Successful twin live birth following a two-step embryo transfer in a patient with poor ovarian reserve: a case report

Globally, the prevalence of infertility ranges from 8 - 12%, but in Sub-Saharan Africa, it is 20 - 32%. The advent of assisted reproductive technology brought hope and has become a huge solution to the social and public health challenge of infertility. However, infertile women with poor ovarian reserve remain a frustrating dilemma to fertility experts worldwide. We report the case of a 32-year-old poor ovarian responder who was successfully treated with in-vitro fertilisation followed by two-step cleavage-stage and then blastocyst-stage embryo transfers in Ghana that resulted in twin live birth

Maternal mortality at the Korle Bu Teaching Hospital, Accra, Ghana: A five-year review

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990’s, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73 - 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths. La mortalité maternelle est un problème de santé mondial majeur ayant le plus grand impact dans les pays à faible revenu.Malgré une légère baisse du taux de mortalité maternelle au Ghana depuis les années 1990, cela a été au-dessous des attentes. Le but de cette étude était de décrire les tendances et les facteurs qui contribuent à la mortalité maternelle à l’Hôpital Universitaire de Korle Bu (KBTH), Accra Ghana. Nous avons effectué un examen rétrospectif des dossiers concernant les décès maternels à KBTH de 2015 à 2019. Les données ont analysé à l’aide de SPSS version 23. Une valeur p de <0,05 était considérée comme statistiquement significatif. Sur la période, il y a eu 45 676 naissances, 276 décès maternels et un taux de mortalité maternelle de 604/100 000 naissances (IC à 95% : 590/100 000 – 739/100 000). Les causes principales des décès maternels étaient les troubles hypertensifs (37,3%), les hémorragies (20,6%), la drépanocytose (8,3%) la septicémie (8,3%) et l’embolie pulmonaire (8,0%). Les facteurs importants associés aux mortalités maternelles à KBTH étaient : les femmes sans éducation formelle [AOR 3,23 (IC : 1,73-7,61)], les femmes qui ont eu moins de quatre visites prénatales [AOR 1.93 (IC : 1,23-3,03)] et l’urgence césarienne [AOR 3,87(IC : 2,51- 5,98)]. Les troubles hypertensifs restent la cause le plus fréquente de la mortalité maternelle à KBTH. Une éducation formelle et une amélioration des visites prénatales peuvent aider à éviter ces décès

Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana

Abstract Background Hypertensive disorders in pregnancy remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality especially in Sub-Saharan Africa (SSA). However, the perinatal burden of HDP in Ghana has not been explored. We conducted this study to determine the perinatal outcomes of HDP at a tertiary hospital in Ghana. Methods A cross-sectional study conducted between January to February 2013 at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Data collection involved baseline review of all the obstetric population who had just delivered to identify those with HDP. An informed consent was obtained after which a structured questionnaire was adminstered to the hypertensive mothers. The medical records of the mothers and their babies were also reviewed to determine the perinatal outcome indicators of relevance to the study. Data obtained were analyzed using SPSS version 20. Results We included 368 women with HDP and singleton births with a mean gestational age at delivery of 37.4 ± 3.3 weeks. Adverse perinatal outcomes determined include the following: 91 (24.7%) neonates were admitted to the Neonatal Intensive Care Unit, 56 (15.2%) had neonatal respiratory distress/asphyxia with 14 (3.8%) requiring ventilatory support and 80 (21.7%) were delivered preterm. Also, stillbirth, early neonatal death, intrauterine growth restriction and low birth weight occurred in 25 (6.8%), 14 (3.8%), 23 (6.1%) and 91 (24.7%) respectively with a perinatal mortality rate of 106 per 1000 births. One and 5 minute APGAR scores <7 occurred in 125 (34.0%) and 55 (14.7%) neonates respectively. Most of the adverse perinatal outcomes were significantly more common in those with preeclampsia compared to the other hypertensive disorders. Conclusion There is a significant burden of perinatal morbidity and mortality associated with HDP in the Ghanaian obstetric population and these adverse outcomes were more prevalent in preeclampsia compared to the other hypertensive disorders. Regular goal-oriented clinical audit into perinatal morbidity and mortality associated with HDP and an active multidisciplinary approach to the management of these disorders in the hospital might improve the clinical outcomes of women with maternal hypertension