Obstetrics and Gynecology Commons^™

Pregnancy Cohorts And Biobanking In Sub-Saharan Africa: A Systematic Review, Jeffrey N. Bone, Kelly Pickerill, Mai-Lei Woo Kinshella, Marianne Vidler, Rachel Craik, Lucilla Poston, William Stones, Esperanca Sevene, Marleen Temmerman, Angela Koech

Obstetrics and Gynaecology, East Africa

Background: Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.

Methods: Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were …

Maternal And Perinatal Outcomes In Women With Eclampsia By Mode Of Delivery At Riley Mother Baby Hospital: A Longitudinal Case-Series Study, Philippe Amubuomombe Poli, Koech Irene, Richard Mogeni, Ann Mwangi, Andrew Cheruiyot, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital.

Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as …

To Be Or Not To Be An Obstetrician / Gynaecologist, Iffat Ahmed, Abid Ashar

Department of Obstetrics & Gynaecology

Objectives: This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges.
Methods: This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and …

Frequency And Outcome Of Meconium Aspiration Syndrome In Babies Born With Meconium-Stained Liquor At Secondary Care Hospital In Pakistan: A Case Series Study, Abdul Moeed, Heeramani Lohana, Sarwat Urooj, Sheraz Ahmed, Khalil Ahmed, Khadija N Humayun

Department of Paediatrics and Child Health

Background: Meconium aspiration syndrome (MAS) in the newborn is characterized by hypoxia, hypercapnia, and acidosis. MAS is a leading cause of morbidity and mortality in neonates. The primary objective of this study was to estimate the frequency of meconium aspiration syndrome (MAP) in babies born with meconium-stained liquor. The secondary outcome was to estimate the meconium aspiration syndrome; in terms of hospital stay, complications, and mortality.
Methods: The study was done at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan. Study design was case series and the duration of the study was of 6 months. All patients who fulfilled …

Nutritional Influences On The Health Of Women And Children In Cabo Delgado, Mozambique: A Qualitative Study, Adelaide Lusambili, Violet Naanyu, Gibson Manda, Lindsay Mossman, Stefania Wisofschi, Rachel Pell, Sofia Jadavji, Jerim Obure, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

In 2017, the Government of Mozambique declared localized acute malnutrition crises in a range of districts across Mozambique including Cabo Delgado. This is in spite of intensive efforts by different non-governmental organizations (NGO) and the Government of Mozambique to expand access to information on good nutritional practices as well as promote nutrition-specific interventions, such as cooking demonstrations, home gardens and the distribution of micronutrient powder to children. This paper examines and discusses key nutritional influences on the health of pregnant and breastfeeding mothers in Cabo Delgado province, Mozambique. We conducted 21 key informant interviews (KIIs) with a wide range of …

High Burden Of Self-Reported Sexually Transmitted Infections Among Key Populations In Mozambique: The Urgent Need For An Integrated Surveillance System, Makini A. S. Boothe, Charlotte Comé, Cynthia Semá Baltazar, Noela Chicuecue, Jessica Seleme, Denise Chitsondzo Langa, Isabel Sathane, Henry F. Raymond, Erika Fazito, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) - are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique.

Methods: Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates …

The Community-Level Interventions For Pre-Eclampsia (Clip) Cluster Randomised Trials In Mozambique, Pakistan, And India: An Individual Participant-Level Meta-Analysis, Peter Von Dadelszen, Zulfiqar Ahmed Bhutta, Sumedha Sharma, Jeffrey Bone, Joel Singer, Hubert Wong, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Tang Lee, Rahat Qureshi, Clip Trials Working Group

Woman and Child Health

Background: To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries.
Methods: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of …

Digital Breast Tomosynthesis Versus Additional Diagnostic Mammographic Views For The Evaluation Of Asymmetric Mammographic Densities, Hira Waheed, Imrana Masroor, Shaista Afzal Saeed, Muhammad Ismail Alvi, Syed Jahanzeb

Department of Radiology

Introduction: Many young females present with an advanced stage of breast cancer, which has a negative effect on the prognosis. Digital breast tomosynthesis is a new emerging imaging technique that aids in improving the specificity of mammography with subsequent early detection of breast cancer, especially in women with radiographically dense breasts. Tomosynthesis is subjectively preferred to conventional mammography and may offer superior diagnostic accuracy for the evaluation of breast lesions.
Method: Two breast radiologists retrospectively reviewed asymmetric densities using protocols that were institutional review board-approved in 185 patients aged 18 - 70 years (mean: 48 years) who underwent diagnostic mammography …

Microrna-16, Programmed Cell Death Protein-4 (Pdcd-4) And Polycystic Ovarian Syndrome, Naseem Zehra, Arfa Azhar, Rehana Rehman

Department of Biological & Biomedical Sciences

No abstract provided.

A Different Strategy For Management Of A Case Of Adenoid Cystic Carcinoma Of Bartholin Gland, Rozilla Sadia Khan, Huda Saleem Abbasi

Department of Obstetrics & Gynaecology

Adenoid cystic carcinoma of the Bartholin gland is a rare vulval cancer. Available literature suggests an aggressive nature with protracted clinical symptoms and local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. This case demonstrates the role of neoadjuvant chemotherapy and interstitial brachytherapy with less radical surgery, in the treatment of adenoid cystic carcinoma of the Bartholin gland. A 63-year-old woman presented in the clinic four months after the removal of vulvar mass with histopathology report showing adenoid cystic carcinoma of the Bartholin gland with positive margins. Clinical examination and imaging showed local disease extension up to the …

Changing Prevalence Of Gestational Diabetes Mellitus During Pregnancy Over More Than A Decade, Aisha Sheikh, Lumaan Sheikh

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Role Of Oxidative Stress And Altered Thyroid Hormones In Unexplained Infertility, Rehana Rehman, Hiba Ismail Rajpar, Mussarat Ashraf, Najeeha Talat Iqbal, Salima Lalani, Faiza Alam

Department of Biological & Biomedical Sciences

Objective: To explore the link between altered thyroid profile and oxidative stress marker in females with unexplained infertility.
Methods: The cross-sectional case-control study was carried out at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2016 to August 2017, and comprised women aged 18-40 years regardless of ethnic background who were divided into two groups; those with unexplained infertility were the cases, while fertile women acted as the controls. Serum was analysed for triiodothyronine, thyroxine and thyroid stimulating hormone as well as for oxidative stress markers including manganese superoxide dismutase, glutathione reductase and adrenaline using enzymelinked immunosorbent assay. …

Family Planning And Afghan Refugee Women And Men Living In Melbourne, Australia: New Opportunities And Transcultural Tensions, Alana Russo, Belinda Lewis, Razia Ali, Atiq Abed, Grant Russel, Stanley Luchters

Population Health, East Africa

This research aimed to explore the family planning perspectives and experiences of Afghan women and men living in Melbourne. A total of 57 Afghan women and men participated in six focus groups and 20 semi-structured interviews. The majority of participants indicated a preference for two or three children and were open to using modern contraception. However, many women described experiencing negative side effects when using hormone-based contraception and expressed difficulty negotiating condom use with their husbands as an alternative. Some women described how these difficulties resulted in inconsistent contraceptive practices and, at times, unintended pregnancy. Participants recognised that health professionals …

Interactions Between The Physical And Social Environments With Adverse Pregnancy Events Related To Placental Disorders—A Scoping Review, Yolisa Prudence Dube, Newton Nyapwere, Laura A. Magee, Marianne Vidler, Sophie E. Moore, Benjamin Barratt, Rachel Craik, Peter Von Dadelszen, Prestige Tatenda Makanga, Marleen Temmerman, Angela Koech, Patricia Okiro, Geoffrey Omuse, Sikolia Wanyonyi

Obstetrics and Gynaecology, East Africa

Background: Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions.

Methods: A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa.

Results: Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants.

Conclusions: More evidence is needed to determine the relationships between the environment and placental …

A Case Series On Uterine Arteriovenous Malformations: A Life-Threatening Emergency In Young Women, Rabia Hammad, Sidrah Nausheen, Mumtaz Malik

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is a rare condition, with few cases reported in the literature. Despite being rare, it is a potentially life-threatening condition in women of child-bearing age. It should be considered in the differential diagnosis of prolonged or irregular vaginal bleeding, which, otherwise, can lead to critical complications ending up in severe morbidity and mortality. This case series describes four cases of young Asian women aged between 33 and 38 years who presented with irregular vaginal bleeding. Trans-abdominal ultrasound of the pelvis showed increased vascularity with multi-directional blood flow in the uterus. Magnetic resonance imaging (MRI) confirmed an …

Persistence Of Oncogenic And Non-Oncogenic Human Papillomavirus Is Associated With Human Immunodeficiency Virus Infection In Kenyan Women, Yan Tong, Philip Tonui, Aaron Ermel, Elkanah Omenge, Nelson Wong, Titus Maina, Stephen Kiptoo, Kapten Muthoka, Patrick J. Loehrer, Darron R. Brown

Obstetrics and Gynaecology, East Africa

Objectives: Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia.

Methods: Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Faculty of Health Sciences, East Africa

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Delivery Of Sexual And Reproductive Health Interventions In Conflict Settings: A Systematic Review, Mariella Munyuzangabo, Dina Sami Khalifa, Michelle F. Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Sarah Metek, Shailja Shah, Reena P. Jain, Daina Als, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: It is essential to provide comprehensive sexual and reproductive health (SRH) interventions to women affected by armed conflict, but there is a lack of evidence on effective approaches to delivering such interventions in conflict settings. This review synthesised the available literature on SRH intervention delivery in conflict settings to inform potential priorities for further research and additional guidance development.
Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and SRH. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries …

Video Analysis Of Newborn Resuscitations After Simulation-Based Helping Babies Breathe Training, Ingunn Anda Haug, Kari Holte, Catherine L. Chang, Carolyn Purington, Joar Eilevstjønn, Anita Yeconia, Hussein Kidanto, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Simulation-based Helping Babies Breathe (HBB) training is currently rolled-out in around 80 low-income countries with various results.

Method: Workflow was analyzed in 76 video-recorded newborn resuscitations performed by regularly HBB-trained nurse-midwives over 3 years in rural Tanzania.

Results: Actual newborn resuscitation practice deviated from HBB intention/guideline: most newborns underwent prolonged suction and stimulation before ventilation; ventilation was delayed and frequently interrupted. Nurse-midwives often worked together.

Conclusions:There is a gap between training intention and clinical practice. HBB trainings should focus more on urgency, ventilation skills, and team training. Combining clinical debriefing with HBB simulations could facilitate continuous learning and …

Detection Of Types Of Hpv Among Hiv-Infected And Hiv-Uninfected Kenyan Women Undergoing Cryotherapy Or Loop Electrosurgical Excision Procedure, Elkanah Omenge, Jordan P. Emont, Aaron Ermel, Tao Liu, Victor Omodi, Yan Tong, Peter Itsura, Philip Tonui, Titus Maina, John M. Ong’Echa

Obstetrics and Gynaecology, East Africa

Objective: To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia.

Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array.

Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence …

Achieving Accurate Estimates Of Fetal Gestational Age And Personalised Predictions Of Fetal Growth Based On Data From An International Prospective Cohort Study: A Population-Based Machine Learning Study, Russell Fung, Jose Villar, Ali Dashti, Leila Cheikh Ismail, Eleonora Staines-Uria, Eric O. Ohuma, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta, International Fetal And Newborn Growth Consortium For The 21st Century (Intergrowth-21st)

Department of Obstetrics & Gynaecology

Background: Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18-36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth.
Methods: …

Perceptions And Experiences Of Men And Women Towards Acceptability And Use Of Contraceptives In Underserved Areas Of Karachi, Pakistan: A Midline Qualitative Assessment Of Sukh Initiative, Karachi Pakistan, Sarah Saleem, Narjis Rizvi, Anam Feroz, Sayyeda Reza, Saleem Jessani, Farina Abrejo

Community Health Sciences

Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.
Methods: A qualitative study was conducted at ten …

Non-Adherence To Who Recommendations Regarding Infant Feeding Practices Results In Dilemma Of Malnourishment: A Community-Based Prospective Cohort Study Conducted In Karachi, Pakistan, Muhammad Osama, Anosh Aslam Khan, Sohaib Hasan Syed, Osama Mohiuddin, Ammar Hassan, Syeda Ramsha Zaidi, Neelofar Sami

Community Health Sciences

Background: The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.
Methodology: Our study is a prospective cohort including 300 infants without predisposing congenital anomaly, followed from 6 months to 18 months of age. The primary outcome …

International Gestational Age-Specific Centiles For Umbilical Artery Doppler Indices: A Longitudinal Prospective Cohort Study Of The Intergrowth-21st Project, Lior Drukker, Eleonora Staines-Urias, José Villar, Fernando C. Barros, Maria Carvalho, Shama Munim, Rose Mcgready, Francois Nosten, James A. Berkley, Shane A. Norris, Ricardo Uauy, Stephen H. Kennedy, Aris T. Papageorghiou

Department of Obstetrics & Gynaecology

Background: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.
Objectives: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21^st Project.
Study design: In Phase II of the INTERGROWTH-21^st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original …

A Mobile Phone–Based Sexual And Reproductive Health Intervention For Female Sex Workers In Kenya: Development And Qualitative Study, Frances H. Ampt, Kelly L'Engle, Megan S. C. Lim, Kate F. Plourde, Emily Mangone, Collins Mudogo Mukanya, Peter Gichangi, Griffins Manguro, Margaret Hellard, Walter Jaoko, Paul A. Agius, Marleen Temmerman, Winnie Wangari, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.

Objective: This paper aimed to (1) describe …

Religious, Socio-Cultural Norms And Gender Stereotypes Influence Uptake And Utilization Of Maternal Health Services Among The Digo Community In Kwale, Kenya: A Qualitative Study, Vernon Mochache, George Wanje, Lucy Nyaga, Amyn Lakhani, Hajara El-Busaidy, Marleen Temmerman, Peter Gichangi

Obstetrics and Gynaecology, East Africa

Background: Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya.

Methods: Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and …

Risk Factors For Postpartum Sepsis: A Nested Case-Control Study, Samina Bakhtawar, Sana Sheikh, Rahat Qureshi, Zahra Hoodbhoy, Beth Payne, Iqbal Azam Syed, Peter Von Dadelszen, Laura Magee

Community Health Sciences

Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.
Methods: A case-control study was nested in an …

Adverse Childhood Experiences And Changing Levels Of Psychosocial Distress Scores Across Pregnancy In Kenyan Women, Pauline Samia, Shahirose Premji, Farideh Tavangar, Ilona S. Yim, Sikolia Wanyonyi, Mohamoud Merali, Wangira Musana, Geoffrey Omuse, Ntonghanwah Forcheh, Aliyah Dosani, Nicole Letourneau, The Maternal Infant Global Health Team (Might) Collaborators In Research

Paediatrics and Child Health, East Africa

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy.

Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy.

Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). As depressive symptoms decreased, t (167) = −8.44, p < 0.001, perceived stress increased, t (167) = 4.60, p < 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p < 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p < 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy.

Conclusions: Higher total ACEs were positively associated with …

Maternal Inflammatory Markers For Chorioamnionitis In Preterm Prelabour Rupture Of Membranes: A Systematic Review And Meta-Analysis Of Diagnostic Test Accuracy Studies, Angela Koech, Geoffrey Omuse, Abraham Mukaindo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: There is no consensus on the role of inflammatory markers in identifying chorioamnionitis in preterm prelabour rupture of membranes (PPROM). We set out to evaluate the accuracy of maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) in diagnosis of histological chorioamnionitis and/or funisitis (HCA/Funisitis) in PPROM.

Methods: We searched MEDLINE, EMBASE and The Cochrane Library from inception to January 2020 for studies where maternal blood CRP, procalcitonin or IL6 was assessed against a reference standard of HCA/Funisitis in PPROM. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess methodological quality. Hierarchical summary …

Delivery Mode For Prolonged, Obstructed Labour Resulting In Obstetric Fistula: A Retrospective Review Of 4396 Women In East And Central Africa, C. J. Ngongo, T. J. Raassen, L. Lombard, J Van Roosmalen, S. Weyers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula.

Design: Retrospective record review.

Setting: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia.

Population: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014.

Methods: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries.

Main outcome measures: Mode of delivery, stillbirth.

Results: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among …