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Complications of Pregnancy and Maternal & Infant Outcomes in Uganda

This article explores the various complications of pregnancy and their impact on maternal and infant outcomes in Uganda. It highlights the high risk of maternal mortality and morbidity in Sub-Saharan Africa and the need for effective interventions. The article emphasizes the importance of conducting pregnancy trials in this setting to address the burden of pregnancy-related complications.

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Complications of Pregnancy and Maternal & Infant Outcomes in Uganda

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  1. Complications of pregnancy and maternal & infant outcomes in Uganda Assoc Professor AnnetteeNakimuli Head of Department and Assoc Professor, Obstetrics and Gynaecology Makerere University Mulago Specialized Women and Neonatal Hospital & Kawempe National Specialized Hospital

  2. A pregnant woman has one foot in the grave

  3. Introduction • Most pregnancies are uneventful but all pregnancies are risky • About 15% of women develop potentially life-threatening complications • Women in Sub Saharan Africa (SSA) have a 100-fold increase in the risk of dying during childbirth compared to high income settings • 1 in 180 fifteen-year old females will die from a maternal complication • The maternal mortality ratio in SSA is ~500/100,000 live births • ~66% of global maternal deaths occur in SSA

  4. Early pregnancy complications • Abortion/Miscarriage • In Uganda defined as loss of a pregnancy before 28 weeks of gestation • Ectopic pregnancy (tubal pregnancy) • Pregnancy in which implantation is at a site other than uterine cavity • A rare form of extra uterine pregnancy is abdominal pregnancy • Hyperemesis gravidarum • Most severe form of nausea & vomiting in pregnancy • May cause dehydration, electrolytes & acid-base imbalances, nutritional deficiencies, & even death • Gestational trophoblastic disease/molar pregnancy • Typified by abnormal trophoblast proliferation and usually no fetus

  5. Mid-late pregnancy complications (1) • Pre-eclampsia/eclampsia and other hypertensive disorders • Gestational diabetes mellitus • Predisposes to preeclampsia, foetal macrosomia, birth trauma, IUFD etc. • Preterm labour & delivery • Labour & delivery that occurs before 37 completed weeks of gestation • Abruptio placentae • Premature separation of placenta from uterus • Usually presents as painful bleeding • Placenta praevia • Is a low lying placenta • Usually presents as painless bleeding

  6. Mid-late pregnancy complications (2) • Placenta accreta spectrum • Formerly morbidly adherent placenta • Premature rupture of membranes (PROM) • Rupture of membranes after 37 weeks' gestation and prior to onset of labor • Preterm premature rupture of membranes (PPROM) • Rupture of membranes prior to 37 weeks' gestation • Both PROM & PPROM predispose to maternal infections and increase neonatal morbidity and mortality • Polyhydramnios • An abnormally high level of amniotic fluid

  7. Mid-late pregnancy complications (3) • Oligohydramnios • Inadequate volume of amniotic fluid • Venous thromboembolism (VTE) • Pregnancy increases risk of VTE 4- to 5-fold over that in nonpregnant state • Manifestations of VTE are deep venous thrombosis & pulmonary embolus • Amniotic fluid embolism • Rare but catastrophic condition when amniotic fluid enters maternal circulation • Post-term pregnancy • Pregnancy that extends beyond ≥42+0 weeks of gestation • Anaemia • Defined as a hemoglobin concentration of less than 11 g/dL

  8. Fetal complications • Intrauterine fetal death • Fetal anomalies • Feta growth restriction • Macrosomia (very big baby- usually 4 Kg and above) • Vertically transmitted infections Eg: Toxoplasmosis , Rubella, Cytomegalovirus, Herpes simplex virus, HIV, Zika virus, syphilis, Hepatitis B virus

  9. Intrapartum complications • Uterine rupture • Perineal trauma (lacerations, tears etc.) • Labour dystocia including obstructed labour • Foetal compromise • Cord prolapse • Perinatal asphyxia • Chorioamnionitis

  10. Postpartum complications • Postpartum haemorrhage – leading cause maternal mortality • Postpartum blues, depression and psychosis • Obstetric fistula and other sequelae of obstructed labour • Postpartum acute kidney injury • Puerperal infections (endometritis) including pelvic abscess • Puerperal mastitis • perineal pain, dyspareunia, sexual dysfunction • Etc

  11. Medical records

  12. Maternal and newborn outcomes in Uganda • Maternal outcomes can be measured by maternal mortality, near miss & proportion of women with postpartum morbidity • In Uganda maternal mortality ratio is 336 deaths per 100,000 live births [2016 UDHS] • For every maternal death in Uganda, at least six survive with chronic and debilitating ill health • Neonatal mortality rate in Uganda- infant deaths btn 0-28 days of life per 1,000 live births is 27 deaths per 1,000 live births [2016 UDHS] • Infant mortality rate - number of infants who die before first birthday per 1,000 live births (43 deaths per 1,000 live births [2016 UDHS]

  13. Conclusions • Despite most pregnancies being uneventful, all pregnancies are at risk • Risk of complications higher in women of SSA • Risk benefit ratios for products could be different • Trials in pregnancy in SSA are a heavy investment directly and indirectly • Pregnancy trials very pertinent in this setting due to the high burden of pregnancy, disease and complications

  14. Thank you- Welcome to visit the New Women’s Hospital!!

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