Proportion of stillbirth and associated factors among women who deliver at public hospitals in Bahir Dar city, north-West Ethiopia.

INTRODUCTION: The annual global burden of stillbirths is estimated to be 3.2 million, of which 98% occur in low and middle-income countries (LMICs). In the Amhara region of Ethiopia, the prevalence of stillbirth outcomes was 85 per 1000. Ethiopia is experiencing an increase in the number of health professionals attending deliveries, however, stillbirth rates are not decreasing as anticipated. However, there are limited numbers of studies done related to the proportion of stillbirths and associated factors in the study area. This study aimed to assess the proportion of stillbirths and associated factors among women who attended deliveries at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital. METHODS: An institutional-based cross-sectional study was conducted on 366 women who delivered at two referral hospitals in Bahir Dar from April 1, 2020, to August 30, 2020. Study participants were selected using systematic random sampling techniques. A checklist and structured questionnaire were used to retrieve information from the clients and their attendants. The collected data were cleaned, coded, and entered into Epi-data version 3.1 and then exported into SPSS 23 for analysis. Bivariate and multivariable logistic regression analysis was computed to identify statistically significant associated factors with a P value < 0.05. The results were presented in tables and charts. RESULT: The proportion of stillbirths was 3.8% in this study area. This study showed that level of education, who completed primary school (AOR = 0.12; 95% CI (0.01, 0.98)), not using partograph (AOR = 3.77, 95%; CI (1.02; 13.93)), and obstetric complication (AOR = 6.7; 95% CI (1.54, 29.79) were the major factors affecting the stillbirth. CONCLUSION: Our study found that stillbirth rate remains a major public health problem. Illiteracy, not using a partograph, and having obstetric complications were major associated factors for stillbirth. The risk factors identified in this study can be prevented and managed by providing appropriate care during preconception, antepartum, and intrapartum periods.

Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study.

BACKGROUND: Maternal mortality is a major public health challenge in Ethiopia. Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. Uterine rupture has been contributing to high maternal morbidity and mortality. However, there is limited research on the factors and management outcomes of women with uterine rupture. Understanding the factors and management outcomes might delineate strategies to support survivors. Therefore the aim of this study is to assess the incidence and factors associated with outcomes of uterine rupture among laboring mothers at Felegehiwot Referral Hospital in Bahir Dar City, Northwest Ethiopia. METHODS: This is a cross sectional study with retrospective facility based data collection technique. All pregnant women who were managed for ruptured uterus at Felegehiwot referral hospital from September 11 2012 to August 30 2017 were included. The chart numbers of the women collected from operation theatre registers. Their case folders retrieved from the medical records room for analysis. Using structured check list, information on their sociodemography, booking status, clinical features at presentation and the place of attempted vaginal delivery was extracted. Data on the intraoperative findings, treatment, and associated complications and outcomes also collected. The collected data cleaned, coded and entered into EPI- Info version (7.1.2.0) and then exported in to SPSS Version 20.0 for analysis. Statistical comparison was done using chi square (X2). Strength of association between the explanatory variables and outcome variables described using odds ratio at 95% CI and P value less than 0.05. The results presented in tables. RESULTS: We studied 239 cases of uterine rupture in the 5 years period. Mothers without previous cesarean delivery including eight primigravidas took 87% of the cases. From all study participants, 54 of mothers (22.6%) developed undesired outcomes whereas 185(77.4%) discharged without major sequel. More than half (56.9%) arrived in hypovolemic shock. Total abdominal hysterectomy was the commonest procedure accounting for 61.5%. Duration of surgery was less than 2 h in 67.8% of the procedures. Anemia is the commonest complication (80.3%) followed by wound infection and VVF (11.7% each). There were 5 maternal deaths (2.1%). Mothers who had prolonged operation time (> 2 h) (AOR: 2.2, 95% CI: 1.10, 4.63) were significantly associated with undesired maternal outcomes after management of uterine rupture. CONCLUSION: Incidence of ruptured uterus and its complications were high in the study area. It reflects the need for improvement in obstetric care and strong collaboration with referring health facilities to ensure prompt referral and management.

Cervical stump pregnancy 6 years after subtotal hysterectomy: a case report.

BACKGROUND: Pregnancy following hysterectomy is very rare and may lead to significant morbidity, especially when diagnosis is delayed. CASE PRESENTATION: A 32-year-old G3P3002 African woman presented with increasing abdominal distension and 1 day of worsening abdominal pain and vomiting. Her previous pregnancy had ended 6 years prior with a stillborn baby delivered by Cesarean hysterectomy after laboring at home for 1 day. At the time of current presentation, this patient was confused and irritable, with an undetectable blood pressure, tachycardia, labored breathing, and a distended and tender abdomen. Urine human chorionic gonadotropin was positive and a transabdominal ultrasound showed significant intraperitoneal fluid collections and a singleton, viable pregnancy consistent with 13 weeks of gestation. A diagnosis of hypovolemic shock secondary to ruptured ectopic pregnancy was made, and she underwent emergency laparotomy. Intraoperative findings included 4.5 liters of hemoperitoneum and a cervical stump pregnancy with active bleeding from a partially detached placental site. CONCLUSION: Any reproductive-aged woman with at least one ovary and a means for sperm to meet egg should be screened for pregnancy if she presents with an acute abdomen or abdominal or pelvic pain.