A review of Intra-uterine foetal deaths at the Cape Coast Teaching Hospital

Aim: To estimate the rate of IUFD/Stillbirths (SB)Study design: This is a retrospective review of delivery suite records from Jan 1 2013 to Dec 31 2014.Methods: Study was undertaken at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana. All pregnant women who had their babies at the delivery suite of CCTH have their records hand written in Ghana health service approved and distributed delivery records book. We identified all patients with IUFD/SB from this delivery suite record book which is kept on the delivery suite. The data collected included the age, parity, mode of delivery, total blood loss, sex of the foetus and condition of foetus i.e. Macerated stillbirth (MSB) or fresh still birth (FSB). Of the 315 IUFDs found in the records book, 26 were incompletely filled, and 13 were abortions (<28 weeks) and therefore excluded. The analysis is therefore based on 276 completed documentations. The data collected from thedelivery suite records were analysed using STATA version 11.0.Results: Of the 315 IUFD/SBs documented in the delivery suite record book, 13 were abortions (<28 weeks), leaving 302 IUFD/SBs. Of this number, 26 had incomplete data and were excluded from the analysis. The analysis was thus based on 276 IUFD/SBs with complete data. Over the study period there were 5176 deliveries, giving a stillbirthrate of 58.5/1000 deliveries. Majority of the IUFD occurred in women 20-35 years of age (74.7%), and who have had two or less births (66.7%). The mean maternal age at which IUFD occurred was 29 years.Conclusion: Our review shows that the SBR of 58.5/1000, over the two years, at CCTH is high. We suggest further studies to focus on the reasons for IUFDs and what interventions can be applied to reduce it.Funding: No internal or external funds sourced.Keywords: Stillbirth, foetal death, pregnancy outcome, parity, caesarean delivery

Factors influencing the intention of women in rural Ghana to adopt postpartum family planning.

BACKGROUND: Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa and very little is known about how pregnant women arrive at their decisions to adopt PPFP. This information is needed to guide the development of interventions to promote PPFP. METHODS: We conducted a survey among pregnant women attending antenatal clinics in a rural district in Ghana. We used univariate and multivariate logistic regression analysis to explore how knowledge of various family planning (FP) methods, past experience with their use and the acceptability of PPFP to male partners and close relations influenced the intention of pregnant women to adopt PPFP. RESULTS: We interviewed 1914 pregnant women in four health facilities. About 84% considered PPFP acceptable, and 70% intended to adopt a method. The most preferred methods were injectables (31.5%), exclusive breastfeeding (16.7%), and oral contraceptive pills (14.8%). Women whose first choice of PPFP method were injectables were more likely to be women who had had past experience with its use (O.R = 2.07, 95% C.I. 1.50-2.87). Acceptability of PPFP by the pregnant woman (O.R. = 3.21, 1.64-6.26), perception of partner acceptability (O.R. = 3.20, 1.94-5.48), having had prior experience with the use of injectables (O.R. = 3.72, 2.61-5.30) were the strongest predictors of the intention to adopt PPFP. Conversely women who knew about the diaphragm (O.R. = 0.59, 0.38-0.93) and those who had past experience with IUD use (O.R. = 0.13, 0.05-0.38) were less likely to want to adopt PPFP. CONCLUSIONS: Acceptability of PPFP to the pregnant woman, male partner approval, and past experience with the use of injectables are important factors in the PPFP decisions of women in this population. Antenatal and early postnatal care need to be adapted to take these factors into consideration