Maternal and neonatal adverse outcomes remain a global problem. Fortunately, they can be prevented through individual, community, and health care providers' actions (1,2). Knowledge of maternal danger signs during pregnancy is critical in the pathway for the prevention of maternal and neonatal morbidity and mortality since it can influence the timely seeking of healthcare, thereby addressing the first delay (3,4), improving birth preparedness/complication readiness (5) and antenatal care attendance (1), and use of delivery services (6). Different studies have used various terminologies to define maternal danger signs, including prolonged labor, vaginal bleeding, fever, convulsions/fits, breech position, swollen limbs, faintness, breathlessness, tiredness, headache, dizziness, and baby not moving. Maternal danger signs during pregnancy, intrapartum and postpartum are listed in the box.

Background:

Cervical cancer and tuberculosis remain significant health concerns, the former is associated with high levels of morbidity and mortality.

Case presentation:

A 37-year-old nulliparous woman presented to the gynecological ward with a five-year history of intermittent per vaginal bleeding, postcoital bleeding, and intermenstrual bleeding associated with per vaginal discharge and dyspareunia. She had a friable cervical mass on speculum examination, and cervical cancer was suspected. The patient was examined under anesthesia, and a biopsy of the mass was performed.

Histological examination revealed cervical tuberculosis. The patient was started antituberculosis therapy for six months and responded well.

Conclusion:

Cervical tuberculosis should be considered as a differential diagnosis for cervical masses, as seen in this rare case of cervical

tuberculosis that mimicked cervical cancer. A high index of suspicion is required for timely diagnosis and treatment.

Keywords:

cervical cancer, cervical mass, cervical tuberculosis, tuberculosis

Background: The potential to predict metaphase II (MII) oocyte yield in controlled ovarian stimulation (COS) has not been elucidated, despite being a mandatory predictor of fertilization potential. Hence this area is marred by the diversity of approaches to ovarian stimulation and the deficiency of standards.

Objective: To determine the role of serum anti-Müllerian hormone (AMH) as a predictor of MII oocyte yield during controlled ovarian stimulation at a

private fertility clinic in Nairobi.

Methods:

A retrospective descriptive cohort study design was employed in which MII outcomes during COS were compared among women aged 18-45 years

with normal or low serum AMH levels. Data were collected sequentially until the desired sample size was achieved. Data were analyzed using the IBM

statistical package for social sciences (SPSS) version 24.0 and STATA version 15. The level of significance was set at p<0.05.

Results:

Approximately one-third of women above 35 years of age had normal serum AMH levels, while nearly three-quarters had low serum AMH levels

(OR=0.1; 95% CI (0.1–0.4); p-value<0.001). By day five, hyperresponse was more preponderant among those with normal AMH levels (39.0% vs. 3.8%;

OR=15.9; CI (2.0-126.0); p-value<0.001) and remained consistent. Almost three-quarters of women with low AMH levels had a low MII yield

compared to nearly one-quarter of those with normal AMH levels (OR=0.3; 95% CI (0.1-0.8); pvalue= 0.014), even after controlling for age. This trend was consistent with that of the total oocyte count. The sensitivity, specificity, and positive and negative predictive values of serum AMH level as a predictor of MII oocyte yield were 86.0%, 54.3%, 72.96%, and 73.1%, respectively.

Conclusion:

Normal serum anti-Müllerian hormone levels is associated with increased follicular count and total oocyte harvest during controlled ovarian stimulation and is a good predictor of MII oocyte yield.

Keywords:

anti-Müllerian hormone, ovarian stimulation, follicular count, follicular harvest, metaphase II oocytes

Background:

Endometriosis is a common gynecological disease that significantly impacts women's health. It presents with dyspareunia, dysmenorrhea, chronic pelvic pain, and infertility. Globally, the prevalence of endometriosis is estimated to be 10%, with comprehensive literature on its clinical presentation in developed countries. However, only scant literature exists in Africa.

Objective: To determine the symptoms of endometriosis in indigenous African women.

Methods:

This was a prospective analytical crossselection study that enrolled indigenous African women undergoing laparoscopic surgery in two

tertiary hospitals in Nairobi, Kenya. The study population included women aged 18-49 years scheduled for laparoscopic surgery. Data on patient history, clinical, laparoscopic, and histopathological findings were entered and analyzed using the IBM statistical package for social sciences (SPSS), version 22.0. The statistical significance was set at p<0.05.

Results:

Between March 2018 and March 2021, 443 women were enrolled in this study. The mean age was 33. The prevalence of histologically confirmed endometriosis was 6.8%. Chronic pelvic pain (scale 8-10), dysmenorrhea, and dyspareunia were the

significant symptoms of endometriosis (p<0.001). Nulliparous patients were more likely to develop

endometriosis (OR=4.1 (1.6-10.2)). Women with menarche at ≤13 years had a significantly higher risk

of developing endometriosis (p=0.001). There was no correlation between infertility and endometriosis

(p=0.031).

Conclusion:

The prevalence of histologically confirmed endometriosis in indigenous Africans was 6.8%. Endometriosis prevalence in Africa is

comparable to the worldwide prevalence, and as such, with its morbidity, it warrants close attention. Chronic pelvic pain, dysmenorrhea, and dyspareunia are significant symptoms of endometriosis, and as such, patients with these symptoms should be investigated for endometriosis.

Keywords:

endometriosis, laparoscopy, indigenous African woman, dyspareunia, dysmenorrhea

Background:

Over 80% of maternal mortalities and complications can be prevented if women recognize danger signs during pregnancy and promptly seek healthcare. Despite the timely recognition of maternal danger signs during pregnancy, delays in seeking healthcare are still prevalent in many low-resource settings.

Objective:

To assess the place and reasons for delays in seeking healthcare and their effect on the use of institutional delivery care by pregnant mothers with danger signs in Matayos subcounty, Busia, Kenya.

Methods:

A mixed-methods approach employing an ethnographic survey was adopted to assess delays among pregnant mothers seeking healthcare in Matayos subcounty. A total of 348 postpartum women were selected using systematic random sampling. Purposive sampling was employed to select postpartum women for 16 in-depth interviews and seven focus group discussions. Qualitative data were analyzed thematically and presented in vignettes. Quantitative data were analyzed using descriptive and inferential statistics and presented in tables using STATA version 13. Statistical significance was set at p<0.05.

Results:

The utilization rate of institutional delivery care was 68%. One in four, 25% (86) respondents experienced danger signs, of which more than half, 51.2% (44), reported delays. Travel to the hospital (type 3 delay) was the most common delay reported by 65.3%, followed by delayed decision-making at home (type 2 delay), delayed recognition at home (type 1 delay), and delays in hospitals (type 4 delay) at 30.7%, 1.7%, and 2.3% of all respondents, respectively. Delayed decision to initiate travel (30.7%) and

distance to healthcare (30.7%), cost of travel (18.2%), and mode of travel (13.2%) were the reasons for delays in seeking healthcare.

Conclusion:

Delayed decision-making rather than recognition of danger signs was associated with delays in healthcare. A four-delay model clearly

distinguished between recognition and making the decision to initiate travel and should be adopted in low-resource settings.

Keywords: Busia, four-delay model, institutional delivery care, maternal danger signs, postpartum

Background:

Cervical cancer is a significant cause of maternal morbidity and mortality despite concerted efforts towards its prevention. The high disease burden is attributed to the high prevalence of HIV, high treatment costs, and inaccessibility to treatment, particularly in developing countries. Multiple

interventions, including metformin therapy, have been proposed for cervical cancer management. Metformin is a standard antidiabetic drug. In vitro studies have demonstrated mechanisms through which it can disrupt cervical cancer pathogenesis.

Objective:

To review the literature on metformin’s anticancer and anti-metastatic effects in cervical cancer.

Methods:

Literature searches were performed in the Google Scholar, PubMed, and ScienceDirect databases using keywords 'metformin', 'cervical cancer', and 'direct drug delivery’.

Results:

Forty-four studies were included in this review. Metformin acts directly or indirectly on the molecular pathways involved in cervical cancer

pathogenesis. Direct inhibition targets protein synthesis and angiogenesis, whereas indirect effects occur through increased insulin levels and the

resultant decrease in glucose levels leading to glucose deprivation in cancer cells. The anti-metastatic effects of metformin are dose-dependent; therefore, high concentrations are required to achieve maximum effect. Direct drug delivery of metformin to tumor cells is viable to increase the bioavailability and

minimize the systemic effects of metformin.

Conclusion:

Metformin is affordable and readily available, with the potential to manage cervical cancer. High doses are needed to achieve antimetastatic effects. Direct delivery of metformin may mitigate the adverse effects of the required high doses.

Keywords: anticancer, anti-metastatic, cervical cancer, diabetes, nanoparticulate, metformin