Prevalence of preterm premature rupture of membrane and associated factors among pregnant women admitted in hiwot fana comprehensive specialized university hospital, eastern ethiopia

BACKGROUND: Preterm premature rupture of membrane (PPROM) affects approximately 3% of all pregnancies and is responsible for one-third of all preterm births. Despite its contribution to maternal and neonatal mortality and morbidity, evidence on the burden of PPROM and its associated factors in the study area is scarce. Therefore, this study was aimed to assess the prevalence and associated factors of PPROM among preterm pregnancies managed from May 2019 to September 2020 at Hiwot Fana Comprehensive Specialized University Hospital University Hospital, Eastern Ethiopia. METHODS: A hospital-based retrospective cross-sectional study was conducted among 449 preterm pregnancies selected by systematic random sampling technique. Data related to socio-demographic variables, obstetric and reproductive health conditions, and labor and related pregnancy outcomes were extracted from their medical records using a structured checklist. Factors associated with PPROM were identified using bivariable and multivariable logistic regression. Association was presented using an adjusted odds ratio (AOR) along with 95% confidence interval (CI). P-value &lt;0.05 in the final model was considered as statistically significant.RESULTS: Of 449 preterm pregnant women included in the study, 64 (14.3%; 95% CI:11.1% -17.5%) had PPROM. Preterm PROM was significantly associated with urinary tract infections (AOR=6.33; 95% CI:3.26-12.29), vaginal bleeding (AOR=2.62; 95% CI:1.23-5.57), history of abortion (AOR= 3.07; 95% CI:1.33-7.06) and mid upper arm circumference &lt;23 (AOR=7.06; 95% CI: 4.02-12.43). A total of 3 (4.3%) stillbirth and 16 (22.9%) early neonatal deaths occurred corresponding with a gross perinatal mortality rate of 271 per 1000 births.CONCLUSION: This study showed that one in seven preterm pregnancies in eastern Ethiopia had PPROM. Urinary tract infection, vaginal bleeding, previous history of abortion, and undernutrition were associated with PPROM. Early screening and treatment of urinary tract infections and nutritional assessments are essential to reduce the risk of PPROM.</p

Prevalence of preterm premature rupture of membrane and associated factors among pregnant women admitted in hiwot fana comprehensive specialized university hospital, eastern ethiopia

BACKGROUND: Preterm premature rupture of membrane (PPROM) affects approximately 3% of all pregnancies and is responsible for one-third of all preterm births. Despite its contribution to maternal and neonatal mortality and morbidity, evidence on the burden of PPROM and its associated factors in the study area is scarce. Therefore, this study was aimed to assess the prevalence and associated factors of PPROM among preterm pregnancies managed from May 2019 to September 2020 at Hiwot Fana Comprehensive Specialized University Hospital University Hospital, Eastern Ethiopia. METHODS: A hospital-based retrospective cross-sectional study was conducted among 449 preterm pregnancies selected by systematic random sampling technique. Data related to socio-demographic variables, obstetric and reproductive health conditions, and labor and related pregnancy outcomes were extracted from their medical records using a structured checklist. Factors associated with PPROM were identified using bivariable and multivariable logistic regression. Association was presented using an adjusted odds ratio (AOR) along with 95% confidence interval (CI). P-value &lt;0.05 in the final model was considered as statistically significant.RESULTS: Of 449 preterm pregnant women included in the study, 64 (14.3%; 95% CI:11.1% -17.5%) had PPROM. Preterm PROM was significantly associated with urinary tract infections (AOR=6.33; 95% CI:3.26-12.29), vaginal bleeding (AOR=2.62; 95% CI:1.23-5.57), history of abortion (AOR= 3.07; 95% CI:1.33-7.06) and mid upper arm circumference &lt;23 (AOR=7.06; 95% CI: 4.02-12.43). A total of 3 (4.3%) stillbirth and 16 (22.9%) early neonatal deaths occurred corresponding with a gross perinatal mortality rate of 271 per 1000 births.CONCLUSION: This study showed that one in seven preterm pregnancies in eastern Ethiopia had PPROM. Urinary tract infection, vaginal bleeding, previous history of abortion, and undernutrition were associated with PPROM. Early screening and treatment of urinary tract infections and nutritional assessments are essential to reduce the risk of PPROM.</p

Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia:a cross-sectional study

OBJECTIVE: To analyse caesarean section (CS) using Robson 10-group classification system in an Ethiopian university hospital. DESIGN: Cross-sectional study. SETTING: A university hospital in eastern, Ethiopia. PARTICIPANTS: 980 women who underwent CS from January 2016 to April 2017. MAIN OUTCOME: Robson groups (1-10-based on gestational age, fetal presentation, number of fetus, onset of labour and history of CS) and indications for CS. RESULTS: Robson group 3 (multiparous women with single cephalic full-term pregnancy in spontaneous labour with no history of CS), group 5 (multiparous women with single cephalic full-term pregnancy with history of CS) and group 1 (single cephalic nulliparous women full-term pregnancy in spontaneous labour) were the major contributors to the overall CS at 21.4%, 21.1% and 19.3%, respectively. The three major indications for CS were fetal compromise (mainly fetal distress), obstructed labour (mainly cephalopelvic disproportion) and previous CS. CONCLUSION: Robson groups 3, 5 and 1 were the major contributors to the overall CS rate. Fetal compromise, obstructed labour and previous CS were the underlying indications for performing CS. Further study is required to assess the appropriateness of the indications and to reduce CS among the low-risk groups (groups 1 and 3)

Beyond No Blame:Practical Challenges of Conducting Maternal and Perinatal Death Reviews in Eastern Ethiopia

Performing effective maternal death reviews as part of the maternal death surveillance and response program has been hindered by challenges including poor attendance, defensive attitudes, and blame shifting. Reviews of maternal and perinatal deaths should be based on a “no blame” principle. Emphasis should be on learning lessons and health professionals should feel safe to discuss the circumstances surrounding death. Meaningful reduction in maternal mortality requires a depoliticizing paradigm shift, a professional body to address patients’ worries, and clear medicolegal guidance to encourage providers to identify care deficiencies

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study

Background Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. Methods In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children—or their mothers, in the case of stillbirths and deaths in children younger than 6 months—had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0–27 days), and child deaths (aged 28 days to <5 years). Findings Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. Interpretation Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. Funding Bill & Melinda Gates Foundation

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study

BACKGROUND: Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. METHODS: In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children-or their mothers, in the case of stillbirths and deaths in children younger than 6 months-had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0-27 days), and child deaths (aged 28 days to <5 years). FINDINGS: Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. INTERPRETATION: Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. FUNDING: Bill & Melinda Gates Foundation

Determinants of preeclampsia among women who gave birth at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: a case–control study

Pre-eclampsia and eclampsia are the second leading causes of maternal mortality and morbidity. It also results in high perinatal mortality and morbidity. Since eclampsia is preceded by preeclampsia and shows the progression of the disease, they share the same pathogenesis and determining factors. The purpose of this study was to determine determinants of preeclampsia, since it is essential for its prevention and/or its associated consequences. An unmatched case–control study was conducted from September 1–30, 2023 among women who gave birth from June 1, 2020, to August 31, 2023, at Hiwot Fana Comprehensive Specialized University Hospital. Women who had preeclampsia were considered cases, while those without were controls. The sample size was calculated using EPI Info version 7 for a case–control study using the following assumptions: 95% confidence interval, power of 80%, case-to-control ratio of 1:2, and 5% non-response rate were 305. Data was collected using Google Form, and analyzed using SPSS version 26. Variables that had a p-value of < 0.05 on multivariable logistic regression were considered statistically significant, and their association was explained using an odds ratio at a 95% confidence interval. A total of 300 women (100 cases and 200 controls) with a mean age of 24.4 years were included in the study. Rural residence (AOR 2.04, 95% CI 1.10–3.76), age less than 20 years (AOR 3.04, 95% CI 1.58–5.85), history of hypertensive disorders of pregnancy (AOR 5.52, 95% CI 1.76–17.33), and no antenatal care (AOR 2.38, 95% CI 1.19–4.75) were found to be the determinants of preeclampsia. We found that living in a rural areas, previous history of preeclampsia, no antenatal care, and < 20 years of age were significantly associated with preeclampsia. In addition to previous preeclampsia, younger and rural resident pregnant women should be given attention in preeclampsia screening and prevention