Journal of Obstetrics and Gynaecology of Eastern and Central Africa

Upscaling advocacy with interventions to eliminate violence against women

Prof. Anne-Beatrice Kihara — Sun, 30 Jun 2024 00:00:00 +0000

Reducing unwanted adolescent pregnancies in Kenya: A policy brief with evidence-based options

Dr. Esther W. Ndung’u, Dr. Ruth McQuillan — Sun, 30 Jun 2024 00:00:00 +0000

Adolescent pregnancy is a global health issue that affects millions of young girls and their families.
According to the World Health Organization, approximately 16 million adolescents aged 15-19
years give birth annually, representing 11% of all births worldwide. Most of these pregnancies occur
in low- and middle-income countries (LMIC), especially in Sub-Saharan Africa. The burden of
adolescent pregnancy in Kenya is 15% of girls aged 15-19 years, with 2.7 % of adolescents aged
15 years having ever been pregnant. Unintended pregnancies among adolescents in Kenya
account for most maternal morbidity and mortality cases from abortions. Pregnant adolescents are
at an increased risk of pregnancy and childbirth complications, unsafe abortion, violence from
intimate partners, HIV/AIDS, and other sexually transmitted infections. Furthermore, infants born to
adolescent mothers have higher probability of mortality and exposure to life-threatening conditions.
This policy brief reviews and analyses the factors associated with unintended adolescent
pregnancies in Kenya and identifies evidence-based interventions that can be applied in the local
context. It argues that a multisectoral approach involving education, contraception, and incentives
is needed to address adolescent pregnancies. In conclusion, more research is needed to tailor
these interventions to the local Kenyan context while analyzing the availability and mobilization of
resources.

Urethral prolapse in a 4-year-old girl: A case report

Sun, 30 Jun 2024 00:00:00 +0000

Background: Urethral prolapse is a rare cause of vaginal bleeding in prepubertal females and occurs
more commonly in black girls. It is characterized by protrusion of the distal urethral mucosa at or
beyond the level of the urethral meatus. It is often mistaken for sexual abuse in children because it
presents with vaginal bleeding, creating anxiety among parents and confusion among clinicians.
Case presentation: A 4-year-old girl presented to the outpatient department with a 2-day history of
vaginal bleeding. However, no lower abdominal pain was reported. Sexual abuse was initially
suspected. A diagnosis of urethral prolapse was made during examination under anesthesia.
Surgical excision and postoperative care were performed.
Conclusion: Urethral prolapse, although rare, can occur in prepubertal black girls and is managed
either surgically or through conservative approaches.

Extensive rectovaginal space hematoma causing urine retention as a complication of vaginoplasty: A case report

Sun, 30 Jun 2024 00:00:00 +0000

Background: Rectovaginal space hematoma following vaginoplasty is a rare complication that can
lead to serious morbidity and disability. In the literature, reported cases remain few, especially in
low-income countries where cosmetic gynecology consultations are increasing.
Case presentation: We present a case of extensive rectovaginal space hematoma presenting with
urine retention following vaginoplasty. The patient had anemia, hypotension, tachycardia, vulval
swelling, and a suprapubic mass from the overdistend bladder. She was surgically managed and did
well postoperatively.
Conclusion: Rectovaginal space hematomas are rare and associated with significant morbidity if
inappropriately managed. Cosmetic gynecological surgeons should be aware of this complication.

Spontaneous ovarian hyperstimulation syndrome: A case report

Dr. Monica Wambui, Dr. Idyoro J. Ojukwu, Dr. Rosa C. Ndiema — Sun, 30 Jun 2024 00:00:00 +0000

Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication caused by
excessive response to controlled ovarian stimulation. It is characterized by ovarian enlargement and
the formation of multiple cysts. When OHSS occurs in spontaneous pregnancies it is known as
spontaneous OHSS (sOHSS).
Case presentation: A 31-year-old para 2+0 gravida 3 presented with gross abdominal distention at 11
weeks of gestation. Abdominopelvic ultrasound revealed a single viable fetus at 12 weeks and 4
days with large multicystic adnexal masses, which were suggestive of mucinous cystadenoma.
Follow-up magnetic resonance imaging revealed ovarian hyperstimulation syndrome. Initial CA-125
levels were >600 U/ml. Her symptoms were mild and resolved with conservative management. She
eventually delivered preterm at 33 weeks.
Conclusion: Pregnancy with sOHSS is a rare condition and may not be obvious. It may mimic other
ovarian tumors, leading to premature termination of a normal pregnancy and unnecessary surgical
intervention.

Cesarean birth decision-to-delivery interval in sub-Saharan Africa: A systematic review and meta-analysis

Sun, 30 Jun 2024 00:00:00 +0000

Background: Globally, in 2017, 810 women died daily from pregnancy- or childbirth-related preventable complications. Of these deaths, 94% occurred in resource-poor countries, with the highest maternal and perinatal mortality occurring in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis of studies on the decision-to-delivery interval (DDI) from the SSA to determine the mean DDI, establish the maternal and neonatal outcomes reported, and evaluate the obstacles to achieving the gold standard DDI of ≤30 minutes.

Methods: We performed a systematic literature review and meta-analysis of eligible studies between January 1995 and December 2022, in seven databases and grey literature. Studies of any design were included if they reported obstetric emergencies delivered by cesarean birth and had information on the DDI. Three independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. The authors performed meta-analysis of mean DDI on studies with adequate data.

Results: Thirty-nine studies with 41 datasets (12,835 participants), qualified for inclusion. In these studies, only 6.34% of cesarean deliveries were performed in under 30 minutes. A meta-analysis of 27 datasets found an overall DDI mean of 2.81 hours (168.8 minutes, 95%CI 151.5 to 186.2)). The pooled perinatal and maternal case fatality rates for the included studies were 61.2 in 1000 and 444.1 in 100,000 CDs, respectively.

Conclusion: This review and meta-analysis found unacceptably high mean DDI, and perinatal and maternal mortality following cesarean delivery in SSA.

Prevalence of Rhesus D negativity and barriers to immuno- prophylaxis among obstetric patients in Kitengela Sub- county Hospital: A cross-sectional study

Sun, 30 Jun 2024 00:00:00 +0000

Background: Rhesus (Rh) alloimmunization is a serious but preventable disease that develops in women who are Rh(D)-negative. This disease contributes significantly to perinatal morbidity and mortality. Prevalence data of Rh(D)-negative blood type among pregnant women in Kenya are scarce. This study aimed to determine the prevalence of Rh(D)-negative blood type, barriers to immunoprophylaxis, and ABO blood type patterns among the obstetric population in Kitengela Subcounty Hospital, Kajiado, Kenya.

Methods: A cross-sectional study design was employed in which medical records of Rh-negative women as documented at the first antenatal visit were retrieved. Data were collected, extracted into a data collection tool, and analyzed using the Statistical Package for Social Scientists Software (SPSS version 23).

Results: Of the 7141 women screened, 1.2 % (85) were Rh-negative. Among these, blood group O was the most common (48.2%), followed by blood groups B (24.7%), A (23.5%), and AB (3.5%). Most Rh-negative women (45.9%) were aged 15-23 years. Following delivery, only half of the women received anti-D immunoglobulin. Among those who did not receive anti-D postnatally, 80.8% lacked a documented reason, whereas 12.2% and 4.9% of the patients lacked access and did not know their Rh status, respectively. None of these patients had fetal blood grouping conducted before anti-D administration.

Conclusion: Rh(D) negativity remains prevalent in the Kenyan population. However, access restrictions at both diagnostic and therapeutic levels remain. In addition, there is an overt hiatus in neonatal blood grouping.