Pregnancy outcomes and associated characteristics at the expected date of delivery and beyond in a large tertiary hospital in Ghana

Background: Globally, pregnancies that have gone beyond the expected date of delivery (EDD) contribute significantly to maternal and perinatal morbidity and mortality.Objective: This study aimed to determine the proportion, pregnancy outcomes, and associated characteristics of deliveries at EDD and beyond at the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana.Methods: This was a cross-sectional study conducted at the KBTH. Postpartum women who delivered at a gestational age of 40 weeks and beyond were selected from the labour wards, grouped according to gestational age, and followed up to their first postnatal visit. Data were collected on demographic, obstetric and postpartum health status. The association between study variables and delivery at and beyond EDD was determined using the F-test statistic and Chi-square test for continuous and categorical outcomes, respectively. A p < 0.05 was considered statistically significant.Results: Of the 300 participants, 44% (n = 132) delivered at 40 weeks plus 0 to 6 days (40 + 0 - 6 weeks) of gestation, 44.7% (n = 134) at 41 + 0 - 6 weeks, and 11.3% (n = 34) at ≥ 42 weeks. The proportion of deliveries at EDD and beyond was 9.9% (n = 300/304) of total deliveries during the period. The pregnancies ≥ 42 weeks were 1.1% (n = 34/3041) of total deliveries. Factors that were significant associations with women who delivered at ≥ 42 + 0 weeks were a referral from other hospitals (p < 0.017), labour induction (p < 0.001), a longer first stage of labour (p < 0.008), and a longer total labour duration (p < 0.009).Conclusion: The proportion of deliveries in which the pregnancies had progressed to the EDD and beyond and that of prolonged pregnancy at the KBTH were 9.9% and 1.1%, respectively. The duration of the first stage of labour and the total duration of labour was longer in women with pregnancies ≥ 42 weeks

Family Planning Needs of Women Experiencing Severe Maternal Morbidity in Accra, Ghana: Another Missed Opportunity?

Women with severe maternal morbidity represent an important group to target for increasing contraceptive uptake. Our objective was to explore the future fertility intentions, use of family planning including methods and reasons for not wanting to use contraception among a group of women who had traumatic delivery experience at a tertiary teaching hospital in Accra, Ghana. Our results show that despite higher educational attainment, longer hospital stays and intention to limit or stop childbearing among women, there is a missed opportunity for family planning among women with  severe maternal morbidity in this urban African hospital setting. Integrating postpartum family planning consultations by linking available services such as reproductive health clinics at the facilities rather than including  additional tasks for the midwives and the doctors in the wards could be a sustainable solution in such urban, high-volume settings.Keywords: near miss, maternal morbidity, family planning, postpartum contraception, Africa, integration, facility deliver

Nitric oxide dysregulation in the pathogenesis of preeclampsia among Ghanaian women

Kwame Adu-Bonsaffoh,1,2 Daniel Ansong Antwi,1 Samuel Amenyi Obed,3 Ben Gyan4 1Department of Physiology, University of Ghana Medical School, Accra, Ghana; 2Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana; 3Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana; 4Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana Background: Preeclampsia (PE) is still a disease of theories as the exact cause remains uncertain. Widespread vascular endothelial cell dysfunction is thought to mediate the generalized vasospasm and hypertension characteristic of PE. Altered nitric oxide (NO) production has been associated with the endothelial dysfunction in the pathogenesis of PE but conflicting results have emerged from previous studies. Objectives: To determine maternal serum levels of NO, a biomarker of endothelial function, in nonpregnant, normal pregnant, and preeclamptic women. Materials and methods: This was a cross-sectional case–control study of 277 women comprising 75 nonpregnant, 102 normal pregnant, and 100 preeclamptic women conducted at the Korle Bu Teaching Hospital between April and June 2011. About 5 mL of venous blood was obtained from the participants for the various investigations after meeting the inclusion criteria and signing to a written consent. Serum levels of NO were determined by Griess reaction. The data obtained were analyzed with SPSS version 20. Results: The study showed significantly elevated serum levels of NO in preeclamptic women (82.45±50.31 µM) compared with normal pregnant (33.12±17.81 µM) and nonpregnant (16.92±11.41 µM) women with P<0.001. The alteration in maternal serum NO levels was significantly more profound in early-onset (severe) PE (119.63±45.860 µM) compared to that of late-onset (mild) disease (62.44±40.44 µM) with P<0.001, indicating a more severe vascular endothelial cell dysfunction in the early-onset disease. Conclusion: This study has determined a profound NO upregulation in PE evidenced by significant elevation of NO metabolite levels compared to normal pregnancy. This might be due to deranged endothelial function with dysregulated production of NO to restore the persistent hypertension characteristic of PE. Keywords: preeclampsia, endothelial dysfunction, nitric oxide, Griess reagen

Impaired renal function and increased urinary isoprostane excretion in Ghanaian women with pre-eclampsia

Paul Winston Tetteh,1,4 Charles Antwi-Boasiako,1 Ben Gyan,3 Daniel Antwi,1 Festus Adzaku,1 Kwame Adu-Bonsaffoh,1,2 Samuel Obed21Department of Physiology, 2Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana; 3Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; 4Hubrecht Institute for Developmental Biology and Stem Cell Research, Uppsalalaan 8, Utrecht, The NetherlandsBackground: The cause of pre-eclampsia remains largely unknown, but oxidative stress (an imbalance favoring oxidant over antioxidant forces) has been implicated in contributing to the clinical symptoms of hypertension and proteinuria. Assessment of oxidative stress in pre-eclampsia using urinary isoprostane has produced conflicting results, and it is likely that renal function may affect isoprostane excretion. The aim of this study was to determine the role of oxidative stress in the pathophysiology of pre-eclampsia and to assess the effect of renal function on isoprostane excretion in pre-eclampsia in the Ghanaian population.Methods: This was a case-controlled study, comprising 103 pre-eclamptic women and 107 normal pregnant controls and conducted at the Korle-Bu Teaching Hospital between December 2006 and May 2007. The study participants were enrolled in the study after meeting the inclusion criteria and signing their written informed consent. Oxidative stress was determined by measuring urinary excretion of isoprostane and total antioxidant capacity using an enzyme-linked immunosorbent assay technique. Renal function was assessed by calculating the estimated glomerular filtration rate using the Modification of Diet in Renal Disease formula.Results: The pre-eclampsia group had significantly (P = 0.0006) higher urinary isoprostane excretion (2.81 &plusmn; 0.14 ng/mg creatinine) than the control group (2.01 &plusmn; 0.18 ng/mg creatinine) and a significantly (P = 0.0008) lower total antioxidant power (1.68 &plusmn; 0.05 mM) than the control group (1.89 &plusmn; 0.04 mM). Urinary isoprostane excretion showed a positive correlation with both mean arterial pressure (r = 0.261) and microalbuminuria (r = 0.510) in the pre-eclampsia cases. The pre-eclampsia group had a significantly lower estimated glomerular filtration rate than the control group (P < 0.001), indicating more renal impairment.Conclusion: The increased urinary excretion of isoprostanes and decreased total antioxidant power in the in pre-eclampsia group suggest increased production of oxidants and depletion and/or reduction of maternal antioxidants. Increased oxidative stress may be important in the pathophysiology of pre-eclampsia by contributing to endothelial dysfunction, proteinuria, and hypertension.Keywords: pregnancy, Ghana, pre-eclampsia, oxidative stres

Labour companionship and women's experiences of mistreatment during childbirth: results from a multi-country community-based survey

BACKGROUND: Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool. METHODS: We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment. RESULTS: Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9-6.9) and non-consented vaginal examinations (AOR 3.2, 1.6-6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7-3.1) and poor communication (AOR 2.0, 1.3-3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3-0.9). CONCLUSION: Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women's choices and autonomy