Socio-demographic profile and maternal-fetal prognosis of emergency caesarean section versus caesarean section programmed on scar uterus

Background: The objective of this study was to determine the maternal-fetal prognosis of emergency caesarean sections on the scar uterus to contribute to the reduction of maternal-fetal morbidity and mortality.Methods: An analytical cross-sectional study of pregnant women who were observed from admission to discharge including their newborns at Panzi Reference General Hospital in gynecology and obstetrics department. The sample was comprehensive for convenience consisting of 150 deliveries by caesarean section who had previously delivered at least once by caesarean section. (In 4 months, from 01st December 2018 to 31st March 2019). A pre-established survey sheet allowed us to collect the data. For data analysis, SPSS software and Microsoft excel were used. The chi-square test was used at the 0.05 level.Results: A total 95.2% of newborns were found to be of normal weight, their mothers were emergency cesarized but should be programmed and macrosomia was noted in 4.8%; (p >0.05). In addition, 57.1% of urgent caesarean sections scheduled to be performed were performed in female children (p 0.05). On the maternal side, morbidity was dominated by puerperal infections in 16.7% and uterine rupture in 2.4% in the emergency caesarean section, and no maternal deaths occurred in both groups during the study period.Conclusions: Maternal-fetal prognosis was characterized by asphyxia, neonatal infection and two cases of neonatal death. Study did not register a maternal death but we noticed puerperal infections

Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone

Background Numerous quality-improvement projects including healthcare professional training are conducted globally every year, but there is a gap between the knowledge obtained in the training and its implementation in practice and policy. A quality-improvement programme was conducted in eastern Democratic Republic of Congo (DRC) to reduce maternal and neonatal mortality and morbidity. Objective This study explores the implementation process, mechanisms of impact, and outcomes of a training intervention addressing labour and birth management and involving healthcare providers in an urban health zone in eastern part of DRC. Methods In 2019, master trainers were educated and in turn trained facilitators from seven participating healthcare facilities, which received the necessary equipment. Data comprised statistics on maternal and neonatal birth outcomes for the years before and after the training intervention, and focus group discussions (n = 18); and interviews (n = 2) with healthcare professionals, at the end of (n = 52) and after the training intervention (n = 59), respectively. The analysis was guided by a process evaluation framework, using descriptive statistics and content analysis. Results The three-pillar training intervention using a low-dose, high-frequency approach was successfully implemented in terms of fidelity, dose, adaptation, and reach. Several improved care routines were established, including improved planning, teamwork, and self-reflection skills, as well as improved awareness of the influence of the care environment, of having a respectful encounter, and of allowing a companion to be present with the birthing woman. The proportions of emergency caesareans decreased and of vaginal births increased without an increase in maternal and neonatal complications. Conclusion The findings of this study are encouraging and provide learnings for other healthcare facilities in DRC as well as other low-income countries. When designing similar training interventions, it is crucial to consider contextual factors such as incentives and to measure more salutogenic outcomes

Prevalence of urinary incontinence in pregnant and postpartum women in the Democratic Republic of Congo

Introduction and hypothesis: The objective was to describe the prevalence of urinary incontinence in pregnant and postpartum women in the Democratic Republic of Congo and to identify factors associated with urinary incontinence (UI) in these populations. Methods: We interviewed eligible women who sought prenatal or postnatal reproductive health clinic consultations over a 2-year period. Interviews collected information about demographics, obstetric history, and urinary incontinence symptoms, as well as the impact on the quality of life, via a validated questionnaire. Descriptive analyses compared women with and without urinary incontinence and compared characteristics of UI, stratified by pregnancy status. Logistic regression identified factors associated with UI among the entire sample, pregnant women, and postpartum women. Results: Overall, 268 out of 880 women had UI (30.5%); the prevalence was 33.4% (168 out of 503) among pregnant women and 26.5% (100 out of 377) among postpartum women, p = 0.03. Women who were pregnant were significantly more likely to experience stress incontinence (p = 0.01) and less likely to report moderate or large amounts of leakage (p = 0.002). A history of macrosomia and being currently pregnant were associated with UI in the entire sample (p \u3c 0.05). Among pregnant women, the risk of UI decreased with increasing gestational age and increased with a history of macrosomia (p ≤ 0.01). Among postpartum women, a history of macrosomia and prior episiotomy were associated with UI (p \u3c 0.05). Conclusions: Urinary incontinence is prevalent in pregnant and postpartum women in the Democratic Republic of Congo and is associated with a history of macrosomia. Efforts should focus on screening, evaluation, and treatment