Search

Background: Women with previous cesarean deliveries, have a heightened risk of poor maternal and perinatal outcomes, associated with short interbirth intervals. We determined the prevalence of short interbirth interval, and associated factors, among women with antecedent cesarean deliveries who delivered at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda., Methods: We conducted a cross-sectional study on the postnatal ward of MRRH from November 2020 to February 2021. We enrolled women who had antecedent cesarean deliveries through consecutive sampling. We obtained participants' socio-demographic and obstetric characteristics through interviewer-administered structured questionnaires. We defined short interbirth interval as an interval between two successive births of < 33 months. Modified Poisson regression was used to identify factors associated with short interbirth intervals., Results: Of 440 participants enrolled, most had used postpartum family planning (PPFP) prior to the current pregnancy (67.5%), and most of the pregnancies (57.2%) were planned. The mean age of the participants was 27.6 ± 5.0 years. Of the 440 women, 147 had a short interbirth interval, for a prevalence of 33% (95%CI: 29-38%). In multivariable analysis, non-use of PPFP (adjusted prevalence ratio [aPR] = 2.24; 95%CI: 1.57-3.20, P < 0.001), delivery of a still birth at an antecedent delivery (aPR = 3.95; 95%CI: 1.43-10.9, P = 0.008), unplanned pregnancy (aPR = 3.59; 95%CI: 2.35-5.49, P < 0.001), and young maternal age (aPR = 0.25 for < 20 years vs 20-34 years; 95%CI: 0.10-0.64, P = 0.004), were the factors significantly associated with short interbirth interval., Conclusion: One out of every three womenwith antecedent caesarean delivery had a short interbirth interval. Short interbirth intervals were more common among women with history of still births, those who did not use postpartum family planning methods, and those whose pregnancies were unplanned, compared to their counterparts. Young mothers (< 20 years) were less likely to have short interbirth intervals compared to those who were 20 years or older. Efforts should be made to strengthen and scale up child-spacing programs targeting women with previous cesarean deliveries, given the high frequency of short interbirth intervals in this study population., (© 2022. The Author(s).)

Purpose: To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS). Methods: A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors. Results: There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1– 15.4), Repeat CS (OR = 4.1; 95% CI: 1.8– 9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5– 15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2– 16.7). Conclusion: The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula. [ABSTRACT FROM AUTHOR]

Introduction. The global prevalence of maternal anemia is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25% to 30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on the prevalence of newborn anemia and its risk factors in people living in resource-limited settings. Objectives. We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda. Methods. This was a cross sectional study of 352 pregnant women presenting to the Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein. We measured hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the study participants and compared demographic characteristics and outcomes using chi-square, t-test, and Wilcoxon rank sum analyses. We defined newborn anemia as umbilical cord hemoglobin <13 g/dl and measured the relationship between maternal and umbilical cord hemoglobin using linear regression analysis. Results. The prevalence of newborn anemia was 17%. Maternal parity was significantly higher for anemic than nonanemic newborns (3 versus 2, P = 0.01). The mean age in years (SD) was significantly lower for participants with umbilical cord hemoglobin <13 g/dl than those ≥13 g/dl (26 years [5.6] versus 28 [6.3], P = 0.01). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin (P = 0.02). Each one-unit increase in parity was associated with a 0.25-point decrease in umbilical cord hemoglobin (P = 0.01). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared with vaginal delivery (P = 0.03). Conclusions. We found a significant association between maternal and newborn hemoglobin, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor for neonatal anemia. [ABSTRACT FROM AUTHOR]