BackgroundGlobally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different risk factors for PPH. We assessed the incidence of, and risk factors for postpartum hemorrhage among rural women in Uganda.MethodsBetween March 2013 and March 2014, a prospective cohort study was conducted at six health facilities in Uganda. Women were administered a questionnaire to ascertain risk factors for postpartum hemorrhage, defined as a blood loss of 500 mls or more, and assessed using a calibrated under-buttocks drape at childbirth. We constructed two separate multivariable logistic regression models for the variables associated with PPH. Model 1 included all deliveries (vaginal and cesarean sections). Model 2 analysis was restricted to vaginal deliveries. In both models, we adjusted for clustering at facility level.ResultsAmong the 1188 women, the overall incidence of postpartum hemorrhage was 9.0 %, (95 % confidence interval [CI]: 7.5–10.6 %) and of severe postpartum hemorrhage (1000 mls or more) was 1.2 %, (95 % CI 0.6–2.0 %). Most (1157 [97.4 %]) women received a uterotonic after childbirth for postpartum hemorrhage prophylaxis. Risk factors for postpartum hemorrhage among all deliveries (model 1) were: cesarean section delivery (adjusted odds ratio [aOR] 7.54; 95 % CI 4.11–13.81); multiple pregnancy (aOR 2.26; 95 % CI 0.58–8.79); foetal macrosomia ≥4000 g (aOR 2.18; 95 % CI 1.11–4.29); and HIV positive sero-status (aOR 1.93; 95 % CI 1.06–3.50). Risk factors among vaginal deliveries only, were similar in direction and magnitude as in model 1, namely: multiple pregnancy, (aOR 7.66; 95 % CI 1.81–32.34); macrosomia, (aOR 2.14; 95 % CI1.02–4.47); and HIV positive sero-status (aOR 2.26; 95 % CI 1.20–4.25).ConclusionThe incidence of postpartum hemorrhage was high in our setting despite use of uterotonics. The risk factors identified could be addressed by extra vigilance during labour and preparedness for PPH management in all women giving birth.

Background: The concept of early initiation of oral feeding after caesarean delivery is well tolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperative dietary management schedulecould have major implications on the management of maternal post-caesarean section mothers. Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefits and gastrointestinal functions in women who had undergone caesarean section in Mulago Hospital. Design: A randomised controlled study. Setting: Mulago Hospital. Subjects: One hundred and ninety two women admitted on the postnatal ward after emergency or elective caesarean section for various indications and who satisfied the eligibility criteria were recruited and randomized into the study. Assignment to the early feeding group or routine feeding group was done randomly using a computer generated numbers. The early feeding group were encouraged to take sips of water within six to eight hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post operative under supervision. The routine group were managed by restricting oral intake for twenty four hours and administration of orals sips of water 24 to 48 hours post operative. The outcome measures were rate of ileus symptoms, post operative presence of bowel sounds, maternal pyrexia and acceptability and benefits of early feeding. Results: The mean age, parity and gravidity were similar in the two groups. The study shows that women of the early feeding group had more rapid return of their bowel function with significant more shorter mean post operative time intervals to bowels sounds (24.2 hours versus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8 hours versus 75.8 hours). The women who fed early, made more rapid recovery and expressed their interest in earlicrhospital discharge. The findings significantly indicated that women in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) than their control group (15.1 hours versus 17.8 hours). This could probably have been because of the adequate rehydration and improved early energy intake. In comparison those who were fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0 bottles). The average hospital stay was similar and not statistically significant in both groups (5.5 days versus 6.0 days). Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well tolerated and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus. Do you need up-to-date peer reviewed medical literature? Kenya Medical Association, in collaboration with GlaxoSmithKiine, is pleased to introduce KMAIGSK RESOURCE CENTRE

BackgroundAsymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. MethodsThis was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. ResultsOut of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim PLOS ONE PLOS ONE | https://doi.

Abstractobjective Pre-eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. conclusion The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre-eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.

Introduction A continuum of maternal care approach can reduce gaps and missed opportunities experienced by women and newborns. We determined the level of coverage and factors associated with the continuum of maternal care in Uganda. Methods We used weighted data from the Uganda Demographic and Health Survey (UDHS) 2016. We included 10,152 women aged 15 to 49 years, who had had a live birth within five years preceding the survey. Stratified two-stage cluster sampling design was used to select participants. Continuum of maternal care was considered when a woman had at least four antenatal care (ANC) visits, had delivered in a health facility and they had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression analysis to determine factors associated with completion of the continuum of maternal care using SPSS version 25. Results The level of coverage of complete continuum of maternal care was 10.7% (1,091) (95% CI: 10.0–11.2). About 59.9% (6,080) (95% CI: 59.0–60.8) had four or more antenatal visits while 76.6% (7,780) (95% CI: 75.8–77.5) delivered in a health facility and 22.5% (2,280) (95% CI: 21.5–23.2) attended at least one postnatal care visit within six weeks. The following factors were associated with continuum of maternal care; initiating ANC in the first trimester (AOR 1.49, 95% CI: 1.23–1.79), having secondary level of education (AOR 1.60, 95% CI: 1.15–2.22) and tertiary level of education (AOR 2.08 95% CI: 1.38–3.13) compared to no formal education, being resident in Central Uganda (AOR 1.44, 95% CI:1.11–1.89), Northern Uganda (AOR 1.35, 95% CI: 1.06–1.71) and Western Uganda (AOR 0.61, 95% CI: 0.45–0.82) compared to Eastern Uganda, and exposure to newspapers and magazines. Conclusion The level of coverage of the complete continuum of maternal care was low and varied across regions. It was associated with easily modifiable factors such as early initiation of ANC, exposure to mass media and level of education. Interventions to improve utilisation of the continuum of maternal care should leverage mass media to promote services, especially among the least educated and the residents of Western Uganda.