was to identify the determinants of POP. Methods: Facility based unmatched case control study was conducted from June 15 to September 10, 2020. All cases diagnosed with POP were enrolled in the study by using consecutive random sampling method by assuming that patient flow by itself is random until the required sample size was obtained. Then 1:2 cases to control ratio was applied. A structured interviewer-administered questionnaire and chart review for type and degree of prolapse was used. Epi-data and SPSS were used for analysis. Chi square test and binary and multivariable logistic regression analysis was employed. Multicolinearity was checked. Result: On multivariate logistic regression, heavy usual work load(AOR=2.3, CI(1.066-4.951), number of pregnancy ≥ 5(AOR=3.911, CI(1.108-13.802), birth space of <2 years(AOR=2.88, CI(1.146-7.232), history of fundal pressure (AOR=5.312, CI(2.366-11.927) and history of induced labor (AOR=4.436, CI(2.07-9.505) were significantly associated with POP with P value <0.05 and 95% CI after adjusting for potential confounders.Conclusion: Heavy usual work load, having pregnancy greater than five, short birth space, history of induced labor, and history of fundal pressure are independent predictors of pelvic organ prolapse. Hence the responsible body and obstetric care providers should counsel the women about child spacing. The obstetric care providers also avoid fundal pressure and the hospital officials set a law to ban fundal pressure during labor.

Uterine rupture at the fundus during labor: A case report

Uterine rupture is a rare but catastrophic complication seen in obstetrical practice. The most crucial predisposing factor is previous caesarean scar and it is generally being reported during labor in patients with scarred uterus. Although rare, rupture of an unscarred uterus is one of the most terrible obstetric complications, resulting in maternal and fetal jeopardy. Shoulder dystocia is one of the most difficult complications of labour that is unpredictable and therefore unpreventable. In neglected cases, grave maternal complications like obstructed labour and rupture of uterus can occur. Very rarely, the reverse, uterine rupture leading to shoulder dystocia can also occur. The present case is reported to emphasize the importance of early recognition of this condition. A 32 year old gravida 5 para 2 live 2 abortion 2 with 9 month period of gestation presented to labor room with shoulder dystocia, with history of fundal pressure. After delivery of head, pain subsided and the trunk failed to deliver. Her previous two deliveries were by normal vaginal delivery 8 years and 5 years back respectively. She had previous two abortions 6 years and 3 years back respectively. Both were spontaneous expulsion followed by dilatation and curettage. On examination, clinical diagnosis of rupture uterus was made and patient was taken up for laparotomy. On laparotomy, fetal body and limbs along with the placenta was seen lying in the abdominal cavity and head was in uterus. Baby of 2.34 kg was extracted as breech. A linear rupture of around 10-12 centimeter was present at fundo-posterior region. Uterus was repaired in 3 layers and bilateral tubal ligation was done. Patient was discharged on post- operative day 10 without any complications.In women with high risk for uterine rupture, delivery must be conducted at tertiary hospitals where facilities for emergency caesarean is available. In these patients, if shoulder dystocia occurs, rupture of the uterus must be suspected as an underlying cause. Assisted fundal pressure during delivery can result in trauma even to the unscarred uterus and cause traumatic uterine rupture. Early diagnosis is vital if maternal morbidity is to be reduced.

Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Purpose: Manual fundal pressure (MFP) is globally used to assist vaginal deliveries during the second stage of labor; however, there is insufficient evidence on the risk factors in MFP-assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP-assisted vaginal deliveries.Methods: The present was a single-center observational study using a cohort of all MFP-assisted vaginal singleton deliveries from 2016 to 2020. Placental location was divided into two categories: posterior-lateral and anterior-fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used logistic regression models to investigate the association between placental location and neonatal outcomes. Results: We extracted 522 MFP-assisted deliveries among 5053 vaginal deliveries. The proportion of posterior-lateral and anterior-fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome for posterior-lateral and anterior-fundal placentation was 69 (28.9%) and 112 (39.6%), respectively. The prevalence of neonatal composite outcome in the anterior-fundal group was significantly higher than that in the posterior-lateral group. Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior-fundal group was significantly higher compared with the posterior-lateral group (adjusted odds ratio, 1.55; 95% confidence interval, 1.05–2.28).Conclusion: Anterior-fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior-lateral placentation in MFP-assisted vaginal deliveries.

Parturients Perception of Care Providers Attitude Towards Women During Labour And Delivery In Southwest Cameroon

Background: The period of labour and childbirth for women is a delicate moment and predisposes them to disrespectful care which has been reported in many countries. In Cameroon, data which could help in formulating policies to modify these attitudes is rare.Objectives: To assess parturients’ perception on the respect and disrespect of women by care providers as well as determining the prevalence, types and predisposing factors of physical and verbal abuse during labour and delivery, in the Buea and Limbe Regional hospitals, Cameroon. Methods: It was a hospital based cross-sectional study carried out in Buea and Limbe Regional hospitals from February 15th to April 20th 2021. It involved parturients aged between 15 and 45 in their first eight weeks post-delivery. Data was collected using a structured questionnaire, and the collected data was entered into and analyzed with SPSS version 25. Dependent variables were dichotomized and a bivariate logistic regression model was fitted to obtain the determinants of mistreatments during labour and delivery, while Chi-squared test was used to establish association between socio-demographic characteristics and care categories. A P-value <0.05 was considered statistically significant. Results: We sampled 274 parturients aged between 15 and 42 (mean=26.69yrs and SD= + 5.34). Sixty-nine (25.18%) of the respondents reported at least a physical and/or verbal mistreatment. The most common physical and verbal mistreatments were abdominal fundal pressure to facilitate expulsion and scolding. Muslims were more likely to report insult. Parturients perceived both respectful and disrespectful forms of care.Conclusion: Disrespectful care during labour and delivery may not be uncommon in our country as suggested by the findings in this study. There is need for development of interventions to address the drivers of disrespect and abuse which will encourage clients’ future facility utilization. More studies are needed in other areas of the country to support this evidence.

The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis

Background Uterine fundal pressure involves a birth attendant pushing on the woman’s uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. Methods The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. Results Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4–27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women’s self-report). Conclusions The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.

A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery

Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.