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

Monoamniotic twin pregnancy discordant for body stalk anomaly: a case report

Body stalk anomaly, also known as limb-body syndrome, is a rare and lethal congenital anomaly. It presents a major abdominal wall defect and severe kyphosis with either a rudimentary or absent umbilical cord. We present a case of monoamniotic twin discordant for body stalk anomaly diagnosed at 27 weeks. Ultrasound findings demonstrated a normal Twin A, but Twin B was abnormal with a large ventral wall defect and severe kyphoscoliosis. The pregnancy was managed conservatively and concluded with an emergency caesarean section at 31 weeks on account of preterm labour. The unaffected twin survived with no significant morbidity. This case highlights some of the challenges posed to the obstetrician in managing such a rare anomaly in twin pregnancy

Massive subchorionic thrombohematoma: a case report demonstrating serial sonographic changes

Massive subchorionic thrombohematoma (MST) is the presence of a large hematoma or thrombus confined to the subchorionic space. Sonographic findings vary and include placenta descriptions such as heterogeneous, homogeneous, hypoechogenic, or jelly-like mass, which can be differentiated from the normal placenta. Our case report highlights the serial sonographic features observed in a singleton pregnancy from 13 to 29 weeks of gestation. Ultrasound findings of the placenta changed from a 65 ml subchorionic hematoma at 16 weeks to a well-defined placental mass with cystic areas at 20 weeks to an amorphous gelatinous mass at 23 weeks which became primarily replaced by an anechoic lesion with internal septations at 27 weeks. She delivered a live female at 29 weeks. MST usually has a dramatic initial presentation, but these findings may be compatible with a favourable outcome. Serial ultrasound assessment of the placenta is helpful to define the perinatal prognosis and may demonstrate gradual changes and eventual resolution