Introducing misoprostol for the management of postpartum hemorrhage in Zimbabwe: final report on operational research.

Postpartum Haemorrhage (PPH) is the most common cause of maternal mortality globally, leading to a woman's death every seven minutes. In Zimbabwe, there has been a 300% increase in the Maternal Mortality Ratio (MMR) between 1994 and 2010 and the MMR was estimated at 960 maternal deaths per 100,000 live births in 2012.2-3 Overall, 14% of all maternal deaths in Zimbabwe are due to PPH. Ensuring prompt access to high-quality prevention and treatment of PPH for all women who deliver is an essential strategy to combat PPH-related morbidity and mortality and to make progress toward reaching Millennium Development Goal 5, the reduction of maternal mortality by three-quarters by 2015.

Induction of labour with titrated oral misoprostol suspension. A comparative study with vaginal misoprostol.

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% CI 0.42 to 2.12) and a longer duration of labour (OR = 0.36; 95% CI 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% CI 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.

HIV-1 and HIV-2 prevalence and associated risk factors among postnatal women in Harare, Zimbabwe.

Studies of antenatal women form the predominant source of data on HIV-1 prevalence in Africa. Identifying factors associated with prevalent HIV is important in targeting diagnostic services and care. Between November 1997 and January 2000, 14,110 postnatal women from Harare, Zimbabwe were tested by ELISAs reactive to both HIV-1 and HIV-2; a subset of positive samples was confirmed with assays specific for HIV-1 and HIV-2. Baseline characteristics were elicited and modelled to identify risk factors for prevalent HIV infection. HIV-1 and HIV-2 prevalences were 32.0% (95% CI 31.2-32.8) and 1.3% (95% CI 1.1-1.5), respectively; 4% of HIV-1-positive and 99% of HIV-2-positive women were co-infected. HIV-1 prevalence increased from 0% among 14-year-olds to >45% among women aged 29-31 years, then fell to <20% among those aged>40 years. In multivariate analyses, prevalence increased with parity, was lower in married women than in single women, divorcees and widows, and higher in women with the lowest incomes and those professing no religion. Adjusted HIV-1 prevalence increased during 1998 and decreased during 1999. Age modified the effects of parity, home ownership and parental education. Among older women, prevalence was greater for women who were not homeowners. Among younger women, prevalence increased with parity and low parental education. None of these factors distinguished women co-infected with HIV-2 from those infected with HIV-1 alone. Prevalent HIV-1 infection is associated with financial insecurity and weak psychosocial support. The ZVITAMBO study apparently spanned the peak of the HIV-1 epidemic among reproductive women in Harare.

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

OBJECTIVE: To investigate the infective morbidity in HIV-positive and HIV-negative women whose babies were delivered by Caesarean section. DESIGN: A hospital based, prospective study: part of a larger operational research project. SETTING: Harare Maternity Hospital, a tertiary referral teaching hospital in Harare, Zimbabwe. SUBJECT: 164 HIV-positive and 382 HIV-negative women who were delivered of their babies by Caesarean sections. MAIN OUTCOME MEASURES: Minor and major infective complications. RESULTS: The results compare HIV-positive and HIV-negative women, 18/164 (10.9%) HIV-positive women developed anaemia requiring blood transfusion compared with 15/382 (3.9%) HIV-negative women. The difference was statistically significant (RR 3.05). HIV-positive women had a statistically significant increase in the incidence of post operative fever (RR 1.3) and wound sepsis/sinus (p = 0.002). CONCLUSION: Our study indicates that HIV-positive women who were given prophylactic pre-operative antibiotics were at an increased risk of minor infective complications and blood transfusion post Caesarean section. The risk of blood transfusion was higher in women who had a pre-operative haemoglobin of 10.5 grams/dl. Post operative fever, wound sepsis and wound sinus was commoner in HIV-positive when compared to HIV-negative women.

Acceptance of HIV screening in an antenatal population at a referral teaching hospital in Zimbabwe: a substudy of an operational research in prevention of mother to child HIV vertical transmission.

OBJECTIVE: To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at a tertiary training hospital. Women who accepted testing and were positive received nevirapine. Their babies also received nevirapine within 72 hours of birth. Doctors, nurses and pharmacists were equipped with counselling and management skills for prevention of mother to child HIV vertical transmission. DESIGN: Substudy of a prospective operational research. SETTING: Harare Central Hospital, antenatal clinic. SUBJECT: 863 women were given lectures in a group followed by individualised pre and post test HIV counselling; 767 accepted testing for HIV. MAIN OUTCOME MEASURES: Acceptance rates for HIV testing, number of mothers and babies who received nevirapine as well as the characteristics of HIV positive and negative women were analysed. RESULTS: 89% of the women accepted HIV testing; 44% were positive. Seventy percent of the women who tested positive and their babies received nevirapine. CONCLUSION: Acceptance rates increased when lectures were given to a group of pregnant women followed by individualised pre and post test counselling. The support and encouragement that the women gave each other may explain this observation. Nevirapine should be issued to pregnant women at the time that the HIV test results are available irrespective of the age of gestation, with instructions to take the drug at the onset of labour at their place of delivery. This practice will increase the uptake of the drug by pregnant women. Medical students, nursing and pharmacy students should be equipped with skills for initiating and managing a mother to child HIV prevention programme during their training followed by refresher courses after graduating.

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.

The purpose of post natal care for the mother is to avert or alleviate significant mortality and morbidity. During the immediate post partum period, the emphasis will be on monitoring to detect complications and assisting the mother to initiate care of the newborn, especially breastfeeding. In the latter post partum period, the aim is to confirm involution and healing of the genital tract, confirm continued good newborn care by the mother and offer protection against pregnancy to the couple.

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 citrate.

Evaluation of the prototype Roche DNA amplification kit incorporating the new SSK145 and SKCC1B primers in detection of human immunodeficiency virus type 1 DNA in Zimbabwe.

We assessed the sensitivity and specificity of a newly developed DNA PCR kit (Roche Diagnostic Corporation, Indianapolis, Ind.) that incorporates primers for all the group M viruses for the detection of human immunodeficiency virus (HIV) type 1 (HIV-1) infection in Zimbabwe. A total of 202 whole-blood samples from adults whose HIV status was known were studied. This included 100 HIV-1-positive and 102 HIV-1-negative samples selected on the basis of concordant results obtained with two enzyme-linked immunosorbent assay kits. The prototype Roche DNA PCR assay had a 100% sensitivity for the detection of HIV-1 DNA and a specificity of 100%. We conclude that the new Roche DNA PCR kit is accurate for the detection of HIV DNA in Zimbabwean samples, in which HIV-1 subtype C dominates.

Hydatidiform mole: a study of 40 patients admitted at Harare Central Hospital, Zimbabwe.

Hydatidiform mole contributes to a significant numbers of hospital admissions at Harare Hospital. The characteristics, diagnosis, management and follow up of the women with molor pregnancy admitted to Harare Hospital are presented. The follow up of these women was grossly inadequate.

Case histories of four patients with abdominal pregnancy admitted to Harare Central Hospital from January 1993 to December 1993.

The incidence of abdominal pregnancy is unknown at Harare Hospital. Four patients admitted to the Hospital in 1993 are presented. Diagnosis was difficult and at laparotomy the placenta, was left in situ in three patients.

Advanced extrauterine pregnancy.

Advanced extra-uterine pregnancy is rare, in the developed countries. They still contribute to a significant maternal morbidity in the developing countries. A review of the literature on the subject is presented. The management of the placenta is paramount, removal is recommended when it is safe for the patient. The morbidity is high in patients where the placenta is left in situ.(ABSTRACT TRUNCATED AT 250 WORDS)

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.