Uterine rupture: A review of 15 Cases at Bandier maternity hospital in Somalia

Background: Uterine rupture is a deadly obstetrical emergency endangering the life of both mother and fetus.Objective: To determine the frequency of ruptured uterus at Bandier Hospital and to elicit possible causes and type of management. Methods: It was cross sectional and hospital based descriptive study implemented during a time period of six months (July – December 2013) in Bandier maternity hospital and a total of 15 women presented with rupture uterus during the period of the study were included.Results: There were 15 cases of ruptured uterus out of a total of 2142 deliveries. Incidence of uterine rupture was found to be 0.7%. The mean age of women was 30.03 ± 4.55 years. Concerning risk factors for rupture uterus, 10 (66.7%) had previous uterine surgery, obstructed labor was found in 33.3%, and oxytocin was used in 46.7% of respondents. Repair was done for 8 (53.3%), 3 (20.6%) of respondents underwent total abdominal hysterectomy and 4 (26.7%) were ended by subtotal hysterectomy. Conclusions: Previous uterine surgery, obstructed labour and improper use of oxytocin increase the risk of uterine rupture in this study. Half of the patients underwent hysterectomy

Impact of Primary Cesarean Section on Grand Multiparous Women

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section.Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications.Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017.An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded.Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%.  Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%.Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.&nbsp

Postdate Pregnancy Maternal and Fetal Outcomes among Sudanese Women

Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses.Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018.An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded.Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%).Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and > 7 in 86.9%.Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week.Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection