Adherence to ministry of health guidelines in management of severe pre-eclampsia/eclampsia in Pumwani maternity hospital, Kenya

Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya.Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of severe pre-eclampsia and eclampsia at PumwaniMaternity Hospital, Kenya.Design: A cross sectionalSetting: Pumwani Maternity Hospital, Kenya.Subjects: Records of women managed for severe pre-eclampsia and eclampsia, deliveredbetween 2010 and 2013.Results: The overall adherence to guidelines was 31.4%. Adherence to specific parameters: history taking and examination, investigations, fetomaternal monitoring, use of recommended guidelines and post-partum guidelines was 67.8%, 13.9%, 26.1%, 29.5% and 20% respectively.Conclusions: Adherence to Kenya Ministry of Health (MOH) guidelines in management of severe pre-eclampsia and eclampsia in Pumwani Maternity Hospital is poor. Studies on the reasons for poor adherence and implementation need to be carried out

Severe meconium aspiration syndrome: case report

This is a case report on severe meconium aspiration syndrome (MAS) that resulted in early neonatal death. Antenatal care was provided at a low-cost non-governmental organization (NGO) clinic. First stage of labour lasted for only 2 hours and 45 minutes. There were no foetal heart rate abnormalities that were noted during the first stage of labour. Artificial rupture of membranes was done in second stage of labour. There was no liquor amnii seen but scanty thick old meconium was noted. Delivery was easy. The baby's skin, nails, umbilical cord, placenta and vernix were deeply stained yellow with old meconium. Resuscitation included suction through direct laryngoscopy, nasotracheal intubation with pulmonary toilet, as well as administration of 100% oxygen. The condition of the baby did not improve. A diagnosis of severe MAS with hypoxic ischaemic encephalopathy (HIE), persistent pulmonary hypertension (PPH), persistent foetal circulation syndrome (PFCS) and meconium chemical pneumonitis was made. The baby was admitted to the intensive care unit (ICU) for assisted ventilation and critical care. The condition of the baby continued to deteriorate and demise occurred 18 hours after birth. The pathophysiologic processes of intrauterine meconium release, mechanisms of foetal effects and dilemmas in management are discussed. The East African Medical Journal Vol. 83(8) 2006: 465-46

SEVERE MECONIUM ASPIRATION SYNDROME: CASE REPORT

This is a case report on severe meconium aspiration syndrome (MAS) that resulted in early neonataldeath. Antenatal care was provided at a low-cost non-governmental organization (NGO) clinic. Firststage of labour lasted for only 2 hours and 45 minutes. There were no foetal heart rate abnormalitiesthat were noted during the first stage of labour. Artificial rupture of membranes was done in secondstage of labour. There was no liquor amnii seen but scanty thick old meconium was noted. Deliverywas easy. The baby’s skin, nails, umbilical cord, placenta and vernix were deeply stained yellowwith old meconium. Resuscitation included suction through direct laryngoscopy, nasotrachealintubation with pulmonary toilet, as well as administration of 100% oxygen. The condition of thebaby did not improve. A diagnosis of severe MAS with hypoxic ischaemic encephalopathy (HIE),persistent pulmonary hypertension (PPH), persistent foetal circulation syndrome (PFCS) andmeconium chemical pneumonitis was made. The baby was admitted to the intensive care unit (ICU)for assisted ventilation and critical care. The condition of the baby continued to deteriorate anddemise occurred 18 hours after birth. The pathophysiologic processes of intrauterine meconiumrelease, mechanisms of foetal effects and dilemmas in management are discussed

PERCEPTIONS AND PRACTICES OF VAGINAL BIRTH AFTER CAESAREAN SECTION AMONG PRIVATELY PRACTICING OBSTETRICIANS IN KENYA

Objective: To determine perceptions, preferences and practices of vaginal birth after Caesarean.Design: Cross-sectional descriptive study.Setting: Private clinics of obstetricians in five major towns of Kenya.Subjects: Obstetricians in private practice.Main outcome measures: Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL.Results: Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria,83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians’ convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policyof “TOL whenever it is deemed as appropriate” was preferred by 88.7%.Conclusion: The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy

Perceptions and practices of vaginal birth after caesarean section among privately practicing obstetricians in Kenya

No Abstract. East African Medical Journal Vol 82(12) 2005: 631-63

IMPACT OF COLPOSCOPY ON MANAGEMENT OUTCOMES OF PATIENTS WITH ABNORMAL CERVICAL CYTOLOGY

Background: With stringent cervical cytology screening programmes for women in reproductiveage group, cervical cancer is, to a large extent, preventable. Back-up confirmatory colposcopicevaluation is necessary in order for cytology to have impact on cervical cancer-related morbidityand mortality.Objectives: To track the management outcomes of abnormal cervical cytology and hence confercredence to the value of colposcopy in management of abnormal cervical cytology.Design: Retrospective descriptive study.Setting: Kenya Medical Women Association Colposcopy Clinic.Main outcome measures: Correlation of cervical cytologic abnormalities with colposcopic outcomesand eventual management outcomes.Results: The population was young, with 50.6% being 25-34 years old, and 59.3% less than 35 yearsof age. Parity was also low, with nearly 75% being para three or less. A substantial proportion ofwomen had normal colposcopic findings (42.0, 26.7, 18.6 and 11.1% for cytologic abnormalities CINI, CIN II, CIN III and invasive carcinoma respectively). Colposcopic abnormality detection rate,irrespective of the severity of the lesion, increased with severity of cytologic lesion (from 58.0%CIN I to 89.0% for invasive carcinoma). The sensitivity of cervical cytology was 58, 59 and 65%for CIN I,II and III respectively, while respective specificity was 72, 71 and 85%. The concordancerates between cytological and colposcopic findings were 38.6, 32.5 and 60% for CIN I, II and IIIrespectively. The eventual management outcome was operative (LEEP and Hysterectomy) in greaterfrequency as the severity of the cytologic lesion increased.Conclusion: Colposcopy has significant impact on the management outcomes of abnormal cervicalcytology and is therefore an invaluable procedure in management of abnormal cervical cytology.For this reason, it is imperative that governments avail these services to all women, in addition toenforcing regular cytologic screening for cervical cancer

COLPOSCOPIC EVALUATION OF PATIENTS WITH ABNORMAL CERVICAL CYTOLOGY

Background: With stringent cervical cytology screening programs for women in reproductiveage group, cervical cancer is, to a large extent, preventable. Back-up confirmatory colposcopicevaluation is necessary in order for cytology to have impact on cervical cancer-related morbidityand mortality.Objectives: To track the management outcomes of abnormal cervical cytology and hence confercredence to the value of colposcopy in management of abnormal cervical cytology.Design: Retrospective descriptive study.Setting: Kenya Medical Women Association Colposcopy Clinic.Main outcome measures: Correlation of cervical cytologic abnormalities with colposcopic outcomesand eventual management outcomes.Results: The population was young, with 50.6% being 25-34 years old, and 59.3% less than 35 yearsof age. Parity was also low, with nearly 75% being para three or less. A substantial proportion ofwomen had normal colposcopic findings (42.0, 26.7, 18.6 and 11.1% for cytologic abnormalities CINI, CIN II, CIN III and invasive carcinoma respectively). Colposcopic abnormality detection rate,irrespective of the severity of the lesion, increased with severity of cytologic lesion (from 58.0%CIN I to 89.0% for invasive carcinoma). The sensitivity of cervical cytology was 58, 59 and 65%for CIN I,II and III respectively, while respective specificity was 72, 71 and 85%. The concordancerates between cytological and colposcopic findings were 38.6, 32.5 and 60% for CIN I, II and IIIrespectively. The eventual management outcome was operative (LEEP and Hysterectomy) in greaterfrequency as the severity of the cytologic lesion increased.Conclusion: Colposcopy has significant impact on the management outcomes of abnormal cervicalcytology and is therefore an invaluable procedure in management of abnormal cervical cytology.For this reason, it is imperative that governments avail these services to all women, in addition toenforcing regular cytologic screening for cervical cancer

Impact of colposcopy on management outcomes of patients with abnormal cervical cytology

No Abstract. East African Medical Journal Vol. 84 (3) 2007: pp. 110-11