Birth and Emergency Planning: A Cross Sectional Survey of Postnatal Women at Korle Bu Teaching Hospital, Accra, Ghana

Birth and emergency planning encourages early decision making, helps overcome barriers to skilled maternity care and reduces preventable maternal and newborn deaths. A facility based postnatal survey of 483 childbearing women in Accra, Ghana determined birth and emergency planning steps, awareness of obstetric danger signs, reported maternal and newborn complications and birth outcome based on length of hospital stay. Supervised antenatal care and delivery were nearly universal. Overall, 62% had a birth plan, 74% had adequate knowledge of danger signs, while 64% and 37% reported maternal and newborn complications respectively. Accompaniment by a birth companion and saving money were considered the most useful planning steps. Knowledge of danger signs was associated with birth and emergency planning, and birth and emergency planning was associated with reported birth outcome. Birth and emergency planning as a critical component of antenatal care can influence birth outcomes and should be extended to all pregnant women.RésuméLa planification des naissances et d'urgence encourage la prise de décision rapide, aide à surmonter les obstacles aux soins de maternité qualifiés et réduit les décès maternels et néonatals évitables. Une enquête post-natale qui a été basée sur l’établissement, et auprès des 483 femmes en âge de procréer à Accra, au Ghana a déterminé les étapes de planification des naissances et d'urgence, la sensibilisation des signes de danger obstétrical, a rapporté des complications maternelles et néonatales et les résultats des naissances selon la durée du séjour à l'hôpital. Les soins prénatals et l'accouchement surveillés étaient presque universels. Dans l'ensemble, 62% avaient un plan de naissance, 74% avaient une connaissance adéquate des signes de danger, tandis que 64% et 37% ont déclaré des complications maternelles et néonatales, respectivement. Le fait d’être accompagné par un compagnon de naissance et d’économiser de l'argent ont été considérés comme les étapes de planification les plus utiles. La connaissance des signes de danger a été associée à la naissance et à la planification d'urgence et la planification des naissances  et d'urgence a été associée à des résultats des naissances déclarées. La planification des naissances et d'urgence comme un élément essentiel des soins prénatals peuvent influer sur les résultats de grossesses et devrait être mis a la portée de toutes les femmes enceintes.Keywords: pregnancy, obstetric complications, birth plan, Accra, Ghan

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/1/bjo15578-sup-0009-ICMJES9.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/2/bjo15578-sup-0008-ICMJES8.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/3/bjo15578-sup-0002-ICMJES2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/4/bjo15578-sup-0003-ICMJES3.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/5/bjo15578_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/6/bjo15578-sup-0004-ICMJES4.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/7/bjo15578-sup-0005-ICMJES5.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/8/bjo15578.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/9/bjo15578-sup-0007-ICMJES7.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/10/bjo15578-sup-0006-ICMJES6.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/11/bjo15578-sup-0001-ICMJES1.pd

Predictors of extra care among magnesium sulphate treated eclamptic patients at Muhimbili National Hospital, Tanzania

\ud The inclusion of Magnesium Sulphate (MgSO4) as a gold standard in the treatment of eclampsia has substantially reduced incidences of repeated fits, eclamptic morbidity and deaths. However, despite treatment with MgSO4, a proportion of patients need extra medical/nursing attention and prolonged stay in the intensive care unit (ICU). The literature on the underlying factors for the need of extra care in the MgSO4 era is lacking. This study sought to establish predictors of extra care in ICU among eclamptic patients after treatment with MgSO4 at Muhimbili National Hospital (MNH). Data were obtained from hospital records of eclamptic patients who were admitted at MNH and treated with MgSO4 from January 1st to December 31st, 2008. Based on set criteria, patients who needed extra care were identified. Analysis was performed using PASW statistics 18 whereby frequencies, cross-tabulations, bivariate and multiple logistic regressions were performed. A total of 366 eclamptic patients were admitted and treated with MgSO4 at MNH during a 12 month study period in 2008. Most of these (76%) were referred from district hospitals and 132 (36%) met the criteria for extra care in ICU. After adjusting for other variables, the risk of extra care in ICU for patients who were admitted with altered consciousness was double (OR = 2.3; 95% CI: 1.3-4.0) that of the ones admitted in alert state. The risk or need of extra care increased by increasing time to delivery and was doubled (OR = 2.0; 95% CI:1.1-3.7) if it was between 12 and 24 hours and tenfold elevated (OR = 10.0; 95% CI:4.3-23.6) if beyond 24 hours as compared to when time to delivery was less than 12 hours.Abdominal delivery was also independently associated with increased risk compared to vaginal delivery (OR = 2.5; 95%CI: 1.4-4.5). The type of referral and number of fits were associated with extra care in ICU but this association was wholly explained by the clinical status of the patient on admission to MNH and prolonged time lag to delivery. We concluded that even with MgSO4 used as the gold standard in the treatment of eclampsia, effective pre-referral care and expedited delivery were crucial in minimizing the need for extra care in ICU.\u

Predictors and birth outcomes: An investigation of birth and emergency preparedness among postnatal women at a national referral hospital in Accra, Ghana

Objective: Birth and emergency preparedness is a safe motherhood strategy which encourages early decision making and minimizes delays in health care seeking in the event of obstetric complications. The aim of this study was to determine individual level factors influencing birth and emergency preparedness.Methods: A cross sectional, hospital based survey was conducted among 483 postnatal women at a national referral hospital in Accra, Ghana. Eligible women were consenting postnatal attendees aged 15-49 years who had a birth in the two months preceding the survey. Study subjects were recruited serially during routine postnatal clinic visits between March and December, 2011. Interviews were conducted using purpose designed, structured questionnaires and collected data was based on maternal reports of recent pregnancy and childbirth experience. Predictors of awareness and adequate knowledge of danger signs, having a birth plan, and a stable birth outcome were determined using Pearson’s Chi-Square test and binary logistic regression analysis.Results: Educational status was a predictor of awareness of obstetric danger signs. Secondary education and formal employment were predictors of adequate knowledge. Older age (>30 years), formal employment and awareness of any obstetric danger sign were predictors of having a birth plan. Having a birth plan was not predictive of a stable birth outcome after controlling for confounders. Absence of maternal or newborn complications was highly predictive of a stable outcome.Conclusions: Women’s empowerment through better education and formal employment is recommended to enhance birth preparedness and access to skilled maternity care. Birth outcomes may be dependent on factors other than having a birth plan; this requires further exploration.Key words: birth preparedness, factors, pregnancy, Ghan

Nitric oxide dysregulation in the pathogenesis of preeclampsia among Ghanaian women

Kwame Adu-Bonsaffoh,1,2 Daniel Ansong Antwi,1 Samuel Amenyi Obed,3 Ben Gyan4 1Department of Physiology, University of Ghana Medical School, Accra, Ghana; 2Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana; 3Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana; 4Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana Background: Preeclampsia (PE) is still a disease of theories as the exact cause remains uncertain. Widespread vascular endothelial cell dysfunction is thought to mediate the generalized vasospasm and hypertension characteristic of PE. Altered nitric oxide (NO) production has been associated with the endothelial dysfunction in the pathogenesis of PE but conflicting results have emerged from previous studies. Objectives: To determine maternal serum levels of NO, a biomarker of endothelial function, in nonpregnant, normal pregnant, and preeclamptic women. Materials and methods: This was a cross-sectional case–control study of 277 women comprising 75 nonpregnant, 102 normal pregnant, and 100 preeclamptic women conducted at the Korle Bu Teaching Hospital between April and June 2011. About 5 mL of venous blood was obtained from the participants for the various investigations after meeting the inclusion criteria and signing to a written consent. Serum levels of NO were determined by Griess reaction. The data obtained were analyzed with SPSS version 20. Results: The study showed significantly elevated serum levels of NO in preeclamptic women (82.45±50.31 µM) compared with normal pregnant (33.12±17.81 µM) and nonpregnant (16.92±11.41 µM) women with P<0.001. The alteration in maternal serum NO levels was significantly more profound in early-onset (severe) PE (119.63±45.860 µM) compared to that of late-onset (mild) disease (62.44±40.44 µM) with P<0.001, indicating a more severe vascular endothelial cell dysfunction in the early-onset disease. Conclusion: This study has determined a profound NO upregulation in PE evidenced by significant elevation of NO metabolite levels compared to normal pregnancy. This might be due to deranged endothelial function with dysregulated production of NO to restore the persistent hypertension characteristic of PE. Keywords: preeclampsia, endothelial dysfunction, nitric oxide, Griess reagen