Identification of women at low risk for early severe postpartum anaemia

Full Length Research Article This study was carried out to identify risk factors for early severe postpartum anaemia (ESPA) and also subgroup of patients at low risk for whom interventions such as routine haemoglobin concentration (Hb) estimation may not be necessary. All women with pre-delivery Hb ≥10 g/dl who underwent vaginal delivery at 28 weeks or greater; from January 2007 through December 2012 at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria, were included. Cases were women with ESPA, defined as Hb <8 g/dl within 1-3 days postpartum; and control group with Hb ≥ 8 g/dl. With univariate analysis, risk factors associated with ESPA were identified and the effects of confounding factors were eliminated on multivariate analysis. Independent risk factors from the analysis were then used to eliminate high risk groups. Estimated blood loss (EBL) >500 ml was the most significant risk factor [odds ratio (OR) 5.10, 95% CI 3.54, 7.35] for ESPA. Abruptio placenta, instrumental vaginal delivery, preeclampsia, perineal and cervical lacerations and active phase arrest were also found to be significant, with associated OR greater than 2.0. If Hb is obtained only in response to EBL >500 ml, only 2.5% of the remaining population will have ESPA. If all risk factors found to be significant are eliminated, only 0.8% of the population will have ESPA. Interventions such as delaying discharge because haemoglobin estimation is being awaited; will be unnecessary in 99.2% of low risk cases (that is, women without the above risk factors); and in 97.5% of women who did not suffer postpartum haemorrhage

Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso

BACKGROUND: Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS: Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS: Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS: Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication

Ureteric injuries following pelvic operations

(East African Medical Journal: 2002 79 (11): 611-613