Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital.

OBJECTIVE: We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. METHODS: This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. RESULTS: The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46-125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07-36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00-18.57; p=0.05). CONCLUSION: The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. RECOMMENDATIONS: We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda.

BACKGROUND: Breast cancer, the third most frequent cancer of women is preventable through knowledge on breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. METHODS: A household survey of women in Kyadondo County was conducted during June, 2014 to August, 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities. RESULTS: This study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16-3.24), television (OR 1.82 95%CI: 1.14-2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01-15.98), knowledge on how to reduce risk of breast cancer (OR 1.98 95% CI: 1.20-3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42-5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62-5.88), and other methods of breast cancer diagnosis in a health care set up. CONCLUSION: The women's level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education.

Stage of labor at admission among Ugandan women with a prior cesarean, and its impact on management and delivery outcomes.

OBJECTIVE: To describe stage of labor at admission among women with a prior cesarean, and examine its impact on intrapartum management and delivery mode. METHODS: In a prospective cohort study, women admitted to Mbarara Regional Referral Hospital, Uganda, for delivery were enrolled between March and June 2015. Rates of vaginal delivery (VBAC) and in-hospital trial of labor (TOL) were compared between early (<4 cm dilation) and late (≥4 cm) presenters. Women were interviewed after delivery about decision making and labor preferences. RESULTS: Overall, 188 women comprised the study sample; 98 (52.1%) and 65 (34.6%) women presented at ≥4 cm and ≥6 cm, respectively, and 18 (9.6%) were fully dilated. In-hospital TOL and VBAC rates were 25.5% (42/165) and 9.6% (18/188), respectively. Compared with early presenters, late presenters were significantly more likely to undergo TOL (28/88 [31.8%] vs 14/77 [18.2%]; odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-5.0), and achieve VBAC (16/98 [16.3%] vs 2/90 [2.2%]; OR 7.6, 95% CI 1.7-35.1). CONCLUSION: Most women arrived in active labor, but most had a repeat cesarean. Work is needed to understand the clinical decision making and provider management driving low TOL and VBAC rates.