In November 2019, world leaders convened in Nairobi for the ICPD25 Summit, pledging their support to end
preventable maternal death. Despite the progress that has been made over the last few years (1), we are
significantly behind achieving the goal of reducing the global maternal mortality ratio to less than 70 in
100 000 live births by 2030 (SDG 3.1). Kenya has set an ambitious goal to achieve zero preventable
maternal deaths. At this year’s Kenya Obstetrical and Gynecological Society (KOGS) scientific meeting in Nyeri, experts discussed the crucial gaps in drug accessibility, education, policies and guidelines that need to be filled to make this a reality.

Background: Liposarcomas and leiomyosarcomas are the most common histological types of
retroperitoneal sarcomas, followed by undifferentiated soft tissue sarcomas in adults.
Case presentation: A 38-year-old, gravida 4 para 3 HIV-positive, presented at 13 weeks of gestation to the
antenatal ward as a referral with an ultrasound diagnosis of a retroperitoneal mass. Abdominal
examination revealed a tender, firm mass in the left upper quadrant, extending to the left flank and fixed
to the underlying structures. The abdomen's magnetic resonance imaging revealed a large soft tissue mass in
the left retroperitoneum, with local invasion suggestive of a soft tissue sarcoma. She was put on
analgesics, antiemetics, intravenous fluids, and total parenteral nutrition, with a plan for an ultrasoundguided
biopsy of the mass and exploratory laparotomy. Her condition deteriorated, and subsequently arrested and succumbed eighteen days postadmission. The histological analysis of the postmortem specimen revealed a pleomorphic
metastatic liposarcoma.
Conclusion: Retroperitoneal liposarcomas are rare and often present a diagnostic and treatment
challenge. Therefore, a high index of suspicion should be indicated in women who present with abdominal masses.
Keywords: sarcoma, retroperitoneal tumor, pleomorphic liposarcoma, pregnancy, HIV

Background: Couvelaire uterus is an uncommon outcome of severe placental abruption and can only be diagnosed by visual inspection of the uterus or biopsy.
Case presentation: A 28-year-old gravida 2 para 1 presented with labor-like pain and vaginal bleeding at 38 weeks + 6 days. She gave no history of hypertensive disorders in pregnancy or trauma. The fetal heart rate was not detected by cardiotocography. An emergency cesarian section revealed a fresh stillbirth male with placental abruption in a Couvelaire uterus. She developed immediate postpartum hemorrhage, which was managed with uterotonics, uterine balloon tamponade, and was transfused 1.5liters of blood. She was discharged on the third postoperative day and
was stable on three distinct postnatal clinic visits.
Conclusion: Couvelaire uterus can be managed conservatively as it resolves spontaneously. This case highlights one of its fatal fetal and maternal complications when the opportunity for timely intervention is missed.
Keywords: Couvelaire uterus, placenta abruption,
fresh stillbirth, antepartum hemorrhage

Background: Abdominal pregnancy is rare and nonfatal. There are no specific associated symptoms, especially in cases of an uncomplicated type, which can reach term gestation.
Case presentation: A 30-year-old gravida 2 para 1 presented to the labor ward as a referral with a confirmed intrauterine fetal demise (IUFD) by a transabdominal ultrasound at 36 weeks + 1 day. She was not in labor, had no drainage of liquor or per vaginal bleeding. A repeat scan confirmed the IUFD. Induction of labor was started but was unsuccessful. Intraoperatively, an abdominal pregnancy was found with a macerated stillbirth. The placenta was adherent to the small intestines and was left in the abdomen. She was managed conservatively with intravenous
fluids and antibiotics. Her postnatal follow-up was unremarkable.
Conclusion: Undiagnosed advanced abdominal pregnancies are common in low-resource settings, especially when antenatal care visits are not adhered to. Sensitization on antenatal care and ultrasound and magnetic resonance imaging, when accessible, are critical in the diagnosis of late-stage abdominal pregnancy.
Keywords: advanced abdominal pregnancy,
intrauterine fetal demise, macerated stillbirth

Background: Intracranial subdural hematoma (ISH) is a known but rare complication of spinal anesthesia that mainly presents with persistent headaches.

Case presentation: A 35-year-old gravida 2 para 2 presented to the outpatient clinic with a history of headaches, dizziness, and vomiting for two days after

an elective cesarean section under spinal anesthesia 20 days prior. Brain magnetic resonance imaging (MRI) revealed bilateral subdural hematomas. She was scheduled for burr hole craniotomy and was discharged five days post-evacuation. She presented seven days later with a two-day history of convulsions and headaches. A computed tomography scan revealed recurrent bilateral subdural hematomas that were evacuated via repeat burr hole craniotomy. Postoperatively, she developed blurred vision, diplopia, slurred speech, and episodes of loss of balance. A repeat MRI showed satisfactory clearance of the hematomas before discharge.

Conclusion: A high index of suspicion for ISH should be indicated in patients with severe and persistent headaches after spinal anesthesia not relieved by

conservative treatment, especially with the onset of other neurological symptoms.

Keywords: intracranial subdural hematoma, spinal anesthesia, surgical management, craniotomy

Background: Retained fetal bones as a cause of infertility is uncommon. Treatment involves removal
of the fetal bones, with resolution of symptoms and resumption to fertility reported.
Case presentation: A 31-year-old para 0+1 presented to the gynecological outpatient clinic with a two-year
history of secondary infertility and recurrent vaginal discharge that begun following a pregnancy loss at 22
weeks gestation. She had undergone labor induction, after which she was scheduled twice for evacuation of retained products of conception. She was managed for vaginal discharge until a repeat scan revealed
retained fetal parts and uterine fibroids a year later. Myomectomy was done, and fetal bones embedded in the myometrium and within the uterine cavity were removed.
Conclusion: Retained fetal bones diagnosis should be entertained in patients presenting with a history of
per vaginal discharge or secondary infertility following a miscarriage. The role of pelvic scan and hysteroscopy in evaluating these patients cannot be over-emphasized.
Keywords: retained fetal bones, secondary infertility, vaginal discharge

Background: Precocious puberty is early pubertal development that results in future short stature and psychosocial problems.
Case presentation: A four-and-a-half-year-old presented to the gynecology clinic with a history of
two menstrual cycles. She had pubic hair growth and adult body odor six months prior to the occurrence of menses. She complained of on and off headaches with blurry vision. The wrist radiograph for age assessment revealed that her age corresponded to the female standard number 18; the skeletal age was 10. The magnetic resonance imaging (MRI) of the brain (pituitary protocol) revealed a pituitary microadenoma. A diagnosis of central precocious
puberty secondary to pituitary microadenoma was made. She was put on leuprolide 11.25 mg administered intramuscularly every three months with repeat investigations at six months. Her dose of leuprolide was changed to 15 mg three-monthly.
Brain MRI two years since the initiation of treatment revealed that the microadenoma had completely resolved.
Conclusion: Central precocious puberty is rare and therefore requires a high index of suspicion. Thorough workup and a multidisciplinary team are essential for its diagnosis and management.
Keywords: pituitary microadenoma, precocious puberty, hypothalamic-pituitary-gonadal axis, leuprolide, Tanner staging

Background: Health provider networks (HPNs), an innovation in the private sector, is a service delivery model that has improved access to health services. However, there are no known studies or empirical evidence to support their effectiveness in Kenya.
Objective: To determine the influence that legal support and provider capacity building have on providing quality reproductive health services in a healthcare provider network in Kenya.
Methods: A cross-sectional study design was used. The study was carried out among Reproductive Health Network Kenya (RHNK) healthcare providers spread all over 42 counties in Kenya. The target population was 457 health care providers within RHNK. A sample of 252 health care providers was drawn using simple random sampling. A structured questionnaire was used to collect data from the 252 health care providers in the network. Quantitative data were analyzed using the IBM SPSS software, version 23, for descriptive and inferential statistics, and results were presented in tables.
Results: A total of 252 respondents were included in this study; 52% (n=132) were male. Forty-six percent (n=117) of the respondents were between 41-50 years. Nurses were the majority at 73%(n=184), and 31% (n=78) of the respondents owned nursing homes. Fifty-one percent (n=127) of the respondents were diploma holders, and 28%(n=70) had 16-20 years of work experience. The bivariate analysis reported that legal support (r=.235**, p< .05) and capacity building (r= .213**, p< .05) had a positive and significant influence on the provision of quality reproductive health services in the provider network.
Conclusion: Legal support and capacity building through training, mentorship, and coaching
significantly impact reproductive health services quality in a provider network.
Keywords: reproductive health services, health provider networks, legal support, capacity building,
Kenya

Background: The prevalence of diabetes and gestational diabetes is rising worldwide. If poorly managed, diabetes in pregnancy has a far-reaching negative impact on the mother and newborn.
Objective: To determine the quality of glycemic control and pregnancy outcomes among patients with gestational diabetes in Kenyatta National Hospital, Nairobi, Kenya.
Methods: A retrospective descriptive cohort study design was employed. The study setting was Kenyatta
National Hospital, Nairobi, Kenya. The study population was women with diabetes in pregnancy. The study period was May 2011 to November 2019. A sample size of 258 diabetic pregnant patients was reached; 230 and 28 were in the exposed and unexposed groups with the average third trimester fasting blood sugar levels of ≥5.3mmol/L and
<5.3mmol/L, respectively. Data were analyzed using the IBM statistical package for social sciences (SPSS) version 23. A p-value of <0.05 was considered statistically significant.
Results: The prevalence of poor glycemic control (average third-trimester fasting blood sugar level
≥5.3mmol/L) was 89.1%. There was a higher incidence of macrosomia (25.7% vs. 21.4%; p-value 0.627), stillbirths (17.9% vs. 3.6%; p-value 0.058) and preterm birth (43.9% vs. 21.4%; p-value 0.025) among patients with gestational diabetes with poor glycemic control compared to those with good glycemic control. Among mothers with poor glycemic
control, the pre-existing diabetes patients experienced significantly worse outcomes of stillbirths (20.9% vs.
0%; p-value 0.004) and preterm births (47.2% vs. 24.2%; p-value 0.014) than the gestational diabetes patients.
Conclusion: Poorly controlled diabetes in pregnancy increases the risk of adverse pregnancy outcomes,
including macrosomia, stillbirths, and preterm births, with the poorly controlled pre-existing diabetic
women experiencing significantly worse outcomes of stillbirths and preterm births than the poorly controlled gestational diabetes patients.
Keywords: gestational diabetes, insulin, macrosomia, stillbirths, preterm births