Rapid assessment of partograph utilisation in selected maternity units in Kenya

Background: Prolonged labour causes maternal and perinatal morbidity and mortality. Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartum haemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units.Objective: To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya.Design: A descriptive cross sectional study.Setting: Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya.Results: All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded 30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of stateof the liquor, moulding and descent as well as maternal parameters such as pulse, and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflictbetween providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation of the partograph.Conclusion: The partograph was available in most units. However, accurate recording of parameters to monitor the foetus, the mother and progress of labour as recommended was mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack of supplies and negative attitude among healthcare providers were some of the obstacles noted to hamper partograph use

Distinguishing intrauterine foetal demise versus abdominal pregnancy in low resource settings, a case report

Diagnosis of abdominal pregnancy always poses a clinical dilemma. Transvaginal ultrasound is the ideal radiological procedure in locating these pregnancies. However in resource limited setting, abdominal and pelvic ultrasounds can be the only available yet unreliable modalities for distinguishing intrauterine versus abdominal pregnancies. We present a case of a 36 year old para 4+0 gravida 5 who presented with foetal demise at 16 weeks of gestation. Multiple abdominal and pelvic ultrasounds showed intra uterine foetal demise for which she underwent induction. The definitive diagnosis of abdominal pregnancy was established using transcervical Foleys catheter aided abdominal-pelvic ultrasound which showed an empty uterus and a gestational sac, placenta and a 16-week foetus with no cardiac activity in the right adnexa/iliac region

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Objectives: To determine the thyroid profile and the prevalence of gestational thyrotoxicosis among women with emesis during early pregnancy.Design: A descriptive cross - sectional study.Setting: Kenyatta National Hospital acute gynaecology ward and the ante-natal clinic.Subjects: Seventy two women presenting with emesis up to 16 weeks gestation.Main outcome measures: The levels of FT3, FT4, TSH and &beta;-hCG during the first 16 weeks of gestation. Correlation between the thyroid hormones and &beta;-hCG as well as the severity of vomiting was also done.Results: The point prevalence of gestational thyrotoxicosis was 8.3%. There was a significant positive correlation between &beta;-hCG levels and FT3 and FT4 (P-values < 0.05), and a significant negative correlation between &beta;-hCG and TSH (P < 0.05).Correlation between the severity of vomiting and the thyroid hormones as well as &beta;-hCG was not statistically significant. Patients' age ranged from 14-38 years (median 26). Majority of the women studied were at a gestation of 8 to 11 weeks (38.9%). Most patients (84.7%) had one to five episodes of vomiting per day. Peak &beta;-hCG was at 12 - 15 weeks gestation.Conclusions: Thyrotoxicosis does occur among women with emesis in pregnancy in this set-up. Screening for it may be beneficial to such women and also those with high serum &beta;-hCG levels above the median for the gestational age

Consistent model of magnetism in ferropnictides

The discovery of superconductivity in LaFeAsO introduced the ferropnictides as a major new class of superconducting compounds with critical temperatures second only to cuprates. The presence of magnetic iron makes ferropnictides radically different from cuprates. Antiferromagnetism of the parent compounds strongly suggests that superconductivity and magnetism are closely related. However, the character of magnetic interactions and spin fluctuations in ferropnictides, in spite of vigorous efforts, has until now resisted understanding within any conventional model of magnetism. Here we show that the most puzzling features can be naturally reconciled within a rather simple effective spin model with biquadratic interactions, which is consistent with electronic structure calculations. By going beyond the Heisenberg model, this description explains numerous experimentally observed properties, including the peculiarities of the spin wave spectrum, thin domain walls, crossover from first to second order phase transition under doping in some compounds, and offers new insight in the occurrence of the nematic phase above the antiferromagnetic phase transition.Comment: 5 pages, 3 figures, revtex

Micromechanical modeling of tension stiffening in FRP-strengthened concrete elements

This article presents a micromodeling computational framework for simulating the tensile response and tension-stiffening behavior of fiber reinforced polymer–strengthened reinforced concrete elements. The total response of strengthened elements is computed based on the local stress transfer mechanisms at the crack plane including concrete bridging stress, reinforcing bars stress, FRP stress, and the bond stresses at the bars-to-concrete and fiber reinforced polymer-to-concrete interfaces. The developed model provides the possibility of calculating the average response of fiber reinforced polymer, reinforcing bars, and concrete as well as the crack spacing and crack widths. The model, after validation with experimental results, is used for a systematic parameter study and development of micromechanics-based relations for calculating the crack spacing, fiber reinforced polymer critical ratio, debonding strength, and effective bond length. Constitutive models are also proposed for concrete tension stiffening and average response of steel reinforcing bars in fiber reinforced polymer–strengthened members as the main inputs of smeared crack modeling approaches

Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed-methods, multicountry evaluation.

Introduction The World Health Organization’s (WHO) Labour Care Guide (LCG) is a “next-generation” partograph based on WHO’s latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG’s usability, feasibility, and acceptability among maternity care practitioners in clinical settings. Methods Mixed-methods evaluation with doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania. Purposively sampled and trained practitioners applied the LCG in low-risk women during labor and rated experiences, satisfaction, and usability. Practitioners were invited to focus group discussions (FGDs) to share experiences and perceptions of the LCG, which were subjected to framework analysis. Results One hundred and thirty-six practitioners applied the LCG in managing labor and birth of 1,226 low-risk women. The majority of women had a spontaneous vaginal birth (91.6%); two cases of intrapartum stillbirths (1.63 per 1000 births) occurred. Practitioner satisfaction with the LCG was high, and median usability score was 67.5%. Practitioners described the LCG as supporting precise and meticulous monitoring during labor, encouraging critical thinking in labor management, and improving the provision of woman-centered care. Conclusions The LCG is feasible and acceptable to use across different clinical settings and can promote woman-centered care, though some design improvements would benefit usability. Implementing the LCG needs to be accompanied by training and supportive supervision, and strategies to promote an enabling environment (including updated policies on supportive care interventions, and ensuring essential equipment is available)