Search

Background: The resolution of hypertension, proteinuria and AKI postpartum among women with preeclampsia is not well documented in Uganda., Objective: To determine the time to resolution of hypertension, proteinuria and AKI postpartum until 6 weeks among women with preeclampsia in Mulago Hospital, Uganda., Methods: Between August 2017 and April 2018, we measured blood pressure, urine protein and serum creatinine on days 1,7,21 and 42 postpartum among 86 women with preeclampsia. The primary outcomes were time to the resolution of hypertension, proteinuria and AKI. We fitted accelerated failure models using Stata 17's stintreg . command with a log normal distribution and obtained time ratios of selected exposures on time to resolution of hypertension, proteinuria and AKI intervals., Results: The median time to resolution of hypertension, proteinuria and AKI was seven (7) days (Inter quartile range, IQR 1-21). The time to resolution of hypertension among primiparous women was 3.5 times that of multiparous women [TR 3.5, 95%CI 1.1, 11.3]. No differences were observed in resolution of hypertension, proteinuria and acute kidney injury., Conclusion: The time to resolution of hypertension, proteinuria and AKI was seven days. We recommend larger studies with longer follow-up beyond six-weeks postpartum to inform revision of our guidelines., Competing Interests: The authors have no conflict of interest to declare., (© 2023 Muteke K et al.)

Introduction: In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence and factors associated with teenage pregnancy in health facilities is not well documented. We determined the prevalence and factors associated with teenage pregnancy in Mbale Regional Referral Hospital., Materials and Methods: We conducted a cross sectional study between July and September 2019.We consecutively enrolled and collected information from 427 respondents. Associated factors were determined using logistic regression, a P-value < 0.05., Results: The prevalence of teenage pregnancy was 20.6% [95% CI : (17.0% - 24.7%)]. Rural residence [(AOR: 2.8 (1.08 - 7.09)], primary level of education [(AOR: 9.57 (3.48 - 26.3)], unhappy feelings about the current pregnancy [(AOR: 3.57(1.05 - 12.15)], primiparity [(AOR: 21.05 (7.36 - 60.15)] increased the likelihood of teenage pregnancy. While, history of ever use of contraceptives [(AOR: 0.32 (0.12 - 0.84)], age at coitarche [(AOR: 0.68 (0.54 - 0.85)], grand multiparity [(AOR: 0.06 (0.01 - 0.51)], and exposure to sex education at home [(AOR: 0.37 (0.15 - 0.89)] decreased its likelihood., Conclusion: The prevalence of teenage pregnancy was high. It was associated with being resident in rural area, low level of education and ever use of contraception. Promotion of reproductive health education may prevent teenage pregnancy., (© 2022 Chemutai V et al.)

Objective: To determine the risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda., Design: A case control study., Setting: Mulago hospital labour suite, Participants: Between 15th November 2001 and 30th November 2002 we identified and recruited thirty six parturients with placenta previa who developed severe bleeding and 180 women with normal delivery. The risk factors were studied., Variables of Interest: Socio demographic characteristics, social and family history, gynaecological operations, blood transfusion, medical conditions, past and present obstetric performance and HIV status., Results: Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6, CI: 1.1-12.5), delivery by caesarean section in previous pregnancy (O.R. 19.9, CI: 6.4-61.7), residing more than ten kilometres from Mulago hospital (O.R. 2.4, CI: 1.0-5.7) and recurrent vaginal bleeding during the current pregnancy (O.R. 7.3, CI 2.4-63.7)., Conclusion: Severe bleeding in placenta praevia is associated with high maternal morbidity and mortality. The determinants of severe bleeding in placenta praevia can be used in the antenatal period to identify mothers at risk. These, with prompt interventions to deliver the women can be used to reduce the maternal morbidity associated with this condition.

Objective: To determine the risk factors for severe abruptio placenta in Mulago hospital, Kampala, Uganda., Design: A case control study., Setting: Mulago hospital labour wards Study population: Women who delivered in Mulago hospital., Participants: Forty five women with severe abruptio placenta (cases) were recruited between 15(th) November 2001 and 30(th) November 2002. They were followed up and compared to five hundred women (controls) who had normal deliveries., Outcome Variables: Socio-demographic characteristics, familial history, medical history, gynaecological and obstetric history., Results: The risk factors for severe abruptio placenta were low socio economic status (OR 10.5,95% CI 3.8 to 29.2), co existing hypertension (OR 56.8, 95% CI 9.0 to 358.5), previous history of stillbirth (OR 3.1,95% CI 1.1 to 9.1), delivery by caesarean section in previous pregnancy (OR 7.3, 95% CI 1.8 to 29.7), non attendance of antenatal care(OR 6.5, 95% CI 2.0 to 21.2), recurrent vaginal bleeding(OR 26.7, 95% CI 8.6 to 85.4) and delivery of male babies(OR 2.2, 95% CI: 1.2 to 4.9)., Conclusion: The risk factors for abruptio placenta were chronic hypertension, recurrent vaginal bleeding, previous delivery with caesarean section and low socio economic status. These factors can be identified during prenatal period and used to prevent maternal morbidity and mortality.

Objective: To determine the presentation and treatment offered to sexually assaulted females attending emergency gynaecological ward in Mulago Hospital, Kampala, Uganda., Setting: Mulago hospital gynaecological emergency ward., Study Design: Prospective descriptive study., Participants: Fifty eight sexually assaulted females were recruited from 1 st March 2000 to 31 st December 2000. They were interviewed, examined, given appropriate treatment and followed up for three months., Outcome Variables: Socio demographic characteristics, genital and bodily injuries, relationship to the assailant, and prevalence of sexually transmitted infections., Results: The mean age was 9.5 with a range of 1-35 years. Seventy two percent of the victims were children below 12 years. Fifty percent of the assault occurred at the assailant's home. The majority (79.3%) of the victims knew the assailant and cases of gang rape were only 6.9%. The injuries sustained were extra genital (19.0%), genital (75.4%). The emotional or psychological disturbance was present in 22.4% of the patients. The sexually transmitted infections found included trichomonas vaginalis (1.7%) and syphilis (3.7%). All cases received counseling and prophylactic treatment for sexually transmitted infections. Those in reproductive age group were offered emergency contraception. None of the victims got post exposure HIV therapy because it was not available in the hospital., Conclusion: Sexual assault is common in Uganda and is one of the most dehumanizing human crimes against women. It is associated with adverse medical and social problems. There is urgent need to sensitize the community about reporting early for medical treatment after sexual assault.

Spontaneous rupture of bladder and extravasation of urine in the peritoneum without evidence of trauma is rare. This condition is an emergency. It presents in a unique way therefore, the diagnosis and treatment is usually delayed. This patient presented with an acute abdominal pain and oliguria. She had delivered normally eight days before re-admission. Investigations were done and an exploratory laparotomy was performed. There was a tear in the fundus of the bladder and the peritoneal cavity contained urine. Peritoneal lavage was done and the bladder was repaired in layers. She was put on continuous bladder drainage for three weeks followed by bladder training. The bladder resumed its normal function. Early diagnosis and appropriate management decreases the morbidity and mortality associated with this condition.

Objective: To determine the maternal and foetal outcomes in mothers with gestational diabetes mellitus attending antenatal clinics in Mulago Hospital Kampala Uganda., Design: This was a cohort study., Setting: Mulago Hospital antenatal clinics., Participants: Ninety mothers with gestational ages between 24-32 weeks were recruited from April to September 2001.They were followed up to the time of delivery. The WHO criterion for the diagnosis of gestational diabetes was used. Thirty mothers with a 2 hrs post prandial capillary blood sugar more than 140 mg/dl were the exposed group and 60 mothers with less than 140 mg/dl were the unexposed group. Blood sugar was measured using a one touch glucometer., Outcome Variables: Socio demographic characteristics, maternal complications, mode of delivery and the foetal outcomes., Results: The mean age of mothers in both groups was similar: 28.6 years vs 27.5 years. Both groups had similar body mass index more than 26. The mothers with gestational diabetes mellitus (GDM) were four times more likely to have hypertensive disease(p=0.04) and nine times more likely to have vaginal candidiasis(p=0.002). The modes of delivery were similar in both groups but genital injuries were more common among mothers with GDM. The indications of Caesarian section in mothers with GDM were two times more likely to be due to big babies and obstructed labour. The babies for mothers with GDM were more likely to be macrocosmic, still born, and have shoulder dystocia than those of normal mothers., Conclusion: Gestational diabetes mellitus exists in Uganda and is associated with adverse maternal and foetal outcomes. There is need to routinely screen mothers for gestational diabetes in this environment.

Objectives: To establish the sexual practices and their associated morbidity among women within 6 months of childbirth in Kampala Uganda., Design: Cross-sectional descriptive study., Setting: The three Mulago hospital child immunization clinics., Participants: Two hundred and seventeen eligible mothers took part in the study from November to December 2001., Outcome Measures: Time to resumption of sexual intercourse after childbirth, reasons for resumption and problems associated with it., Methods: Partially coded questionnaires, Results: Sexual intercourse was resumed by 66.4% of the women within six months of childbirth. Of these 49.3% did so during the puerperium. The main reasons for early resumption of sexual intercourse were husbands' demands, cultural demands and inherent inability to do without sexual intercourse but not level of education of mothers. Of the mothers who resumed sexual intercourse 22.2% had sexual problems. The problems included vaginal pain (62.5%), discharge (18.8%), bleeding (15.6%) and bruises or tears (3.1%). Perineal or genital damage at the time of delivery was not associated with a delayed resumption of sexual intercourse with (OR1.08, 95% CI 0.51-2.30). Of those who had sexual intercourse and had problems only 59.4% sought medical assistance. The reasons for not resuming sexual intercourse within six months of delivery included advise from health workers (38.4%), husbands were away (21.9%), no interest (21.9%) and not feeling well(17.8%)., Conclusion: Most women resumed sexual intercourse within six months of childbirth and had high morbidity. There is need for appropriate postpartum sexual practice advice. SITE OF STUDY: Mulago hospital.