A cluster randomized controlled trial of the non-pneumatic anti-shock garment for obstetric haemorrhage: sub-analysis of the Zimbabwean Arm.

Objectives: To determine whether earlier application of the Non-pneumatic Anti-Shock Garment (NASG) at clinic level compared to the referral hospital level reduces maternal morbidity and mortality and recovery time from shock due to severe Obstetric Haemorrhage (OH) and to determine the safety of the NASG when applied at clinic level. Design: A cluster Randomized Controlled Trial (RCT) Setting: Harare and Parirenyatwa Referral Hospitals (RH) in Harare and the twelve Harare City Council clinics that offer maternity care. Subjects: Women who had suffered severe OH at clinic level and were being transferred to a Referral Hospital (RH). Iterventions: The clinics were randomized into two groups. In the early NASG group eligible women were given the standard management for OH and had the NASG applied at the clinic level before transport to RH. In the control group, eligible women were given the standard management for OH at the clinic level, transferred to the RH, and received the NASG at the RH. All women received equivalent OH/hypovolemic shock management at the RH. Main Outcome Measures: The main outcome measures were maternal mortality and morbidity, blood loss, recovery from shock and the occurrence of side effects whilst in the NASG. Results: There were few maternal deaths and morbidities, and no statistically significant differences between the two groups were noted. Women in the early NASG group spent a statistically significant shorter time in the NASG at referral hospital level (OR 0.64, 95% CI 0.52 - 0.79, p < 0.001) and had a non-significant 40% faster recovery from shock (HR 1.39; 95% CI 0.98-1.97, p=0.07). There were no differences in reported side effects. Conclusion: Earlier NASG application at the clinic level was associated with faster recovery from shock in women who had suffered severe OH and appears safe to use.

Acute postpartum uterine inversion: a case report.

The case described is that of an African 24 year old and Para 2. She had a normal vaginal delivery at a local clinic and sustained an acute uterine inversion and postpartum haemorrhage. Resuscitative measures were done and she was referred to the central hospital. At the central hospital and under general anaesthesia attempts to manually replace the uterus were unsuccessful. The uterine inversion was successfully corrected at laparotomy after which an area of gangrene and perforation was noted on the uterine fundus. A decision to perform total abdominal hysterectomy was taken. The patient had an uneventful post-operative recovery. A discussion of acute postpartum uterine inversion is presented.

An assessment of the maternal death notification system in Zimbabwe--2006.

OBJECTIVE: To determine the completeness and usefulness of the maternal death notification system in Zimbabwe for the year 2006. METHODS: As part of the Zimbabwe Maternal and Perinatal Mortality Survey (ZMPMS) maternal death notification forms lodged at the national and provincial levels were collected and analyzed. Data was entered into Stata version 6. The forms were also given to two clinician reviewers who assessed the quality of the information on the forms. RESULTS: A total of 364 forms were found at the provincial level. Of these, 56% had had copies forwarded to national level. Information on antenatal booking status was available on 84% of the forms. The forms had been completed by ten different grades of health worker and cause of death was entered on 80% of the forms. Information on whether the death had been potentially avoidable was entered on 68% of the forms. Five different versions of the maternal death notification form were found in the field and a significant proportion of the forms were missing important demographic variables. CONCLUSION: The maternal death notification system for Zimbabwe was found to be incomplete and not standardized.

Heterotopic pregnancy a case report.

A 27 year old patient was admitted with heterotopic pregnancy. Ultrasound scan done by her general practitioner had shown a 14 week viable intra-uterine pregnancy and fluid in the paracolic gutters. An exploratory laparatomy was done and she was found to have a ruptured right-sided ectopic pregnancy. Right partial salpingectomy was done. She had an uneventful post operative course. Ultrasound scan done at 18 weeks showed that the foetus was growing well.

How are condoms used in a family planning setting: evidence from Zimbabwe.

OBJECTIVES: (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.) DESIGN: A prospective cross sectional study. SETTING: The study was carried out at three Zimbabwe National Family Planning Council clinics. SUBJECTS: We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire. MAIN OUTCOME MEASURES: The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/HIV prevention. We measured self-reported condom use during the last 30 days prior to each interview. RESULTS: The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use. CONCLUSIONS: The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use.

Prophylactic augmentin in prelabor preterm rupture of the membranes.

OBJECTIVE: To determine whether the use of prophylactic Augmentin in PPROM prolongs gestation and reduces neonatal and maternal morbidity due to sepsis. METHOD: Study setting was Harare Maternity Hospital, Zimbabwe. Women with PPROM between 26 and 36 weeks' gestation were randomly allocated either to a group given a course of prophylactic oral Augmentin or another receiving no prophylactic antibiotic treatment. The calculated sample size was 72 women per group. Data were analyzed using the EPI INFO program. RESULTS: A total of 171 women were recruited into the study, 84 in the Augmentin group and 87 in the No Treatment group. The group receiving prophylactic Augmentin had a significantly longer latency period between rupture of membranes and delivery. There was a trend towards increased neonatal and maternal morbidity due to sepsis in the No Treatment group although no statistical significance was reached. CONCLUSION: The use of prophylactic Augmentin in PPROM significantly prolongs gestation. It appears to decrease neonatal and maternal morbidity due to sepsis.