Issues

In February 2019, the 43rd Kenya Obstetrical and
Gynecological Society Conference took place at
Movenpick Hotel and Residences in Nairobi. We
are pleased to present a collection of abstracts based
on this conference’s theme. The KOGS Annu

In February 2019, the 43rd Kenya Obstetrical and Gynecological Society Conference took place at Movenpick Hotel and Residences in Nairobi. We are pleased to present a collection of abstracts based on this conference’s theme. The KOGS Annual Scientifi

Cervical cancer is a preventable disease affecting an estimated 530,000 women each year and leading to nearly 275,000 deaths (1). It is estimated that about 88 percent of women dying from cervical cancer reside in developing countries (1), with the lack of effective screening and treatment programs being the main cause of this health inequity. Factors that hinder effective uptake of screening and treatment services include: poverty, poor access, long waiting times at the health facilities, high cost of the services, low capacity, poor infrastructure, inconsistency in service provision, low staffing levels and poor referral systems (2). 

Heterotopic pregnancy is a rare concurrence of intrauterine and extra-uterine pregnancies. We present a heterotopic pregnancy case in which a 25-year-old woman, Para 1+0, gravida 2, presented with a natural conception at 10 weeks to the gynaecological ward at the Kenyatta National Hospital, Kenya. She gave a history of acute abdominal pain and vomiting. A left adnexal mass, an intrauterine non-viable pregnancy, and free fluid were demonstrated on transvaginal ultrasonography. Laparoscopy was done, and a heterotopic pregnancy was diagnosed. 

Introduction: Unsafe abortion and associated consequences remain familiar, albeit the occurrence being inadequately documented. Due to the circumstances under which abortions are performed, quantification of the magnitude of the problem, and the extent of morbidity and mortality, has remained inadequate. Hence, there is a need to both conduct studies and highlight examples of severe morbidity and mortality related to abortion to raise awareness and pave ways towards informed policy development. 

Methodology: We followed the patient prospectively followed up for seven months with diligent documentation of events, investigations, and outcomes from admission to discharge. Informed consent for publication was obtained during this period. 

Findings and management: The patient presented three weeks after failed medical abortion and a manual vacuum aspiration trial at 16 weeks of gestation in a private slum-based clinic. She had fulminant sepsis complicated by pelvic and subphrenic abscesses, which were drained. There was suture-line dehiscence that was complicated by an extensive subcutaneous abscess that necessitated drainage, during which there was inadvertent small bowel injury. A high-output enterocutaneous fistula, associated with severe morbidity, developed. Due to severe morbidity, conservative management was deemed as more preferable. Intravenous alimentation and supportive antibiotic therapy did not result in spontaneous healing, and repair was undertaken when the patient was stable. 

Conclusion: This case exemplifies the cascade of adverse outcomes in unsafe abortions and the consequent high risk of maternal mortality. Hence the need for educational interventions to avert such incidences. 

Objective: We report a case of a 41-year-old, Para 4+0 who presented at the Kenyatta National Hospital, referred from a level V hospital where she had been diagnosed with breast cancer and managed with chemotherapy. 

Findings and Management: The patient gave a history of lower abdominal pain radiating to the back. Magnetic Resonance Imaging (MRI) revealed bilateral cystic ovarian masses. Exploratory laparotomy was done, and both ovaries were noted to be cystic with intact capsules, and bilateral high-grade serous carcinoma was reported on histological investigation. A total abdominal hysterectomy and bilateral salpingo-oophorectomy, infracolic omentectomy, and peritoneal washing were done. The patient was then started on chemotherapy scheduled for six cycles. 

Conclusion: Ovarian cancer can occur after or before breast cancer. However, these two primary cancers can occur concurrently. Due to the high risk of breast cancer in individuals with Breast Cancer (BRCA- 1/BRCA-2), gene mutations, chemoprevention, and prophylactic surgery are recommended. Pelvic examination, Transvaginal Ultrasound (TVU), Human Epididymis Protein 4 (HE4), and Cancer Antigen 125 (CA-125) assays should be considered to routinely screen for cervical cancer.

Introduction: The World Health Organization (WHO) estimates that 75% of the 2.6 million stillbirths occur annually in Africa. This study aimed to evaluate stillbirth etiology and determine the association between antenatal care quality and utilization, and intrapartum care quality with stillbirths in Nairobi, Kenya. 

Methodology: This was a case-control study conducted in four Kenyan tertiary hospitals between August 2018 and April 2019. Two hundred and fourteen (214) cases and 428 controls were enrolled and evaluated at more than 28 weeks of gestation. Data were collected via interviews and data abstraction from medical records. The outcome variable was the birth outcome (stillbirth vs. livebirth); the exposure variables were socio-demographic characteristics, medical & obstetric risk factors, antenatal care utilization and quality, and intrapartum care quality. The exposure variables were compared using the two-sample t-test for continuous variables, whereas the Chi-square or Fisher’s exact tests were used for categorical variables. 

Results: Mothers who did not receive antenatal care, made 1 or 2 ANC visits, received low quality antenatal & intrapartum care, and were referred, were likely to have a stillbirth. The prevalence of hypertensive disorders (P=<0.001), antepartum haemorrhage (P=<0.001), preterm delivery (P=<0.001), previous preterm birth (P=0.01), and diabetes mellitus (P=<0.001) was higher among those with stillbirth. There was no statistically significant difference between the prevalence of intrauterine growth restriction (IUGR), multiple gestation, congenital anomalies, previous stillbirth, previous abortion, HIV, anaemia amongst cases versus controls. 

Conclusion: Our findings reiterate the significance of medical and obstetric complications, antenatal care quality and utilization, referral status, and intrapartum care associated with stillbirth in a Kenyan urban setting. Proper antepartum and intrapartum care, surveillance to identify and manage medical or obstetric conditions, and improved referral systems are recommended. 

During pregnancy, several physiological changes in the mother, acting mainly through the vascular endothelial dysfunction, do occur that put them at high risk of several neurological conditions such as eclampsia, preeclampsia,

stroke, posterior reversible encephalopathy, and headaches (1). Some preexisting neurological conditions such as intracranial neoplasms worsen during pregnancy, but others such as multiple sclerosis often improve during pregnancy (2). Other conditions such as cerebral venous thrombosis, viral hepatitis E, and falciparum malaria occur in pregnant women more frequently than in the general population. Some neurological conditions may result from clear-cut abnormalities, whereas others may be functional, resulting in pain, fatigue, or altered mentation (3).