The value of early trimester ultrasound scanning: a case of congenital malformation from Kibaha, Tanzania

A case report of a mother presenting at 25 weeks pregnancy. An ultrasound scan suggested the size of the foetus to be about 32 weeks with indications of a malformation and hydrops foetalis. A balloon catheter followed by misoprostol given vaginally was used but labour did not progress satisfactorily. A Caesarean Section was carried out and confirmed the congenital abnormalities. The value of early obstetric ultrasonography is discussed.Keywords: Early trimester sonography, foetal congenital anomaly, induction of labour, intracervical balloon catheter, misoprostol, Caesarian Sectio

The effects of maternal Body Mass Index on placental morphology and foetal birth weight: a study from Dodoma Central Region,Tanzania

Introduction: The placenta plays a pivotal role during pregnancy by being intimately connected to the mother and foetus.Objective: To determine the effects of maternal Body Mass Index (BMI) on placental morphology and foetal birth weight.Method: The placental samples were obtained with consent from 236 mothers with a singleton full term pregnancy and who had a live birth between January 2017 and June 2018. Statistics on maternal BMI, placental morphology and foetal birth weight were collected and analysed using SPSS version 20 for Window (SPSS Inc., Chicago, IL, USA).Results: The mean maternal BMI was 24.25 ± 131.605 and was positively correlated with the foetal birth weight (r=0.66; p<0.001), number of cotyledons (r=0.71, p<0.001), placental weight (r=0.50; p <0.001) and placental thickness (r=0.42; p<0.001).Conclusion: The study supports the hypothesis that maternal factors which are known to influence foetal growth, birth weight and neonatal body composition are also the determinants of the placental morphology. Therefore, all the parameters can be clinically used in the prediction of birth outcomeKeywords: placenta, morphology, birth weight, maternal BMI, TanzaniaSouth Sudan Medical Journal Vol 12 No 3 August 201

Obstetric fistulae, birth out comes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania

Introduction: Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally.Objective: To determine the predictors and contributing factors associated with OF and birth outcomes in women undergoing fistula repair at the Dodoma Regional Referral Hospital (DRRH).Method: This retrospective study used hospital records of women repaired over 2013 and 2014. Data were analysed using SPSS version 21 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted to determine the contributing factors associated with OF using chi-squared statistics.Results: Fifty two women underwent surgical repair of a fistula; 47(90.2%) were primiparous and 5(9.6%) multiparous. There were 42(80.8%) vesico-vaginal fistulae (VVF), and 10(19.2%) recto-vaginal fistulae (RVF). Of those with VVF 5 (9.6%) had been living with urine leakage for 10 years, 25 (48.1%) for 17 years, and 12 (23.1%) for 20 years; all 10 (19.2%) with RVF had been living with the defect for 10 years. No patient had been living with both vaginal and recto fistulae.Most of the fistulas were associated with prolonged difficult spontaneous vaginal delivery but two were associated with surgery: Caesarean Section and hysterectomy.Surgical repair was by the transvaginal 47(90.4%) and trans abdominal 5(9.6%) routes. Female genital mutilation (FGM) was found in all the 28 women from the Gogo tribe but only in 12 of the 24 women from other tribes.Conclusion: Timely fistula repair by experienced fistula surgeons, adhering to fastidious basic surgical principles, will improve outcomes and limit the clinical insult and distress that OF invariably causes.Keywords: obstetrics fistula, recto-vaginal fistula, vesico-vaginal fistula, surgical repair, female genital mutilation, Tanzani

The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania

Introduction: Female Genital Mutilation (FGM) is widespread in Tanzania and poses a risk when women give birth.Objective: To determine the association between FGM and perineal injury among women in labour in DodomaMethods: A matched case-control study of 364 randomly selected consenting women in labour was conducted in Dodoma Region between January 2017 and June 2018. Controls (no perineal injury) were matched to the cases (with perineal injury) based on maternal age at a ratio 2:1 making a sample of 243 controls and 121 cases. FGM and perineal injury was directly observed during labour using WHO guidelines. Data were analysed by using SPSS version 20 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted. The association between FGM and perineal injury was determined using chi-squared statistics.Results: Of the 364 women were investigated 40.4% (n=147) were circumcised and 59.6% (n=217) were not. There was a significant association between FGM and perineal injury (p=0.001).Conclusion: The FGM rate was high. FGM (total and Type II) was significantly associated with perineal injury.Keywords: Female genital mutilation, FGM/C, perineal injury, Tanzani

A Case of Haematometra Secondary to Cervical Stenosis after Vesicle Vaginal Fistula Surgical Repair

Background. Haematometra is a rare postobstetrics fistula surgical repair outcome complication; however the condition can be misinterpreted especially in limited resource areas that lack routine ultrasound guidance and with a slowly progressed increase in size of abdomen accompanied with a history of amenorrhoea together with a history of having unprotective sexual intercourse which may increase the possibility of being controversial to full-term gravid uterus. The causes of haematometra might be either due to congenital abnormality of the vaginal canal or acquired iatrogenically. However, any other cause that involved vaginal canal can be a predisposing factor of haematometra. We present a case of a 32-year-old female patient, who had obstetric fistula which was successfully repaired over the past two years. She presented with one-year-and-two-month history of an amenorrhoea that was progressive accompanied with distended abdomen to the extent of looking typically as the gravid uterus. Explorative laparotomy was performed successfully and surgical incision managed by hysterotomy and salpingotomy, whereby approximately ten liters of serosanguinous blood fluid mixed with blood clots was completely suctioned. Despite being a rare condition after vesicle vaginal fistula repair complication outcome, haematometra remains to be relatively common gynaecological condition among female adolescence during postpubertal period

The effects of maternal Body Mass Index on placental morphology and foetal birth weight: a study from Dodoma Central Region,Tanzania

Introduction: The placenta plays a pivotal role during pregnancy by being intimately connected to the mother and foetus. Objective: To determine the effects of maternal Body Mass Index (BMI) on placental morphology and foetal birth weight. Method: The placental samples were obtained with consent from 236 mothers with a singleton full-term pregnancy and who had a live birth between January 2017 and June 2018. Statistics on maternal BMI, placental morphology and foetal birth weight were collected and analysed using SPSS version 20 for Windows (SPSS Inc., Chicago, IL, USA). Results: The mean maternal BMI was 24.25 ± 131.605 and was positively correlated with the foetal birth weight (r=0.66; p<0.001), number of cotyledons (r=0.71, p<0.001), placental weight (r=0.50; p <0.001) and placental thickness (r=0.42; p<0.001). Conclusion: The study supports the hypothesis that maternal factors that are known to influence foetal growth, birth weight, and neonatal body composition are also the determinants of the placental morphology. Therefore, all the parameters can be clinically used in the prediction of birth outcom

Case report: The value of early trimester ultrasound scanning: a case of congenital malformation from Kibaha, Tanzania

A case report of a mother presenting at 25 weeks pregnancy. An ultrasound scan suggested the size of the foetus to be about 32 weeks with indications of a malformation and hydrops foetalis. A balloon catheter followed by misoprostol given vaginally was used but labour did not progress satisfactorily. A Caesarean Section was carried out and confirmed the congenital abnormalities. The value of early obstetric ultrasonography is discussed

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Background. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture

Obstetric fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania

Introduction: Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. Objective: To determine the predictors and contributing factors associated with OF and birth outcomes in women undergoing fistula repair at the Dodoma Regional Referral Hospital (DRRH). Method: This retrospective study used hospital records of women repaired over 2013 and 2014. Data were analysed using SPSS version 21 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted to determine the contributing factors associated with OF using chi-squared statistics. Results: Fifty two women underwent surgical repair of a fistula; 47(90.2%) were primiparous and 5(9.6%) multiparous. There were 42(80.8%) vesico-vaginal fistulae (VVF), and 10(19.2%) recto-vaginal fistulae (RVF). Of those with VVF 5 (9.6%) had been living with urine leakage for 10 years, 25 (48.1%) for 17 years, and 12 (23.1%) for 20 years; all 10 (19.2%) with RVF had been living with the defect for 10 years. No patient had been living with both vaginal and recto fistulae. Most of the fistulas were associated with prolonged difficult spontaneous vaginal delivery but two were associated with surgery: Caesarean Section and hysterectomy. Surgical repair was by the transvaginal 47(90.4%) and trans abdominal 5(9.6%) routes. Female genital mutilation (FGM) was found in all the 28 women from the Gogo tribe but only in 12 of the 24 women from other tribes. Conclusion: Timely fistula repair by experienced fistula surgeons, adhering to fastidious basic surgical principles, will improve outcomes and limit the clinical insult and distress that OF invariably causes. Keywords: obstetrics fistula, recto-vaginal fistula, vesico-vaginal fistula, surgical repair, female genital mutilation, Tanzania