Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study.

BACKGROUND: Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16-31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. METHODS: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher's exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. RESULTS: During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0-40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3-17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1-2.0). CONCLUSION: There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.

Predictors of contraceptive implant uptake in the immediate postpartum period: a cross-sectional study.

Objectives: The aim of the study was to investigate how to improve access to family planning and address unmet contraceptive need in postpartum women, by determining the predictors of contraceptive implant uptake in the immediate postpartum period.Methods: A descriptive cross-sectional study was conducted among women who had given birth up to 6 d earlier at the Riley Mother and Baby Hospital, which is part of the Moi Teaching and Referral Hospital in Eldoret, Kenya. Participants were systematically sampled and data collected using pre-tested interviewer-administered questionnaires. Statistical analyses were performed to determine associations between variables. Logistic regression was used to determine the relationship between variables and contraceptive implant uptake.Results: The study comprised 353 women. Most (92%) were Christians and were married (74%). More than 76% had received secondary education or above; 9% were HIV-positive. Most (87%) had heard of the contraceptive implant and almost half (46%) had ever used it before their current pregnancy. Older women (p = .036), those who had reached their desired family size (p = .003), those who had planned for the current pregnancy (p = .027), those who had used the implant before (p < .001) and those who were HIV-positive (p = .001) were more likely to agree to use the contraceptive implant.Conclusions: Older age, achievement of family size, previous use of the same method, HIV positivity and planned pregnancy positively predicted uptake of the contraceptive implant.