RESUMO
This study focused on the psychological, social, and cultural dimensions of infertility among women with infertility in Harare Urban who have utilised traditional healthcare systems to address their infertility problem. It also emphasises their coping strategies for dealing with the challenges encountered along the infertile journey. This was a qualitative study using a phenomenological approach, focusing on the experiences of five women. Data from the interviews was analysed using a simplified version of Hycner's (1985) five-step explication process. The study produced three main themes: psychological experiences, socio-cultural experiences, and coping experiences, along with seven sub-themes. The results showed that women experienced intense distress, sorrow, and self-blame because of their inability to have children, further compounded by the stigma they faced from their families and communities. Women with infertility are subjected to derogatory labels, social contempt, ridicule, and being undervalued, which leads them to develop coping strategies to endure the adverse encounters. These coping mechanisms can have either positive or negative effects on their overall welfare. The exploration of psychological, socio-cultural factors, and coping mechanisms of women with infertility problems' presents a chance to co-create interventions that empower them.
Cette étude s'est concentrée sur les dimensions psychologiques, sociales et culturelles de l'infertilité chez les femmes infertiles de Harare Urban qui ont utilisé les systèmes de santé traditionnels pour résoudre leur problème d'infertilité. Il met également l'accent sur leurs stratégies d'adaptation pour faire face aux défis rencontrés tout au long du parcours stérile. Il s'agissait d'une étude qualitative utilisant une approche phénoménologique, axée sur les expériences de cinq femmes. Les données des entretiens ont été analysées à l'aide d'une version simplifiée du processus d'explication en cinq étapes de Hycner (1985). L'étude a produit trois thèmes principaux : les expériences psychologiques, les expériences socioculturelles et les expériences d'adaptation, ainsi que sept sous-thèmes. Les résultats ont montré que les femmes éprouvaient une détresse, un chagrin et une culpabilité intenses en raison de leur incapacité à avoir des enfants, encore aggravés par la stigmatisation à laquelle elles étaient confrontées de la part de leur famille et de leur communauté. Les femmes infertiles sont soumises à des étiquettes désobligeantes, au mépris social, au ridicule et à la sous-évaluation, ce qui les amène à développer des stratégies d'adaptation pour supporter les rencontres défavorables. Ces mécanismes d'adaptation peuvent avoir des effets positifs ou négatifs sur leur bien-être global. L'exploration des facteurs psychologiques, socioculturels et des mécanismes d'adaptation des femmes souffrant de problèmes d'infertilité présente une opportunité de co-créer des interventions qui les autonomisent.
Assuntos
Adaptação Psicológica , Infertilidade Feminina , Pesquisa Qualitativa , Estigma Social , Humanos , Feminino , Adulto , Zimbábue , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , População Urbana , Estresse Psicológico/psicologia , Infertilidade/psicologia , Infertilidade/terapiaRESUMO
Infertility has a significant impact on the lives of women. Therefore, affected women often consider the treatment options available to deal with their condition, including traditional healthcare services (THS). The aim of this phenomenological study was to explore the lived experiences of women with infertility problems who sought help from traditional health practitioners in Harare, Zimbabwe. Data from interviews with five women with infertility was explicated using a simplified version of Hycner (1985) five step explication process. Two major themes and eight sub themes emerged from the findings. The major themes were traditional diagnosis experiences and traditional treatment experiences. Consultation and divination were the diagnosis methods experienced by the women with infertility. The THS offered comprehensive management of infertility through couples therapy, as well as pre- and post-natal therapies, which include lifestyle counselling. The findings also showed that women with infertility commonly receive concurrent treatment, including both allopathic and traditional medicine. This presents an opportunity to explore the convergence of traditional and allopathic approaches in the management of infertility in women.
L'infertilité a un impact significatif sur la vie des femmes. Par conséquent, les femmes affectées envisagent souvent les options de traitement disponibles pour faire face à leur maladie, y compris les services de santé traditionnels (THS). Le but de cette étude phénoménologique était d'explorer les expériences vécues de femmes souffrant de problèmes d'infertilité qui ont demandé l'aide de praticiens de santé traditionnels à Harare, au Zimbabwe. Les données provenant d'entretiens avec cinq femmes infertiles ont été expliquées à l'aide d'une version simplifiée du processus d'explication en cinq étapes de Hycner (1985). Deux thèmes majeurs et huit sous-thèmes ont émergé des résultats. Les thèmes principaux étaient les expériences de diagnostic traditionnel et les expériences de traitement traditionnel. La consultation et la divination étaient les méthodes de diagnostic expérimentées par les femmes infertiles. Le THS proposait une prise en charge complète de l'infertilité grâce à une thérapie de couple, ainsi que des thérapies prénatales et postnatales, qui comprennent des conseils sur le mode de vie. Les résultats ont également montré que les femmes souffrant d'infertilité reçoivent généralement un traitement concomitant, comprenant à la fois la médecine allopathique et la médecine traditionnelle. Cela présente l'occasion d'explorer la convergence des approches traditionnelles et allopathiques dans la gestion de l'infertilité chez la femme.
Assuntos
Infertilidade Feminina , Medicinas Tradicionais Africanas , Humanos , Feminino , Zimbábue , Adulto , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Pesquisa Qualitativa , População Urbana , Entrevistas como AssuntoRESUMO
BACKGROUND: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
Assuntos
Morte Materna , Near Miss , Complicações na Gravidez , Países em Desenvolvimento , Feminino , Instalações de Saúde , Humanos , Morte Materna/etiologia , Mortalidade Materna , GravidezRESUMO
BACKGROUND: Maternal 'near miss' can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care. METHODS: A prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal 'near miss' at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal 'near miss' and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death. RESULTS: During this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal 'near miss' morbidity and 13 were maternal deaths. The maternal 'near miss' ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission. CONCLUSION: The MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.
Assuntos
Aborto Espontâneo/epidemiologia , Serviços de Saúde Materna , Near Miss/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Unidades de Terapia Intensiva , Mortalidade Materna , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Infecção Puerperal , Qualidade da Assistência à Saúde , Centros de Atenção Terciária , Adulto Jovem , Zimbábue/epidemiologiaRESUMO
INTRODUCTION: Infertility adversely affects the sexual reproductive health and overall quality of life of people. Recent estimates show that about one in six people (both men and women) experience infertility in their lifetime. This scoping review will, therefore, map the existing evidence on traditional management of female infertility in Africa including the effectiveness of the traditional healthcare systems, to inform policy and practice. METHODS: The scoping review will be guided by the Arksey and O'Malley framework in conjunction with the Joanna Briggs Institute updated methodological guidance for scoping reviews. A search strategy will be developed, which will target the following databases: PubMed, Scopus, Embase, CINAHL, Google Scholar and Africa-Wide Information including grey literature. The screening of titles, abstracts and full text will be done by two independent reviewers. Data will be extracted, analysed numerically and thematically. The reporting of the scoping review will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION: This scoping review will not require ethical approval as this is secondary analysis of peer-reviewed articles. The findings of the review will be disseminated on various platforms including conferences, meetings to key stakeholders and in a peer-reviewed journal for wider sharing.
Assuntos
Infertilidade Feminina , Masculino , Humanos , Feminino , Infertilidade Feminina/terapia , Qualidade de Vida , Atenção à Saúde , Projetos de Pesquisa , Reprodução , Revisões Sistemáticas como Assunto , Literatura de Revisão como AssuntoRESUMO
Malaria in pregnancy is associated with significant morbidity and mortality, and requires early diagnosis and intervention. Plasmodium falciparum is responsible for 98% of malaria cases in Zimbabwe and causes the most severe disease. Abnormal haematological parameters are a frequent finding in patients with malaria; however, they are rarely the sole presenting feature. We present the case of a 32-year-old woman in her fifth pregnancy, with a history of one previous caesarean section, who presented for caesarean section and was incidentally noted to have severe thrombocytopenia. Subsequent investigations at a tertiary institution revealed a pancytopenia with thrombocytopenia as the most prominent feature in an asymptomatic patient. The unavoidable caesarean section done under platelet cover was eventful, with severe intractable haemorrhage necessitating an emergency hysterectomy. However, the patient made a full recovery with antimalarial treatment and blood product transfusions. This case is presented to illustrate the need to consider malaria as a differential diagnosis in pregnant patients from malaria-transmitting areas who have thrombocytopenia. Previous studies have shown that thrombocytopenia can be a predictor of malaria in patients who present with fever, and a marker of disease severity, but has no utility in prognostication and follow-up.
Assuntos
Anemia , Antimaláricos , Malária Falciparum , Malária , Pancitopenia , Trombocitopenia , Adulto , Anemia/complicações , Antimaláricos/uso terapêutico , Cesárea , Feminino , Humanos , Malária/complicações , Malária/diagnóstico , Malária/tratamento farmacológico , Malária Falciparum/diagnóstico , Pancitopenia/diagnóstico , Pancitopenia/etiologia , Gravidez , Trombocitopenia/diagnóstico , Trombocitopenia/etiologiaRESUMO
The COVID-19 pandemic and resultant lockdowns have brought unprecedented challenges for Maternal, Sexual and Reproductive Health (MSRH) services. Components of MSRH services adversely affected include antenatal, postnatal, and newborn care; provision of family planning and post-abortion care services; sexual and gender-based violence care and prevention; and care and treatment for sexually transmitted infections including HIV. Resuscitating, remodeling or inventing interventions to restore or maintain these essential services at the community level, as a gateway to higher care, is critical to mitigating short and long-term effects of the COVID-19 pandemic on essential MSRH. We propose a possible framework for community involvement and propose integrating key information, education, and communication of MSRH messages within COVID-19 messages.
Assuntos
COVID-19 , Infecções por HIV , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Participação da Comunidade , Feminino , Infecções por HIV/prevenção & controle , Humanos , Recém-Nascido , Pandemias/prevenção & controle , Gravidez , Saúde ReprodutivaRESUMO
Governments in sub-Saharan Africa implemented restrictive measures, including lockdowns, to curb the spread of COVID-19, without measures to protect women and girls. Evidence from previous humanitarian crises in resource-limited settings in sub-Saharan Africa indicates that these populations may suffer disproportionately from the effects of the restrictive control measures, owing to differential access to services, including maternal, sexual and reproductive health services. These services are time-sensitive, and delays and disruptions introduced by the restrictive measures may result in adverse consequences, including increased maternal and perinatal morbidity and mortality. Therefore, governments must find ways of ensuring continuity of these essential services during pandemic times, in a conducive environment, protective to both care providers and care seekers. Surveillance of the impact of the pandemic must be ongoing to inform practice and refine public health interventions, as the indirect effects of the COVID-19 pandemic might be worse than the direct effects.
Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Feminino , Humanos , Pandemias , Gravidez , Saúde Reprodutiva , SARS-CoV-2RESUMO
INTRODUCTION: clinical infertility is failure to conceive within a year of regular sexual intercourse by a non contracepting couple. Infertility care is costly and result in investigations being incomplete and inconclusive. It is therefore important to streamline investigations offered to infertile couples such that only the most cost effective tests are done. This paper explores the adequacy of investigations and treatments offered to women presenting for infertility care. METHODS: the data used in this analysis was obtained from a cross sectional sample of 216 women who presented with infertility in public and private gynaecological clinics in Harare, Zimbabwe. Information on investigations and treatment offered to women presenting for care was extracted from hospital cards, case notes, laboratory and radiological reports. Data was analysed using STATA SE/15. RESULTS: of the 178 (82.4%) who had ultrasound scan evaluation (USS) 50 (28.1%) had fibroids and 22 (12.4%) had polycystic ovaries. Tubal patency tests were done in 118 participants using (hystero-salpingogram) HSG alone in 62.7%, laparoscope and dye alone in 21.2% and both in 16.1% of them. Of the 97 (44.9%) men who had semen analysis 61 (62.9%) had abnormal parameters. CONCLUSION: this study reveals that evaluation for tubal patency and USS to rule out reproductive organ pathology are not being offered to all women with a diagnosis of infertility. Likewise, male partner semen evaluation is not being done in all male partners. There is a high prevalence of abnormal semen parameters. Studies should be done to understand why some male partners are not forthcoming in providing semen for analysis. It is important for protocols to be produced by professional bodies which prescribe the minimum basic investigations in couples with infertility.
Assuntos
Infertilidade Feminina , Infertilidade Masculina , Estudos Transversais , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Masculino , Análise do Sêmen , Zimbábue/epidemiologiaRESUMO
Lockdown policies, travel restrictions and reduced provision of healthcare in Zimbabwe in response to the COVID-19 pandemic have brought unprecedented challenges for healthcare delivery. Maternity services, including antenatal care, labour and delivery as well as postnatal care have been affected directly and indirectly by the pandemic and resultant control interventions, with delays introduced at several points across the continuum of care. Unfortunately, maternity conditions are time-sensitive, and delays can negatively impact feto-maternal outcomes, with increased maternal, fetal or neonatal morbidity and mortality. An audit at central hospitals revealed reduced utilisation of maternity services and a trend towards an increase in maternal mortality. A formal evaluation is required; however, mitigating public health interventions are required, especially as the burden of COVID-19 in the country has considerably come down. The World Health Organisation offers useful technical guidance for maintaining essential health services in pandemic times in low-resources settings, and rationalising the use of personal protective equipment, which can be contextualised and adopted to restore and maintain essential health services. Restoration of essential maternity services is urgently required in an environment that protects healthcare workers and their clients, minimising their risk of contracting COVID-19 whilst optimising fetomaternal outcomes. Thus, the various stakeholders involved in maternity care must urgently come together and find ways of achieving this goal.
Assuntos
Atenção à Saúde , Serviços de Saúde Materna/provisão & distribuição , Saúde Pública , COVID-19 , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , ZimbábueRESUMO
The TRAP sequence, also known as acardiac twinning is a rare complication that is unique to monochorioinic multiple pregnancies affecting 1% of monochorioinic pregnancies and about 1 in 35000 of all pregnancies. In TRAP, blood flows from the umbilical artery of the pump twin to the umbilical artery of the perfused twin through artery to artery (AA) anastomosis. The perfused twin has poor development of the upper extremities and the normal or pump twin is at risk of a poor perinatal outcome. This is a report of a patient with TRAP sequence diagnosed in the second trimester who was managed conservatively and had a good outcome for the normal twin.
Assuntos
Tratamento Conservador/métodos , Transfusão Feto-Fetal/terapia , Resultado da Gravidez , Adulto , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Gravidez de Gêmeos , Diagnóstico Pré-Natal/métodosRESUMO
BACKGROUND: Cesarean section scar ectopic pregnancies are a rare complication of pregnancy that may follow previous hysterotomy for any cause, uterine manipulation, and in vitro fertilization. It has become more common with the increasing number of cesarean sections worldwide. Fortunately, the use of first-trimester ultrasound imaging has led to a significant number of these pregnancies being diagnosed and managed early. CASE PRESENTATION: We report a case of a 36-year-old black African patient who had two previous cesarean sections and one previous surgical evacuation. She presented with a type 2 cesarean section scar ectopic pregnancy that was suspected on the basis of transvaginal ultrasound imaging, but not at laparoscopy/hysteroscopy. A bladder adherent to the upper segment of the anterior uterine wall obscured the gestational mass at laparoscopy. There were extensive intracavitary adhesions that interfered with hysteroscopic visualization. This resulted in the original operative procedure being postponed until magnetic resonance imaging confirmed the ectopic location of the pregnancy. The ectopic gestation was subsequently excised, and the uterus was repaired via laparotomy. CONCLUSIONS: It is important for clinicians and radiologists managing women with risk factors for a scar ectopic pregnancy to maintain a high index of suspicion during follow-up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal death.
Assuntos
Cicatriz/cirurgia , Gravidez Ectópica/cirurgia , Adulto , Cesárea/efeitos adversos , Cicatriz/complicações , Diagnóstico Tardio , Feminino , Humanos , Histerotomia/métodos , Laparoscopia/métodos , Imageamento por Ressonância Magnética , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Fatores de Risco , UltrassonografiaRESUMO
INTRODUCTION: Giant ovarian cysts are rarely described in the literature, owing to the availability of advanced imaging technologies in developed countries leading to early treatment. In resource-limited settings, various factors lead to late presentation. CASE PRESENTATION: We present a case of a 48-year-old black African woman with a giant mucinous cystadenoma who presented to a tertiary hospital with massive abdominal distention 5 years after being referred from a district hospital for the same problem. Surgical management resulted in fatal complications. CONCLUSIONS: The surgical management of these huge tumors is associated with many life-threatening complications. Transvaginal ultrasound should be used in resource-limited settings to delineate ovarian masses. Community health workers must be involved in scouting and follow up of community members with unusual abdominal swellings in developing countries to avoid delays in care.
Assuntos
Parede Abdominal/patologia , Cistadenoma Mucinoso , Gangrena , Neoplasias Ovarianas , Ovariectomia , Complicações Pós-Operatórias , Cistadenoma Mucinoso/patologia , Cistadenoma Mucinoso/fisiopatologia , Cistadenoma Mucinoso/cirurgia , Diagnóstico Tardio , Países em Desenvolvimento , Evolução Fatal , Feminino , Gangrena/etiologia , Gangrena/terapia , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Avaliação das Necessidades , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/cirurgia , Ovariectomia/efeitos adversos , Ovariectomia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Carga Tumoral , ZimbábueRESUMO
INTRODUCTION: Abortion in Zimbabwe is allowed to preserve the physical health of the woman, or in cases of rape, incest, or fetal impairment. Access even under these conditions is difficult and rare. We aimed to understand knowledge of the abortion law and attitudes towards abortion amongst health care providers' and abortion experts in Zimbabwe as these can hinder access to safe legal abortion. METHODS: In 2016, we conducted a Health Facility Survey (HFS) (n=227) among health care providers' knowledgeable about abortion services in their facility in a census of facilities offering Post Abortion Care (PAC), and a Health Professionals Survey (HPS) among 118 abortion experts. RESULTS: Twenty-five percent of providers and 47% of experts knew all four reasons under which abortion is legal in Zimbabwe. Amongst providers and experts, 31% and 50% respectively were misinformed about one or more legal criteria. Most providers and experts were in support of expanding the legal provision of abortion to cases when the woman's mental health is at risk (65% and 79%, respectively) and if the woman is mentally incapacitated (66% amongst all). Seventy-one percent of experts recommend liberalizing the abortion law in order to reduce unsafe abortions. CONCLUSION: There is incomplete and sometimes inaccurate knowledge on the legal provisions for performing abortions in Zimbabwe amongst both health care providers and abortion experts. Incomplete knowledge of the law may be further reducing abortion access, highlighting the urgent need for educating health care providers on the legal status of abortion.
Assuntos
Aborto Induzido/psicologia , Aborto Legal/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/psicologia , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , ZimbábueRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0205239.].
RESUMO
Hepatic rupture from haematomas is a rare complication of severe preeclampsia/eclampsia especially when complicated with the haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. It is associated with poor maternal and foetal outcomes as demonstrated by three cases we describe. The first case had eclampsia at 31 weeks gestation with features of abruptio placentae and at caesarean section we found haemoperitoneum of 1.5 litres, a 10cm liver rupture and a still birth. She subsequently died in ICU within 24 hours of surgery; the second case had eclampsia at 35 weeks and ended up as a table death during emergency caesarean section. She had 4 litres of haemoperitoneum, hepatic rupture, placental abruption and a stillbirth; the third case had pre-eclampsia at 33 weeks with markedly elevated liver enzymes. She had one litre haemoperitoneum, right lobe hepatic rupture and a stillbirth. She recovered after conservative management. Severe pre-eclampsia/eclampsia associated hepatic rupture calls for rapid and aggressive intervention with prompt multidisciplinary management to avert adverse outcomes.
Assuntos
Eclampsia/fisiopatologia , Hematoma/etiologia , Hepatopatias/etiologia , Pré-Eclâmpsia/fisiopatologia , Descolamento Prematuro da Placenta/fisiopatologia , Adulto , Cesárea , Feminino , Humanos , Gravidez , Resultado da Gravidez , NatimortoRESUMO
OBJECTIVES: Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe. DESIGN: Prospective, facility-based 28 day survey among women seeking PAC and their providers. SETTING: 127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities. PARTICIPANTS: 1002 women presenting with abortion complications during the study period. MAIN OUTCOME MEASURES: Severity of abortion complications and associated factors, delays in care seeking, and clinical management of complications. RESULTS: Overall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception. CONCLUSION: Zimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.
Assuntos
Aborto Induzido/efeitos adversos , Aborto Espontâneo/epidemiologia , Anticoncepção/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Curetagem a Vácuo/efeitos adversos , Abortivos não Esteroides/uso terapêutico , Adolescente , Adulto , Assistência ao Convalescente/métodos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Misoprostol/uso terapêutico , Análise Multivariada , Complicações Pós-Operatórias/terapia , Gravidez , Estudos Prospectivos , Análise de Regressão , Índice de Gravidade de Doença , Adulto Jovem , Zimbábue/epidemiologiaRESUMO
BACKGROUND: Zimbabwe has the highest contraceptive prevalence rate in sub-Saharan Africa, but also one of the highest maternal mortality ratios in the world. Little is known, however, about the incidence of abortion and post-abortion care (PAC) in Zimbabwe. Access to legal abortion is rare, and limited to circumstances of rape, incest, fetal impairment, or to save the woman's life. OBJECTIVES: This paper estimates a) the national provision of PAC, b) the first-ever national incidence of induced abortion in Zimbabwe, and c) the proportion of pregnancies that are unintended. METHODS: We use the Abortion Incidence Complications Method (AICM), which indirectly estimates the incidence of induced abortion by obtaining a national estimate of PAC cases, and then estimates what proportion of all induced abortions in the country would result in women receiving PAC. Three national surveys were conducted in 2016: a census of health facilities with PAC capacity (n = 227), a prospective survey of women seeking abortion-related care in a nationally-representative sample of those facilities (n = 127 facilities), and a purposive sample of experts knowledgeable about abortion in Zimbabwe (n = 118). The estimate of induced abortion, along with census and Demographic Health Survey data was used to estimate unintended pregnancy. RESULTS: There were an estimated 25,245 PAC patients treated in Zimbabwe in 2016, but there were critical gaps in their care, including stock-outs of essential PAC medicines at half of facilities. Approximately 66,847 induced abortions (uncertainty interval (UI): 54,000-86,171) occurred in Zimbabwe in 2016, which translates to a national rate of 17.8 (UI: 14.4-22.9) abortions per 1,000 women 15-49. Overall, 40% of pregnancies were unintended in 2016, and one-quarter of all unintended pregnancies ended in abortion. CONCLUSION: Zimbabwe has one of the lowest abortion rates in sub-Saharan Africa, likely due to high rates of contraceptive use. There are gaps in the health care system affecting the provision of quality PAC, potentially due to the prolonged economic crisis. These findings can inform and improve policies and programs addressing unsafe abortion and PAC in Zimbabwe.
Assuntos
Aborto Induzido , Aborto Espontâneo/epidemiologia , Gravidez não Planejada , Aborto Legal , Aborto Espontâneo/mortalidade , Aborto Espontâneo/fisiopatologia , Adolescente , Adulto , Censos , Feminino , Inquéritos Epidemiológicos , Humanos , Mortalidade Materna , Gravidez , Estudos Prospectivos , Zimbábue/epidemiologiaRESUMO
Pregnant women with severe mitral stenosis tend to experience clinical decompensation with approximately 50% mortality and they may experience adverse effects of the medication they are taking, notably congenital malformations from warfarin exposure. Corrective heart surgery may increase the risk of pregnancy loss. We present 2 cases of RHD in pregnancy. The first case was a 27-year-old patient in her first pregnancy with severe mitral stenosis. Caesarean section was done for foetal distress and she delivered a small for gestational age baby. She was closely monitored postpartum and was stable on discharge. She presented with supraventricular tachycardia and died in the coronary care unit 4 weeks postpartum. The second case was a 28-year-old who was on warfarin for a mechanical mitral valve. A foetal anomaly scan done at 20 weeks showed severe congenital malformations which were not compatible with extra-uterine life. The pregnancy was terminated and she recovered well. The first case illustrates the significant mortality risk with uncorrected severe rheumatic heart disease. The second case highlights the risks of warfarin on the foetus and the need to avoid mechanical heart valves if possible in young women. RHD patients require preconception counselling so they can make informed reproductive choices.