National policies and care provision in pregnancy and childbirth for twins in Eastern and Southern Africa: A mixed-methods multi-country study.

Background: High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods And Findings: We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and policies.

Interventions to reduce unnecessary caesarean sections in healthy women and babies.

Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm.

Monitoring fetal growth in settings with limited ultrasound access.

Abnormal fetal growth significantly increases neonatal mortality and the risk of stillbirth. This creates the need for accurately monitoring fetal growth in all pregnancies regardless of the risk status. Several methods used in clinical practice include abdominal palpation, symphysio-fundal height measurements, and obstetric ultrasound.

External cephalic version in East, Central, and Southern Africa.

Objective: To evaluate the views of maternity care providers in East, Central, and Southern Africa on external cephalic version (ECV), and its determinants, with the aim of drawing lessons for practice.

Methods: In February 2009, a cross-sectional survey using self-administered semi-structured questionnaires was conducted among delegates attending a regional conference of obstetricians and gynecologists. Descriptive statistical analysis was undertaken, and comments were analyzed for themes.

Health-related quality of life changes among users of depot medroxyprogesterone acetate for contraception.

Background: Depot medroxyprogesterone acetate (DMPA) may have other noncontraceptive effects that could impact on the quality of life. The objective of this study was to assess the health-related quality of life changes associated with the use of DMPA for contraception.

Study Design: A prospective, observational study using the Short Form-36 quality of life questionnaire.

Correlation between laparoscopic and histopathologic diagnosis of endometriosis.

Objective: To review the histopathologic diagnosis of biopsies taken following visualization of endometriosis at laparoscopy and to correlate visual with microscopic diagnoses.

Methods: A retrospective review was undertaken of medical charts with a diagnosis of endometriosis at Aga Khan University Hospital, Nairobi, Kenya, between January 2001 and October 2010. Eligibility included visual diagnosis of endometriosis at laparoscopy, with a clear record of site, size, morphology, and number of lesions.

Factors contributing to failure of vacuum delivery and associated maternal/neonatal morbidity.

Objective: To determine factors contributing to the failure of vacuum delivery and to compare the neonatal and maternal morbidity associated with failed and successful procedures.

Methods: A retrospective case-control study was undertaken at Aga Khan University Hospital, Nairobi, Kenya, by review of medical charts from the period of January 2007 to December 2010. In total, 31 cases of failed vacuum delivery were compared with 124 controls where extraction was successful.

The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation.

Background: The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies.