Ethiopian Journal of Reproductive Health

A pilot study comparing mild stimulation Invitro-fertilization(IVF) versus long protocol IVF among women with advanced maternal age in a developing country

Abel Teshome — Fri, 26 Jan 2024 08:24:16 +0000

Abstract

Background: Due to the high costs involved with conventional Invitro-fertilization (IVF) methods, access to IVF is still restricted in many low- and middle-income nations. Mild stimulation IVF has been suggested as a cheaper alternative to conventional IVF to enhance access to IVF in places with limited resources since it employs lower doses of ovarian stimulating drugs. Introducing mild stimulation IVF in Ethiopia could help increase access to assisted reproductive services. There is no previous research in Ethiopia

Objective: This paper aimed to examine outcomes of a mild stimulation IVF pilot program at a clinic in Addis Ababa, Ethiopia.

Methods: This study was conducted at the Center for Reproductive Medicine IVF clinic. Ethical approval was obtained before the start of the data collection. A chart review of those infertile women who had undergone IVF in the past 3 years (April 1, 2019–April 1, 2022) was done. All of the electronic registrations at the clinic were complete for the data we need, and data abstraction was done using Open Data Kit (ODK). The ODK was tested on 5% of the study population and the validity checked before the start of data collection. The data was exported to Stata 14 for analysis. Summarization using frequency distribution was done for the clients’ socio-demographic characteristics. A Chi-square test was used to test associations between categorical variables and outcome variable. The intention was to do bivariate analysis followed by multivariate analysis for those factors that have significant association with outcome variable. A p-value of less than 0.05 is considered statistically significant, with a 95% confidence interval.

Results: A study of 296 IVF clients found that 69.3% were women whose age was less than or equal to 35 years, while 30.7% of women were older than 35. Of the 296 women, 97.3% had their B-HCG result known, with 62.5% being negative and 37.5% positive. The study focused on assessing which protocol was preferred for women with advanced age (age higher than 35 years). A subgroup analysis of 83 women with advanced age found that there was no significant statistical difference in pregnancy rate between mild stimulation and long protocol IVF (COR=0.78, P-value=0.727, 95% C.I=0.22-2.85). However, cross-tabulation analysis shows that among the 17 cases who are positive for pregnancy mild stimulation has higher pregnancy rate 13 (76.5%) compared to the long protocol 4(23.5%) in this age group. The long protocol cases had a mean requirement of Gonadotropin medication which is threefold higher than mild stimulation IVF.

Conclusion and recommendation: Even though there is no statistically significant difference between the two protocols, cross-tabulation showed that pregnancy rate is higher among mild stimulation cases. Additionally, the cost of gonadotropin treatment was three fold higher for long protocol IVF. Further studies with a larger sample size be conducted to confirm the results. However, based on the current findings, we recommend that mild stimulation IVF be considered as a better option for women with advanced maternal age in low resource settings, as it achieves a similar pregnancy rate at a lower cost.

Adolescent girls’ participation in peer-group improved condom use at sexual debut in rural Eastern Ethiopia: a community based cross-sectional study

Fri, 26 Jan 2024 08:26:31 +0000

Background: Adolescent girls engaged in sexual activity are unlikely to use condoms during their sexual debut. Younger adolescents are also not often targeted for sexual-related interventions because of the taboos associated with sexuality in traditional societies. This study examined the association between peer-group participation and condom use at sexual debut among young adolescent girls in rural Eastern Ethiopia.

Design: The study analyzed data from a large quasi-experimental study involving 3290 young adolescent girls aged 13-17. The intervention targeted adolescent girls aged 10 – 14 years. Unmarried sexually active adolescent girls, and married girls who had their sexual debut before marriage were the study population. Multi-level mixed-effect logistic regression analysis was employed to examine associations using STATA/SE version 16 statistical software.

Results Among 3290 adolescent girls surveyed, 258 (7.84%) reported engaging in sexual intercourse. The Mean(+SD) age at sexual debut was 14.36 (+1.32), with no observed statistical difference between the intervention and control groups (p=0.1164). The magnitude of condom use at sexual debut was 22.46%, 95 % CI (14.11, 33.81%). The odds of using condoms during sexual debut among girls who participated in peer-group was 11.51 times higher (Adjusted OR: 11.51, 95% CI: 1.95, 67.84) than those in the control group.

Conclusions Peer group participation improved condom use at sexual debut. Peer groups can be critical for engaging adolescent girls in HIV and other sexually transmitted infection prevention and avoiding unwanted/unplanned pregnancies. Further studies with larger sample size and specifically design research is necessary to generate evidence for scale up of this potentially lifesaving intervention.

Pregnancy Outcomes In Obese Women Who Gave Birth During The Outbreak Of The Covid-19 And Before It

Sepideh Dolati, Leila Farzad, Salime Goharinezhad, Mitra Zarrati — Fri, 26 Jan 2024 08:28:51 +0000

background: Due to its nature, the covid-19 disease can have adverse effects on pregnant mothers, fetuses and newborns.

Objective:Therefore, this study was conducted to investigate pregnancy outcomes in obese women who gave birth during the outbreak of the covid-19 and before it.

Methods: This is a descriptive-analytical study that was conducted on 444 obese pregnant women in two groups, before and during the outbreak of covid-19, and the outcomes of pregnancy and the role of covid-19 in their development have been investigated. The data were collected through online questionnaires. In order to analyze the data, logistic regression model and odds ratio analysis were performed.

Results: According to the independent t-test between the two groups, the average BMI in the two groups was 32.95 and 33.12, respectively. According to the obtained statistics (Pr (T > t) = 0.7076 and t = -0.5469), this difference was not significant. Also, corona-virus infection had no effect on pregnancy outcomes such as gestational vomiting, gestational diabetes, high blood pressure, pre-eclampsia, postpartum hemorrhage and weight gain during pregnancy, but it increases the chances of urinary infections, need to cesarean section and premature delivery, although these increases were not significant.

Conclusion: Covid-19 can cause some consequences and outcomes, including premature birth, gestational diabetes, increased body mass index and other dangerous complications for pregnant mothers, fetuses or babies.

Partograph utilization is associated with educational status of obstetrics care givers in Ilu Aba Bor Zone, Ethiopia: a cross-sectional study

Getamesay Aynalem, Fentaneh Teshome , Ebissa Negera — Fri, 26 Jan 2024 08:30:31 +0000

Background: Worldwide, several thousands of mothers die every year due to pregnancy and birth related complications. Most of maternal deaths can be minimized by using partograph routinely. However, the level of utilization and associated factors among obstetrics care providers in Ilu Aba Bor Zone has been barely known.

Objective: This study assessed the level of partograph utilization and its predictors among obstetric care givers working in public health institutions of Ilu Aba Bor Zone, South West Ethiopia.

Methods: An institution-based cross-sectional study design was employed. A structured self-administered and pretested questionnaire adapted from available literatures were used. In addition to descriptive statistics, logistic regression analysis was applied to assess association.

Results: The level of partograph utilization among obstetrics care providers in the study area was 32.8%. Receiving on-job training on partograph (AOR (Adjusted Odds Ratio) = 2.21, 95%CI (Confidence Interval) = 1.19, 4.11), working in a hospital compared to working in a health center (AOR = 2.43, 95%CI = 1.01, 5.82), having BSc (Bachelor of Science) and above educational status in contrast to having Diploma (AOR = 3.12, 95%CI = 1.59, 6.12), and having partograph in a health facility (AOR= 4.19, 95%CI = 2.12, 8.29) were positively associated with partograph use.

Conclusions: Partograph utilization level was much lower than World Health Organization recommendation. On-job training on partograph, work place, educational status, and partograph availability were predictors of level of partograph utilization among the obstetric care givers.

Prevalence and predictors of ovarian hyper stimulation syndrome at Center fertility and repro-ductive medicine at Public IVF center, Ethiopia

Meseret Ansa, Mustefa Negash, Mekitie Wondafrash, Abel Teshome — Fri, 26 Jan 2024 08:35:35 +0000

Abstract

Background

Infertility affects fifteen percent of couples who wish to conceive. The mainstay of artificial reproductive technologies is in vitro fertilization and embryo transfer (IVF-ET), in which aspirated Oocytes are fertilized, followed by the trans cervical replacement of an embryo(s) into the uterine cavity.However, the practice of assisted reproductive technology is loaded with short- and long-term complications. Complications may occur during the course of stimulation, ovum pickup, or embryo transfer. Ample studies are done on in vitro fertilization, but the frequency and importance of complications of IVF in low-resource setups where the treatment itself is not widely available are poorly known.

Objective

This study aimed to determine the rate of ovarian hyper stimulation syndrome and associated factors among women who underwent controlled ovarian stimulation and IVF in a public IVF center.

Methodology

A simple random sampling technique was used to review the medical records of women who have undergone ovarian stimulation and IVF treatment at the Saint Paul’s Hospital Center for Reproductive Medicine and IVF.

Results

A total of 428 clients had controlled ovarian stimulation and IVF. The mean age of the participants was33yrs among 428 couples who had IVF, majority 245 (57%) had IVF for female factor infertility followed by male factor infertility 89(20%) and unexplained causes 53(12%).

The incidence of OHSS in our IVF population was 19(4.4%) out of 428 women. out of the 22 patients with OHSS 17 (87%) developed mild and moderate and the rest 2 out of 22(10 %) had severe OHSS. The odd of developing OHSS was 6 times among those with PCOS, OR 5.78 CI (1.19, 28.22), p value of 0.03.

Conclusions and recommendations

The overall rate of ovarian hyper stimulation syndrome is higher in our IVF population.

Emphasis should be given on counseling and risk minimizing measures when women withPCOS

Key words: IVF, Complications, Ovarian hyperstimulation syndrome

Gynecololgic Cancers at a Tertiary Hospital at Teritiery Hospital in AddisAbaba, Ethiopia. A 5 years Review

Malede Birara, Tadesse Urgie, Abraham Fessehaye Sium — Fri, 26 Jan 2024 08:39:47 +0000

Abstract

Back Ground Gynecologic cancers are an important cause cancer related of morbidity and mortality among women globally. The trend and incidence however varies according to different geographical settings and demographic differences. The main aim this study was to review the profile of gynecologic cancers managed at a Saint Paul Hospital Millennium Medical College,

Methods: A retrospective chart review was done for all patients managed at the hospital from 2016 to 2020, The relevant information was retrieved from patient charts, and pathology reports, the data was entered and analyzed Using SPSS software version 24.

Result: A total of 768 Gynecologic cancer cases were seen at the hospital and 700 of them were analyzed, the rest were excluded because of chart incompleteness. The most common primary tumor origin was cervix 339 (48.35%) followed by ovarian 194 (27.67%), GTN 90 (12.8%), Uterine 46(6.56%), and vulvar 29(4.1%). Most patients with cervical cancer present with late stage with only 37.5 % were early stage and surgically operable and the median age was of 46 years. The majority of ovarian cancer patients present at advanced stage.

Conclusion cervical cancer emerges as the most common gynecologic cancer in women requiring admission, constituting a substantial cause of cancer-related morbidity and mortality. Despite being preventable through effective screening programs, cervical cancer remains insufficiently addressed. Awareness creation for people from rural area is essential so that early heal seeking behavior will be established.

PERINATAL AND MATERNAL OUTCOME OF PREECLAMPSIA WITH SEVERITY FEATURE MANAGED EXPECTANTLY AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC), 2021, ADDIS ABABA, ETHIOPIA. A CROSS SECTIONAL STUDY

Birhanu Kebede, Ananaya Solomon, Tizita Abraham — Mon, 29 Jan 2024 08:12:06 +0000

ABSTRACT

Background

Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is labeled as Preeclampsia with severe features when one of the severity signs occurs. Worldwide, Preeclampsia occurs in up to 7.5 percent of pregnancies and 10 - 15 % of direct maternal deaths are associated with preeclampsia and eclampsia. Majority of adverse maternal and perinatal outcome occur in Preeclampsia with severe features and when Preeclampsia occurs remote from term ( ).

Objective

The main objective of this study was to determine the maternal and perinatal outcome of Preeclampsia with severe features managed expectantly at SPHMMC in one year period.

Materials and Methods: Facility based cross-sectional study was conducted. The study participants were selected consecutively by including all mothers admitted during the study period (January 2021 to December 2021 G.C.) with the diagnosis of Preeclampsia with severe features to SPHMMC that fulfill the inclusion criteria.

Data taken was, the patients chart and a direct patient interview using pre-tested & structured questionnaire. Collected data was entered in to Epi info version 7 & analysis was made through SPSS version 25. Descriptive statistics, tables & figures was used to describe the study finding.

Result –the mean days of prolongation of pregnancy was 11.5 days with slight increment of maternal complication from expected proportion that completely resolved postpartum. The most common maternal complications were HELLP syndrome (15.1%) and abruptio placenta (7.2%). There were 21 perinatal deaths (08 still births and 13 neonatal deaths) that give perinatal mortality rates of 276 per 1000 live births. The rate of NICU admission was 66.7% and the neonatal survival to seventh day was 71.7%.

Only 66(90.4%) of the women were a good candidate for expectant management. Magnesium sulphate and steroid (dexamethasone) at admission was given 100% but 8.2% of the mothers didn’t get magnesium sulphate during intra partum and post partum period.

Conclusion / Recommendation - Proper selection of pregnant mothers with pre-eclampsia with severity feature and Close and frequent maternal and fetal surveillance during expectant management is associated with a good perinatal outcome without significant difference in maternal complication.

Key Words: pre-eclampsia ,Perinatal outcome, maternal complication.