Hydatidiform mole

A CAJM article on recent clinical research findings pertaining to the Hydatidiform mole.This article critically reviews the current understanding of the origin of hydatidiform mole. The pathogenesis, clinical presentation and diagnosis is discussed. Suction curettage and close patient follow up reduces the mortality and morbidity of the patients with this disease

Induction of labour with titrated oral Misoprostol suspension: a comparative study with vaginal Misoprostol

A CAJM journal article comparing the effectiveness of titrated orally and vaginally administered misoprostol for induction of labour administered at the University of Zimbabwe Teaching Hospital..Objective: To compare the effectiveness of titrated orally and vaginally administered misoprostol for induction of labour. Study Design: Unmasked randomized controlled trial. Setting: Department of Obstetrics and Gynaecology University of Zimbabwe, Harare. Subjects: Pregnant women with singleton foetus in cephalic presentation booked for induction of labour, were randomized to receive titrated orally or vaginally administered misoprostol. Main Outcome Measures: The main outcomes were the duration of labour and induction to delivery interval. The secondary outcomes were neonatal and maternal complications. Methods: 134 women were recruited into the study; 69 and 65 were randomized into orally and vaginally administered misoprostol respectively. Results: The baseline characteristics in the two groups were similar. Women induced with titrated oral misoprostol suspension had a shorter interval from administration of the drug to initiation of uterine contractions (OR = 0.94 .95% Cl 0.42 to 2.12 ) and a longer duration of labour (OR = 0.36; 95% Cl 0.16 to 0.79). Labour was augmented with oxytocin in the oral group. The mean drug dose was 28mcg in the oral group. There was no difference in the mode of delivery between the two groups. Hypertonic uterine contractions were not detected. Ruptured uterus did not occur in the study population. There were more neonatal admissions in the vaginal than the oral group (OR = 1.03 .95% Cl 0.29 to 1.39). Conclusion: Titrated oral misoprostol suspension is as effective and safe as vaginal misoprostol for induction of labour even in poor resource countries where intrapartum monitoring is inadequate

Lipid-soluble Vitamins A, D, and E in HIV-Infected Pregnant women in Tanzania.

There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions

The impact of food assistance on weight gain and disease progression among HIV-infected individuals accessing AIDS care and treatment services in Uganda

BACKGROUND: The evidence evaluating the benefits of programmatic nutrition interventions to HIV-infected individuals in developing countries, where there is a large overlap between HIV prevalence and malnutrition, is limited. This study evaluates the impact of food assistance (FA) on change in weight and disease progression as measured by WHO staging. METHODS: We utilize program data from The AIDS Support Organization (TASO) in Uganda to compare outcomes among FA recipients to a control group, using propensity score matching (PSM) methods among 14,481 HIV-infected TASO clients. RESULTS: FA resulted in a significant mean weight gain of 0.36 kg over one year period. This impact was conditional on anti-retroviral therapy (ART) receipt and disease stage at baseline. FA resulted in mean weight gain of 0.36 kg among individuals not receiving ART compared to their matched controls. HIV-infected individuals receiving FA with baseline WHO stage II and III had a significant weight gain (0.26 kg and 0.2 kg respectively) compared to their matched controls. Individuals with the most advanced disease at baseline (WHO stage IV) had the highest weight gain of 1.9 kg. The impact on disease progression was minimal. Individuals receiving FA were 2 percentage points less likely to progress by one or more WHO stage compared to their matched controls. There were no significant impacts on either outcome among individuals receiving ART. CONCLUSIONS: Given the widespread overlap of HIV and malnutrition in sub-Saharan Africa, FA programs have the potential to improve weight and delay disease progression, especially among HIV-infected individuals not yet on ART. Additional well designed prospective studies evaluating the impact of FA are urgently needed

Heterotopic pregnancy of a ruptured ectopic pregnancy coexisting with a twin intra-uterine pregnancy: A case report

A case of ruptured ectopic and twin intra-uterine pregnancy is presented. The patient had conceived following ovulation induction with clomiphene citrat

Best practices for intrapartum care in Zimbabwean health facilities

Evidence-based interventions to ensure a good outcome during childbirth are widely available. Their applicability in various settings depends on local conditions and the resources available. Best practices during normal labour and delivery are described for Zimbabwean health facilities. Practices that have proved value are encouraged and those without benefit are discouraged

Best practices for post natal care in Zimbabwe.

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Post Caesarean section infective morbidity in HIV-positive women at a tertiary training hospital in Zimbabwe

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