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The COVID-19 pandemic created global crises on almost every facet of the global economy, most especially on medical logistics. The purpose of the study was to determine the effects of the pandemic on the Tamale Teaching Hospital’s healthcare resource management and utilization. The study compared data on the hospital utilization by clients by reviewing a three-month data before COVID-19 and three months data after the hospital started recording COVID-19 cases. Findings revealed that on the advent of COVID-19 in the hospital, patients’ admission figures declined by 21% bringing down the revenue generation by 31%. However, the value of logistics and supply chain increased by 35.72%, reflecting in the hospital’s expenditure that went up by 44.8%. The COVID-19 pandemic left the Tamale Teaching Hospital with a ballooned expenditure and a disruption of the health service delivery.

Background: Ectopic gestation is a major cause of morbidity and mortality among women of reproductive age. The clinical presentations vary depending on whether it is ruptured or not. Understanding the various modes of presentation is therefore critical to early detection and management to reduce associated morbidity and mortality. We determined the patterns of presentation and outcomes of ectopic pregnancy in the Korle Bu Teaching Hospital (KBTH) of Ghana.Objective: This study aimed to determine patterns of presentation of ectopic pregnancy in the KBTH of Ghana and the outcomes for patients presenting with the condition.Methods: We collected data from pregnant women presenting to the Obstetrics and Gynaecology Department of the KBTH during the study period and diagnosed with ectopic pregnancy. A case of ectopic pregnancy was any woman diagnosed by an obstetrician/gynaecologist either by clinical features or pelvic ultrasound. Data were collected on sociodemographic characteristics, as well as clinical history, examination findings, treatment, and outcomes. Data were analyzed descriptively to determine the patterns of presentation of ectopic gestations.Results: A total of 104 ectopic pregnancies representing 8.81% (n = 104/1,180) of gynaecological emergencies were recorded during the study period. Of the 104 ectopic pregnancies recorded, 6.7% (n = 7) were diagnosed as unruptured. The mean (± standard deviation) gestational age at diagnosis of ectopic pregnancy was 7.2 ±1.9 weeks. About 94.2% (n = 98) of patients with ectopic pregnancy had visited a health facility before the visit at which the diagnosis was eventually made, and 76.9% (n = 80) of the ectopic cases had ruptured at diagnosis. For 1.9% (n = 2) of the participants, ectopic pregnancy was detected by ultrasound. The triad of amenorrhoea in 91.3% (n = 95), lower abdominal pains in 91.3% (n = 95) and irregular vaginal bleeding in 47.1% (n = 49) of the ectopic pregnancies were the main presenting symptoms of ruptured ectopic pregnancy.Conclusion: The incidence of ruptured ectopic pregnancy in the KBTH was high. Primary health care practitioners should rule out ectopic pregnancy in women of the reproductive age group who present with the triad of amenorrhoea, lower abdominal pain and irregular vaginal bleeding.

Background: Globally, pregnancies that have gone beyond the expected date of delivery (EDD) contribute significantly to maternal and perinatal morbidity and mortality.Objective: This study aimed to determine the proportion, pregnancy outcomes, and associated characteristics of deliveries at EDD and beyond at the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana.Methods: This was a cross-sectional study conducted at the KBTH. Postpartum women who delivered at a gestational age of 40 weeks and beyond were selected from the labour wards, grouped according to gestational age, and followed up to their first postnatal visit. Data were collected on demographic, obstetric and postpartum health status. The association between study variables and delivery at and beyond EDD was determined using the F-test statistic and Chi-square test for continuous and categorical outcomes, respectively. A p < 0.05 was considered statistically significant.Results: Of the 300 participants, 44% (n = 132) delivered at 40 weeks plus 0 to 6 days (40 + 0 - 6 weeks) of gestation, 44.7% (n = 134) at 41 + 0 - 6 weeks, and 11.3% (n = 34) at ≥ 42 weeks. The proportion of deliveries at EDD and beyond was 9.9% (n = 300/304) of total deliveries during the period. The pregnancies ≥ 42 weeks were 1.1% (n = 34/3041) of total deliveries. Factors that were significant associations with women who delivered at ≥ 42 + 0 weeks were a referral from other hospitals (p < 0.017), labour induction (p < 0.001), a longer first stage of labour (p < 0.008), and a longer total labour duration (p < 0.009).Conclusion: The proportion of deliveries in which the pregnancies had progressed to the EDD and beyond and that of prolonged pregnancy at the KBTH were 9.9% and 1.1%, respectively. The duration of the first stage of labour and the total duration of labour was longer in women with pregnancies ≥ 42 weeks.

An intraligamentary pregnancy is an extremely rare form of ectopic pregnancy, with only a few cases reported. We report a 20-year-old woman who had an ongoing pregnancy at about 22 weeks gestation, consulted for recurrent urinary retention and severe lower abdominal pain of two days duration. Pelvic ultrasonography revealed an extrauterine gestation of 19 weeks and four days on the left adnexal region. Exploratory laparotomy was performed that found left intraligamentary pregnancy (unruptured) measured 20 - 25 cm across, attached posteriorly to the bowel (sigmoid colon) and extended to the pouch of douglas impinging on the bladder base. Resection of ectopic pregnancy was successfully performed, urine retention resolved, and the patient was discharged with no postoperative complications. Early recognition of this rare form of ectopic gestation is of considerable importance because of the risk of a life-threatening haemorrhagic complication necessitating emergency surgical intervention.

Caesarean scar ectopic pregnancy is defined as the implantation of the blastocyst in a previous Caesarean scar. It is a rare type of ectopic pregnancy. The incidence is however rising due to the increasing rates of Caesarean sections as well as in-vitro fertilization embryo-transfer. It can be diagnosed early by ultrasound. This remains a challenge in lower middle income countries where the availability of high resolution ultrasound and the skill for such sonography may be lacking. Misdiagnosis or a delay in diagnosis often leads to poor treatment outcomes. We present a case of a gravida 3 para 2 + 0 who had laparotomy for a caesarean scar pregnancy and highlight the challenges associated with diagnosis and management of this rare ectopic pregnancy in a lower middle income country.

Objective: To find out the prevalence of contraceptive use among female adolescents and the associated factors for contraceptive choice and use. Methods: Using systematic sampling technique, one female adolescent (10-19 years) from each of 110 houses was interviewed using structured questionnaire. One house was selected and a female adolescent who consented was administered structured questionnaire. Data collected included; socio-demographic factors, adolescent sexuality, contraceptive use/non-use and contraceptive choices. Data was analysed using SPSS: 16.0 and frequencies, means, Chi Squared test and Logistic regression was used, setting significance at p=0.05. Results: The mean age at first sexual intercourse was 15.9 years (12-18 years) and 55.5% of female adolescents were sexually active. Contraceptive prevalence among sexually active female adolescents was 38.0%. The commonest method used was the male condom (73.9%). Main reasons for choice of method were easy access and safety of method, and also dual protection specifically for the male condom. Most adolescents besides having not thought about protection at time of sexual intercourse had no specific reason for not using contraception. There was a generally low level of encouragement from social contacts to female adolescents to use contraceptives. Common reasons given for abstinence included being young and afraid of pregnancy and HIV/AIDS and also want to further education and achieve goals in life. Discouragement from contraceptive use was generally low and was mainly from peers and sex partners and statements used in this regards stemmed mainly from misconceptions and misinformation. Unadjusted analysis suggested that Mother’s/female guardian’s highest level of education and sex partner encouragement were significantly associated with contraceptive use (p=0.035 and 0.040 respectively) and multivariable logistic regression analysis showed that only mother’s/female guardian’s highest level of education was a significant factor (p=0.047). With the current low level of contraceptive prevalence there is the urgent need to address perceived barriers from this study such as lack of encouragement from close social contacts of this vulnerable group, misinformation and misconceptions about contraceptives and also research into appropriate ways of helping abstaining youth and practical ways of empowering women by educating the girl child must be researched.