Journal of Obstetrics and Gynaecology of Eastern and Central Africa

Gestation substance abuse enhances the propensity toward adverse pregnancy outcomes

2025-07-17T03:39:23+00:00

Substance abuse during pregnancy has predominantly afflicted younger echelons and has routinely been associated with multiple obstetric complications. These adverse outcomes have routinely been attributed to impaired access to care (1). This has been recognized as a problem in multiple settings and is acknowledged as having the potential for far-reaching long-term impact of the maternal-fetal dyad (2).

In this issue, Obwaya et alia undertook a retrospective cohort study to evaluate adverse pregnancy outcomes amongst gravidae who chewed Khat (Catha edulis) in Meru County, Kenya (3). The majority of their Khat-consuming study participants (90%) were under 35 years of age, with no differences observed in their mode of delivery. On analysis, they found that the use of Khat resulted in a duodecuple, quadrupled, and tripled increase in the risks of postpartum hemorrhage, preterm birth, and low birth weight, respectively. They also inferred increased associations with admission to the neonatal intensive care unit and premature rupture of membranes, although the latter lacked statistical significance. This evidence corroborates the inference of a previous meta-analysis which concluded that: substance abuse is a risk factor for adverse pregnancy outcomes; and that one in five substance users are engaged in polysubstance use (4). Despite the limitations incurred, this study generated objective evidence that associates Khat use with significant adverse pregnancy outcomes in the Kenyan setting.

Overall, there is a considerable association between adverse pregnancy outcomes and substance use during gestation. Additionally, there may be considerable value in following up on such study populations to determine if maternal substance abuse during pregnancy would be associated with conduct problems in the offspring (5) in our setting.

Strengthening maternal, newborn, child, and adolescent health (MNCAH) resilience in Makueni County amid climate change: A policy brief

2025-07-17T03:39:15+00:00

Phyllodes tumor, cardiovascular and chronic renal disease in a young lady on hormone replacement therapy: A case report

2024-11-25T11:24:12+00:00

Background: Hormonal replacement therapy (HRT) has been associated with an
increased risk of developing breast cancer. The level of risk varies with different types of
HRT and the duration of use. Phyllodes tumor accounts for less than 1% of all breast
neoplasms and is associated with Li-Fraumeni syndrome.
Case presentation: A 37-year-old nulliparous woman presented with a left breast lump.
Histological examination revealed a spindle cell neoplasm consistent with a malignant
phyllodes tumor. She was diagnosed at age of 12 with ovarian dysgerminoma, had
subtotal hysterectomy and right oophorectomy, radiotherapy and chemotherapy. She
has been on HRT with conjugated equine estrogens for 13 years and tibolone for the
last 5 years. Following the diagnosis of phyllodes tumor, a mastectomy was performed,
and HRT was changed to vaginal estrogen gel.
Conclusion: Hormonal replacement therapy may pose a risk for certain types of breast
cancer, especially with prolonged use of combined therapy. Patients who develop
cancers early in life, as well as those on HRT, require close follow-up and adequate
patient education with an emphasis on self-breast examination. Sensitization of
healthcare providers and patients on the value of genetic screening would facilitate
early identification of such patients and follow-up at high-risk clinics.

Type 2 cesarean section scar pregnancy managed by hysteroscopic resection and methotrexate: A case report

2025-07-01T03:14:03+00:00

Background: Diagnosis and management of cesarean scar ectopic pregnancy (CSP) remain challenging. We describe ultrasound diagnosis followed by hysteroscopic resection and methotrexate administration.

Case presentation: A 42-year-old woman, para 2+1, presented with 8 weeks of amenorrhea and vaginal bleeding. She had two previous cesarean deliveries. Initial ultrasound suggested an incomplete miscarriage and beta human chorionic gonadotropin (β-HCG) was 46,129 mIU/ml. After failed medical management, repeat ultrasound diagnosed CSP. Hysteroscopic resection was performed, and she received methotrexate, resulting ß-HCG resolution.

Conclusion: Though rare, CSP should be entertained in any woman presenting with vaginal bleeding with a history of cesarean delivery. Hysteroscopic resection with methotrexate provides good fertility-preserving modality for management.

Keywords: cesarean scar ectopic pregnancy; hysteroscopic resection; methotrexate

Obstructive Hemivagina with Ipsilateral Renal Agenesis in a 16-year-old Diabetic African Girl: a case report

2025-07-01T03:14:13+00:00

Background: The obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome is a type of Müllerian duct anomaly (MDA) resulting from abnormal development of Müllerian ducts. Its features typically become apparent at puberty when girls present with menstrual abnormalities. The varied presentation of MDAs presents diagnostic and management challenges.

Case presentation: A 16-year-old diabetic African girl presented to Savannah Healthcare with cyclical lower abdominal pain and foul-smelling per vagina discharge. Magnetic resonance imaging (MRI) showed complete duplication of the uterus, cervix, and vagina (uterine didelphys) with an obstructed left hemivagina with hematocolpos. The septum obstructing the hemivagina was resected with drainage of the hematocolpos. A follow-up abdominal renal ultrasound showed the absence of the left kidney.

Conclusion: Careful clinical examination and MRI are essential for diagnosing OHVIRA syndrome. Prompt surgical intervention improves outcomes.

Diagnosis and management of misplaced intrauterine devices: A case series

2025-07-10T03:27:17+00:00

Background: Intrauterine contraceptive devices (IUCDs) are widely used for long-term contraception and are generally safe. However, misplacement can occur, often presenting as a missing thread and typically remaining asymptomatic. A misplaced IUCD can lead to complications like uterine perforation, migration to adjacent organs, pelvic abscess, or ectopic pregnancy. Various diagnostic and treatment modalities are available for management.

Case series: We present 10 cases of misplaced IUCDs encountered at Kenyatta National Hospital, highlighting their clinical presentations, diagnostic approaches, and treatment strategies.

Conclusion: This case series highlights the importance of vigilant monitoring for nonspecific symptoms indicative of IUCD displacement or migration. Timely evaluation and intervention are essential, with imaging and minimally invasive surgery playing a central role in achieving favorable outcomes.

Keywords: hysteroscopy, intrauterine contraceptive device, laparoscopy, misplaced IUCD

Cost of surgical management of laparoscopically treated ectopic pregnancies at a tertiary referral hospital: A 10-year review of admission costs and contributing factors

2025-07-11T03:28:48+00:00

Background: Laparoscopic management is the gold standard for treating ectopic pregnancies (EP), but its cost limits its widespread use in developing nations. A 10-year period audit was conducted evaluating laparoscopically treated EPs at a tertiary referral hospital, focusing on admission cost and contributing factors.

Methods: This was a retrospective observational study conducted at the Aga Khan University Hospital. All women admitted with surgically managed Eps were included. Analysis of data was done against a preset checklist. Descriptive statistics for continuous variables were computed and presented in tables and figures.

Results: The adjusted admission cost for patients with surgically managed EP ranged from US $2 017 (KES 220 252) to US $ 6,326 (KES 690 828). The mean cost of admission was US $ 3 254 (KES 355 384; n=259). The following factors were significantly associated with an increased admission cost: increasing patient age (p=0.000), volume of hemoperitoneum(p=0.000) duration of surgery (p=0.003) and duration of hospital stay (p=0.000).

Conclusion: The mean admission cost for surgically managed EP was similar to that in high-income countries. However, when adjusted for per capita gross domestic product, the cost was disproportionately high. No consistent decline in the mean annual cost was observed over the study period. Increasing patient age, hemoperitoneum volume, surgery duration, and duration of hospital stay all significantly impacted on the admission cost.

Comparison of third-trimester indices in pregnant women with and without COVID-19 infection: A cross-sectional study

2025-07-10T03:27:33+00:00

Background: The third trimester represents a critical window in pregnancy when these hematologic changes could have the greatest impact. Therefore, understanding how coronavirus disease 2019 (COVID-19) infection influences blood profiles during this period is vital for clinical management and risk stratification. In Kenya, while national guidelines recommend laboratory evaluation, including complete blood count, c-reactive protein (CRP), lactate dehydrogenase (LDH), and coagulation profiles for pregnant women with suspected or confirmed COVID-19, there is a paucity of local data documenting these hematologic trends.

Objective: To investigate hematologic profile differences between pregnant women in the third trimester with and without COVID-19 infection.

Methods: A cross-sectional comparative study was employed to compare hematological parameters in pregnant women with and without

COVID-19 between May 1st and August 31st, 2021. We recruited 60 eligible patients from the Nairobi hospital using purposive sampling. We assessed the complete blood count, coagulation profile, lactate dehydrogenase, and C-reactive protein.

Results: Pregnant women with COVID-19 had significantly higher levels of neutrophils, prothrombin time, CRP, and LDH compared to those without, with respective AORs of 9.50 (p<0.01), 11.52 (p=0.001), and 3.06 (p=0.078). No significant differences were observed in white blood cells, basophils, and international normalized ratio after adjusting for age, parity, COVID-19 vaccination, and fetus number.

Conclusion: This study reported significant associations between neutrophil count, prothrombin time, CRP, LDH levels, and COVID-19 infection status in pregnant women. These indices may aid in distinguishing healthy pregnant women from those with COVID-19 infection.

Keywords: COVID-19 infection, pregnant women, third trimester, blood profile

Adverse Pregnancy Outcomes Among Khat Chewing Pregnant Mothers in Meru County, Kenya.

2025-07-10T03:27:25+00:00

Background: Khat (Catha edulis) is a green leafy plant containing psychoactive alkaloids, such as cathine and cathinone. Khat use in pregnancy affects maternal and fetal well-being.

Objective: This study aimed to determine the risk of adverse pregnancy outcomes among pregnant women who chew khat compared with pregnant women who do not chew khat in Meru County in 2023.

Methods: A retrospective cohort study was employed at the Meru Teaching and Referral Hospital and Nyambene Level 4 Hospital that compared immediate postpartum mothers who chewed khat during pregnancy (exposed, n=150) and those who did not chew khat during pregnancy (unexposed, n=300). Data on khat chewing during pregnancy and various maternal, fetal, and early neonatal outcomes were collected using a questionnaire. Data were summarized as means, frequency, and percentages and com

pared using the Students t-test, Pearson’s Chi-square, and Fischer’s exact test. All statistical tests were considered significant if the p<0.05.

Results: There was a statistically significant increased risk of preterm birth (AOR 4.44, 3.31-10.92, p 0.001), low birth weight (AOR 2.95, 1.19-7.57, p 0.02), admission to neonatal intensive care unit or newborn unit (AOR 1.13, 1.03-4.10, p 0.01), and postpartum hemorrhage (AOR 12.85, 2.17 – 244.02, p 0.02). An increased risk of premature rupture of membranes was observed, but this was not statistically significant (OR 1.61, 0.9-2.85, p 0.11).

Conclusion: Women who used khat during pregnancy had an increased risk of adverse pregnancy outcomes, including preterm birth, low birth weight, admission to neonatal intensive unit, and postpartum hemorrhage.

Keywords: adverse pregnancy outcomes, khat, Meru