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Item 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, BoniphaceABSTRACT. 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. mortalityItem 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, MonicaBackground: 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.Item Does the use of modern family planning promote healthy timing and spacing of pregnancy in Dar es Salaam?(Reproductive health, 2013) Mageta, Debora.; Muganyizi, Projestine S.Background Timing, spacing and limiting of pregnancy are key outcomes of family planning (FP) whose role in promoting health of mothers and babies is evidence based. Despite the evidence, recent studies in Tanzania have reported a trend towards child birth in older age, non-adherence to standard inter-pregnancy spacing, and preference of large families in the background of a rising national contraceptive prevalence rate. We explored if the use of modern FP promotes healthy timing and spacing of pregnancy among women seeking antenatal services. Design Analytical Cross-sectional study Methods Women seeking antenatal services at Muhimbili National Hospital, Tanzania (August-October, 2012) were enrolled. We used a semi-structured questionnaire to obtained information from the women. Data were analyzed using SPSS version 19. Outcomes of interest were adherence to timing of first pregnancy and to inter-pregnancy spacing after normal childbirth. Use of modern FP prior to index pregnancy was the independent variable of primary interest. Bivariate and multivariate logistic regression analyses were conducted to obtain odds ratios (OR) and 95% confidence intervals (CI) as estimates risk and clinical importance respectively. Ethical approval was obtained from the Research and Publications Committee at Muhimbili University of Health and Allied Sciences. Results In total 427 women were interviewed. Ages ranged 15–45 years, mean 29.2 (SD ± 5.1). Among all, 129 (30.2%) were primigravida, 298 (69. 8%) multigravida. Of these 298 women, 51 (17.1%) lost pregnancies preceding the index. Overall, 179 (41.9%) had ever used modern FP, 103 (24.1%) were on modern FP just prior to index pregnancy. Non-adherence to timing was increased for primigravida (AOR = 4.5, 95% CI: 2.1-9.6) and for women older than 29 years (AOR = 7.6 95% CI: 3.8-15.2). Non-adherence to spacing was increased with loss of the immediate past pregnancy (AOR = 2.5; 95% CI: 1.3-4.7). Use of modern FP was neither associated with adherence to timing (AOR = 1.0; 95% CI: 0.5-1.9) nor spacing (AOR = 1.0; 95% CI: 0.6-1.8). Conclusion Modern FP does not promote adherence to timing and spacing of pregnancy among women seeking antenatal services at MNH. Past obstetric experience was key to women’s decisions on spacing. There is need to promote educational messages on timing and spacing of pregnancy for healthy outcomes.