Obstetrics and Gynaecology

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Browsing Obstetrics and Gynaecology by Author "Chiduo, Monica"

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    Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
    (East African Health Research Journal, 2022-07) Mushema, Beata; Makanda, Isaac H.; Chiduo, Monica
    Background: Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fundamental role in guiding the treatment approach and minimizing potential complications. However, the vague presentation coupled with low accuracy of ultrasound detection often leads to misdiagnosis of abdominal pregnancy, and hence delaying initiation of appropriate management. We present a case of a second trimester abdominal pregnancy detected following failure of induction for an initial diagnosis of missed abortion, and the ensuing outcome, rarely reported in limited-resource settings. Case presentation: A 19 year old unbooked woman, gravida 2 para 1 at 17thweek gestation age by ultrasound presented with loss of foetal movement for one week. Based on clinical assessment and referral ultrasound findings, she was initially diagnosed with missed abortion and planned for induction. Failure of induction prompted a repeat ultrasound which revealed a non-viable abdominal pregnancy. Laparotomy was done, localisation of the pregnancy at the omentum was observed and a dead foetus was extracted with the placenta left in-situ. A complication of surgical wound dehiscence with infection developed post-operatively and was managed with secondary sutures. The patient recovered and was discharged in a stable condition. Conclusion: This case demonstrates that the diagnosis of abdominal pregnancy remains a challenge especially in settings where skilled human resources for health are few and equipment and supplies for effective and timely treatment are limited. The case sheds some light on the broader challenges in maternal and perinatal health in developing countries. Accurate pre-operative diagnosis requires a high index of suspicion, especially due to the variability of its presentation. This case emphasises the important of quality antenatal care and the need for clinicians to conduct comprehensive assessments of patients and receive training on obstetric ultrasound skills.
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    Fetal-maternal outcomes of induction of labour among women delivered at Regional referral hospitals in Dar es salaam Tanzania
    (African Journal of Applied Research, 2022) Chuwa, Salvatory; Chiduo, Monica; Sylvester, Boniphace
    ABSTRACT. Purpose: Africa has a very low rate of induction of labour with high maternal and perinatal morbidity and mortality. However fetal-maternal outcomes following induction of labour are not well documented in Tanzania. This study aimed to assess fetal-maternal outcomes following induction of labour among women delivered at Dar es Salaam regional referral hospitals in Tanzania. Design/methodology/Approach: A total of 301 expectant mothers were recruited in a prospective observational study conducted at all regional referral hospitals in Dar es Salaam, Tanzania. Data on fetal-maternal outcomes were collected using a pre-designed clinical sheet. Demographic data, obstetric history, methods as well as outcomes of labour induction were recorded. The continuous variables were summarized using the median and corresponding interquartile range. Categorical variables were summarized using frequency and proportions and the significance of differences were assessed using Chi-square at P<0.05. Results: The leading methods for induction of labour were Oxytocin (48.5%) and a combination of Folley’s catheter with Oxytocin (28.4%). Induction of labour significantly improved fetal outcomes at birth P<0.05. Induction of labour associated with improved Apgar scores in newborn babies. Failure of induction of labour was the largest contributor to the increased Caesarean Section rate observed in this study. Research limitation/Implication: This study has therefore explored the fetal-maternal outcomes following induction of labour in Tanzanian regional referral hospitals. Practical implication: Induction of labour improves and minimizes neonatal complications in referral regional hospitals in Dar es Salaam. Originality/Value: These findings fill a gap of information which was missing on the fetal- maternal outcomes following induction of labour among expectant mothers in Dar es Salaam regional referral hospitals. Keywords: Fetal-materna. hospital. induction. labour. mortality