Obstetric Anesthesia Practice Significantly Evolved: A Field for Cesarean Delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

Obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of Kara, in Northern Togo

Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.

Pattern of Referral of Obstetric Patients at a Tertiary Care Hospital in Southern Nigeria

Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient’s biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre of the referral system, hence adequate facilities should be made available in primary and secondary health centres to tackle obstetric emergencies.

Disparities across the CREOG Districts —Variations of Wellness and Inclusivity Efforts in Obstetrics & Gynecology Residency Websites between Two Consecutive Years

Background: Few studies have focused on the geographic and chronologic assessment of inclusivity and wellness in Obstetrics and Gynecology residency websites across the US. Objective: To identify variations in wellness and inclusivity website depictions across CREOG districts over the past two years. Methods: This is a cross-sectional analysis of the websites of ACGME-accredited OB/GYN residency programs across the United States between April 2022 and April 2023. The assessment was based on a compilation of 22 attributes devised and piloted by 49 medical students. A racially, geographically, and gender-diverse cohort of 11 students performed data collection. Results: A total of 560 websites were analyzed over two years. Wellness efforts remained unchanged in both years (website content, dedicated support personnel, and group activities). In 2023, a reduction in referencing of wellness (22%) and inclusivity (30%) occurred in leadership messaging. However, a 7% increase in the use of inclusive pronouns was noted. A reduction in gender diversity was identified (9% in faculty, 5% in residents), with programs favoring female-only teams. Similarly, a 7% reduction in the number of underrepresented in medicine faculty and residents was noted. A 15% reduction was noted in curricula referencing inclusivity in their mission statement and inclusivity focused research. Conclusions: This study suggests the variations across websites relative to inclusivity and wellness over the past two years. Updated websites may provide an accurate reflection of the offerings of programs and their investment in wellness and inclusivity across the nation.

Obstetric Emergencies at the Kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

Knowledge and Attitudes of Nursing Staff towards Obstetric Fistula at the Abeche University Hospital, Chad

Introduction: Prevention of obstetric fistula (OF) remains a challenge in Chad where its incidence is 464 cases/year. The present study aims to determine the knowledge and attitudes of nursing staff towards obstetric fistula. Patients and Method: This was a cross-sectional, descriptive and analytical study including nursing staff at the Abéché University Hospital. The survey took place from March to May 2023 and the sampling was exhaustive. Data collection was done using a form including a questionnaire on sociodemographic parameters, knowledge and attitudes. Participation in the study was voluntary and individual. Results: Participation in the study was 76.11%. Emergency department staff were the most represented, followed by gynecology-obstetrics staff with 34.4% and 20.91% of cases respectively. Nurses represented 53.17% of participants followed by doctors (23.52%). An exact definition of obstetric fistula was reported by 7.84% of participants and it was partial in 80.39%. The level of knowledge of risk factors was considered good in 12.41%. Exact knowledge of clinical signs was reported by 74.5% of cases. Among the participants, 1.96% reported that the treatment of obstetric fistula is traditional. Knowledge about means of prevention was considered good by 13.72% (n = 21), and attitudes by 26.79%? Obstetric fistula knowledge was influenced by profession (doctor, p = 0.011) and attitudes by service (p = 0.004) and profession (doctor, p = 0.001). Conclusion: Obstetric fistula is a curable disease whose prevention remains possible and requires good knowledge of the disease and the promotion of safe motherhood. This study should serve as a basis for the establishment of the obstetric fistula module in the curriculum of healthcare personnel and the promotion of continuing training for its eradication.

Obstetric Fistula: Epidemiological, Social and Therapeutic Aspects: Prospective Study of 196 Patients Admitted to the ZINDER Mother and Child Health Centre (CSME)

Introduction: Obstetric fistula (OF) is an abnormal communication between the genital and urinary tracts and/or associated with a recto-vaginal communication resulting from prolonged dystocic delivery. It is a frequent pathology in underdeveloped countries. In Zinder no study has been carried out on obstetric fistula. The aim of this study was to evaluate the epidemiological, social impact and therapeutic aspects of obstetric fistula at the CSME of Zinder. Patient and Method: This was a descriptive cross-sectional study of obstetric fistula care at CSME during the period of (January 2018 to June 2020). Results: A total of 196 cases were collected over 30 months. This represents an annual incidence of 78.4 fistulas. The median age of the patients was 18.63 years, and more than 65% were over 20 years old. One hundred and ninety-one patients (97.45%) did not attend school, and 56.12% (n = 110) lived in polygamous households. One hundred and fifty-one women (n = 151), 77.04% had full assistance from their husband during the first four (4) months of the pathology. Twenty-four (12.24%) had been notified of repudiation. Obstetrical risk of dystocia was found in 39.79% (n = 78) of the patients, of whom 24.49% (n = 48) had a focused antenatal consultation (CPNR). The labour lasted more than 24 hours in 100%. The majority of women are multiparous and 60% had at least 2 pregnancies. vesicovaginal fistula is the main pathological type with 86.23%. Fistulas were closed in 83.16% and 68.87% exited without urine loss. Conclusion: Obstetric fistula is a devastating disease affecting girls and young women in Niger, as in other countries in Africa and Asia. It is a major concern worldwide and is a social tragedy because it is disabling and depressing.

Obstetrical Emergencies in Ouahigouya Regional Teaching Hospital (Burkina Faso) in the Context of Insecurity Linked to Armed Groups: A Comparative Study between Patients from Precarious Security Zones and Those from Safe Areas

Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in a region plagued by insecurity linked to armed groups. Method: This was an analytical cross-sectional study with prospective data collection over a 4-month period, from June 10 to October 10, 2020. Patients from precarious security areas were compared to those from safer areas. The Chi squared and Fisher tests were used for comparison of variables. Results: Obstetric emergencies accounted for 38.62% of admissions, from which 25.59% came from precarious security zones. Age was similar in both comparison groups. However, patients from unsafe areas were more likely to reside in rural areas (p 0.001) and more likely to be in unpaid occupations (p 0.001). Prenatal visits were less frequent (p 0.01) and women were more often multigravidae (p 0.01) in the precarious security group of patients. Apart from the more frequent uterine rupture (p = 0.02) in the group from precarious security zones, diagnosed complications and maternal mortality were similar in the 2 groups, while perinatal mortality was higher in the group of patients from precarious security zones (p 0.01). Conclusion: The precarious security situation has negative consequences on maternal and perinatal morbidity and mortality. Further studies are needed for better understanding of these consequences, and improvement of health system resilience strategies, to reduce related maternal and fetal morbidity and mortality.

The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

Assessing Strategies of Obstetric Fistula Management by Nurses/Midwives of Yaoundé Central Hospital and University Teaching Hospital

Every minute, a woman dies in pregnancy, and for every woman who dies 20 - 30 others will survive with morbidity, one of which is obstetrical fistula. Women who suffer from obstetric fistula experience continuous incontinence of urine and/or stool, stigma, social isolation and associated health problems. The World Health Organization estimates that there are currently more than 2 million women living with untreated obstetric fistula mostly in sub-Saharan Africa and South-East Asia, as well as in various other parts of the world. Caring for fistula patients and nursing them back to full physical and mental health can be one of the most challenging and also rewarding tasks undertaken by nurses. The surgery cannot succeed without proper pre-, peri- and post-operative care. The patients undoubtedly recover better with high-quality care—meaning the truly holistic, generous, and selfless care of a nurse who has the skills, understanding and determination to help these very vulnerable patients. Objective: This research seeks to assess the strategies of obstetric fistula management by nurses/midwives of Yaoundé central hospital and CHU by exploring the care they offer to clients pre-operatively, post-operatively, and when they are discharged from the hospital. Achieving Millennium Development Goal (MDG) 3 still remains a challenge to the developing countries although maternal mortality reduction is a priority agenda of each country. Methodology: This retrospective cross-sectional descriptive study design employed a sample of 100 nurses/midwives on active service, and who have at least managed a case of obstetric fistula. A quantitative questionnaire was used to collect data, which was analyzed using SPSS version 23. Results: The study proved a highly significant difference between management and qualification, with a p-value of 0.002. Also, it showed that there was a statistically significant difference between longevity of service and management with a p-value of 0.001. A majority of respondents were nurse assistants (52%), and up to 43% of respondents had 11 - 20 years of work experience. Up to 53% did not offer standard care with respect to their qualification, and up to 52% did not offer standard care with respect to their longevity in service. Conclusion: VVF is the most common type of obstetric fistula with a frequency of 6 to 10 cases, there is an overall poor management of obstetric fistula by nurses and midwives in YCH and CHU. There is an urgent need to train and retrain these health workers on the management strategies of obstetric fistula and to remind them of their personal commitment as care givers.

Obstetric Emergencies: Frequency, Socio-Demographic Aspects and Risk Factors at the Labe Regional Hospital Maternity Unit (Guinea)

Introduction: Obstetric emergencies are clinical situations of a serious nature, often dangerous, which develop unexpectedly, threatening the vital prognosis of the mother and/or foetus in the short term. The aim of this study was to contribute to a review of obstetric emergencies at the Labé Regional Hospital maternity unit. Methods: This was a prospective descriptive and analytical study conducted over a period of 6 months in the maternity unit of the Labé Regional Hospital. It concerned all patients admitted to the department for obstetric emergencies. Results: Obstetric emergencies accounted for 20% of obstetric admissions. The mean age of the patients was 25.12 ± 7.15 years, with extremes of 14 and 45 years. The patients were housewives (42.52%), 42.86% did not attend school and 77.41% were from urban areas. The poor were the most numerous (43.52%). The ambulance was the means of transport in only 9% of cases. Acute foetal distress, pre-eclampsia, bony dystocia and post-partum haemorrhage were the most common types of emergency in our series, with frequencies of 27.57%, 22.59%, 17.94% and 10.63% respectively. The risk factors identified were age, origin, gestational age and the state of the maternal pelvis. Conclusion: Obstetric emergencies are frequent in our study site and represent a major concern for patients, providers and the community alike. In order to reduce the frequency of obstetric emergencies, young girls should be enrolled in school, the legal age for marriage should be respected, quality antenatal care should be provided in basic health facilities, and proper planning and spacing of pregnancies should be implemented.

Epidemiological and Therapeutic Aspects of Obstetric Fistula in 2021: A Review of 97 Cases at the Departmental University Hospital Centre of Borgou and Alibori in Benin

Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors.

Factors Determining the Postponement of Schedule Gyneaco-Obstetric Surgery at CHUMEFJE in Libreville (Gabon)

The study aimed to identify factors causing delays in scheduled gynaeco-obstetric surgeries at CHUMEFJE in Libreville from January 2019 to July 2020. Through a 16-month observational survey, it was found that out of 346 scheduled procedures, 128 (36.4%) were postponed. Organizational issues in the operating theatre were responsible for 80.3% of these delays, with 95.3% being preventable. To enhance efficiency, improvements in operating theatre organization are recommended.

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the state of hemodynamic shock before the operation;lack of blood transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric hysterectomy is a very mutilating and complicated surgical procedure and is still common practice in Africa. The maternal prognosis is still reserved with a very high mortality rate in Togo.

Epidemiologic and Therapeutic Aspect of Urogenital Fistula Following Obstetric and Gynecologic Surgeries Repaired at the Nkwen Baptist Hospital

Introduction: Urogenital fistula is an abnormal communication between the urinary and the genital systems. It may occur following vaginal deliveries or following pelvic surgeries. Data concerning urogenital fistula post-surgery is limited and we have noticed in recent years in Sub-Saharan Africa, an increase in the burden of iatrogenic urogenital fistula. Objective: The aim of this study was to assess the epidemiology, clinical profiles and therapeutic aspects of urogenital fistula following obstetric and gynaecologic surgeries repaired at the Nkwen Baptist Hospital Bamenda. Materials/Methods: This was a longitudinal descriptive study with a retrospective and prospective phase carried out at the Nkwen Baptist Hospital for 5 months. However the complete duration of the study was about 17 months. Data was collected using a pretested questionnaire containing socio-demographic information, clinical features, and therapeutic methods used. We used the statistical software SPSS (Social Package for Statistical Sciences) V 26.0 for data analysis. Results: The number of participants in the study was 40. The mean age was 43.5 years (+/- 13.3) ranging from 16 - 74 years. The prevalence of urogenital fistula post obstetric and gynecologic surgeries at the Nkwen Baptist hospital was 64.6%. The most common symptom was urine leakage and the most common surgery that exposed the patient to the urogenital fistula was total abdominal hysterectomy (60%) followed by caesarean section (35%). The different indications for these surgeries were mostly symptomatic leiomyoma (70.8 %) and prolonged labor (64.2%) respectively. The different types of fistula encountered were Vesicovaginal fistula (55%), Ureterovaginal fistula 40% and Vesicoutetrine fistula 5%. The different treatment modalities used were trans abdominal (77.5%) and transvaginal repair (22.5%). The overall repair success rate after one month was 85%. Conclusion: There is high burden of urogenital fistula post surgeries in our setting. Having more specialists trained in obstetric and gynaecologic procedures may help in the prevention of such an event.

Contribution of Simulation to the Skills Laboratory for the Learning of Obstetrical Examination in an African Setting with Limited Resources

Objective: To evaluate the interest of the simulation in the learning of the obstetric examination of parturient by medical students. Materials and methods: It was an analytical cross-sectional study that took place from 1 to 28 February 2020 at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. The study population was made up of medical students at the Doctorate II level. The previous experience of the students in the obstetric examination of the parturient, the contribution of the simulation on their feelings and on their skills towards this examination were studied. The Mc Nemar Chi2 test was used to compare percentages on paired samples. Results: The level of difficulty in performing the obstetrical examination in the parturient evolved downwards after the practice of the simulation. The stress level to perform the obstetric exam has been significantly reduced. On the other hand, confidence has increased. The students’ ability to appreciate each of the elements of the obstetric examination studied had improved after the practice of simulation. Conclusion: The simulation in the skills laboratory was a great contribution and the acquisition of models of better fidelity would help to improve the contribution to the confidence building and the acquisition of skills by learners.

Rationale of Longitudinal Cohort Study on Obstetrical Outcomes of Trichomonas vaginalis Infection in Kinshasa, DR Congo

Background: Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world, and the occurrence of this infection during pregnancy is responsible for adverse obstetrical outcomes like premature labor, premature rupture of membranes (PROM) and low birth weight (birth weight < 2500 g). The association with a number of factors (maternal age, low level of education, low socio-economic status and multiple sexual partners, etc.) that can be found in our environment suggest its probably high prevalence amongst vaginal infections that are responsible for adverse obstetrical outcomes, but up-to-date estimates are lacking. Objective: To assess the obstetrical risk associated with Trichomonas vaginalis (T. vaginalis) infection in our environment. Methods: We designed a protocol for a prospective cohort study which will take place in four medical facilities in the city of Kinshasa, where all pregnant women with a pregnancy of at least 20 weeks and who will give written consent will be included. Vaginal swab specimens will be collected for T. vaginalis research by direct microscopy wet mount. Follow-up will consist of recording the process of the pregnancy and obstetrical outcomes. Conclusion: Results from this study will allow to enhance management and also bring updated estimates on T. vaginalis prevalence and its obstetrical outcomes for infected pregnant woman in our environment.

Application of the “Six-Step Teaching Method” in the Nursing Teaching of Obstetric Interns

Objective: The “six-step teaching method” is a teaching method, which is summarized based on practical experience. This study aimed to explore the effect of “six-step teaching method” in clinical teaching of obstetrics. Methods: A quasi-experimental study design was used, 30 nursing students who entered obstetrics practice from March 2022 to July 2022 were selected as the control group according to the order of time, and traditional teaching methods were adopted. From August to December 2022, 30 interns were selected as the experimental group, and the “six-step teaching method” was adopted. After 8 weeks of clinical practice, the assessment results and teaching effect satisfaction of the two groups were compared. Results: The scores of obstetrical specialty in the experimental group were higher than those in the control group, and the difference was statistically significant (P < 0.05);The evaluation of teaching methods, teaching quality, classroom atmosphere and individual observation ability, clinical thinking ability and nurse-patient communication ability of the experimental group were higher than those of the control group, and the differences were statistically significant (P Conclusion: “six-step teaching method” can effectively master the professional knowledge of obstetrics, stimulate the clinical thinking ability of interns, and improve the teaching effect and satisfaction. .

A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage

Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.