Association of placenta praevia with repeat cesarean section in Omdurman Maternity Hospital, Sudan 2010- 2012

Background: Several risk factors for placenta praevia exist, including  previous cesarean section(C/S). This association has been investigated long time ago, however in this hospital there is no documented evidence. This study was done to assess the risk of placenta praevia based on number of previous cesarean sections.Methods: A hospital-based study, at Omdurman maternity hospital- OMH during; January 2010-December 2012. Deliveries in OMH were reviewed by trained registrars. Patients diagnosed prenatally or during delivery as  placenta praevia were included. All women operated were followed till  discharge from hospital.Results: Total number of deliveries during the study period is 94758.Of them 68415 (72.2%) delivered vaginally and 26343 (27.8%) by C/S.Of the latter 10643 (40.4%) underwent elective and 15700 (59.6%) emergency CS.448 (0.5%) were diagnosed as placenta praevia. Placenta praevia was more common in patients with scarred uterus being found a 250 out of 9853 CS (2.5%). Its frequency increased with the number of uterine scars: one scar; (1.7%), (RR = 1.45, CI= 1.12-1.88), 2-4 scars (2.8%), (RR = 2.32, CI= 1.87-2.87) & five or more scars; (12.7%), (RR = 10.54, CI= 7.34-15.13). Nineteen patients (7.6%) had adherent placenta, (RR = 42.41, CI =5.69-315.83), 68(15.2%) had history of dilatation and  curettage (D&C) or evacuation,(RR = 1.5, CI = 1.18-1.94), 37 (8.3%) had previous history of placenta praevia, (RR= 8.30, CI = 6.17- 11.19). Threematernal deaths were encountered (0.7%).Conclusion: The frequency of placenta praevia in this study increased with increasing number of previous C/S, and was associated with adverse  feto-maternal outcome. This study provides a reason to reduce primary C/S and encouraging vaginal birth after C/S (VBAC).Key words: Placenta praevia. Repeated cesarean section. Sudan

Maternal Death Review in Sudan (2010 – 2012): Achievements and Challenges

Background: Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. Maternal death review (MDR) is a tool used to measure maternal mortality ratio (MMR) and to improve quality of obstetric care.Objectives: This study was done to assess maternal mortality and to identify underlying causes during 2010-2013.Materials and Methods: Facility and community- based maternal death review was conducted during three years in Sudan to study maternal mortality. National and states’ maternal death review committees were established. A focal person for each state, health facility and locality was nominated. Notification of maternal deaths was done by telephone, followed by review of all notified maternal deaths using a structured format. Data was analyzed using microcomputer, with SSPS, version 18.0.Results: Over three years, 2933 maternal deaths were notified, out of 1509354 Live births (LB). MMR was 194/ 100000 LB, with different variation between states. Facility maternal deaths were 2503 (85.3%) and community deaths were 430 (14.7%), reviewed formats were 2859 (97.5%). Direct obstetric deaths were 1845 (64.5%), mainly due to haemorrhage 884 (30.9%), eclampsia 383 (13.4%) and sepsis 321 (11.2%). Indirect causes were 1014 (35.5%), 363 (12.7%) due to hepatitis and 197 (6.9%) to anemia. Most of hospital deaths 1947 (77.9%); admitted late from home, 2462 (73.4%) were critically ill and 1484 (60.3%) died within 24 hours.Conclusion: Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal deaths. Maternal death review has to be integrated within the health management information system (HMIS) with strong commitment of various stakeholders.Key words: Maternal mortality, maternal death review, Sudan

Impact of Health Care Provider’s Training on Patients’ Communication During Labor at Omdurman Maternity Hospital, Sudan 2011

Background: Comprehensive patient’s health care provider’s (HCP) communication usually increases patients’ participation in their health management on childbirth.Objective: This is a quasi interventional study for assessing impact of health care providers (HCP) training on patient- provider’s communication during childbirth in the labour ward at Omdurman Maternity Hospital during 2011.Material and Methods: A situation analysis was done before training to assess existing practice of providers’ communication skills and patient’s satisfaction. All care providers in labour ward were trained and their practice was assessed before and after training. A ten percent sample of patients delivered in hospital before and after training was used to assess providers’ practice. Results were analyzed using SPSS version 18.Results: Health care providers, included were 225 (120/ 105) and interviewed women were, 4469 (2000/ 2469) before and after training respectively. Before training, patients were informed on onset of labour (76.8%), requested investigations (54.9%), permission for vaginal examination (60.3%) and when given antibiotics (85.1%), which improved significantly after training. No improvement in information on adverse effect of drugs and procedures or taking of an informed consent. Patient’s opinion on health care providers’ behavior after delivery in labour ward, were supportive, friendly and respectful (89.7%) and (94.6%) with improved satisfaction (89.8%) and (95.7%) before and after training respectively.Conclusion: The study showed that training of health care providers on communication skills has effective improvement on HCP knowledge and practice towards communication with patients in many areas during labour with resulting good patient’s satisfaction. However, improvement in communication skills need sustained in-service training.Key words: patients- providers’ communication, satisfaction, Sudan

Impact of Female Genital Mutilation on second stage of labour in Primigravida at Omdurman Maternity Hospital, Sudan 2010

Objective: To find out the impact of female genital mutilation (FGM) on the second stage of labour at Omdurman Maternity Hospital (OMH).Methodology: A descriptive cross-sectional study, for primigravidae delivered vaginally in 2010. After an informed consent circumcised women, were included as study group and uncircumcised ladies as control group. Data was collected by trained registrars using a structured questionnaire to collect frequency of postpartum haemorrhage (PPH), perineal tear, birth asphyxia, neonatal death and hospital stay.Results: A total of 1961 primigravidae, delivered in 2010 at OMH, 629(32.1%) were circumcised and 1332(67.9%) were uncircumcised. There was no significant difference in the mode of delivery and episiotomy.Conclusion: FGM places women at a greater risk during childbirth, endangering their health and their babies compared to uncircumcised.Key words: Female Genital Mutilation, second stage of labor, Sudan

Histopathological Pattern and Age Distribution, of Malignant Ovarian Tumor among Sudanese Ladies

INTRODUCTION: Ovarian cancer is the cause of a high case-fatality ratio, and most of the cases are diagnosed in late stages.OBJECTIVES: To determine the histopathological types, age distribution, and ovarian tumour stages among diagnosed with ovarian cancer at Al - Amal Tower a multi-referral polyclinic of Radiology & Isotope Center Khartoum (RICK), Sudan.METHODS: All histopathology reports patients' case from January to June 2015 were reviewed. The cancers classified according to federation international of Obstetrics and Gynecology (FIGO).RESULTS: There were 127 cases of ovarian cancers. Surface epithelial cancers were the most common 77.7% ( n = 98), followed by sex cord-stromal cancers 11.23% (n = 14), Germ cell tumor 1.6% (n = 2). Metastatic cancers were seen from colon and breast in 6.3% and 3.9 % of cases respectively. Few cases (14%) of ovarian cancers were reported before 40 years of age, after the age of 50 is a sharp increase in the incidence of a tumour. The mean age at presentation was 52.36 ± 14.210 years, there is mean age of menarche 13.59 ± 2.706 years. Very few patients used HRT (1.6%) or had been on ovulation induction treatment (8.7%). Most of patients 39 (30.7%) presented in stage IIIC, and stage 1V 32 (25.2%) indicating a poor prognosis.CONCLUSION: The incidence of different types of ovarian cancers in the present study is similar to worldwide incidence. The surface epithelial tumour is the commonest ovarian cancer, of which serous adenocarcinoma is the commonest and most of our patients present in late stages