Gynaecology

Background: The caesarean section rate has increased all over the world for the past 3 decades. This has now become an issue of intemational public health concern. Obstetric intervention would have the risks to both the mother and baby.There is no clinical evidence justified caesarean section lead to better outcomes. Methods: The main objective of this clinical audit was to test if maternal and neonatal outcomes improved with increase in caesarean section rate. An observational retrospective study was carried out in our university hospital from January 2004 till January 2014.Data were collected from registered files at the department of gynecology and obstetrics in El-Minia University Hospital from January 2004 to January 2014. Data included personal history (age, residence), medical history, obstetric history (antenatal care, number of pregnancies, number of labor) operative details and suspected cause of death. In situations where these data were deficient, verbal autopsy was done through interview with patient relatives or phoning them. Results: There was a significant increase in caesarean section rate from 18.4% in 2004 to 23.6% in 2014. Failure of progress and fetal distress were the primary indications for emergency caesarean section, while previous caesarean birth, maipresentation and maternal request were common reasons for elective caesarean section. Both maternal request and repeat caesarean section were significantly increased across 10- year study period. Advanced maternal age was indicated as a contributing factor for caesarean section.Maternal blood loss was significantly higher in women with caesarean section than normal vaginal delivery and assisted delivery. More obstetric perineal trauma was found in women with normal vaginal births.Subgroups of gestational age less than 33 weeks and birth weight 1 toI .5kg had the highest caesarean section rate. Newborns delivered by caesarean section had lower Apgar score i minute after birth than those by normal vaginal delivery. Higher rate of admission to neonatal intensive care unit was found in newborns delivered by caesarean section. More serious birth trauma occurred in newborns by instrumental delivery. Conclusion: caesarean section rate is significantly increased in those with previous history of caesarean section (11.16%).The main indications were done in primiparas and fetal distress. A 4.02% decrease was found in sections done for fetal distress. Key words: caesarean section, maternal outcome, fetal outcome

Umbilical Endometriosis is very rare condition, and its incidence is 0.5-1%. Endometriosis is a common gynecological condition seen in reproductive age group and represents about 15-22%.Extra pelvic site of lesion is very rare. The diagnosis is confirmed by histopathological examination after Surgical excision of the lesion.

This study assessed the health care services in relation to guardians level of satisfaction with childcare services at the Tamale Central (TCH) and Tamale West hospital (TWH), Ghana. The target populations of this study were guardians of sick children under five who visited the TCH and TWH. A total sample size of 100 respondents was used. 50 participants were each taken from the two Hospitals by using convenience sampling technique. Questionnaires was used for data collection and the data was analyzed using SPSS. A total of 41.2% of the patients were satisfied with the overall service received at the hospital. Guardians who were satisfied with the service significantly had a shorter waiting time than those who were not satisfied. In conclusion, mothers/guardians’ level of satisfaction with childcare are associated with four important dimensions namely; time spent at the hospital, relationship between health worker and parents, affordability of healthcare services and level of confidentiality that exist in the hospital. Long waiting time negatively affected satisfaction. If this is improved upon, it will lead to increased guardian satisfaction regarding the care rendered to their children.

Brucellosis is rare during pregnancy and most common route of infection is unpasteurized milk and milk products consumption. Brucellosis is associated with higher incidence of pregnancy loss, especially early pregnancy during febrile episodes and also associated with vaginal bleeding. Therefore it is advisable to have awareness for brucellosis in pregnant women, both in rural and in urban areas. Public health department should be directed to spread the news about the route of infection, dangers of contact with infected animals, dangers of consumption of raw milk and milk products.