Summary Background We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the ...coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO. 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 95% CI 0·802–0·851). Interpretation High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.
Abdominal pregnancy is a rare medical condition that is still missed in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are ...nonspecific, making it challenging to diagnose and often leading to delayed detection. However, obstetric ultrasound serves as an essential tool in early detection. Our objective was to share our experience dealing with this condition and emphasise the importance of early ultrasound diagnosis through efficient pregnancy monitoring in our regions.
35-year-old Black African woman who had ten months of amenorrhea sought consultation due to an absence of active foetal movements. Her pregnancy was of 39 weeks with fetal demise which was confirmed following clinical examination and ultrasound. She underwent cesarean section in view of transverse position of fetus. During cesarean section, the fetus was found within the abdominal cavity with the placenta attached over the left iliac fossa including surface of left ovary. The uterus and right adnexa were within normal limits. A 2600 g macerated fetus with placenta and membranes were extracted without any complications. The maternal outcome was successful.
Abdominal pregnancy remained an inadequately diagnosed condition in developing countries. It is imperative to increase awareness among pregnant women regarding high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised. To ensure accurate diagnosis, the location of the gestational sac must be identified for every pregnant woman during their initial ultrasound appointment.
Myomectomy during pregnancy is a rare situation, reserved for exceptional cases. We report two cases of myomectomy during pregnancy. Case 1 was a 31-yearold primigravida with a large transmural ...myoma complicated by intense pelvic pain not responding to medical treatment due to red degeneration in a 6-week pregnancy. Case 2 was a 30-year-old primigravida with multiple myomas complicated by necrosis and hydronephrosis. We performed multiple myomectomy at 17 weeks’ pregnancy after failure of medical treatment. Concerning the operative technique, we performed myomectomy during pregnancy followed by prophylactic cerclage of the cervix. The operation is carried out as quickly as possible by the most experienced surgeon of the team, in order to shorten the operating time and limit blood loss. Myomas that are in contact with the uterine cavity are not removed. In all, 500mg of hydroxyprogesterone was administered intramusculary 24h before the procedure, intraoperatively, and after operation to limit the risk of abortion. In Case 1, myomectomy was performed successfully without maternal or fetal complications. However, the patient developed placental abruption at 33 weeks of pregnancy. The newborn died 3h after birth. In Case 2, myomectomy was complicated by a spontaneous abortion at the end of the operation. The patient developed necrosis of the remaining myomas and endometritis leading to hysterectomy. Thus myomectomy during pregnancy should be performed as a last resort in only well-selected patients.
Introduction l´objectif de cette étude était de déterminer la fréquence et d´évaluer le pronostic maternel et périnatal lors de la grossesse suivi de l´accouchement chez les élèves mineures mariées, ...dans la ville de Niamey. Méthodes: c´était une étude cas-témoin des gestantes et parturientes de janvier 2018 au 31 décembre 2018 à la Maternité Issaka Gazobi de Niamey. Les élèves mineures (<18 ans) ont été comparées aux élèves âgées de 18-27 ans. Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. Les statistiques usuelles et la régression logistique ont été utilisées pour analyser les résultats. Le seuil de signification a été fixé à une valeur de P-value (p<0,05). Résultats la fréquence d´accouchement chez les élèves mineures était de 3,06%. Les mineures étaient plus assidues au suivi prénatal (46,7% vs 41,9%). La césarienne (ORa=2 1,0-3,0), l´éclampsie (ORa=2 1,0-4,4), l´épisiotomie (ORa=21,2-1,8) et la dépression néonatale (P<0,05 (10,6% vs 5,8%)) étaient plus élevés chez les mineures que chez les adultes. La mortalité périnatale était élevée dans les deux groupes. Conclusion nos résultats sont proches de ceux décrits dans d´autres études européennes et africaines. Les différences retrouvées pour les risques obstétricaux et périnatals semblent être liées aux facteurs sociodémographiques entourant ces gestantes mineures. Ces derniers devraient être pris en compte dans toute démarche de prévention des complications des grossesses chez les mineures.
IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication ...severity, describe their management, and to report women’s experience of abortion care in Africa.MethodsA cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsThere were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).ConclusionThere is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.
To set up a global system for monitoring maternal and perinatal health in 54 countries worldwide.
The WHO Global Survey for Monitoring Maternal and Perinatal Health was implemented through a network ...of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas.
The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 125 institutions in seven African countries and 119 institutions in eight Latin American countries participated.
This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.
Induction of labor is being increasingly used to prevent adverse outcomes in the mother and the newborn.This study assessed the prevalence of induction of labor and determinants of its use in Africa.
...We performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005. The African database was analyzed to determine the use of induction of labor at the country level and indications for induction of labor. The un-met needs for specific obstetric indications and at country level were assessed. Determinants of use of induction of labor were explored with multivariate regression analysis.
A total of 83,437 deliveries were recorded in the 7 participating countries. Average rate of induction was 4.4% with a range of 1.4 - 6.8%. Pre-labor rupture of membranes was the commonest indication for induction of labor. Two groups of women were identified: 2,776 women with indications had induction of labor while 7,996 women although had indications but labor was not induced.Induction of labor was associated with reduction of stillbirths and perinatal deaths OR - 0.34; 95% CI (0.27 - 0.43).Unmet need for induction of labor ranged between 66.0% and 80.2% across countries. Determinants of having an induction of labor were place of residence, duration of schooling, type of health facility and level of antenatal care.
Utilization of induction of labor in health facilities in Africa is very low. Improvements in social and health infrastructure are required to reverse the high unmet need for induction of labor.
L’ascite survenant chez la femme enceinte est un tableau clinique rare. Nous rapportons deux cas cliniques d’ascite et grossesse observés chez des jeunes patientes. La symptomatologie était dominée ...par la dyspnée,l’anémie sévère(taux d’hemoglobine de 5,1g/dl pour l’une et 6,1 pour l’autre) la distension abdominale et les œdèmes des membres pelviens. Les étiologies étaient la tuberculose péritonéale et l’hypertension artérielle. Plusieurs ponctions d’ascite furent réalisées ainsi que l’utilisation des diurétiques afin de diminuer la distension abdominale. La correction de l’anémie était obtenue par la supplémentation en fer et les transfusions sanguines. L’utilisation des antituberculeux était faite chez la patiente atteinte. Les accouchements se sont effectués par voie basse avec des nouveaux nés en bonne santé. L’évolution clinique des patientes et celle de leur nouveau-nés a été favorable au bout de30 jours d’hospitalisation pour la prémirère et 10 jours pour la séconde.
Ascites occurring in pregnant women are a rare clinical picture. We report two clinical cases of ascites and pregnancy observed in young patients. The symptomatology was dominated by dyspnea, severe anemia (hemoglobin level of 5.1 g/dl for one and 6.1 for the other), abdominal distention, and oedema of the pelvic limbs. The etiologies were peritoneal tuberculosis and arterial hypertension. Several ascites punctures were performed as well as the use of diuretics to reduce abdominal distension. Correction of anemia was achieved through iron supplementation and blood transfusions. The use of anti-tuberculosis drugs was done in the affected patient. Deliveries were vaginal with healthy newborns. The clinical course of the patients and their newborns were favorable after 30 days of hospitalization for the first patient and 10 days for the second.
Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and ...outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio AOR 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.
Textiloma complicating myomectomy: A case report Diaouga, Hamidou Soumana; Yacouba, Maimouna Chaibou; Oumara, Maina ...
International journal of surgery case reports,
10/2023, Letnik:
111
Journal Article
Recenzirano
Odprti dostop
Textiloma or gossypiboma is a rare complication of pelvic surgery. It can mimic both, clinically, and radiologically an abscess, or a tumor, thus, making its diagnosis difficult and late. It can lead ...to a high morbidity and mortality rate for the patient and engages the surgeon's civil liability.
We report a case of textiloma following a myomectomy in a 42 year old patient treated in our department. Textiloma was diagnosed three years after myomectomy. Treatment consisted of a second laparotomy to remove the textiloma without complication.
Incidence of textiloma varies from 1/833 to 1/32.672 but more often encountered in African surgical practice. Systematic counts of instruments, sponges and needles is not yet usual in our operating room. Through the analysis of this case, we call on surgeons to be more vigilant in order to avoid this serious medical error.
The aim of this study was to describe the intraoperative errors that led to the occurrence of the textiloma, depict the diagnostic difficulties of textiloma, and the medico-legal implications in a tertiary hospital in Niger.
•Despite the cheklist” of procedures published by the Wold Health Organization to reduce textiloma, this complication est. is still observed in our surgical practice, because systematic counts of instruments, sponges and needles is not yet usual in our operating room.•The absence of specific signs, both clinical and radiological, makes the diagnosis often difficult and late particularly in a low ressorce setting. Textiloma constitutes a fault for the judge, especially since its consequences can be serious on the patient. It calls into question the responsibility of the surgeon because it is an involuntary personal fault. This case report show that honesty and respect for medical ethics also make it possible to protect colleagues against claims. Diagnosis must never be take secret.•This study describe the intraoperative errors that led to the occurrence of textiloma, depict the diagnostic difficulties and the medico-legal implications in a tertiary hospital in Niger
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