Faculty of Obstetrics and Gynaecology

Permanent URI for this collectionhttps://repository.gcps.edu.gh/handle/123456789/18

Browse

Now showing 1 - 7 of 7

DIABETIC KETOACIDOSIS IN PREGNANCY AND MATERNAL AND FETAL OUTCOMES IN KORLE BU TEACHING HOSPITAL
(Ghana College of Physicians and Surgeons, 2023-03-31) AGYAPONG, JEFF OSEI
Introduction Diabetic ketoacidosis (DKA) is a state of relative or absolute insulin deficiency that results in major metabolic changes including increased glucose production accompanied by decreased peripheral uptake and enhanced protein catabolism and lipolysis. It affects 1 to 3% of diabetic pregnancies. It most commonly complicates type 1 diabetes mellitus (DM) but also affects type 2 DM and more occasionally gestational DM. The incidence is higher in the second and third trimesters of pregnancy when insulin resistance peaks. Diagnosis is based on a triad of hyperglycaemia, ketonaemia or ketonuria, and metabolic acidosis. In pregnancy, DKA tends to occur at lower blood glucose levels. Euglycaemic DKA is a rare condition in which ketoacidosis occurs at normal blood glucose levels. This occurs more commonly in pregnancy. DKA in pregnancy significantly increases the risk of maternal and fetal morbidity and mortality. Management can be very challenging and must involve a multidisciplinary team in a high-dependency or intensive care unit. Maternal complications include acute kidney injury, adult respiratory distress syndrome, cerebral oedema, coma, and death. Fetal complications include fetal heart rate abnormalities, fetal demise, prematurity, and long-term neurodevelopmental delay. The objective of this study was to determine the incidence of DKA in pregnancy in KBTH and maternal and fetal outcomes. Methods This was a prospective cohort study. The study population was pregnant women with diabetes admitted at KBTH. Pregnant women who met the eligibility criteria were screened for ketonuria every time they were seen at the obstetrics emergency room or admitted to the maternity ward or labour ward. Women with urine ketones ≥2+ were tested for bicarbonate and/or pH. Women with pH<7.3 or bicarbonate <15mmol/l became the DKA cases. All the women were followed up for maternal and fetal outcomes including maternal mortality, fetal demise, preterm birth, etc. The association between DKA and maternal and fetal outcomes was determined with logistic regression using a confidence interval (CI) of 95%. Odds ratios were obtained and measurements with p-value <0.05 were deemed statistically significant. Multivariate analysis was done to control for confounders and adjusted odds ratios were determined. viii Results We screened 234 women, representing 91% of pregnant women with diabetes who were admitted at KBTH from 1 st September 2021 to 28th February 2022. Forty-four of them had significant ketonuria and six had DKA, giving an incidence of 2.6%. Two-thirds of the cases occurred in the second and third trimesters. Half occurred in women with GDM. A third had euglycaemic DKA. All the cases were managed according to the KBTH management protocol for DKA in pregnancy. They all recovered. There was no maternal mortality among the DKA cases. We found no significant effect of DKA on maternal and fetal outcomes. Conclusions The incidence of DKA in pregnancy in KBTH is similar to what has been reported in other parts of the world. Universal screening of all pregnant women with diabetes for DKA led to early diagnosis and prompt treatment. The pregnancy outcomes in pregnant women with DKA were comparable to those without DKA.
FACTORS ASSOCIATED WITH ABNORMAL CERVICAL CYTOLOGY AMONG 6 POSTPARTUM WOMEN IN THE ACCRA METROPOLIS
(Ghana College of Physicians and Surgeons, 2023-05-22) AMOH, MICHAEL YAW
Background Cervical cancer is a growing global health issue that significantly increases morbidity and mortality among women, particularly those in sub-Saharan Africa. The extended pre-invasive stage of the disease characterized by cervical cytological abnormalities can be detected early and prevented from developing into invasive tumors with the aid of robust screening procedures such as Pap (Papanicolaou) smear. Ghana does not have a national programme on screening for cervical cancer. The postpartum period presents a golden opportunity for a Pap smear to be done as most women will go through this stage at least once in their lifetime and also, a large cohort of women can be evaluated at that time. Aim To determine the prevalence and the types of abnormal cervical cytology as well as the associated factors among 6 weeks postpartum women in selected hospitals in the Accra Metropolis. Methodology In this cross-sectional study, 370 women who were 6 weeks postpartum and attended postnatal clinics at Korle Bu Teaching Hospital and the Greater Accra Regional Hospital were assessed for the prevalence and the types of abnormal cervical cytology as well as the associated factors. Participants were recruited via consecutive sampling after ethical approval and informed consent had been obtained. Pretested researcher administered questionnaire was used to collect the socio-demographic, obstetric and gynaecologic characteristics of the participants. Conventional Pap smears were taken and analyzed for all the study participants. Those with abnormal results underwent colposcopy. Data collected were summarized and analyzed using Statistical Package for the Social Sciences version (SPSS) 20. Descriptive statistics such as frequencies, mean and standard deviation were used. Bivariate analysis and multivariate analysis with logistic regression were used to model associations between the dependent and independent variables. A p-value of <0.05 was considered statistically significant at a confidence interval of 95%. Results In all data on 370 participants were included in the analysis. The prevalence of abnormal cervical cytology among the participants was 39/370 (10.5%) at a confidence interval of 95% (7.6%-14.1%). ASCUS (Atypical Squamous Cell of Undetermined Significance) was the most common abnormal cervical cytology representing 31/370 (8.4%). A multiple logistic regression analysis showed that a history of Sexually Transmitted Infection (aOR = 34.88; 95% CI = 13.75 – 88.48; p < 0.001) and a history of irregular condom use (aOR = 4.95; 95% CI = 2.03 – 12.05; p < 0.001) were significantly associated with abnormal cervical cytology. Colposcopy was performed on all participants with abnormal cervical cytology, excluding ASCUS, and the results were adequate and normal. Conclusion The prevalence of abnormal cervical cytology in the post-partum period is 10.5%. The factors associated with abnormal cervical cytology are a history of Sexually Transmitted Infection and a history of irregular condom use. Colposcopy was adequate and normal for all the participants who had abnormal cervical cytology. Efforts must be made to include routine cervical precancer screening in the care given to women during their six-week postpartum visit.
SONOGRAPHIC MEASUREMENT OF THE FETAL ADRENAL GLAND AS A MARKER OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA.
(GHANA COLLEGE OF PHYSICIANS & SURGEONS, 2023-11-13) ADARKWA, OPEI KWAFO
Background Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality worldwide. The situation is alarming in Lower- and Middle-Income Countries like Ghana. Data from the two leading tertiary referral centres in Ghana corroborate these statistics. Perinatal morbidity and mortality rates remain high despite several advances. This has been the situation in the two leading Tertiary Health facilities in Ghana. Tools are needed to better predict perinatal outcomes, improve clinical decision-making, and facilitate parental counselling. The fetal adrenal gland plays a crucial role in the survival of the fetus in utero, ex-utero and later in life especially under stressful conditions like preeclampsia. Few studies have investigated the role of the ultrasound measurement of the fetal adrenal gland among growth-restricted fetuses. This is a major fetal complication of preeclampsia and further studies are needed to better elucidate the role of gestational-age-specific fetal adrenal gland size as a marker of adverse perinatal outcomes. Objective The main objective of the study was to evaluate the ultrasound measurement of the fetal adrenal gland dimensions and their relationship with adverse perinatal outcomes in preeclampsia. Methods This was a cross-sectional study conducted in a tertiary referral facility in Ghana, which explored the sonographic measurement of the human fetal adrenal gland and its relationship with adverse perinatal outcomes. The study involved 120 pregnant women aged at least 18 years and above with Preeclampsia, carrying singleton non-anomalous fetuses, with Estimated Gestational Ages above 28 weeks. Sonographic measurements of the Fetal Adrenal gland and key clinical data such as physical examination findings and important laboratory results were taken. Perinatal outcome data were extracted from patients’ records on the 7th day after delivery. Data captured was cleaned and transported into STATA 17.0 and analysed. The main outcome of the study was a composite of adverse perinatal outcome including low APGAR scores (<7) at the 5th minute, neonatal death, NICU admission, stillbirth, seizures, and iv Final version 1.0 6/2023 intubation, oxygen therapy. These were compared to the measured fetal adrenal gland dimensions. Results In all 80.00% were classified as having adverse perinatal outcomes and 20.00% had good perinatal outcomes. There was a statistically significant difference between the means of the fetuses that had an adverse perinatal outcome and a good perinatal outcome. The means of fetuses who eventually had an adverse outcome were smaller compared to those who had a good outcome. The Total Adrenal gland length and the Total Adrenal Gland Volume remained statistically significant even after adjusting for gestational age. P value <0.05 was used as the level of significance. The two dimensions obtained an Area Under the Receiver Operating Curve of 0.8268 and 0.8303. Conclusion There was a statistically significant relationship between the Total Adrenal Gland Length, Total Adrenal Gland Volume and perinatal outcomes of fetuses of mothers with preeclampsia with relatively good predictive ability. Further research is needed to calibrate its use.
LABOUR INDUCTION: TRANSVAGINAL SONOGRAPHIC CERVICAL LENGTH VERSUS BISHOP SCORE IN PREDICTING VAGINAL DELIVERY AT KORLE-BU TEACHING HOSPITAL
(GHANA COLLEGE OF PHYSICIANS & SURGEONS, 2023) MENSAH, TERESA ABA
BACKGROUND Induction of labour is a common and important obstetric intervention for averting caesarean section whiles optimizing pregnancy outcomes. Traditionally, cervical assessment for favourability of induction has been done using the Bishop Score which involves invasive digital vaginal examination; with a score greater than 6 out of 13 considered favourable. Transvaginal sonographic cervical assessment of the cervix is considered a useful stand-alone tool for cervical assessment. It is less invasive and may be comparable to the Bishop Score in predicting successful induction, given the limitations of the Bishop Score. The main objective of this study was to compare the transvaginal sonographic cervical length and the Bishop Score in the prediction of successful induction among pregnant women with low risk postdate pregnancies induced at Korle- Bu Teaching Hospital. METHODOLOGY This was an analytical cross-sectional study conducted between 1st July 2022 and 30th April 2023. The study population comprised women with low risk postdate pregnancies admitted to the maternity unit of Korle- Bu Teaching Hospital for a scheduled induction of labour. The Bishop Score and transvaginal sonographic cervical assessments were done for all participants before the start of induction. The primary outcome was the predictive abilities of the transvaginal sonographic cervical length and the Bishop Score in predicting vaginal delivery within 24 hours. Secondary outcomes included the pain scores post assessment, number of hours from induction to delivery and adverse maternal and perinatal outcomes. Data analysis was done using STATA 17. Appropriate statistical tests for comparison of categorical and continuous values were used (independent t test, Wilcoxon Rank Sum test, Chi-square test and Fisher’s exact test). Optimum cut off values were identified with Receiver Operator Characteristic Curves and the predictive values determined for both successful induction of labour and vaginal delivery. RESULT Of 184 women recruited, 168 participants were included in the final analysis. The rate of vaginal delivery was 82.1%. Successful induction occurred in 117 out of 168 participants (69.9%) with a confidence interval of 62.1-76.5. vii Bishop Score ³ 4 was predictive of both successful induction and vaginal delivery. Transvaginal sonographic cervical length £ 2.31cm was predictive of successful induction and transvaginal sonographic cervical length £ 2.5cm was predictive of vaginal delivery. The predictive values of transvaginal sonographic cervical length were (sensitivity: 48.7%, specificity: 66.7%, Area under Receiver Operator Characteristic curve: 0.5769). The predictive values of Bishop Score were (sensitivity: 80.3%, specificity: 41.2%, Area under Receiver Operator Characteristic curve: 0.6076). Ninety five percent of women preferred the transvaginal sonographic cervical length. CONCLUSION Bishop Score and transvaginal sonographic cervical length were shown to be comparable in predicting both successful induction and vaginal delivery when used for pre induction cervical assessment. Transvaginal sonographic cervical length measurement was better tolerated by patients than Bishop Score assessment. In a tertiary setting where expertise for and availability of transvaginal ultrasound exist, transvaginal sonographic cervical length may be the more desirable pre-induction cervical assessment tool or a viable alternative for patients who cannot tolerate the pain of Bishop Score assessment. vii
OVARIAN STIMULATION OUTCOMES IN WOMEN CLASSIFIED AS EXPECTED POOR OVARIAN RESPONDERS UNDERGOING AUTOLOGOUS ASSISTED REPRODUCTIVE TECHNOLOGY IN KUMASI, GHANA
(KANFRA MAWUSE, 2024-03-27) KANFRA, MAWUSE
Introduction: Poor ovarian response (POR) in in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) programs refers to an insufficient response to standard superovulation regimens, resulting in few mature oocytes. This deficiency reduces oocyte yield, embryo yield, cumulative live birth rates, and overall, IVF/ICSI-embryo transfer effectiveness. Managing POR presents challenges in IVF/ICSI-embryo transfer programs, leading to emotional distress and financial burden, especially when IVF/ICSI-embryo transfer is self-funded. Fertility specialists and infertile couples require data to aid in counselling and decision-making for poor ovarian responders, especially for women reliably identified as expected POR. However, knowledge about POR in Africa, particularly in Ghana, is limited. Are the outcomes of OS in women with expected POR different between POSEIDON groups three and four? This study assessed the outcome of ovarian stimulation among women classified as expected POR undergoing autologous IVF or ICSI in Kumasi, Ghana. Methods: A multicenter prospective study involving 117 consecutively selected women with expected POR undergoing autologous IVF/ICSI-embryo transfer in six fertility centres in Kumasi was conducted from August 2023 to February 2024. The study participants were classified as expected POR using the Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. A pretested structured questionnaire was used to collect data on participants’ socio-demographic characteristics, obstetric and gynecological characteristics, and the outcomes of ovarian stimulation (OS). Data were analyzed and summarized using descriptive statistics including frequencies and percentages. The OS outcomes (i.e., number of oocytes retrieved, number of metaphase 11 oocytes, number of embryos formed, number of blastocytes obtained, cycle cancellation rates, positive pregnancy test and clinical pregnancy rates) were compared using chi-square and the students’ t-test with a p-value of <0.05 deemed statistically significant. Results: The proportion of expected POR among women who underwent autologous IVF/ICSI embryo transfer was 31.6% (n = 117). The age range of participants was 27-48 years, with the mean age being 37.5 (±3.7) years. Over two-thirds (68.4%) of the study participants had primary infertility and a median infertility duration of 6 years. Generally, the total cycle cancellation rate iv among the study participants was 38.5%, and out of this, 18.8% of them had their cycle cancelled before oocyte-pick up. About 21.4% of the women achieved clinical pregnancy. There was no statistically significant difference in OS outcomes (i.e., number of oocytes retrieved, number of metaphase 11 oocytes, number of embryos formed, number of blastocytes obtained, cycle cancellation rates, positive pregnancy test and clinical pregnancy rates) among the two groups of women with expected POR according to the POSEIDON criteria. Conclusion: The current study found that the proportion of expected POR among women who underwent autologous IVF/ICSI-embryo transfer in the fertility centres in Kumasi was low. Similarly, the proportion of the study participants who achieved clinical pregnancy was low. Additionally, there was a high cycle cancellation rate among the study participants. OS outcomes were similar in the two expected POR groups (POSEIDON groups 3 and 4).
LOW DOSE ASPIRIN PROPHYLAXIS USE AMONG PRE-ECLAMPTIC/ECLAMPTIC WOMEN WITH HISTORY-BASED RISK FACTOR(S) IN A TERTIARY HOSPITAL IN GHANA
(OWUSU, YAW GYANTEH, 2022-09-29) OWUSU, YAW GYANTEH
Background Pre-eclampsia/eclampsia remains a top cause of maternal morbidity and mortality as well as a major cause of perinatal morbidity and mortality at Komfo Anokye Teaching Hospital and the world over. Starting low dose aspirin before 16 weeks in high-risk women prevents preterm preeclampsia. Anecdotal evidence suggests that it is common to find patients admitted with preeclampsia/eclampsia with risk factors at the beginning of pregnancy who would have benefited from low dose aspirin but never received it. Objective This study assesses the use of prophylactic low dose aspirin among women admitted to Komfo Anokye Teaching Hospital with pre-eclampsia/eclampsia who had history-based risk factors in early pregnancy. Methods This is a cross-sectional analytical study. Women admitted to the obstetric high dependency unit with preeclampsia/eclampsia were recruited consecutively till the sample size of 271 was attained. A structured questionnaire, antenatal care records, hospital in-patient records and discharge notes were used to obtain the relevant data which were analyzed using IBM SPSS version 26.0. Chi square was used to assess associations of adverse maternal and fetal/neonatal outcomes among women that received low dose aspirin compared to those that did not receive low dose aspirin. P-values less than 0.05 were considered statistically significant. Results 59% of the women with preeclampsia/eclampsia had the risk factors warranting prophylactic low dose aspirin in early pregnancy with only 26.9% of these high-risk women receiving prophylactic low dose aspirin. Low dose aspirin prophylaxis was significantly associated with estimated gestational age of pre-eclampsia/eclampsia diagnosis (p < 0.0001). Low dose aspirin prophylaxis was significantly associated with a reduction in the incidence of intra- uterine growth restriction (p = 0.008), intra-uterine fetal death/termination of pregnancy (p = 0.001), prematurity (p = 0.001), neonatal intensive care unit admission (p = 0.001), neonatal mortality (p = 0.023) as well as the composite adverse neonatal outcome (p = 0.001). Low dose aspirin prophylaxis significantly reduced maternal organ dysfunction (P = 0.001) with no significant reductions observed for other maternal outcomes of caesarean section, eclampsia, CVA, maternal mortality as well as the composite adverse maternal outcomes. Conclusion Whiles the risk factors for preeclampsia do exist in our women at booking, majority of these high-risk women are not receiving prophylactic low dose aspirin. Prophylactic low dose aspirin reduces the incidence of early onset preeclampsia with a reduction in adverse fetal outcomes but no reductions in adverse maternal outcomes except for maternal organ dysfunction.
COMPARISON OF EFFECTIVENESS OF COUNSELLING ONLY, SUPPOSITORY DICLOFENAC AND LIDOCAINE SPRAY AT INTRAUTERINE DEVICE INSERTION
(YANNEY HENRY EKOW, 2021-09-30) YANNEY, HENRY EKOW
Background In Ghana, only 0.8% of married and 0.4% of unmarried women are on IUD. The perception of pain at IUD insertion is one of the main barriers of its uptake. Several pharmacological and non-pharmacological interventions have been studied. Despite these attempts, there is currently no consensus on the best form of pain management at IUD insertion. The aim of this study was therefore to compare the effectiveness of counselling only (standard of care), 10% lidocaine spray of the cervix and 100mg suppository diclofenac sodium in reducing pain at IUD insertion. Methodology A prospective study involving women of reproductive age who presented at the Family Planning Unit, Korle Bu Teaching Hospital and had accepted IUD method of contraception was conducted. Clients who met the inclusion criteria were randomized into 3 arms; suppository diclofenac, lidocaine spray and counselling only arms in a ratio of 1:1:1. A calculated sample size of 99 participants, 33 in each arm was used. All participants had a baseline counselling on the procedure and then those on diclofenac arm were given 100mg diclofenac sodium suppository 30 minutes whilst the 10% lidocaine spray arm were given 4 pumps on the cervix before the insertion. Using a 10cm- Visual Analog Scale (VAS), the pain experienced at various stages of IUD insertion, the overall pain experienced after IUD insertion, 5 minutes and 4 hours post procedure were assessed. Mean pain scores were compared using a one way ANOVA and a Post-Hoc test used to compare which two groups were significantly different from each other. Categorical variables between groups were compared using a chi-square test. The statistical significance was set at p < 0.05 and confidence interval at 95%. Results Ninety nine participants were recruited for the study. The average age of the participants was 33.6+ 6.2 years whilst the average BMI was 29.5+ 5.7kg/m2. There were 11/99 (11.11%) of respondents who were single, 3/99 (3.03%) who did not have formal education, 39/99 (39.39%) of them who had tertiary education; and 34/99 (34.34%) who were professionals. Traders and artisans represented 31/99 (31.31%) each and majority 93/99 (93.94%) were Christians. Suppository diclofenac was superior to counselling only at pain control during speculum insertion, tenaculum insertion, uterine sound insertion, IUD placement, immediately after procedure and 5 minutes after procedure. Lidocaine spray of the cervix on the other hand, was superior to counselling only throughout the procedure and up to 4 hours post procedure. Again, Lidocaine spray of the cervix was found to be superior to suppository diclofenac at pain control 5 minutes after procedure (mean pain score 0.6 versus 1.5) and 4 hours after procedure (0.7 versus 0.9) Conclusion Lidocaine spray (10%) of cervix is more effective compared to 100mg Diclofenac Sodium in reducing pain at IUD insertion. The use of 10% lidocaine spray of cervix at insertion of IUD will therefore greatly enhance clients’ satisfaction at IUD insertion and in the long run help to increase the uptake of the IUD, a highly effective long acting reversible contraceptive.

Browse

Recent Submissions