THE 27
27TH CONGRESS OF OBSTETRICAL AND GYNECOLOGICAL SOCIETY OF THE
SUDAN
Collaboration with the Arab FetoFeto-Maternal Expert Group
THEME
MANAGEMENT OF OBSTETRICAL AND GYNACOLOGICAL EMERGENCIES
UNDER THE PATRONAGE OF HIS EXCELLENCY
THE SUDAN VICE PERESIDENT
BAKRIE HASSAN SALIH
Venue: Police Club-Burri-Khartoum-Sudan
Editors
Prof A/
A/Salam Gerais
: Faculty of Medicine, University of Khartoum
Dr.Abdul Rahman Khalid
: Faculty of Medicine, University of National Ribat
Dr.Wisal Omer M.Nabag
: Faculty of Medicine, ALziem ALazhari University
Dr.Sami
Dr.Sami Mahmoud A.Bakiar
: Reproductive Health Care Center
Dr.Elhadi Ibrahim Miskeen : Faculty of Medicine, University of Gezira
1
CONTENTS
Conference Committees………………..…………………….…………..…………….6
Committees
Forwards……………………………………………..……………..…………….…….7
Forwards
Opening Cer
Ceremony
eremony…………………………………….…………..……….….………8
emony
Welcome speech from the OGSS President……………………………..….………….9
President
The relationship between obstetric emergencies and the health care system
Professor Ahmed Bayoumi……………………………..…………………………..10
Bayoumi
Perinatal Nutrition and supplementation
Dr.Hisham Arab……………………………………………………...…...…………..14
Arab
Non Invasive Prenatal Diagnosis
Dr.Mahir Maaita..……..………………………………………………………..……15
Maaita
Recent advance in ultrasound technology
Dr. Soha Farghal…………………………………………………..………..……..…..16
Farghal
Management of acute Postpartum Haemorrhage
Dr.Rabih Chahine ……………………………..…………………………………….17
5 Things Ob/Gyns Shouldn't Do
Prof Badreldeen Ahmed……………………………..…………………….…..…….19
Ahmed
Antenatal management of selected fetal abnormalities
Dr Wesam Kurdi……………………………..………………..………….………….21
Kurdi
Makassed Experience In Management of Placenta Accreta 2007-2013
Dr . Saadeh S.Jaber……………………………..………………..………...…..….….22
S.Jaber
Hypertensive Disorders Of Pregnancy Based On ACOG Guidelines
Dr. Mamoun M E Awad………………………..………………..…………..…….….23
Awad
Management of severe complications of eclampsia
Dr.Mahir Maaita………………………..………………..…………..…...……….….25
Maaita
Role of Ultrasound in the management of diabetes in pregnancy
Professor Badreldeen Ahmed………………………..……..………..…...……….….26
Ahmed
Fetal Obesity
Dr Hisham Arab………………………..……………..…………..…...……….….….27
Arab
Assisted Conception and Multiple Pregnancy: Where should we circle the Circle?
Dr. Elsamawal El Hakim…………………………………..………..……..…..….….28
Hakim
Pregnancy outcomes in women with diabetes treated with metformin, insulin or
both in a newly established Joint Obstetric- Diabetes Clinic, Al Wakra HospitalHMC Qatar
N…...…….….29
Dr Hiba Satti, Dr M Dagash, Dr M Alloub, Shry K, Najla S, Fatma N
Uterine Transplantation From The Research Releam To The Arena of Clinical
Application
2
M. Elamin Elsherif ‘Alhindi……………………………..…………..……….....……31
‘Alhindi
Oral Contraceptive a recent update
Dr Ashraf Kortam…………………………….………………………………...……33
Kortam
Female Genital Mutilation (FGM): UK Perspective & Guidance for Practitioners
Abdelrahman Abdelmageed…………………………..…………………..…...……34
Abdelmageed
The Role Of Cervical Length Assessment In Management Of Low And High Risk Of
Preterm Labour, Review Article
Dr Khalid Yassin ……….…………………..………………………………….……37
Laparoscopic Surgery in a Regional Hospital Eastern Sudan
Dr.Safa Ahmed …………….………………..…………..…………………….....……38
Community Health Workers (CHWs) rule in Obstetrical emergencies
Rwanda ………….………………………………..……………………….….....……40
Obesity and pregnancy
Dr.Reem Nasur……………………………………………………………..……….42
Nasur
Diagnosis of Ruptured Ectopic Pregnancy is still a Challenge in Eastern Sudan
Dr AbdelAziem A. Ali,
Ali, Tajeldin M. Abdallah, Mohammed F. Siddig……….……43
Siddig
Expectant Management of Ectopic pregnancy Is it Safe?
Mr.Mohamed A. Siddig……………………………..…………………….…...……44
Siddig
Cesarean Section Scar Ectopic Pregnancy, Seven Years' Experience Reflection (20072014), Newham University Hospital-London, UK
Dr Mohamed Elamin Ibrahim………………..…………..........................................……45
Ibrahim
Scope of Medical Management of early pregnancy complications
Dr.Randa Omer ……………………………..……….…………..……………....……46
Helicobacter pylori seropositivity & stool Antigen in patients with hyperemesis
gravidarum
Dr. Somia Abdalla Fadel Elmoula Dr. Bashir Elgaily & M.Emam………………47
M.Emam
Emergency management of first trimester miscarriage in Kosti Maternity Hospital in
the period of 1st of October 2013 – October 2014
Dr: Muna A. Mohamed Ahmed & Dr. Ali M. Mohamedein ………………………48
B- Lynch suture for the control of postpartum hemorrhage: an alternative to
caesarean hysterectomy? Elobied. from 2008 to 2014
Dr. Ahmed Abdelkerim Ahmed……………
Ahmed……………………………………
………………………………………
……………………………..…………
…..…………50
…………50
Management & outcome of Placenta Previa in Khartoum Maternity Hospitals in
Sudan
Dr Siddig Omer Bamsica, Hajar Hassan Sakin, Rania M Omer
Omer……………………52
Massive Intraperitoneal Haemorrhage Due To Uterine Fibroid In Pregnancy, Case
Report
Dr Moawia E Hummeida ………………………………………….……………….53
3
Prevention and Treatment of Postpartum Hemorrhage –Project to Sudan
Dr..Mohamed Ibrahim …………..………………………………………………..…..54
Kosti Maternity Hospital..Development of maternity services
Dr.Ali Mohamed Mohamedin…………..…………………………………………..55
Mohamedin
Maternal Mortality Review 2014- Gezira State
Childhood…………..………….56
Prepared by Gezira Initiative Safe motherhood and Childhood
Intensive Care Unit & High Dependence Unit for obstetric emergences with
reference to service pre-eclampsia
Dr. Saad Abdelrahman…………..………………………………..…………..……..57
Abdelrahman
Risk factors and management patterns for emergency obstetric hysterectomy over
3years
Dr Wisal. O.M Nabag . Sumyia Kheri. Zienab Elfaki……………………………..58
Elfaki
Maternal death due to delayed management of Sigmoid Volvulus at 32 weeks
Pregnancy Case Report
Gamal k Adam , Khalid Alhaj , Samaual E Elgaili& Khalid Yassin …………..59
Maternal mortality and near miss at Omdurman maternity hospital (OMH), 2013
Dr.Rawia Eltyeb……..…………………………………………………………….…..60
Eltyeb
Risk Management & Patient Safety in Obstetrics & Gynaecology
Dr. Ahmed Eltigani Elmahdi Hussain …………………………………….……..…..62
Maternal and neonatal complications associated with caesarean section in the
second stage of labour at Omdurman maternity hospital during 2012-2013
Prof Taha Umbeli ……..……………………………………………………………..63
Cerebral Venous Sinus Thrombosis an imitator of Eclampsia in three referral
Hospitals in Khartoum, Sudan
Dr Moawia Elsadig Hummeida …………..…………………..……………….……..65
Primary caesarian section in El-obeid North Kordofan , July – December 2013.
Dr. Khidir Elamin Awadalla , Dr. Rawaa Kamal Abdellatif ……………………...…67
Mangement of emergency C/S in Kosti M H October 13- October2014
Dr S. Adam & Dr Ali Mohamadeen…………..……………………………………..69
Mohamadeen
Time Series Analysis Of Waiting Time Before Definitive Intervention In Obstetric
Emergencies In OMH
Bayoumi, Ahmed; Gerais;
Gerais; Bayoumi, Khalid A/Rahman, Malaz & Ahmed, Ala’a……70
Ala’a
Assessment of Maternal Risk Factors of Preterm Labour in Omdurman New Hospital
Ahmed Khalid M. Albashir & Prof. Mohamed Ali ………………………...……….…72
Efeect of Vitamin D defiency in pregnancy and pregnancy outcome
Dr. Selma gerais and Dr. shahad mahmoed………………………………………....74
mahmoed
4
POSTER PRESENTATIONS………………………………………………………….....7
PRESENTATIONS………………………………………………………….....75
………………………………………………………….....75
The age at Menarche on primary, secondary and high schoolgirls Khartoum state
Dr.Mohamed
r.Mohamed A.Bagi & Pro.Mohamed Ali Elshiesh ……………………………..……76
Assessment of umbilical artery Doppler Ultrasound findings in patient with
preeclampsia between 32-36 weeks of gestation in OMH
Dr Sara Foud Richard,Dr Kameel Kamal Kamil……………………………………..77
Kamil
Large solitary luteinized follicle cyst of pregnancy and puerperium Case Report
Moawia Elsadig Hummeida, Ali abdel Satir……………………………………..…..78
Satir
Prevalence of antenatal depression amongmultigravidae at Soba University Hospital
(2013 – 2014)
Dr. Rania D. Eltaher
Eltaher E lgack & Dr. Bashir Algaily Mohamed Imam……………79
Imam
Primary Cesarean Section Indication, Maternal and Fetal Outcome in Oumdurman
Maternity and Saad Abu Elella Maternity hospital (2014)
Dr. Elameen Khougli Elameen,
Elameen Dr. Nada Gaafar Hassan ……………………...……80
Role Of Sweeping In Initation Of Labour In Post- Date Pregnancy In Omdurman
Maternity Hospital
DR. Sarah A. Musaad &.Prof Taha Umbeli, …………………………………….…..81
Review of predictive Factors and the Outcomes of VBAC At Omdurman Maternity
hospital
Dr. Nafisa Ibrahim
Ibrahim Ahmed & Dr. Mohammed Hassen Idris ……………..…….82
Maternal And Fetal Outcome Of Grandmultiparity In Omdurman Hospital
Dr Nahid Sulieman Ismael & Professor A/Slam Gerais………………..……………83
Gerais
Advance Maternal Age and Late Pregnancy Outcome At Omdurman New Hospital
Dr.Shireen Abdalla ahmed & Dr.Khalid Yassin…………………….……….….……..84
Yassin
Ginger For Nausea And Vomiting in Early Pregnancy
Dr.Isam Mohammed Babiker& Prof. Moawia E.Hummeida…………...…….………85
E.Hummeida
Cinical presentation and Treatment Outcome of Genito-Urinary Fistula in El-Obeid
Dr. Mohammed Ibrahim & Dr. Khidir Elamin ……………………………………86
Postpartum Rupture of subcapsular Haematoma of the liver, Case report
Moawia E Hummeida, Magdi Lwis, Durea Erayes, Ismail Omer……………...……88
Omer
Pre
Pre and
and post
post confe
conferenc
onference
rence work
worksh
rkshop
shops
ops……………………….………….…………….89
Scientific program…
program………………………………………………………………......103
......103
5
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Forwards
Welcome to the 27th Congress of the Obstetrical & Gynecological Society of
the Sudan .This year the congress is organized in collaboration with the Arab
Feto-Maternal Expert Group
The Society’s theme this year deals with obstetric and gynecological
emergencies such as, First Trimester complications, Labour and its
complications mainly obstetric haemorrage maternal mortality and morbidity,
Medical Disorders with pregnancy and the role of Ultrasound in Obstetrics
and Gynecological emergencies .
The program includes over 50 presentations covering all relevant topics
during a period of four days twelve posters and round table discussion
addressed two important topics with a business meeting at the end
Eminent delegates and colleagues from United Kingdom, USA, Ireland, United
Arab of Emirate, Kingdom of Saudi Arabia, Rowanda Kuwait and Palestine will
participate and share in deliberation.
Eminent expertises are going to participate in pre & post conference
workshops and courses.
The efforts of all conference committee and the secretariat are highly
appreciated.
Thanks
Editors
7
Opening Ceremony
Venue:
Venue: Police Club-Burri-Khartoum-Sudan
Friday 20 February 2015 - 19:30
19:30-19:35
Al Quran Al-kareem
Abdelhameid E.
E. Abuzied
19:35–19:45 Welcome Speech from OGSS
Prof A.Ashmaig
President
19:45–19:
Sudan Medical Association
Prof Babikir Kabalo
50
19:50–19:55 Arab Feto-Maternal Expert
Dr Hisham Arab
Group
19:55-20:00
SLG Representative
Dr. Abdelrahman Abdelmageed
20:00-20:10
Federal Minister of Health
His excellancy Bahar Eidres
Abugarda
20:10-20:20
Sudan Vice President
His
His excellancy Bakri Hassan
Salih
20:20-20:45
Takreem
Dr Abdulbagy Elzain
20:45-21:00
Quest lecture
Prof Ahmed Bayoumi
21:00-23:00
Entertainment And Reception
8
Welcome speech from the President of Obstetric &Gynaecological Society of Sudan
Professor A.Latif Ashmaige
Your Excellency Sayed Bakri Hassan Salih the Sudan Vice President
Your Excellency Federal Minister of Health
Honorable quests
Drug companies’ representatives
Members of media
Dear colleagues
I am very pleased and honored to welcome you all to our 27th congress of the
obstetrics and gynecologic society of Sudan, in Khartoum, Sudan.
Our theme for this congress deals with obstetric and gynecological emergencies
together with our congress we are pleased to host the second Arab Feto -maternal
meeting in Khartoum on Saturday 21/02/2015 at 09:00 to 15:00.
The obstetrical and gynecological society of Sudan, has been working hard to
improve women heath and rights as well as advancing the science and practice of
Gynecology and obstetrics in Sudan .The society pursues this mission through
advocacy, pragmatic activities, and capacity strengthening of its members and
partners.
To achieve these goals, training courses and workshops will be held in Khartoum,
Wad-Medani and Obied. Pre and post congress include:
-
ALSO, Obstetric An aesthesia, FGM, Detailed Anomaly Scan, TOT, Pelvic
Floor Dysfunction "Twice", Laparoscopy "Twice", Clinical Governance,
PPH and Perineal Repair Course.
I wish to thank the members of the scientific program committee and many other
colleagues who helped organize the program . We hope you enjoy the blend of up to
date social program and the opportunities to make new contacts and to reconnect
with old friends.
Finally, on behalf of the organizing committee, I am happy to welcome you.
9
GUEST LECTURE
The relationship between obstetric emergencies and
the health care system
Professor Ahmed Bayoumi , MBBS, DPH, MD, FFPHM, FACTM
Medical and Research Centre (MRC)
Formerly, Founding Dean, Faculty of Medicine, Al-Neelain University, Khartoum
Professor Abdel-Salam Gerais, and the honourable members of
the Scientific Committee (SC) of this Conference about
obstetric emergencies (OEs), kindly asked me to speak to you
about the conference theme (OE), and how it relates to our
health care system (HCS). Although, this is no mean task, without a moment’s
hesitation, I accepted their kind invitation with enthusiasm, .... for, I was unable not
to respond for three good reasons: 1- Abdel-Salam, besides being an illuminating
research partner on controversial issues on RH and the HCS, is close to my heart, ...
indeed all OB-GYN health personnel- from midwives (MWVs to Consultant
Specialists- are close to my heart, because of a cherished common interest in
reproductive health (RH). 2. It was, equally, difficult not to respond for one who
claims some knowledge of Sudan HCS, and who has followed its historical
development from its Turko-Egyptian roots era; started his medical career during its
golden era; witnessed its present era of decline; and hopes to see- within his
lifetime- the birth of its era of revival, which is looming on the horizon. 3. Once
more, it was difficult for me not to respond as no specialty of medicine is more
marred with emergencies than OB-GYN. Moreover, in OB-GYN there are two
patients to care for instead of one, a mother and a baby or foetus. The management
of one patient heavily affects the management of the other. Sometimes, the decision
10
has to be made by the HCS managers to care for one patient at the expense of the
other; care for the mother first. The second patient (the foetus) may be viable or not.
Their immediate intentions (Abdel-Salam, and the honourable members of the SC)
behind this kind invitation was benevolent: choosing Ahmed Bayoumi to look for
major interrelationships, critical issues, major obstacles within the Sudan HCS that
relate to OEs. The tools, at my hand, for doing this are: observation, impression,
intuition, and analysis. Some problems are described with data, such as morbidity,
disability, and mortality rates, for both the foetus and its bearing mother. These data
help us to look squarely at the quantitative problems of OEs, compared to the
resources of the HCS and their limitations. But there are other problems that cannot
be described this way; the obstructive forces that lie in tradition; the myopic
attitudes of professional and auxiliary groups; the rigidities of administrative
systems; the limited vision of ordinary men and women. The HCS is obliged to
provide basic care for the patient(s) including: the ABCs of resuscitation: patent
airway, smooth breathing and efficient circulation. The patient has to be quickly
assessed: quick history, and a quick physical examination has to be performed by the
caring OB-GYN physician. Some crucial questions and issues have to be resolved in
urgency by the HCS institutions and personnel: 1. Are vital signs stable?, 2. Is the
patient in shock?, 3. IV access should be installed, and two large bore IVs placed, and
if there is active bleeding, 4. Does the patient (and baby) need oxygen?, 5. What
laboratory and radiographic studies are needed?, 6. How much blood has to be
prepared by the blood bank of the caring HCS institution?, 7. Did anyone come with
the patient?, 8. Is the patient conscious?, 9. Are there signs of external Trauma?, 10.
Is the patient in pain?,
11. Is the patient labour?, 12. How far along is the
pregnancy?, Does the patient look term or preterm?, 13. Are there foetal heart
11
tones?, 14. A bedside ultrasound, if availed by the HCS, can provide gestational age,
viability, if the pregnancy is alive, presentation, placental localization, number of
foetuses, etc.15. Does measurement of fundal height correspond to weeks of
gestation, if there is only one foetus. 16. If the pregnancy is viable, can the HCS care
for the patient and baby at this institution or does the patient need to be transferred
to a higher level of care?, 17. Has the HCS availed someone at this institution to care
for the baby if it needs to be delivered?, 18. Has the HCS availed paediatricians,
neonatologists and a high-risk nursery at this institution?, 19. Has the HCS posted
an anaesthesiologist at this institution?, 20. Has the HCS provided to this institution
tocolysis, Betamethasone, or Group B Strep prophylaxis?, 21. Has the HCS provided
facilities at this institution for the baby to be monitored? The number one OE
problem worldwide is preterm labour. It is the most common single cause that costs
HCSs worldwide more healthcare dollars. Preterm deliveries comprise about 10% of
all deliveries but constitute 85% of neonatal morbidity, disability and mortality.
Preterm labour needs to be aggressively faced by the HCS to stop labour, determine
the cause (though 50% of the time the aetiology is not known). The HCS must
transfer pregnant women in labour by proper ambulance.
Although Sudan is a less developed country, it is clear that the more developed
countries are troubled with similar problems of OEs, similar interrelationships with
the HCS, and are being drawn towards similar solutions that were used for decades
by Sudan HCS, such as the role of and are now being experimented with in North
America. These relationships should not be surprising, since the HCSs of all nations,
regardless of affluence, are involved in the same process, that of making optimum
use of resources while attempting to reach all the people with high quality OE care.
In this country many of the problems of OE care are already being met and
12
overridden in our centre of excellence for OB-GYN healthcare, OMH, by managers,
professionals and auxiliary personnel with creativity, persistence, courage, and
devotion. These men and women deserve to be commended in front of this
international gathering. Indeed, due to their dedicated efforts, solutions now exist to
some of the problems that trouble us most, and hider the progress of our HCS. But
other problems remain, some of them elusive and complex, others obvious and
unyielding, and still others neither complex nor unyielding but simply awaiting
creative attention. What must not be missed, however is that if these problems of
OEs are to be met, radical innovations, research orientation, and educating health
personnel must permeate our HCS.Essentially, the humble effort I put in this guest
lecture was to present the important issues in a form that would be readable and
useful to those who struggle with the problems and those who should struggle them,
who collectively can make the decisions and bring about the changes necessary to
improve the quality of our HCS.
13
Perinatal
Perinatal Nutrition and supplementation
Dr.Hisham Arab
14
NON INVASIVE PRENATAL DIAGNOSIS
Dr.Mahir Maaita
15
Recent advance in ultrasound technology
Dr. Soha Farghal
Consultant obstetrics and Gynaecology
Ultrasound Clinical Specialist ( Egypt & Africa ) for Mindray Medical International
Limited.
3D/4D imaging is the latest advance in ultrasound technology. If the 3D has added
volume to the traditional 2D ultrasound, the 4D imaging gives us a fourth
dimension: time, thus processing instantaneously the volumes generated by the 3D
probes, and presenting them as movements in real time.
In the vast majority of cases the day of her 3D/4D ultrasound scan is, for the
expectant mother, one of the most exciting and rewarding of the pregnancy; but the
benefits of 3D/4D obstetric diagnosis go far beyond. The multiple and temporal
sequences of this ultrasound can render life-like visualization of different parts of
the fetal anatomy.
They offer insights, for example, in the morphology and function of areas as
sensitive as the cranial structure or the circulatory system. The 3D images are also
useful for the detection of fetal abnormalities, especially in face, extremities, chest,
spine and central nervous system. 4D scanning, on the other hand, allows
monitoring the development of fetal movements, whose alterations can indicate the
existence of pathologies of the neurological system.
The application of 3D imaging in the diagnosis of gynecological problems is equally
significant. Numerous pathologies of the uterine cavity, fallopian tubes and ovaries
can now be studied in details from the three-dimensional reconstructions of the
female reproductive tract that this technology allows. The 3D ultrasound has helped
16
in the diagnosis of uterine malformations, such as Bicornuate Uterus or Septate
Uterus. Also, help in the detection and assessment of ectopic pregnancies, ovarian
cysts, endometrial polyps or uterine myomas. Its use in combination with Doppler
ultrasound also improves the early diagnosis of tumours in cases of ovarian or
endometrial cancer.
17
Management of acute Postpartum Haemorrhage
Dr Rabih Chahine
18
5 Things Ob/Gyns Shouldn't Do
Prof Badreldeen Ahmed
Weill Cornell Medical college- Fetal Medicine Centre Feto Materanl Centre
The Society for Maternal-Fetal Medicine has released its list of the top 5 common
practice procedures that may not be necessary, offering clinicians recommendations
on what not to do in certain situations. The evidence-based recommendations are a
part of the Choosing Wisely campaign, an initiative of the American Board of
Internal Medicine Foundation.
The recommendations are:
1. "Don't do an inherited thrombophilia evaluation for women with histories of
pregnancy loss, intrauterine growth restriction (IUGR), preeclampsia and
abruption." Scientific data are lacking for a causal association, and when
clinically indicated, testing for antiphospholipid antibodies should be limited
to lupus anticoagulant, anticardiolipin antibodies, and beta 2 glycoprotein
antibodies.
2. "Don't place a cerclage in women with short cervix who are pregnant with
twins." Scientific data show that in this situation, the procedure is not
beneficial and may be associated with an increase in preterm births.
Choosing wisely
3. "Don't offer noninvasive prenatal testing (NIPT) to low-risk patients or make
irreversible decisions based on the results of this screening test." Utility of
NIPT remains unclear for low-risk pregnancies.
19
4. "Don't screen for [IUGR] with Doppler blood flow studies." Studies have
produced inconsistent results on this, and no standards exist for optimal
determination of an abnormal test. If IUGR is detected, however, antenatal
fetal surveillance may be beneficial.
5. "Don't use progestogens for preterm birth prevention in uncomplicated
multifetal gestations." Research has not shown that use of progestogens
reduces incidence in this situation.
20
Antenatal management of selected
selected fetal abnormalities
Dr Wesam Kurdi
21
Makassed Experience In Manage
Management of Placenta Accreta 20072007-2013
Dr . Saadeh S.Jaber MBBS, MRCOG, MRCPI,
Head of OBGYN department at al-makassed hospital & Al_quds universityjerusalem
Background: Placenta accreta (PA) remains one of the most fearful conditions in
obstetrics and is associated with high maternal and perinatal mortality and
morbidity.
The incidence of PA has increased and this seems to parallel the
increasing cesarean delivery (CS) rate 4. High fertility rate of 4.6/woman among
Palestinians coupled with high cesarean section rate of 15%5 is expected to result in
high incidence of PA. Al-Makassed hospital is one of the main tertiary hospitals in
Palestine. There are about 2500 delivery/year and most of them are high risk cases.
Objectives: 1– Auditing the current practice at Al-Makassed hospital concerning the
management of placenta accreta cases in our department. 2– Reaching conclusions
and recommendations that may be delivered to other units facing the same high
incidence of P.A. 3-keeping in mind that obstetric hemorrhage remains the leading
cause of maternal mortality in palestine (consensus )
Method: Retrospective analysis of medical files for all PA cases between 2007 and
2013 was done. Information about hospital incidence, antenatal diagnosis, peripartum preparations, intra-partum approach and final maternal outcomes were
obtained. SPSS program was used for data analysis.
Findings: Fifty one PA cases were identified. The hospital incidence in 2007, 2008,
2009, 2010, 2011, 2012 and 2013 was: 2, 1, 3, 2, 2, 6 and 6 per 1000 respectively.
The mortality was zero. All cases were diagnosed antenatally.
The following morbidities were reported in the 51 PA cases: 1 ureter injury, 2
reopening due to bleeding, 7 ovarian oopherectomy and 10 bladder injury cases.
22
Hypertensive Disorders Of Pregnancy Based On ACOG Guidelines
Dr. Mamoun M E Awad
Consultant Obstetrician and Gynecologist King Fahad Medical City , Riyadh
Despite extensive clinical research the etiology of preeclampsia is still unknown It is
a leading cause of maternal and perinatal mortality and morbidity worldwide and is
a risk factor for future cardiovascular disease in women.
The understanding of the pathophysiology of the disease lead to the use of
antihypertensive and magnesium sulphate rather poly the pharmacy of the past and
the adoption of the conservative management when possible.
Classification: Preeclampsia, Chronic hypertension, Chronic Hypertension and
Superimposed Preeclampsia and Gestational Hypertension.
Proteinuria is not essential for the diagnosis of preeclampsia and the level
proteinuria is irrelevant to decisions.
Diagnosed by BP over 140/90 and proteinuria over 300 mg/24 hours In the absence
of proteinuria
Thrombocytopenia
less than 100.000/microliter.
Renal insufficiency
serum creatinine more than 1.1 mg/dl
Impaired liver function elevated liver enzymes
Pulmonary edema
Cerebral and visual symptoms
The management of preeclampsia with no severe features is largely conservative till
37 weeks.
23
In women the severe preeclampsia ( with severe features ) when maternal and fetal
conditions are stable in a unit with adequate maternal and fetal resources. Steroids
should be given for lung maturation.
In some situations the delivery can be delayed for 48 hours to give steroid while
immediate delivery is recommended when the maternal and fetal conditions are not
stable e.g. eclampsia, placental abruption. Antihypertensives and magnesium
sulphate is always needed in severe preeclampia and delivery need not always be
Cesarean Section. In the post partum period these patients should be closely
observed for the development of high BP , NSAID should be avoided. The patients
should be warned about risk of developing future cardiovascular disease
24
Management of severe complications of eclampsia
Dr.Mahir
Dr.Mahir Maaita
25
Role of Ultrasound in the management of diabetes in pregnancy
Professor Badreldeen Ahmed
Weill Cornell Medical college- Fetal Medicine Centre Feto Maternal Centre
The purpose of this review is to discuss the established role of ultrasound in the
management of pregnancy complicated by Diabetes Mellitus (DM), as well as new
developments with regards to the use of ultrasound in this situation. We choose to
explore the role of US in pregnancy complicated by DM in three areas:
1- Role of ultrasound in estimation of fetal weight
2- Role of ultrasound in diagnosis of congenital malformation
3- Role of ultrasound in monitoring diabetic pregnant patients
26
Fetal Obesity
Dr Hisham Arab
27
Assisted Conception and Multiple Pregnancy: Where should we circle the Circle?
Dr. Elsamawal El Hakim MRCOG MD CCST
Introduction:
Introduction The most serious risk to in vitro fertilization (IVF) children’s health and
wellbeing are multiple pregnancy and birth. Many of the health risks for twins are
due to their higher risk of being born prematurely. Perinatal mortality, neonatal
morbidity, and long-term health implications are all higher for twins. Multiple
pregnancy and birth also result in increased health risks for mothers.
The psychosocial impact of the birth of multiples affects many areas of life:
emotional, practical and financial. Some evidence suggests that parents of IVF
multiples experience greater difficulties in parenting and more problems with child
behaviour than parents of naturally conceived children.
Most forms of fertility treatment (drugs, IUI, IVF, and ICSI) involve some degree of
increased risk of multiple pregnancies. To combat this risk, it is important to be
aware of and to follow the appropriate guidelines and to do everything possible to
minimize the risk to the patient.
Methodology: To implement best practice for single embryo transfer (SET), we
reviewed the available data and guidelines of 9 different developed countries mostly
European, and studied the experience of 44 international centers and clinics that
follow the latest guidelines and have an appropriate protocol in place.
Conclusion: It is important that if SET is offered and the initial treatment is
unsuccessful, frozen follow-up treatment (freezing and storage of embryos followed
by further SET) is offered.
28
Pregnancy outcomes in women with diabetes treated with metformin, insulin or both
in a newly established Joint ObstetricObstetric- Diabetes Clinic,
Clinic, Al Wakra HospitalHospital- HMC
Qatar
Dr Hiba Satti, Dr M Dagash, Dr M Alloub, Shry K, Najla S, Fatma N
Contact of correspondent Authors:
Dr Hiba Satti, MRCOG- Maternal Medicine. Consultant Ob & Gyn AWH-HMC
Doha – Qatar. Email hsatti@hmc.org.qa
Background: Globally DM in pregnancy affects 2-6% of pregnant women. In Qatar
it is 15.8% in AWH-HMC 2014 which is the most prevalent health concern during
pregnancy. .There is a higher prevalence of DM in pregnancy in this part of the
world due to the increase incidence of obesity, multiparty, life style and a family
history of diabetes and of course pregnancy itself is a diabetogenic state.
CEMACH 2007 Confidential Enquiry into Maternal and Child Health in UK :
Key recommendations: All pregnant women with diabetes should be managed in
joint pregnancy diabetic clinics by a team comprising obstetricians, physicians,
dietician, specialist diabetic nurses and specialist midwives.
Accordingly we set our JOD clinic in AWH in April 2014.
The clinic is staffed by: Consultant obstetrician, Consultant endocrinologist,
Obstetrics specialist, 2 nurses with special interest in DM in pregnancy and patient
Educator.
Aim of the clinic: apart from the clinical benefit to the patient as a one stop multidisplinary team it also work as Research and Audit: by reviewing of clinic process
and outcomes to continue improving service, and to help define.
Objectives of this study: To compare perinatal outcomes in women with DM in
pregnancy either gest or pre-GEST DM, who were treated with diet alone,
metformin, insulin, or both.
Methods: Retrospective descriptive comparative study in pregnancy outcomes in
those who treated with diet alone. Or those not adequately controlled by dietary
29
measures received Metformin (the dose was titrated to achieve target blood glucose
values) And/ Or Insulin.
Study Period: From April-December 2014.
Primary outcome: In each group of treatment option:
1- Mode of delivery (induction of labour, Caesarean section)
2- Neonatal Outcome including perinatal loss, admission to NICU, prematurity, RDS,
hypoglycemia or macrosomia.
Secondary outcome:
To compare our finding in AWH_HMC to the international published data
Results: More than 150 pregnant women with DM seen.Pregnancy outcomes were
looked on all treatment groups.
Conclusion:
Conclusion Our data from this study reinforces the conclusions of the MiG trial that
there is no increase in adverse perinatal outcome in metformin with insulin users.
Recent (NICE) guidance recommends that pregnant women with DM may be
advised to use metformin as an adjunct or alternative to insulin. The results of this
study support this recommendation.
Furthermore Metformin clinically effective as insulin & highly cost-effective, saving
specialist health professional time as well as drug expense.Further prospective
studies needed in this field.
Literature Review:
1- Rowan JA et al for the MiG Trial Investigators. Metformin versus insulin for the
treatment of gestational diabetes. N Engl J Med 2008; 358: 2003–2015
1. NICE. Diabetes in Pregnancy: Full Guideline. Clinical Guideline 63. 2008. Available
at: http://www.nice.org Last accessed 29 June 2009.
2. Diabetes Care.Treatment Pregnancy outcomes in women with gestational diabetes
treated with metformin or insulin: a case–control study
3. J. 2009 Diabetes UK. Diabetic Medicine, 26, 798–802 Balani, S. L. Hyer, D. A. Rodin
and H. Shehata.
30
Uterine Transplantation From The Research Releam To The Arena of Clinical
Application
Critical Systematic Review Of All Published Research Related To Surgery, Ischemia,
Rejection, Immuno Suppresion Pregnancy Ethics And Institutional Requirements
M. Elamin Elsherif ‘Alhindi’ FRCOG (London); MSC (GynEndocr) Harvard
Assoc. Professor and Consultant OBGYN and ART
The Saudi Centre for Assisted Reproduction, Abha, Saudi Arabia
Background:
Background: Uterus transplantation is well developed in animals with pregnancy
occurrence long time ago. Recently three trials in humans with variable results were
reported as a method to treat uterine infertility.
Method:
Method: All published studies in the area of uterine transplantation. Research and
relevant articles and additional articles cited in primary references included were
identified.Aspects relating to diagnosis, patients and donor suitability, surgery, cold
ischemia and warm ischemia, immunosuppression, rejection, pregnancy effects of
mother and child, ethics and institutional requirements for clinical application were
critically discussed. The main objective of this presentation to open a door for
further discussion of the issue and clinical application of this new modality for
treating uterine infertility.
Discussion and Results:
Results: Uterus transplant surgery was achieved in animals many
years ago but recently three cases were reported in the literature with variable
results and other nine cases were successfully performed in humans.
Transplantation with vascular anastomoses differs in animals according to the
species and even in humans in spite of the success in two cases and failure of one no
consensus is reached. Pregnancy were recorded in two cases one had an abortion at
8 weeks and the other was a preterm baby at 32 weeks which survived. Tolerance of
Uterine ischemiawhich is the main cause of rejection differs according to method
used and can reach 6 hours for humans and 24 hours for animals. The major cause
of ischemia is poor methodology of vascular anastomoses during uterine
transplantation.
Conclusion:
Conclusion: Uterine infertility whether congenital or not could be treated by uterine
transplantation if there is no contraindication to pregnancy. Albeit several aspects of
31
the procedure have been optimized still some remain to be solved. This can be
achieved by proper selection of cases and mastering surgical skills in appropriate
institutes.
32
Oral Contraceptive a recent update
Dr Ashraf Kortam
33
Female Genital Mutilation (FGM): UK Perspective & Guidance for Practitioners
Abdelrahman Abdelmageed MSc DFFP Med MD FRCOG
Consultant Obstetrician & Gynaecologist SWAH Northern Ireland UK
FGM is all procedures involving partial or total removal of the external genitalia or
other injury to the female genital organs for non- medical reasons. It is classified by
WHO into 4 types & mainly practiced in African, Middle East & Asian communities.
It is practiced to control women’s sexuality, cultural and also for religious
obligations, and in UK to preserve girl’s cultural identity.
Since 1985 FGM is a criminal offence in UK other relevant laws & regulation
includes: children Act, Human rights Act, and Child protection policies, however
FGM Act in 2003 & 2005 is the key law. It is a criminal offence to do the procedure,
aid, abet, counsel or procure a girl to mutilate her own genitalia or another person
who is not British & outside UK and will carry maximum penalty of 14 years
imprisonment. Girls with FGM are a potential victim of crime if they are UK resident
since 3rd March 2004 should be referred to police & support services even If FGM
‘COMITTED ABROAD’ Consent is not needed for disclosure.
Recent media reports highlighted concerns that in UK Girls/ women still subjected to
mutilation and parents are being sued as well as doctors when performing re
infibulations after birth. It is highlighted as a form of child abuse & medically
unnecessary.
Currently data are collected from acute hospitals, from 4/2015 enhanced data will
be introduced, focusing attention and continuing effort to prevent/eradicate FGM
from UK and to use valuable recourses in planning and commissioning services for
FGM survivors. RCOG involved with the government on FGM issues, being partner
of the intercollegiate group; produced tackling FGM in the UK report on November
2013 also published clinical guidance on the care and management of women with
FGM.
34
The UK Government is committed to eradicate the practice and developed multi-
departmental prevention programme, Organised & Co-hosted with UNICEF ‘’The
Girl Summit’’ in London summer 2014. Many UK organisations now addressing
FGM issue raising awareness and developing strategies e.g. Ministry of Justice
amended serious crime bill to protect vulnerable women , Home Office is having a
consultation on mandatory reporting and will be published soon also have £50 000
grants available for civil society groups. The London Metropolitan Police Force has
set strategy group on FGM, and proactively engaged in creating prosecution
opportunities. Mayor of London’s Taskforce on ‘Harmful Practices’ focus on FGM.
Department For International Development Launched a programme: Ending FGM in
Africa with Budget up to £35 million over 5 years Aiming in reduction of FGM by
30% in ten countries The Director of Public Prosecutions developed an action plan
on FGM and the recommendations focusing on information sharing pathways and
better evidence gathering to support prosecutions. Local Safeguarding Children
Board has responsibilities for developing interagency policies & procedures for
safeguarding and should focus on a preventive strategy involving community
education.
Department of Health & Social Care wrote to all health & social care professionals to
be familiar with the relevant guidelines & actions needs taken where they have
reason to believe a girl or a women has undergone FGM or is at risk of FGM., all
clinical staff must record FGM in healthcare record and all acute hospitals must
have a monthly return.
The Care of women and girls with FGM in UK remains very complex because of the
cultural & social norms aligned to the practice. Duties of health care professionals is
to consider safety and welfare, recognition & FGM prevention, be Familiar with local
safeguarding procedures, and the Midwives should have experience in managing
the condition during child birth. IF Working in FGM practicing communities FGM
should be part of history taking. IF adult women undergone FGM there is no need
for automatic reporting, however support is needed and offer referral to community
specialist advocacy group for Psychological support or Clinical intervention as
appropriate. If having clinical procedure e.g. laparoscopy we should discuss the
reasons why she should not be re infibulated. When giving birth we should discuss
35
why she should not be re infibulated, and explain: FGM is illegal in UK if any
concern urgent action is needed. The At risk girls e.g. her mother with FGM , Sibling
with FGM, Relative with FGM or going abroad at school holiday time & requesting
vaccination for extended break overseas Should be ‘‘REFERRED’’ as a part of doctor’s
obligation to safeguard children
Conclusion: FGM is illegal in UK. Government is committed to eradicate FGM.
RCOG involved with the government on FGM issues. The care of clients with FGM
remains complex issues. Record & reporting is mandatory. In children it is an
‘abuse’ and in
adult re infibulations is a ‘crime’. Children with signs of FGM refer
to safeguarding however in adults no requirement of automatic referrals to social
services or to police. We should ask ourselves where we are from the FGM Act!!??
36
The Role Of Cervical Length Assessment In Management Of Low And High Risk Of
Articlee
Preterm Labour, Review Articl
Khalid Yassin 1 MD, MRCOG, Elhadi Miskeen 2 MD & A/Salam Gerais 3 MD, FICS,
FRCOG
1. Associate professor of obstetrics & gynecology, Head department of obstetrics&
Gynecology, Faculty of Medicine Al Neelain University , Sudan
2. Assistance professor of obstetrics & gynecology, University of Gezira
3. Professor of obstetrics & gynecology, Faculty of Medicine, University of Khartoum
Background: Transvaginal ultrasonography has been widely accepted as a noninvasive and objective method for the evaluation of cervical status in women with
preterm labor, low risk and high risk.
Method: In this review, we focus on clinical studies involving transvaginal
sonographic assessment of the cervix in asymptomatic women at high risk of
preterm delivery and in the general pregnant population. Publication Types included
systematic reviews, meta-analysis, randomized-controlled trials (RCTs), and casecontrolled studies.
Result: We included thirty studies in this review. A significant role of the role of
cervical length assessment in management of preterm labour was shown in details.
Conclusions: High-quality ultrasound machines in labour wards is more strongly
indicated for predicting spontaneous preterm, although staffing issues and the
feasibility and acceptability to mothers and health providers of such investigation to
be explored. Further research should include compare with other investigations of
low-cost and effective tests to assess the cervical length by transvaginal sonography
in predict of preterm labour is highly require.
Keywords: Preterm labour, TVS
37
Laparoscopic Surgery in a Regional Hospital Eastern Sudan
Dr.S
Dr.Safa Ahmed & Dr. Sami Eldirdiri
Gadarif University- Faculty of Medicine - Gadarif – Sudan
Correspondence: Dr. Safa Ahmed & Dr. Sami Eldirdiri
Faculty of Medicine, University of Gadarif Sudan. P. O. Box 449,
E-mail: safsaf29@gmail.com & samieldirdiri@yahoo.com
One of the greatest transformations within the history of surgery has been the
paradigmatic shift away from open surgery and into the realm of operative videolaparoscopy, an approach which truly captured all that minimally invasive surgery
laparoscopic procedures being performed were essentially no more advanced than
those which had been introduced nearly fifty years earlier by endoscopy’s early 20th
century pioneers; draining cysts, lysis of adhesions, taking biopsies, electrocautery,
and tubal ligations. Laparoscopic gynecological operations started worldwide in the
mid eighties and being practiced in Sudan since mid nineties. The procedure was
introduced in Gadarif (Eastern Sudan) in December 2005.
An analysis of 51 laparoscopic procedures was done. Laparoscopic ovarian
cystectomy cases were 11, while other procedures were frequently done: diagnostic
15 ,9 ovarian drilling 7 and female to Male ratio was 6 to 1
43 patients underwent gynecological laparoscopic procedures were females and 8
were males. Age ranges between 25 and 40 years with a mean of 30.5 years.
Preoperative ultrasound was done for all patients. It showed different finding some
PCO in other patients measurable cysts different in sizes .The data analysis showed
significant relation between the cyst size and wall thickness with the operative time,
the duration of symptoms and operative time and conversion rate.
Operative time ranges from 9 to 150 minutes with a mean of 40.1 minutes. no
Conversion from laparoscopy to open intervention.
38
In conclusion: introduction of laparoscopic gynecological procedures in a regional
hospital Eastern Sudan, have improved the surgical gynecology outcome of in
handling certain conditions. Further training of staff and improvement of setup is
needed in order to spread the practice and introduce other laparoscopic procedures
mainly in emergency gynecology and major surgery .
39
Community Health Workers (CHWs) rule in Obstetrical emergencies
(Rwanda)
Background: Rwanda is located in the central Africa; it is landlocked, relatively small
country the total area of Rwanda is 26,338 km2 and land boundaries of 893 km.
The population is 11.6 million 2013.
Rwanda has achieved impressive development progress after 1994 genocide and
civil war. It is now consolidating gains in social development. Central to Rwanda’s
goal is to ensure inclusive development and to provide equitable, efficient and
effective pro-poor service delivery.
The health services are delivered mainly by the public facilities and are equitably
distributed throughout the country. The health system in Rwanda is a decentralized,
multi-tiered system.
Community Health Insurance achieved universal health coverage; one of the most
important Pillars of this system was community health workers (CHWs).
In Rwanda there are
46000 (CHWs) they play vital rule in community health
service including maternity care, their payment is performance based
CHWs Lives in the local village, two women, one man, elected by Communities in
the village, are aged between 20-50 years they can read and write and willing to
volunteer
CHWs Identify and register women of reproductive age (encourage family planning)
Identify pregnant women and encourage ANC, birth preparedness and facility
based deliveries they also Identify women and newborns with danger signs and refer
them to health facilities for care, Accompany women in labor to health facilities,
Encourage early postnatal checkups at health facilities for mothers and newborns,
Use Rapid SMS to support emergency activities
40
There are different information systems :
SISCOM is a Community Health
Information System is gathering data generated by CHW activities at the end of each
month. And they use Rapid SMS tracking for first 1000 days of mother and baby ,
RED ALERT response system for life-threatening emergencies to save mothers’ lives
and mUbuzima mobile system for CHWS.
Among other achievements Maternal Mortality Rate (MMR) from 1071 /100.000 to
268/100.000 in 10 years (2000 to 2013)
In Rwanda there only 450 GP and 150 Specialist .primary care centers runed by
trained nurses but 80% of the service provided by CHWs.
Sudan health system reform is mandatory, providing free primary care , going down
to villages and ,and training nurses, midwives and CHWs is one of the pillars of this
reform
41
Management Of Women With Obesity In Pregnancy
Dr. Reem Nasur MRCOG
General Secretary, RCOG Sudan Liaison Group,STDH, UK
The prevalence of obesity in the general population worldwide has increased
markedly since the early 1990s.
Maternal obesity has become one of the most commonly occurring risk factors in
obstetric practice. Obesity in pregnancy is usually defined as a Body Mass Index
(BMI) of 30 kg/m2 or more at the first antenatal consultation.
Obesity in pregnancy is associated with an increased risk of a number of serious
adverse
outcomes,
including
miscarriage,
fetal
congenital
anomaly,
thromboembolism, gestational diabetes, pre-eclampsia, dysfunctional labour,
postpartum haemorrhage, wound infections, stillbirth and neonatal death. There is a
higher caesarean section rate and lower breastfeeding rate in this group of women
compared to women with a healthy BMI. There is also evidence to suggest that
obesity may be a risk factor for maternal death.
The talk will address these risks and how to manage women with obesity in
pregnancy in low recourse countries.
42
Diagnosis of Ruptured Ectopic Pregnancy is still
still a Challenge in Eastern Sudan
AbdelAziem A. Ali1*, Tajeldin M. Abdallah1, Mohammed F. Siddig1
* Correspondence: AbdelAziem A. Ali
P.O. Box 496, Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala
University, Kassala, Sudan
Tel: +249912351175- Fax: +249411823501- E. mail: abuzianab73@yahoo.com
Citation: Ali et al. Diagnosis of ruptured ectopic pregnancy is still a challenge in Easten
Sudan. Afr J Reprod Health 2011; 15[4]: 106-108).
Background:
Background: Ectopic pregnancy remains the most common cause of maternal
mortality in the first trimester of pregnancy.
Methods: This was a cross sectional prospective study carried out in Kassala Hospital
over three years duration (2008-2011) to investigate the incidence rate and factors
associated with delayed presentation in ruptured ectopic pregnancy.
Results: The total number of deliveries at Kassala Hospital during the study period
was 9578 deliveries. The total number of ectopic pregnancy was 199 yielding an
incidence rate of (1 in 48 deliveries or 20.7 per 1000 deliveries). One hundred
eighty six (93.5%) out of these were ruptured ectopic reflecting very low rate of
diagnosis (6.5%) before rupture occurred. Maternal education≤ secondary, parity
and history of subfertilty were associated with ruptured ectopic pregnancy (P =0.00,
0.003 and 0.00 respectively). The causes of delay reported by the patients include:
64.5 not aware of the pregnancy, 28% have been seen by health provider but
reassure and 7.5% regarded the symptoms not serious enough to ask for care.
Conclusion: there was a high incidence rate of ectopic pregnancy and low rate of
diagnosis before rupture occurs in eastern Sudan. There should be more efforts to
encourage the level of education and improve the rate of diagnosis among health
care providers before the occurrence of rupture.
43
Expectant Management of Ectopic pregnancy Is it Safe?
Mr.
Mr.Mohamed A. Siddig DM, MD, ABOG, MFFP, FRCOG
Consultant Obstetrician, Gynaecologist & Urogyaecologist
Dorset County Hospital Foundation Trust Dorchester, Dorset, UK
Management strategies for patients with ectopic pregnancy have evolved rapidly,
with ambulatory medical and expectant management becoming an option for more
patients. In this paper we discuss the physical findings that most reliably suggest
ectopic pregnancy, describe sensible use of laboratory and imaging studies, and
explain what to do when results are equivocal. Once the diagnosis of ectopic
pregnancy has been made, options include surgical, medical, or expectant
management. The goal of treatment is to minimize disease-and treatment-related
morbidity while maximizing reproductive potential.
Expectant management should be offered to asymptomatic patients with small
adnexal masses (≤3 cm) lower beta-human chorionic gonadotropin (β-hCG) levels
(<1000 mIU/mL), evidence of spontaneous resolution (eg, falling β-hCG levels). 4570% of pregnancies of unknown location resolve spontaneously with expectant
management.
The length of time needed for serum B-hCG to return to pre-pregnancy levels in
women who had successful expectant management of tubal ectopic pregnancy has
not been examined. In this paper we present our experience of expectant
management of ectopic pregnancy.
Key words: Ectopic pregnancy, PUL, Serum B HCG, Expectant management
44
(2007-Cesarean Section Scar Ectopic Pregnancy, Seven Years' Experience Reflection (2007
2014), Newham University HospitalHospital-London, UK
Mohamed Elamin Ibrahim,MD,MRCOG
Objective; The diagnosis and treatment of cesarean section scar ectopic pregnancy
(CSEP) is challenging. The objective of this study was to evaluate the diagnostic
method, treatments, and follow up.
Study Designs; This is a retrospective case series of 10 patients between 6-12 weeks
pregnant diagnosed to have CSEP . The diagnosis was confirmed with TVS san. In 6
of the 10 patients (60%), BHCG level is less than 5000 and in 2 cases (20%) is more
than 10000. Initially, these 8 cases (80%) are treated by Intramuscular
methotrexate. They were followed up by Serial BHCG (day 4, 7 and then weekly),
gestational sac volume and vascularization.
One case is treated `conservatively
as BHCG is less than1000 and dropping .The other by surgery as presented with
rupture scar.
Results; The 10 treated pregnancies were followed for 6 months. There was an initial
increase in the concentrations of BHCG as well as in the volume of the gestational
sac and their vascularization .6 out of the 8 cases (75%) who treated medically are
successfully cured by medical treatment (60% of total).One out of these 6 cases need
another dose of methotrexate at day 7.The other 2 of the 8 cases are failed medical
treatment after the second dose of methotrexate (one of them BHCG is more than
10000). Those patients were treated using hysteroscopic resection, curettage, folly's
catheter and laparoscopy. No complications were observed. All kept in the hospital
till BHCG started to drop. No admission to ICU.2 cases received blood transfusion of
2 units
Conclusion; Medical treatment using methotrexate is the initial treatment and
significantly successful in selective stable cases. Otherwise, hysteroscopic resection
and laparoscopy is the surgical treatment of choice. Future fertility is uncertain but
cesarean section is the mode of delivery of choice in the future
45
Scope of Medical Management of early pregnancy complications
Dr.Randa Omer MBBS MRCOG
Senior Specialist Obstetrician & Gynaecologist
Dorset County Hospital Foundation Trust, Dorset-UK
The introduction of medical and expectant management of miscarriage has
increased options for women as well as clinicians alike for the management of this
common condition. Various medical methods have been described using
prostaglandin
analogues
(gemeprost
or
misoprostol)
with
or
without
antiprogesterone priming (mifepristone). However, there is lack of consensus as to
whether the addition of the mifepristone confers any benefit for the treatment of
miscarriage. Increasingly, newer evidence suggests that Misoprostol alone has
equivalent efficacy and is more cost-effective than use of mifepristone and
misoprostol.
Currently, a high index of suspicion, serial BHCG assays and transvaginal
ultrasonography facilitate the diagnosis and treatment of ectopic pregnancy before
rupture occurs. Methotrexate is an anti-metabolite which prevents the growth of
rapidly dividing cells by interfering with DNA synthesis. It can be given IM and a
92% pregnancy reabsorption rate has been reported, with higher reported
pregnancy rates compared to surgical treatment.
Key Words: Miscarriage, Misoprostol, Ectopic pregnancy, Mexotrexate
46
Helicobacter pylori seropositivity & stool Antigen in patients with hyperemesis
gravidarum
Dr. Somia Abdalla Fadel Elmoula1 Dr. Bashir Elgaily 2 M.Emam
M.Emam
1. Consultant of Obstetrics & Gynaecolog
2. Consultant of Obstetrics & Gynaecolog , Soba University Hospital
Objective: To investigate the relationship between Helicobacter pylori infection and
hyperemesis gravidarum during early pregnancy by using serologic and stool
antigen test.
Methodology: a comparative descriptive cross sectional hospital-based study was
conducted at Ibrahim Malik Teaching Hospital, Department of Obstetrics and
Gynaecology in the period from June 2013 till May 2014, included 30 women
complained of hypermesis gravidarum (cases) and 32 healthy women (control).
Results: Type of investigation for Helicobacter pylori indication were ICT and stools
antigen, performed for all study population (case & control). Our study
demonstrated statistically significant H pylori seropositivity rates (27%) in HG cases
versus non in control group. The difference between the two groups was significant
(P. value = 0.02).the sensitivity and specificity of the test 26% and 100% respectively.
The rate of stool antigen positivity was 17% versus 16% in control. The difference
between the two groups found insignificant (P = 0.51).the sensitivity and specificity
of the test 16% and 83% respectively.
Conclusion: There was significantly higher rate of H. pylori infection in HG
pregnant women in early pregnancy in comparison to controls.
47
Emergency management of first trimester miscarriage in Kosti Maternity Hospital in
the period of 1st of October 2013 – October 2014
Dr: Muna Abdel Rahman Mohamed Ahmed & Dr.
Dr. Ali Mohamed
Mohamed Mohamedein
Kosti Maternity Hospital
Introduction: Early pregnancy loses is the most frequent early pregnancy
complication . around 15% of women with a clinically recognized pregnancy will
miscarry spontaneously during first trimester current management often involves
the surgical evacuation of retained products of conception even though serious
complication for example , infection , uterine perforation , or bowel damage may
arise .
Objectives: This study is aimed to asses the medical services in kosti maternity
hospital in managing first trimester pregnancy loses in one year from October 2013
up to October 2014 and the out come of the patience and the difficulties facing the
medical staff in managing patience coming from rural areas around kosti .
Study design: This is a retrospective study
Study area: Kosti materninty hospital
Study duration :One year extends from October 2013 till October 2014
Results : Total number of cases were 2,302 . Causes of miscarriage varies in which
1677 ( 73%) were retained products of conception , 583 ( 25%) were blighted ovum
and the remaining 42 ( 21%) were molar pregnancy . Majority of early pregnancy
loses were managed by surgical evacuation 1490 (65%) , 492 ( 21%) of pts were
evacuated following medical treatment , 274 ( 12%) ended with spontanuose
expulsion of products following medical treatment , 18 ( 1%) treated expectantly
with good out come and 21 ( 1%) were managed by MVA . no reported cases of
maternal death or infection caused by early pregnancy lose managed in the hospital
, 3 cases ended by uterine perforation managed surgically with good out come .
48
Conclusion : Inspite of limited hospital facilities and difficulties in managing patient
who are in majority illiterate and coming from rural areas around kosti no records
of significant complications were seen , and as mentioned the surgical evacuation
was the main method for treatment due to late presentation and inability for long
hospital stay .
49
B- Lynch suture for the control of postpartum hemorrhag
hemorrhage:
e: an alternative to
caesarean hysterectomy? Elobied. from 2008 to 2014
Dr. Ahmed Abdelkerim Ahmed
Obs & Gyn consultant, Elobied Teaching Hospital, University of Kordofan, Sudan.
Email: ahsumemo@yahoo.com
Tel: 00249912139163
Introduction: The technique was first described in 1997. It can stop postpartum
hemorrhage without the need for pelvic surgery and potentially preserving fertility.
It is regarded as "the best form of surgical approach for controlling atonic PPH as it
helps in preserving the anatomical integrity of the uterus."
Absorbable suture can be left in situ, and would typically not lead to problems with
future pregnancies.
Objectives: The aim of this study is to know the efficacy of B- Lynch suture done in
Elobied town from 2008 – 2013 in controlling primary postpartum haemorrhage
due to uterine atonia which did not respond to utertonic drugs , together with the
reflection of its role in reducing caesarean hysterectomy and so that preserving
patient fertility.
Study design: This is a case series descriptive study.
Study area: Elobied teaching hospital and other private hospitals( kordofan
specialized clinic, police hospital and ultimate care hospital) all are located in
Elobied town.
Study duration: March 2008 – December 2014.
Results: The total number of cases were 22. It succeed in 21 patient(95.5%) with
preservation of the uterus and fertility and no case was reported having post
operative complications. 8 (36.4%) of them had atonia due to multiple pregnancy.
18 (81.8%) patents were presented stable while 4 (18.2%) were shocked. 15 (68.2%)
patients delivered at 38 – 40 weeks gestation. it was done by consultant in 16
(72.7%) patients while the registrars perform it in the remaining 6 (27.3%) patients.
50
7 (31.8%) patients had spontaneous vaginal delivary, 2 (9.1%) operative vaginal
delivery, 7 (31.8%) elective caesarean section and 6 (27.3%) emergency caesarean
section.
Conclusion : B- Lynch compression suture is easy to apply and should be considered
as primary treatment in cases of severe atonic postpartum haemorrhage when
oxytocic agents failed , and before resorting to hysterectomy.
51
Management & outcome of Placenta Previa in Khartoum Maternity Hospitals in Sudan
Siddig Omer Bamsica1, Hajar Hassan Sakin2, Rania M Omer3
1. Department of Ob& Gyn Empyreal Maternity Hospital - Khartoum
2. Department of Ob& Gyn Royal Hayat Maternity hospital -Elkwit
3. Department of Ob& Gyn Police Maternity hospital Khartoum
Background The management of pregnancies complicated by placenta previa is best
addressed in terms of the clinical setting: asymptomatic women, women who are
actively bleeding, and women who are stable after one or more episodes of active
bleeding.
Objective: Specific issues explored were how placenta previa was managed . The
study had a focus on maternal morbidity and mortality.
Methodology: It was cross sectional and hospital based study implemented during a
time period of six month (July – December 2012) in Khartoum maternity hospital
and a total of 50 women presented with VB diagnosed as placenta previa were
selected through convenience sampling method . The inquiries were recorded by pre
designed questionnaire.
Results: Only two patients were deliver vaginally and C/S was done for 48(96.0%).
Regarding outcome 16(32.0%) of patients were developed bleeding , 5(10%) of
patients were ended by hysterectomy , 2(4%) developed acute renal failure ,one
maternal death and 26(52.0%) of patients were without obvious complications.
Conclusions: the majority of women were underwent C/S and about (90.0%) their
placenta were completely separated , ,(4.0%) left inside and (6.0%) left partially
Key Words: Management , Outcome and Placenta previa ,
52
n Pregnancy,
Massive Intraperitoneal Haemorrhage Due To Uterine Fibroid IIn
Pregnancy, Case
Report
Moawia E Hummeida
Department of Ob/Gyn, Alneelain University, Sudan
Email: abuawa25@gmail.com –
Phone: 00249 912332067
We report one case of massive intraperitoneal haemorrhage in the third trimester of
pregnancy due to rupture of vessels overlying uterine Leiomyoma. The patient was
treated with emergency caesarean section and myomectomy. Management of such a
case depends, on the clinical awareness of the condition, the high index of suspicion
for early diagnosis, aggressive resuscitations of patient, and on prompt multi
disciplinary interventions.
The objective of this case report is to highlight the clinical presentation, diagnostic
challenges, and management of unusually rare case of rupture of surface veins of
uterine fibroid during late pregnancy, and review of a literature.
Key words: haemoperitoneum, uterine fibroid, Leiomyoma
53
Prevention and Treatment of Postpartum Hemorrhage –Project to Sudan
Dr. Mohamed Ibrahim, MBBS, MD, FACOG.
Postpartum hemorrhage remains the leading cause of maternal mortality and severe
morbidity in Africa and around the globe. Worldwide, 140,000 women die from
postpartum hemorrhage each year- one women every 4 minutes. The risk of
maternal death from postpartum hemorrhage is approximately 1 in 1000 deliveries
in developing countries. Maternal death from obstetrical hemorrhage in Sudan
contributed to 28% of the reported maternal mortality cases in 2013. Uterine atony
remains the leading cause of death (55%) in deceased women, followed by ruptured
uterus (22.2%), retained placenta (16.7%) and birth canal injuries (5.6%), in
addition to other causes of postpartum hemorrhage. (Reference: MDR 2013 final
report, Sudan).
Improving maternal health services, promoting clinical training, continuous
medical
education,
improving
midwifery
services,
aggressive
postpartum
hemorrhage prevention and treatment, supporting pharmacological intervention
and early utero-tonic agents administration following baby's delivery according to
international and national guidelines will significantly decrease the maternal death
rate from postpartum hemorrhage which will eventually decrease the overall
maternal mortality and morbidity.
54
Kosti Maternity Hospital..Development
Hospital..Development of maternity services
Dr.Ali Mohamed Mohamedin
Consultant of obstetrics and gynecology
This article reviews the maternity services in Kosti town since 1907 at the level of
medical assistance and its progress to date .
The first obstetrician was the great professor Aboo Hassan aboo ( 1969 ), followed
by his prominent successor dr.Mohamed Salem Omran , dr.Alsadig Alameen Alhaj ,
dr.Ahmad Khalifa abo Median , the late dr.Hasanien Mohamed Fadul almola ,
dr.Moawia Alsadeg Hemaida , dr.Abdel Salam Babekr
and dr.Hassan
Ahmed
Hassan.
It also shows the marvelous progress in the services and training of doctors and
registrars . It is now a separate entity since January 2012 .
55
Maternal Mortality Review 20142014- Gezira State
Prepared by Gezira Initiative Safe motherhood and Childhood
Dr.Somia Khalafalla, Dr.A/Rahem
Dr.A/Rahem Hgaz, Prof Mohamed Elsanousi, Dr.Hala Gasim ,
Sisteer Fatima M.Abdalla, Dr.Rufyda Mansour, Dr.Elhadi Miskeen, Prof Ismael Hassan
Hussain and Prof Omer Ahmed Mirghani
Gezira Initiative for Safe motherhood and Childhood was established in 2005. The
aim of the initiative to Reduce the maternal mortality rate (MMR) and neonatal
mortality rate in Gezira State By at least 50% within five years (2005-2010).
Extended to another 5 Years (2010-2015).
This is a maternal death review in Gezira, during years 2014. To assess the progress
in maternal mortality & to identify underlying causes.
All maternal deaths were reviewed (hospitals & community). Notification of
maternal deaths was daily, followed by review of all notified maternal deaths using a
structured format and furthered investigations for each deaths.
Total number of maternal death were 73. Total live birth were 57456. Maternal
Mortality Rate 57.45/100000 LB. There is delay reported among 52/73 (71.2 %).
The avoidable deaths among the maternal death was found to be 49/73 (67.1 %) and
non avoidable deaths was 24/73 (32.9 %).
Cause of death were; haemorrhage (either post partum haemorrhage or rupture
uterus) (23.3 %), viral hepatitis (19.2 %), pulmonary embolism (15.1 %), Eclampsia
(13.7 %), sepsis (12.3 %), malaria(5.5 %), anemia (2.7 %), heart failure (2.7 %),
bronchial asthma (2.7 %), abortion (1.4 %) and Portal hypertension (1.4 %).
Conclusion: Awareness regarding warning sign in pregnancy is recommended. Safe
delivery by increase the coverage of skill birth attendants and Continue in midwifery
in-serve training .Theses interventions can lead to more improvement.
56
Intensive Care Unit & High Dependence Unit for obstetric emergences with reference
to service prepre-eclampsia
Dr. Saad Abdelrahman,
Abdelrahman, F.R.C.O.G., M.G.O.
Objectives:
1. To define & explain the importance & functions of the I.C.U. & H.D.U.
2. To know when & how I.C.U. & H.D.U. provided.
3. To know how I.C.U. & H.D.U. are setup & organized.
4. To show the indications for admission to the I.C.U. & H.D.U.
5. To describe the investigations & results of pregnant ladies how they differ
from non-pregnant, & how to interpret them.
Management of obstetrics emergencies & especially pre-eclampsia present a great
challenge which can only be met by facilities and expertise offered by I.C.U. &
H.D.U.
We will present here when and how this type of care should be provided. The setup
and organization of these two will be explained.
The physiology of normal pregnancy is explained briefly to differentiate between
pregnant and non-pregnant patients.
The pathophysiology of pre-eclampsia also explained.
The I.C.U. is not only for pre-eclampsia, this includes haemorrhage, massive
transfusion, placental abnormalities, septic shock, amniotic fluid embolism, cardiac
disease, thyroid crisis, diabetic ketoacidosis, trauma, and so on.
Separate I.C.U. units are not available in our hospitals and patients will be admitted
to a general I.C.U. unit if available.
Confusion between pregnant & non-pregnant patients in interpreting the results
occurs.
This paper stress on having our separate I.C.U & to be followed up by obstetricians.
57
Risk factors and management patterns for emergency obstetric hysterectomy over
3years in Khartoum North Teaching Hospital Sudan
Wisal. O.M Nabag1 . Sumyia Kheri2. Zienab Elfaki3
1,3 ALziem ALazhari University.
2 Bahri University.
Correspondence to: Dr. Wisal O.M Nabag, Department of obstetric & Gynecology,
ALziem ALazhari University .Email:wisnab3@yahoo.com
Back ground: Obstetric haemorrhage is the leading cause of maternal mortality
About 14 million mothers develop postpartum haemorrhage (PPH) each year 2% of
them die within 2 to 4 hours. Objective: To review the demographic characteristics
of patients, risk factors, indications, and complications of emergency obstetric
hysterectomy (EOH), and To determine its outcome..Method: A retrospective review
of all consecutive cases of EOH over the last 3years at KNTH Sudan .Results we
conduct about 28039 deliveries from January 2012 to December 2014,
23195(82.8%) vaginal and 4834(17.2%) C/S among these 371(1.06%) developed
PPH Fifty-two women had an EOH, with an incidence of 0.18 per 1000 deliveries
The underlying cause of EOH was uncontrolled primary hemorrhage in 50 (96.2%)
women and severe sepsis leading to secondary hemorrhage in 2 (3.8%) women. A
total of 30 (58%) EOHs were performed for intractable bleeding after cesarean
delivery.21 placenta previa, 3 placenta accereta, 4 rupture uterus& 2 unrepairable
tear . Twenty-five EOHs were performed in 2012,fivteen in 2013 and twelve in
2014
Conclusion:, There was reduction in the prevalence of EOH due to the
introduction of pharmacologic agents and new surgical techniques to control
postpartum hemorrhage Previous cesarean delivery with associated placenta previa
or placenta accreta was a major contributor toward EOH.
Keywords: Cesarean delivery; Emergency obstetric hysterectomy; Major obstetric
hemorrhage;, Placenta previa
58
Maternal death due to delayed management of Sigmoid Volvulus at 32 weeks
Pregnancy Case Report
Gamal k Adam1* , Khalid I Alhaj1 , Samaual E Elgaili 2 Khalid Yassin M.Ahmed 3
1. Faculty of Medicine and Health Science Gedarif University Sudan
2. Gedarif General Hospital Sudan
3. Neelain University, Department of obs & gyne
*Correspondence
Dr.Gamal k Adam , Professor ,Faculty of Medicine & Health Science
university
Sudan. Telephone No. 00249912539372
Email:
Gedarif
gamalkhalid
5@hotmail .com
Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but
complication with significant maternal and foetal mortality. We describe a case of
sigmoid volvulus in a patient with 32 weeks of gestation that developed complete
necrosis of the sigmoid colon was admitted with 6 days of abdominal distension,
vomiting, and the stoppage of the passage of gases and feces with poor clinical
conditions and signs of diffuse peritonitis. Abdominal ultrasound showed single
viable foetus 32 weeks, abdominal radiography showed severe dilation of the colon
with horseshoe signal suggesting a sigmoid volvulus, The patient
vaginally
delivered
1.8 KG male baby admitted to the nursery and passed latter
from
respiratory distress syndrome. With a diagnosis of complicated sigmoid volvulus she
was underwent to the laparotomy where we found, an enormously distended
sigmoid loop with gangrenous changes
The sigmoid colon was resected and
Hartman's colostomy was performed. Poor postoperative recovery and the patient
passed day 3 postoperatively from septic shock.
Keywords:
Keywords pregnancy; volvulus
59
Maternal mortality
mortality and near miss at Omdurman maternity hospital, 2013
Umbeli T. MD, FCM, PhD1*, Salah Ismail MD2, Kunna A.
A MD 3, Elmahgoub A.
A
FRCOG 4, Sumia Elshafie MD 5, Rabaa AbdAlwahab MD 6 and Rawiya Eltayeb 7.
___________________________________________________________________________
1. Professor of Obstetrics & Gynecology and Community Physician, Omdurman Islamic
university (OIU),Omdurman Maternity Hospital (OMH), Sudan
Corresponding Author’s E-mail: umbeli_taha @hotmail.com
2. MD. Dept of OBGYN, Omdurman Islamic University (OIU).
3. MD. Dept of OBGYN, University of Bahri.
4. FRCOG, Dept of OBGYN, OIU.
5. MD. Physician of internal medicine, (OMH)
6. MD, Dept of Anaethesia, OIU.
7. MBBS, resident registrar OMH.
Maternal mortality and morbidity remain public health problems in the developing
countries influenced by access to health care and the quality of service provided.
Assessment of maternal near miss (MNM) will provide more information to improve
the quality of obstetric care and to reduce maternal mortality and morbidity. This is
a prospective cross-sectional study conducted at Omdurman maternity hospital
(OMH) during 2013 to assess the occurrence of maternal near miss (MNM) and
maternal mortality. Also, to indentify the causes of MNM and determine the sociodemographic characteristics of women experiencing MNM and MD. A modified
WHO criteria (clinical, laboratory and management based) for identifying MNM
were applied and the data was collected by reviewing of all medical records using a
structured data abstraction form.
During the study period a total of 305 women with life threatening conditions were
identified at OMH, 260 MNM, 45 MD and 35863 live birth (LB).
Maternal
mortality ratio (MMR) was 125/100000 LB, the maternal near miss incidence ratio
60
(MNMIR) was 7.2/1000 LB, MNM to MD ratio was 5.8:1 and the total mortality
index was 14.8%. Haemorrhage was the most common cause of MNM, followed by
eclampsia, sepsis, hepatitis, cardiac disease and other indirect events; 48.5%, 28.8%,
15.7%, 3.1%, 2.7% and 1.2 % respectively. Highest mortality index was caused by
hepatitis, followed by cardiac disease, sepsis, eclampsia and haemorrhage; 46.7%,
22.2%, 12.8%, 11.8% and 8.1% respectively. Maternal mortality and morbidity
remain challenging problems in this hospital with hepatitis as an emerging cause of
high mortality index. Progress can be made by improving the referral system,
antenatal care (ANC) and hospital delivery to prevent late presentation.
key words: Maternal near miss, maternal mortality, Omdurman, Sudan.
61
Risk Management & Patient Safety in Obstetrics & Gynaecology
Dr. Ahmed Eltigani Elmahdi Hussain FRCOG
Consultant Obstetrician & Gynaecologist, Cavan County General Hospital, IRELAND
Contact: Email: himoudi@gmail.com Tel: +353878306627
Background: Adoption of systematic approach towards reducing the risk of harm to
patients. Patient Safety, Risk Management & Quality of Care. Managing the risk
(Definition of risk management, issues addressed by risk management, view of
patient safety, application of risk management). Organizational requirements for the
risk Management (Integrated framework, Link with
hospital-wide strategies and Initiations.
. The risk management process
a. Risk identification (Incident reporting, Identifying prospective risk, Looking
at what
Went wrong).
b. Risk analysis and evaluation.
c. Risk Treatment.
d. Risk Register.
The National context
Conclusion
62
Maternal and neonatal complications associated with caesarean section in the second
stage of labour at Omdurman maternity hospital during 20122012-2013
Umbeli T,
T MD, FCM, PhD 1*, Salah Ismail,
Ismail MD 2, Kunna A,
A MD3, Elmahgoub A,
A
FRCOG 4, Nasr A,
A MRCP 5. Rabaa Abd Alwahab MD 6
1. Prof. Taha Umbeli Ahmed, MD, FCM, PhD.
Consultant obstetrician and gynecologist and community physician
university (OIU), Sudan.
Omdurman maternity hospital (OMH).Tel: 00249 912360153
E mail: umbeli_taha@hotmail.com Umbeli2010@gmail.com
1- MD, Dept of OBGYN, OIU.
2- MD, Dept of OBGYN University of Bahri
3- FRCOG, Dept of OBGYN, OIU.
4- MRCP, Dept of Paediatrics (neonatologist), University of Bahri, OMH
5- MD, Dept of Anesthesia, OIU.
Caesarean section (C/S) in the second stage of labour is associated with many
maternal and neonatal complications, inspite of that little has been paid to its rise in
obstetrical practice.
This is a hospital- based study conducted at Omdurman
maternity hospital (OMH) during the period from January 2012- December 2013 to
assess maternal and neonatal complications associated with C/S performed in the
second stage of labour. Records of all patients delivered by emergency C/S at full
dilatation of cervix over two years were reviewed (10988). Women delivered by
emergency C/S during second stage of labour included in this study were 470out
of10988 (4.3%). All had term singleton pregnancy; of them 256 (54.5%) were
primigravida. Labour started spontaneously in 428 (91.1%), 300 (63.8%) were
augmented by oxytocin and decision for C/S was made by resident registrars for 427
(90.9%). Failure to progress in second stage of labour was the commonest indication
for second stage C/S, in 459 women out 470 (97.7%). Unsuccessful instrumental
63
delivery was 56 (11.9%). Intra-operative complications developed for 240 (51.1%),
including; extended uterine tear, intra-operative bleeding, bowel, bladder, ureter
and baby injuries. Post-operative complications reported in 142 (30.2%), mainly due
to puerperal infection, post partum haemorrhage (PPH), paralytic ilius, wound
dehiscence and one maternal death. Twenty three (4.9%) had fresh still birth (FSB)
and seven (1.5%) perinatal deaths, 138 (29.4%) were admitted to neonatal unit. C/S
in the second stage of labour carries a high maternal and neonatal mortality and
morbidity, which necessitates involvement of senior obstetrician in decision –
making and delivery.
Key words: Caesarean section, second stage of labour, maternal and neonatal
complications, Sudan.
64
Cerebral Venous Sinus Thrombosis an imitator
imitator of Eclampsia in three referral Hospitals
in Khartoum, Sudan
Moawia Elsadig Hummeida
Department of Obstetrics and Gnaecology, Alneelain University
Email: abuawa25@gmail.com Phone: 00249 912332067
Background: Pregnancy induces several changes in the coagulation system, which
persists into the puerperium resulting in a prothrombotic state. Cerebral venous
thrombosis (CVST), has variable clinical presentations that can easily be
misinterpreted with other neurological and obstetrical conditions such as eclampsia
and epilepsy
Methods: This is a case control hospital-based study conducted from 1st January
2011 to 31st December 2012 to investigate the epidemiology of CVST during
pregnancy and puerperium in three main referral hospitals in Khartoum, Sudan.
The different variables were compared between women with confirmed CVST and
two consecutive women who delivered in the hospitals without CVST using logistic
regression analysis
Results: During the study period there were 31 patients with radiological confirmed
CVST. These hospitals had an annual 37471 deliveries yielding an incidence rate of
0.01 per 100.000 deliveries. Among these 31 patients 25 (80.6%) and 6 (19.4%)
were identified during the postnatal and antenatal periods respectively. The most
common presenting symptoms were headache (77.4%) followed by convulsions
(74.2%), neck pain (39%), neck stiffness (32.2%), limb weakness (29%), loss of
65
consciousness (29%), impaired vision (25.8%), and cranial nerve symptoms (22.5%).
Some patient may have more than symptoms). 25.8% of patients were initially
misdiagnosed and mistreated as cases of eclampsia. Concerning risk factors there
was significant association between age (CI= 1.0 – 1.2, OR= 1.1, P= 0.024), mode of
delivery (CI= 3.8 – 58, OR= 14.9, P= 0.000), anemia (CI= 1.0 – 26.1, OR= 5.2, P=
0.041), and preeclampsia (CI= 1.1 – 89.5, OR= 10, P= 0.039) with favourable
outcome of CVST cases during pregnancy and puerperium.
Conclusions: CVST presenting with extremely varied symptoms can simply be
mistaken for eclampsia, epilepsy, and other neurological diseases. Caesarean
delivery, older age, anemia and preeclampsia are the dominant risk factors for
pregnancy-associated CVST.
66
Primary caesarian section in ElEl-obeid North
North Kordofan , July – December 2013.
Dr. Khidir Elamin Awadalla , MD. JMHPE. Dr. Rawaa Kamal Abdellatif ,MBBS .
Introduction : Primary caesarian section (PCS) is defined as caesarian section which
is done for the first time . Its incidence is the major determinant factor for overall
caesarian section rate or incidence in any region . Interventions that focus on
reducing caesarian section rates are mainly addressing PCS rates.
Objectives : The study aimed at determination of indications , incidence and
outcomes of primary caesarian section ( PCS ) in El-Obeid in the period from first of
July to last of December 2013 . .
Methodology: A prospective study carried out in El-Obeid ,North Kordofan State
The study involved all pregnant women who had been delivered by ( PCS )
operations in El-Obeid Teaching Hospital(OTH ), El-Obeid Military Hospital(OMH )
,El-Obeid Police Hospital (OPH ) and kordofan Speciallized Clinic ( KSC ) in the
specified period. Data was collected by reviewing patient’s records . .
Results : Total number of live births were 4212 , overall number of caesarian
sections was 1448. Overall incidence of C/S was 34.4% . Total number of cases of
PCS were 612 . Incidence of PCS was 14.5%. Indications for PCS were cephalopelvic disproportion 44%, breech presentation 11.8%, fetal distress in the first stage
of labour 11.1%, abnormal lie and malpresentation 6.5%, failed induction of labour
5.7%, failure to progress in the second stage of labour 4.9%, pre-eclampsia and
eclampsia 4.9%, antepartum haemorrhage 4.2%, failure to progress in first stage of
labour 3.3%, induced pregnancy 1.3%, maternal request 1.1% and others 1.1%.
Regarding maternal outcome (91.8 %) of the mothers were discharged from hospital
in good health and 8.2%
developed complications
including postpartum
haemorrhage and sepsis . There were two maternal deaths due to postpartum
haemorrhage and severe sepsis. Fetal complications were encountered in (8.8 %) of
the cases , which were poor Apgar score (4.4 %), stillbirths (1.9 %), low birth
weight (1.6 %) and congenital malformations (0.9 %).
Conclusion : PCS incidence high , some of the indications were not satisfactorily
justified .
Recommendations :The study provided very important data which can help in the
formulation of recommendations to reduce the incidence of PCS such as
67
encouraging the practice of external cephalic version in cases of breech , also the
practice of trial of labour in primigravidae with mild to moderate degree contracted
inlet of the pelvis and the application of instrumental vaginal delivery in cases of
failure to progress in the second stage of labour.
68
Mangement of emergency C/S in Kosti M H October 1313- October2014
Dr Salama
Salama.
alama. Adam & Dr Ali Mohamadeen
Introduction: This paper will show the management of Em c/s during a period of
1year. It will reflect the tremendous efforts done by the doctors& the paramedical
staff& the role played by the hospital in reducing maternal mortality.
Objectives:To show the magnitude of Em c/s as a problem & make use of limitted
facilities & setup & to reduce maternal & perinatal deaths.
Study Design:Retrospective study from hospital records. Study Area:Kosti maternity
hospital- white Nile State.Study Duration:From Oct 2013_Oct 2014
Results:The total number of cases is 2340, 600 of them represents Em c/s with
percentage of 25.6% .1 maternal death reported (0.1%) it was an eclampsia case ,
not recovered from anaesthesia (local anesthesia+diazepam+pethidine).2.8%
perinatal death mostly occur due to ruptured uterus , severe PH & repeated scars.
Conclusion:Despite limited hospital facilities &resources, 0.1% maternal mortality
occurs.Ketamine is the main anaesthetic drug used & spinal anaesthesia in very few
cases
69
Time Series Analysis Of Waiting Time Before Definitive
Definitive Intervention In Obstetric
Emergencies In Omdurman Maternity Hospital
Bayoumi, Ahmed; Gerais, Abdel Salam; Bayoumi, Khalid;
Abdelrahman, Malaz and Ahmed, Ala’a
Correspondence: Professor Ahmed Bayoumi, Mobile:(+ 249) 912387707.
E-mail: ahmedbayoumi@hotmail.com
Background:Omdurman Maternity Hospital (OMH) is the main specialized
maternity hospital in the country. It was established in 1957, adjacent to
Omdurman Midwifery Training School (OMTS), to cater for the rising number of
deliveries and their complications. OMH is an important training centre of
excellence for all categories of medical personnel. This pilot study was planned to
deal with the important issue of delay, if any, in taking definitive intervention in
obstetric emergencies as a prelude to further comprehensive studies in Khartoum
State Ministry of Health (KSMOH) hospitals. Specific Aims: The long term goal: was
to help OMH and KSMOH in the formulation and implementation of a clear policy
and guidelines for quality care in obstetric emergencies. Specific aims were: to
perform a time series analysis by measuring delay, if any, in taking intervention
measures in different types of obstetric emergency, to investigate the quality of
emergency facilities in OMH and use OMH results as a yardstick to set a Gold
Standard.
Methodology: A cohort study design of 23 case studies of obstetric emergencies of
11 types were followed up prospectively by passive observation until definitive
intervention was initiated. A time series analysis questionnaire was completed
noting the timing within 5 minutes of different important intervention milestones
Results: Age group distribution showed a majority of young women under 30 years
(78.2%), about one third were primigravidae (34.8%), about one-half (43.5%) had
parity of 3, one-fifth (21.7%) presented with postpartum haemorrhage (PPH),
followed by 13.0% each for severe preeclampsia and ectopic pregnancy with shock.
Premature rupture of the membranes, prolapsed umbilical cord, antepartum
70
haemorrhage, abortion with
haemorrhagic shock, disseminated Intravascular
coagulation (DIC) and acute abdominal pain during pregnancy constituted 4.3%
each. The missing obstetric emergencies were not reported. Time series analysis
graphs showed a range of definitive intervention time of 10-440 minutes, with
severe preeclampsia displaying the minimal and retained placenta displaying the
maximal. (mean = 81.7 + SD 114.8). All maternal and foetal outcomes were
favourable, excepting three ectopic and three intrauterine foetal deaths (IUFDs).
Discussion: With a total of about 100 medical personnel, reasonably equipped, and a
progressive research-oriented administration, OMH set the Gold Standard for
optimal definitive intervention time in obstetric emergencies, as anticipated, despite
its unique position as Khartoum Obstetric and Gynaecological reference hospital. It
deserves to be commended, encouraged and supported for this outstanding
performance.
Expected outcomes: Results would be of value to OMH and KSMOH in correcting
causes of un-necessary delay, and will provide insight about how to initiate policy
and guidelines on quality of care. They are presented in a scientific report, a paper
for publication and are communicated to this important Conference.
71
Assessment of Maternal Risk Factors of Preterm Labour in Omdurman New (Saudi)
Hospital,Omdurman locality, Khartoum State
Ahmed Khalid Mohamed Albashir Ahmed
6th Year Medical Student. University of Khartoum, Faculty of Medicine
Supervisor: Prof. Mohamed Ali (Prof of Community Medicine , University of
Khartoum)
Introduction: Preterm birth is the birth of a baby of less than 37 weeks of pregnancy
(gestational age) but more than 23 weeks. Preterm birth is the leading cause of
neonatal deaths and the second leading cause of death after pneumonia in children
under five years. A number of maternal factors including demographic factors,
chronic illnesses, previous preterm births and pregnancy spacing have been
identified to be linked to a higher risk of a preterm birth. The exact burden of
preterm deliveries in Sudan needs further research.
Objectives: To assess the maternal risk factors of preterm labour in Omdurman New
(Saudi) Hospital, Omdurman locality.
Materials and Methods:This is a descriptive analytical cross-sectional hospital-based
study. A structured interview using a 24-itemquestionnaire was used to approach
103 mothers at Omdurman New (Saudi) Hospital. Participants were selected &
interviewed at the time of hospital visits which was three times weekly during the
period from April to August 2013. Data was analyzed by using SPSS.
Results:103 mothers of preterms were interviewed.The commonest age group
among the study population was 20-35 years old comprising 46.6% and the least
were adolescents 13.6%. About 67% of mothers didn’t have education levels beyond
high schools. Over 74% of mothers gave birth to singleton preterm babies the
remaining had multiple pregnancies but mainly twins (22.3%). Almost half of
women 49% had an average duration of pregnancy of 7 months. About one third
(35%) of the study population were Nulliparae (i.e it was their first delivery) and
17.5% were Grandmultiparae (i.e had 5 or more births). Preterm Premature Rupture
of Membranes was reported in over half of (mothers 52%) and about 60% developed
72
infections during pregnancy of which UTIs representing 61% were the commonest.
Almost 36% of mothers developed bleeding during the course of pregnancy, the
same percentage (35.9%) mentioned having significant psychological distress or
violence in their pregnancies. Regarding chronic illnesses: Diabetic mothers just
constituted 4% most of which had Gestational DM; in conjunction to hypertension
or pre-eclampsia that was present in 20% of the study group; Regarding substance
abuse it was found to be in 10.7% of mothers most of which were heavy coffee
drinkers. Most of births were Spontaneous preterm deliveries representing 78.6%
mostly due to PPROM the remainder 21.4% were medically-indicated preterm
labours mainly due to bleeding and pre-eclamsia and other maternal or fetal
indications.
Conclusion:Most of the mothers included in the study had low educational levels,
low to moderate family incomes and were unoccupied. Infections and rupture of
membranes were present in over half of them. Over one third of mothers had
significant psychological stresses and bleeding during pregnancy. Indicated preterm
births constituted just 21.4%, and the commonest cause of Preterm labour was found
to be spontaneous rupture of membranes (PPROM). All these risk factors require
objective, multidisciplinary approach to reduce the burden of preterm births
Therefore All pregnant women should receive good antenatal care and should try as
much as possible giving birth at proper health facilities where appropriate care can
be provided.
73
Vitamin D defiency in pregnancy and pregnancy outcome
Dr. Selma gerais and Dr. shahad mahmoed
Objective: Vitamin D is essential for skeletal health and prolonged deficiency results
in infantile rickets and adult osteomalacia. The aim of this study is to determine the
vitamin D status in pregnancy and to evaluate the effects of daily vitamin D
supplementation.
Design
A prospective randomized study at royal care international hospital from 20122014.
A total of 88 women were recruited at different gestational age the incidence o f
vitamin d deficiency about 66%.
Results: single daily dose ranging from 1000-2000IU according to the level of
deficiency were given to the patient, for six weeks.
The final maternal 25-hydroxyvitamin D levels were significantly higher in the
supplemented group after 4- 6 weeks from starting of the treatment .
Conclusion: Single or daily dose improved 25-hydroxyvitamin D levels significantly.
However, even with supplementation, only a small percentage of women and babies
were vitamin D sufficient. Further research is required to determine the optimal
timing and dosing of vitamin D in pregnancy.
74
POSTER
PRESENTATIONS
75
No.1
The age at Menarche on primary, secondary and high schoolgirls Khartoum state
Sudan
D. Mohamed A.Bagi A.Ghani Babiker M.B.B.S U of K Pro.Mohamed Ali Elshiesh
M.B.B.S MRCOG FRCOG
Menarche is one of the important stages of puberty of females as it has many aspects
to think of and to study. In this cross-sectional research which was conducted in
December 2013-febreuary 2014, 367 primary and secondary high school girls in
Bahri area Khartoum state were chosen randomly and interviewed to determine the
age at menarche and it’s relation to the body mass index .The mean age at menarche
was found to be 12.73 years, the mean age at first regular cycles was 13.06 years.
The lower the body mass index, the higher the age at menarche (P value 0 .000).In
conclusion and compared to previous studies in Sudan age at menarche is
decreasing and factors like body mass index does affect it. It is recommended to
carry out more research in Sudan and to increase the awareness of the community
and school girls about the subject of menarche.
.
76
No.2
Assessment of umbilical artery Doppler Ultrasound findings in patient with
preeclampsia between 3232-36 weeks of gestation in OMH
Dr Sara Foud Richard,Dr Kameel Kamal Kamil
Background:
Background Doppler parameters of umbilical artery aren’t useful in just diagnosing
preeclampsia; they are also used as indicators for fetal well-being.
Objectives:
Objectives To determine the prevalence of absent/ reversed end-diastolic flow in
preeclamptic women and IUGR.
Methodology:
Methodology This was a descriptive, cross-sectional, hospital based study of
singleton, preeclamptic mothers, at their 32-36 weeks of gestation.
Results:
Results Of the 300 women recruited in this study, (83.7%) had mild preeclampsia
and (16.3%) had severe preeclampsia. The occurrence of IUGR in our preeclamptic
population was (20%). There were (83%), (14%), and (3%) cases with FEDF, AEDF
and REDF, respectively. With (92.7%) accuracy, it was found that late-onset
preeclampsia increases the likelihood of not having IUGR by (5) times. Furthermore,
it was noted that having IUGR and abnormal liver function test increase –with 90%
accuracy rate- the likelihood of having abnormal Doppler by (4) times.
Conclusion:
Conclusion Abnormal umbilical artery findings and severe preeclampsia increases
the likelihood of IUGR. Moreover, the likelihood of having abnormal umbilical
artery Doppler increases four times by the presence of IUGR and abnormal liver
function test. The presence of absent end-diastolic flow should warn the physician
of significantly increased fetal risk.
77
No.3
Large solitary luteinized
luteinized follicle cyst of pregnancy and puerperium
Case Report
Moawia Elsadig Hummeida, Ali abdel Satir
Correspondence
Moawia Elsadig Hummeida. Department of Obstetrics and Gynaecology
School of Medicine, Alneelain University Email; abuawa25@gmail.com
We report a case of a large solitary luteinized follicle cyst arising in a 32-year-old
multipara four days post partum which required postpartum surgical intervention.
Solitary luteinized follicle cyst is a rare cause of ovarian enlargement during
pregnancy and puerperium. Only rare cases of this clinical condition have been
reported in the literature. The perinatal outcome is usually good, with liveborn
infants being delivered, as in the present case, at or near term. The complications of
the disease include ovarian torsion, intracystic haemorrhage, and rupture. The
condition should be included in the differential diagnostic workup whenever a
growing simple cyst is encountered during pregnancy and puerperium.
Key words:
words luteinized follicle cyst; pregnancy; puerperium
78
No.4
Prevalence of antenatal depression amongmultigravidae at Soba University Hospital
(2013 – 2014)
Dr. Rania D. Eltaher E lgack MBBS (Khartoum College of medical sciences, 2008)
Dr. Bashir Algaily Mohamed
Mohamed Imam
Background: Major Depressive Disorder (MDD) in pregnancy or antenatal depression is
twice as common and frequently cluster during the childbearing years. Antenatal
depression is a more common than generally thoughts; also, the onset of new depression is
higher during the perinatal period.
Objectives and Methods:
Methods An observational, cross-sectional hospital-based study was
conducted in SUH between January 2014 and June 2014 to estimate the prevalence of
antenatal depression among multigravidae women, and to investigate the effect of certain
maternal factors on the prevalence of antenatal depression, among 246 multigravidae who
attended refer clinic in study area during the specified period. After taking an informed
consent, a structured questionnaire was conducted to each woman to gather information
about sociodemographic and depression status.
Results: among two hundred and forty six eligible pregnant women were identified during
the antenatal care period. It was found that, the prevalence of antenatal depression in
multigravidae women in SUH in a specified period of time was 55.28 %, while border line
cases found to be 44.7%and no depression cases in 11.15% of women in this study.
Moreover, it apparent that there was a significant relation between the antenatal depression
and age(p.0.00), parity (0.006),occupation (0.015),past history of medical disorders
(p.0.00),previous
miscarriage
(
p.0.00)
,
previous
history
of
preterm
labour
(p.0.00),previous history of still birth (p.0.001),history of fetal loss (p.0.00), history of
antenatal complication (p.0.00), previous mode of delivery (p.0.00), history of previous
depression (p.0.00), family history of psychiatric disorder (p.0.00), history of marital conflict
(p.0.00), and relation to antenatal care visit (p.0.028). On the other hand, there were no
significant associationbetween education group (p.0.187), and duration of marriage
(p.0.268).
Conclusion:
Conclusion Antenatal depression among multigravidae is common and significantly
associated with clinically relevant and identifiable risk factors, as well as most
sociodemographic variables, this is highlights the importance of activation of antenatal
screening programs for high risk women and liaison of antenatal care unit with
reproductive mental health department
79
No.5
Primary Cesarean Section Indication, Maternal and Fetal Outcome in Oumdurman
Maternity and Saad Abu Elella Maternity hospital (2014)
Dr.
Dr. Elameen Khougli Elameen MBBS University of Kassala, Dr. Nada Gaafar Hassan
MD, University of Khartoum
Background
Background:
round Primary cesarean is defined as the first cesarean delivery. It has effects
on the subsequent pregnancies represented in maternal and fetal outcome and
complications. Thus, providing efforts to reduce them may have a substantial effect
on maternal and fetal health care.
Objectives:
Objectives To characterize the common indications, complications and outcome for
primary cesarean section and to identify opportunities to lower the, primary
cesarean delivery rate.
Methods:
Methods This is a prospective descriptive cross-sectional and hospital based study
conducted among 200 ladies admitted to the labor room in active labor and planned
for vaginal delivery with no history of previous cesarean section in Omdurman
Maternity Hospital and Saad Abu Elella hospital during the period from 1st February
2014 up to July 2014.
Results:
Results it was found that, the most common age group were 20-30 years (60.5%),
the most common GA group was 37-41 representing 173(86.5%), the most common
indications detected was failure to progress in the first and second stage of labour;
52(26%), followed by fetal distress 80(40%). Postpartum hemorrhage as a
complication found in 11(5.5%), intrapartum hemorrhage in 8(4%), blood
transfusion in 7(3.5%) and extension of uterine tears in 6(3%). Alive birth found in
195(97.5%) cases, neonates admitted to the nursery were 31(15.5%) fresh stillbirths
were 2(1%) and early neonatal deaths were 3(1.5%).
Conclusion: the study concluded that, The most common indications detected were
failure to progress and fetal distress. The commonest maternal complications were
postpartum hemorrhage and intrapartum hemorrhage, while the commonest fetal
outcome included admission to the nursery unit and fresh stillbirth.
80
No.6
Role Of Sweeping In Initation Of Labour In PostPost- Date Pregnancy
Pregnancy In Omdurman
Maternity Hospital (January(January-November 2012)
DR. Sarah Abd-Elmagid Mohamed Musaad .prof.Taha Umbeli,MD.Uof K
Objective:
Objective To study the role of sweeping of fetal membranes in initiation of labour in
post-date pregnancy from 40-42weeks gestational age in Omdurman maternity
hospital in 2012.
Methodology: This is a descriptive, cross-sectional, analytic study, conducted in
Omdurman Maternity Hospital in 2012.An informed consent was taken before the
start of data collection. Sweeping was done by the registrars. Data were collected by
using questionnaire. Data were analyzed by computer program SPSS.
Results
Results: This study included 389 post –date pregnancies gestational age between 4042 weeks with uncomplicated pregnancy all underwent sweeping of fetal
membrane to induce labour in Omdurman maternity hospital OMH in study period
January 2012 to November 2012.The majority of participants age between 20-30
years which represent 283(72.8%).319 (82%) women delivered vaginally,
64(16.5%) women delivered by cesarean section, and 6 (1.5%) women delivered by
instrumental vaginal delivery. There was 9 (2.3%) of participant were complicated
by ruptured of membrane during sweeping, 247(63.5%) of participant suffered
from discomfort during procedure. There is one neonatal death due to congenital
malformation.
Conclusion:
Conclusion Sweeping of fetal membranes is an intervention helps in initiation of
onset of labour from 40-42weeks gestational age .That could be used to decrease the
used of other methods of induction of Labour
81
No.7
A Review of predictive Factors and the Outcomes of VBAC
At Omdurman Maternity hospital
Dr. Nafisa Ibrahim Ahmed MBBS University of Khartoum & Dr. Mohammed Hassen
Idris MRCG
Objectives: To estimate success rate of VBAC at OMH and to study the predictive
factors and the outcomes at Omdurman Maternity Hospital in a period :JanuaryJune 2014.
Results: The study included 172 women with one previous LSCS who were admitted
in labour at term with single viable fetus and cephalic presentation and who were
allowed to have a trial of VBAC after careful assessment. The study was a prospective
observational cohort study. Successful VBAC was 72.1%.Certain factors had been
shown to increase the success rate of VBAC. These include high parity, previous
vaginal delivery, non recurrent indication of previous CS, high bishop score on
admission and short duration of the active phase of labour.
There were three cases of uterine rupture (1.7%) in the failed VBAC group, one case
of scar dehescience (0.58%) in the failed VBAC group and one case of bladder injury
(0.58%) in association with uterine rupture. There was no maternal deaths and no
women needed hysterectomy. There was one case of still birth (0.58%) in the failed
VBAC group and in association with uterine rupture. Seven cases (4.1%) needed
blood transfusion, three of them (42.9%) were in the successful VBAC group and the
remaining four (57.1%) were in the failed VBAC group.
82
No.8
Maternal and Fetal Outcome of Grandmultiparity in Omdurman
Maternity Hospital
Hospital
Nahid Sulieman Ismael Abdalla and Professor A/Slam Gerais
Objective: To study maternal and fetal outcome of grandmultiparity in Omdurman
Maternity Teaching Hospital (OMH)
Method:
Method This is a descriptive prospective cross-sectional study ,It was carried out in
in Omdurman Maternity Teaching Hospital, in the period from March-Dec 2013.
Study population was all grand multipara admitted for delivery and managed in the
labour room in OMH. Data was collected using a coded direct interview
questionnaire. Most of women were reviewed by me. Data was analyzed by
computer using statistical package for social science (SPSS) software version 16 and
the results were expressed in tables and figures ..
Results
Results: Total number of grandmutipara ladies included in prospective review was
400. Regarding the maternal outcome that those who discharged well were 364
(91 %), severe morbidity 33 (5.5 %) and unfortunately 3 (3.5 %) maternal death.
Those who developed complications were 124/400 (31 %). These were abnormal
fetal presentation 30 (7.5 %), postpartum haemorrhage 28 (7 %), long hospital stay
22 (5.5 %), labour dystocia 20 (5 %), antepartum haemorrhage 8 (2 %), uterine
rupture 8 (2 %), precipitated delivery 5 (1.2 %) and others 3 (0.8 %).
Regarding fetal outcome those discharged well there 370 (92.5 %), fetal death were
22 (5.5 %), congenital malformation 6 (1.5 %) and severe morbidity were 2 (0.5 %).
Total delivery with fetal complications were 59/400 (13.8 %).
Conclusion: We can conclude that women with high birth order are at increased
risk for adverse obstetric outcomes (maternal and fetal). The risk is higher for great
grand multiparous women compared to grand multiparous women.
83
No.9
Advance Maternal Age and Late Pregnancy Outcome At Omdurman New Hospital
Hospital
Dr.Shireen Abdalla Ahmed
Ahmed1 MD Khalid Yassin 2 MD, MRCOG,
Objective:
Objective The aim of this study is to investigate advanced maternal age and late
pregnancy outcome at Omdurman New Hospital, during July 2013 – Jan. 2014.
Methodology: This is a cross-sectional case-control, hospital-based study was
carried to address important obstetric problem in Omdurman New Teaching
Hospital during period from July 2013 to January 2014. Hundred women presented
in labour in Omdurman New Hospital and they aged 40 years or more was selected
as case group, while 200 women whose age 18-39 years was selected as control
group. Data was analyzed using SPSS (Statistical Package for Social Sciences) .
Consent was obtained.
Results:
esults: The mean of age was 42±2 Std (min 40 and max 45 years) among the case
group, and it was 27±2 Std (min 20 and max 39 years) among the case group. We
enrolled 300 pregnant women (100 case group and 200 control group). About 70%
not aware about risk of pregnancy at this age.
The association of advanced maternal age and pregnancy complications was found
to be statistically significant (p value was 0.00) for Pre-pregnancy diabetes mellitus
and hypertension
Correlation of case and control study according to mode of delivery showed no
significant association (P = 0.08/ Confidence: 95%). Vaginal delivery in case group
was 52 (52%) against 125 (63.1%) in control group, caesarean section found in 47
(47%) of case group against 36.9% of control group, instrumental found in one
patient (1%) of case group and it was absent in control group.
The study confirmed statistically significant association of maternal age and fetal
outcome in the regards of Alive birth, birth weight, congenital anomalies and NICU
admission.
Conclusion:
Conclusion Advanced maternal age is associated with a range of adverse pregnancy
outcomes. The study findings call for intervention programs based on both clinical
and community interventions.
84
No.10
Ginger for Nausea and Vomiting In Sudanese Pregnant Ladies
During Early Pregnancy
Dr.Isam Mohammed Babiker.MBBS
(University
(University Of Kordofan) Prof.
Moawia
E.Hummeida ,MD (MPH)
Background:
Background Nausea and vomiting are common experiences in pregnancy, affecting
70–80% of all pregnant women.
Objectives: To assess the effectiveness of Ginger to control nausea and vomiting
in early pregnancy .
Methodology:
Methodology This is a comparative prospective analytic case control study done in
the period from March 2014 to July 2014 at Maternity Hospital and Soba University
Hospital, Department of Obstetrics & Gynecology among pregnant women with
nausea and vomiting in their early pregnancy who agree to participate in the
study . We included 100 patients ; 50 patients were study group labeled as
group A and 50 patients were control group labeled as group B.
Eligible women gave consent and received oral ginger 1 g per day in form of
juice in 3-4 doses .Consent was obtained.
Results:
Results Most of study populations have good educational level 42% of group (A)
and 50% of group (B) have university education 56% and 48% respectively have
secondary education with bulk of them -64% for group (A), and 76% for group (B)between 25 – 34 y old .
The total number of patients included in this control case study were 100
Patients . We found that (38 %) Knew about using ginger for treatment
NVP.
Regarding case group only (4 %) developed new complain (gastric esophageal
reflux), (70 %) feel better after taking ginger, total cure average in days 4 ± 6
(Max 14 – min 2) . In control group total cure average in days 5.5 ±3 (Max 30 –
min 4) and only (24 %) think it is hoping way of treatment.
Conclusion:
Conclusion Ginger is effective treatment for relieving the severity of nausea and
vomiting of pregnancy in a reasonable duration with a minimum side effect profile.
85
No.11
Cinical presentation and Treatment Outcome of GenitoGenito-Urinary Fistula in ElEl-Obeid
Teaching Hospital in the period January 2012 to December 20
Dr. Mohammed Ibrahim A.
A. Yassin . MD & Dr. Khidir Elamin Awadalla, MD, JMHPE.
ElEl-Obeid Teaching Hospital
Introduction : Genito-urinary fistula , GUF, is a common gynaecological problem. It
is a medical problem with an extremely adverse social impact.
The obstetric vesico-vaginal fistula is the commonest variety .Its main cause is
prolonged obstructed labour . In some of the cases it is also associated with recto
vaginal fistula and peroneal nerve injuries . Other fistulae follow surgical injuries
during caesarian sections or hysterectomies resulting in vesico – vaginal or ureterovaginal fistulae ,and some of them are due to advanced genital cancer or following
radiation .
Obstetric VVF is an indicator to poor antenatal and intra-partum care. It occurs
predominantly in young mothers living far away from health facilities .
Objectives : -Highlight the clinical presentation of GUF in El-Obeid Teaching
Hospital in the period January 2012 till December 2014.
Assess the treatment outcome of GUF in El-Obeid Teaching Hospital in the period
January 2012 till December 2014.
Methodology ;- The operating team in this unit consists of two gynaecologists who
operate jointly ,with a group of registrars and house-officers . Following ordinary
pre-operative preparations , all patients were operated using spinal anesthesia .
Surgical techniques adopted were simple fistula repair (93 cases ) ,repair with
labial graft ( 6 cases ) and ureteric re-implantation ( 3 cases ) and one case of
urethral reconstruction. Standard post-operative care provided .
Results :- Cases admitted were 103 cases. Obstetrics VVF cases were 98 cases(
97.o8%). Three cases of uretero vaginal fistula following ureteric injury during
surgery. One case of distal urethral avulsion and one case vesico-vaginal fistula
following carcinoma of the cervix . Ninety seven percent of the cases were living in
rural areas. Patients aged below 20 years constituted 47.5% of the cases ,and 53.4%
86
were primiparous . Patients who were first seen and managed in labor by trained
midwives 59.22% , TBAs 23.30 % and those seen by doctors and started labor in
hospital 17.48% . The patients who delivered at home were 35.08% ,while the
patients delivered in hospital were 64.92% . Caesarian section was performed
in29.30%
, 20.21% had instrumental vaginal delivery and 50.49% delivered
vaginally. The outcome of the delivery was stillbirth in 84.47% . In 21.36% the
fistula developed immediately, in 37.86% developed during the first 7 days ,and in
40.78% in more than 7 days. Successfully managed cases were 88 cases 91.26%.
Conclusion :El-Obeid Teaching Hospital like any other hospital in Sub Saharan
Africa receive all varieties of UGF . In most of the cases the defect is operable. By
provision of adequate training to gynaecologist in such hospitals like El-Obeid
Teaching Hospital most of the cases will be managed locally without being referred
to Khartoum.
Recommendation :In order to reduce the incidence of GUF following obstructed
labour, Antenatal and Intrapartum care should be improved and extended to reach
mothers living in remote areas and the nomads who are moving looking for water
and grass for their animals.
For effectively treating affected mothers , training of young specialists should be on
regular basis .
The establishment of the Sudanese Urogynaecological society ,as a joint society
between a group of interested gynaecologists and surgeons .
87
No.12
liver,, Case report
Postpartum Rupture of subcapsular Haematoma of the liver
Moawia E Hummeida, Magdi Lwis, Durea Erayes, Ismail Omer
We describe a case of postpartum hepatic rupture in a 40-years-old
grandmultiparous woman admitted to the labour ward with the diagnosis of
abruptio placentae at 37 weeks gestation. The clinical presentation, aetiology,
pathology, diagnosis and treatment of this condition are discussed. We emphasize
the modern concept of the treatment of hepatic rupture. Knowledge and increase
awareness and
Hepatic rupture as a late complication of pre-eclampsia is a rare but lethal condition
requiring rapid recognition and surgical management. The clinical triad of preeclampsia , right upper quadrant pain and sudden hypotension is the diagnostic
hallmark of the presentation. In many cases the event take place near delivery and
are usually
found to have subcapsular haematoma of the right hepatic lobe with
free rupture into the peritoneal cavity resulting in sever catastrophic haemorrhage.
The diagnosis of subcapsular haematoma should be considered in patient with acute
abdominal pain in the last trimester or just after delivery. Laparotomy must be
performed at the first sign of hemodynamic instability. The prolonged stormy
postoperative course and frequent complications must be stressed.
88
WORKSHOPS
89
The Sudanese youth initiative to stop "khitan" of girls
“Be the change you want to see”
In Sudan we call it “khitan” the rest of the world calls it FGM. The cutting of a
young girls' genitals, performed in the name of tradition and culture, has no
benefit whatsoever for health or preservation of morality. It is not demanded
or supported by any religion and is known to be practiced by Muslims,
Christians, Jews and others. Many governments, inside and outside Africa,
have condemned FGM as a violation of women and professional health,
human rights and women’s organisations have repeatedly called for measures
to stop it.
Khitan is still performed in Sudan on girls from all social groups, both urban
and rural, in defiance of actions taken since the 1960’s by medical
professionals, religious leaders and women’s NGOs.
So in February 2014, a group of Sudanese young women and men decided to
take matters into their hands and start a movement among the youth
generation to stop khitan. They do not preach but ask each and every
individual to stand up and take personal responsibility against an act that
shames and degrades our nation. They called it “Ana Lan” meaning “I will
not”. The youth are the parents of the future and they want their peers to
pledge never to inflict khitan on their daughters and ask everyone else- men,
women, young and old - to make every effort to protect vulnerable girls
around them. The vision of Ana Lan initiative is to lead a social wave of
change so that the youth generation will put an end to this mindless and
shameful practice and dissociate it, once and for all, from our sense of being
Sudanese. www.facebook.com/AnaLanSudan
90
On December 12, 2014, Ana Lan performed at the TEDxSoba event to an
audience of 1200 people. The performance was moving and original.
On December 12, 2014, Ana Lan performed at the TEDxSoba event to an
audience of 1200 people. The performance was moving and original.
The mission of the Institute is to promote reproductive health and rights of women
and men in Sudan, to improve the quality of life of families, support sustainable
development, reduce poverty and preserve environmental resources.
RH&RI1 believes in private-public-partnership through collaborating with Federal
and State Ministries of Health, research and academic institutions, professional
associations, non-government organisations, networks, and private companies
locally, in the Africa and Middle East regions and internationally.
What RH&RI does?
1
Desk-top reviews, population-based studies and clinical research
RHRI is a subsidiary of Imagine, a Social Enterprise Co.
91
Projects conceptualization, design, implementation, monitoring & evaluation
Advocacy & policy development
Well Woman clinic
Curriculum & protocol development and training
Development of technical content and logistical support to workshops,
seminars & conferences
Consultancies for various requirements
Contact information:
Telephone:
+249 183183- 463132
E-mail: RHRI@imaginesudan.com
RHRI@imaginesudan.com
92
How To Be An Education Supervisor
Date 24/2/2015Venue: SMSB
Coordinator:
Moawia Hummeida , AbdelrahmanAbdelmageed and ReemNasur
First session
8:30 – 8:45
Welcome and Introduction
8:45-9:00
Course Objectives
Hani Fawzi & MoawiaHummeida
9:00-9:20
Principles of Adult Learning
John Duthie
9:20- 9:40
Faculty Development – Quality agenda
9:40 – 10:00
Supervision – clinical and Educational
MoawiaHummeida
Hani Fawzi
Hani Fawzi
10:00 -10:20
Feedback – essential ingredient of learning
10:20 – 11:00
Core Curriculum /standard setting /progress through matrix JDuthie
11:00 – 11:20
11:20 – 12:30
Second session
ReemNasur
Formative and Summative assessment& outcome
A. A Mageed
BREAK
Sudan’s contributions
12:30 –12: 50
Trainer’s perspective
MoawiaHummeida
12:50 – 13:10
Trainee’s perspective
MoawiaHummeida & Wisal O. Nabag
13:10 -13:30
Conclusions & Recommendations
John Duthie
NB
Trainees with Different Needs (Doctors in Difficulty)
93
Hani Fawzi (Optional)
Seminar on Women’s Health
Organiser: IRC, SLG ( RCOG), MUBADARAT, IVWG,
CoCo-ordinator:, Abdelrahman
Abdelrahman Abdelmageed, Iman Abugarga, Hala Abdullahi,
Ahlam Eliboudi, Suad I Essa
Health education is an integral responsibility of the Obstetricians & Gynaecologist.
For the first time, we the SLG, are targeting the stake holders –women in the
Khartoum community- directly, aiming to provide women with information about
their health to empower them to optimise it and seek medical attention in a timely
fashion. This new partnership has the potential to bring about major improvement
in women’s health.
In this seminar, a group of specialists in their field, representing the SLG, aim to
cover essential topics such as early recognition of common gynaecological cancers,
the menopause, urinary tract symptoms, and the impact of obesity on various
aspects of a womans’ wellbeing are addressed. Women’s Rights in Reproductive
Health, FGM and Mens involvement in women’s health is also covered.
94
Clinical Governance
Organiser: SLG/IRC(RCOG) /SUA /Military Hospital
CoCo-ordinator: Abdelrahman Abdelmageed, Reem Nasur, Nasr
Nasr A Ramadan , Abdalrazig
Mustafa and Wisal Noori
The Clinical Governance in Medani
Organiser: SLG/IRC/ U.G Initiative for Motherhood & Childhood Safety
CoCo-ordinator:
ordinator Mohamed Sanousi, Reem Nasur and Somia Khalfallah
A good doctor treats patients. A great doctor does the same with a clinical practice
focusing on patient safety with continuous improvement on the quality of service
provided.
This Workshop is the first by the SLG in a series in which we aim to cover the
evolving science of Clinical Governance. Our objective is to train our fellow
colleagues on a variety of branches of clinical governance.
This workshop will cover managerial and attitudinal aspects in clinical practice that
minimize patients dissatisfaction which may lead to doctors being sued; the
importance and art of communicating with patients and relatives in addition to
auditing your practice and comparing it with National Standards. Documentation of
the clinical encounters is of paramount importance - when things go wrong, the
patient presents an injury to the judge, and we have only our medical record: it is
the only proof you can present in a court of law or dispute. How to document and its
significance in medical practice will be detailed.
The system of Risk Management is protective to all: health care professionals,
patients and managers and will be addressed in a number of different ways.
Professionalism in day to day practice is an acquired skill and essential for the
modern doctor to master.
Consent for procedures and examinations shall be expertly discussed.
After a morning of talks, 3 interactive scenarios will be played out; Comparing
substandard and standard technique on:
1. breaking bad news
2. building relations with patients
3. Communication
95
Postpartum Hemorrhage (PPH) - Workshop, Khartoum, SudanSudan-02/26/2015
Mohamed Ibrahim, MBBS, MD, FACOG.
Title: “Postpartum Hemorrhage (PPH) - Workshop”.
Method: Power Point Oral Presentations.
Workshop Name: “Postpartum Hemorrhage (PPH) - Workshop”.
Workshop venue: CPD Central Khartoum, Sudan.
Workshop organizer: Postpartum Hemorrhage (PPH) - Collaborative Project.
Workshop coordinators: A) Najwa Mohmed Ahmed ELfky, MD.
B) Abdelmageed Elmugabil, MD..
Workshop moderators: Mohamed Ibrahim, MD, FACOG and Sami Mahmoud
Abdelkhair, MD.
Workshop day: Thursday, February/26th/2015.
Workshop time: From 8:00 am to 5:00 pm.
Workshop audiences: Consultants, registrars and invited personnel’s concerned in
women reproductive health and welfare.
Workshop schedule:
schedule:
1- Workshop opening/welcoming: Professor Abdellatif Ashmaig/Dr. Khalid Yasin.
(8:00 am - 8:15 am).
2- The Impact of Postpartum Hemorrhage (PPH) on Maternal Death in Sudan
during the LastFour Years (2011-2014). Professor Taha Umbeli Ahmed, MBBS, MD,
FCM, PhD. (8:15 am - 8:45 am).
3- “Prevention and Treatment of Postpartum Hemorrhage (PPH) - Project to Sudan”
Overview. Mohamed
Ibrahim,
MD,
FACOG.
(8:45
am
- 9:15
am).
4- Postpartum Hemorrhage (PPH) - Overview. Mohamed Ibrahim, MD, FACOG.
(9:15 am - 9:45 am).
6- Postpartum Hemorrhage (PPH) - Uterine atony and uterotonic agents.
Mohamed Ibrahim,FACOG. (9:45 am - 10:15 am).
7- Postpartum Hemorrhage (PPH) - Abnormalities of the 3rd stage of labor and
abnormal placentation. Sami Mahmoud Abdelkhair, MD. (10:15 am - 10:45
am).
7- Postpartum Hemorrhage (PPH) - Birth canal injuries. Ameer Osman, MD.
(10:45 am - 11:15 am).
96
8- Postpartum Hemorrhage (PPH) - Uterine inversion. Randa Omer Elshiekh, MD,
MRCOG. (11:15 am - 11:45 am).
Questions and answers Session (11:45 am - 12:00 noon).
Lunch/Break-time (12:00 noon- 01:00 pm).
9- Secondary Postpartum Hemorrhage- Endometritis and sepsis. Ahmed
Abdelkarim, MD.
(01:00 pm - 01:30 pm).
10- Postpartum Hemorrhage (PPH) - Resuscitation and blood Therapy. Ihab
Abdalrahman,
MD. (01:30 pm - 2:00 pm).
11- Postpartum Hemorrhage (PPH) - Surgical interventions. Iman Abugarga, MD,
MRCOG.
(02:00 pm - 2:30 pm).
12- Postpartum Hemorrhage (PPH) - Interventional radiology. Mohamed Khider
Tayfor, MD.
(02:30 pm - 3:00 pm).
13- The Women Trial on the effect of tranexamic acid on PPH. Awadia Khojali, MD.
(03:00 pm - 03:30 pm).
14- The midwife in Sudan, the Current and Potential Role in Prevention, Recognition
and Management of PPH. Dr. Nasr Abdalla. (03:30 pm - 04:00 pm).
Questions and answers session (04:00 pm - 04:30 pm).
Discussion session (04:30 pm - 05:00 pm).
97
Urognaecology Workshop
Coordinators: Sami Eldirdiri, Osman Oratshi, Ahmed Abdelkarim and Amin Hassan
Abdelmagied
Tuesday 24/02/2015
Venue: Gadarif Hospital
Programme
8 am
Registration
8:15
Welcome and Introduction
8:30
Dynamic Pelvic Floor Anatomy Implications for functional & Surgical Repair.
-
Mr Hassan Omer
8:50
Epidemiology and quality of life and conservative management of women with
incontinence
Mr A Abdulmagid
9:10
_
Recent management of Overactive bladder
Mr M A Siddig
9:30
_
Discussion
09:35
_
The role of urodynamic in surgical management of stress incontinence
Mr A A Elmardi
09:55
-
Update in surgical management of stress incontinence
Mr A A Elmardi
10:20 -
Voiding dysfunction
Mr Baba Gana
Consultant Urologist
10:40
-
Discussion
10:45
-
Management of Anterior Compartment
_
Traditional cystocele Repair
_
Fascial Repair
_
Management of Recurrent Cystocele
_
What are the options locally?
11:10
_
Tea break/breakfast
11:40
_
Management of Mid compartment
_
Management of vault prolapse
_
Sacrospinous Colpopexy V/S Lap Sacrocolpopexy
_
Conservation of prolapsed uterus what options?
Mr Hassan Ali Omer
Mr M A Siddig
12:05 --
The Role of Mesh in management of Mid compartment
12:30
_
Management of Posterior Compartment
-
Update in management of Rectocele & Enterocele
-
Obstructive defecation complication of Rectocele
_
Discussion
12:55
98
Mr Islam Abdulmagid
Mr Lenzi Hanna
13:10
The Debate:
This house believe that pelvic floor dysfunction following child birth is preventable
For: Local
Against: Mr M Siddig
13:50
_
14:00 -
Panel Discussion & message to take home.
Close
Wednesday: 25/02/2015
Venue:
08:30 Video presentation
Suburethral tape for treatment of Urodynamic stress incontinence
Management of Anterior compartment
09:00
Live Surgery video Link: Two cases
10:3
Video presentation
Management of mid compartment
Vaginal sacrospinous colpopexy
Abdominal/Laparoscopic Sacrocolpopexy
11:00
Break/Breakfast
11:30
Live Surgery video link: Two cases
13:30
Discussion
14:00
Close
99
Laparoscopy workshop
Venue : Saad Abu Alelaa Hospital
Coordinators:
Coordinators:
Islam A/Mageed
Mohamed Awad
Sahar Mageed
Randa Gaili
Activities
8.30 - 8.45
Registration and welcoming
8.45- 9.10
Relevant Laparoscopic Anatomy
9.10- 9.40
Principle of electrosurgery -Safety Mohamed Awad
9.40-10.00
Safe laparoscopic entry
10.00- 10.30
Overview in laparoscopic Hysterectomy Islam
10.30 11.00
Complication Of laparoscopic Surgery
11.00 11 20
laparoscopic instrument-Carol Storz
11.20 11. 40
Coffee Break
11.40- 12 40
Dry Lab
12 40 13 00
Hysteroscopy or ergonomic
1300
Prayer and Lunch
13 45
Duria,Mohamed,Islam
Sahar
Ahamed Abdelkarim
Randa Ghailly
Mossab
Faculty with help of Mossab
Mohamed
13-45 14 30
Steps and ergonomic in Laparoscopic total &SubtotalHysterectomy Islam
14 30
Dry Lab
15 30
Faculty with help of Mossab
15 30 16 00
Quiz and certificateS
16 00
Close and Feedback
100
Pre- and Post Conference Workshops list
Date
Workshop
Organizer
Venue
02/02/2015
Obstetric
OGSS & Anaesthesia
Anaesthesia
society
Police club
8:00-2:00
Coordinator
Dr.Khalid Nasrallah
Magdi Mulah
Hind Agabani
17 -18-19
Basic &
SSOG , SLG & Gadarif
02/2015
Intermediate
University
Gadarif Hospital
Osman Oratshi
Laparoscopy
8:00-2:00
Workshop for
(By invitation only)
Ahmed Abdelkarim
Gynaecologists &
General Surgeons
Tuesday 17th
FGM
Sami Eldirdiri,
Amin H. Abdelmagied
OGSS , WHO & FMOH
Police Club
Nahid Tobia
Feb. 2015
Nawal Elnour
9:00-1:00
Wafa AbdelRazig
Friday
Detailed Anomaly
OGSS & Arab FM group
Police Club
Sami Mahmoud
scan
20/02/2015
Abubaker Abo Shoke
9:00-1:00
Khalid Nasralla
Monday
Women’s Health
SL/IRC/GIVWG/
To be confirmed
AbdelRahman Mageed
Seminar
23/02/2015
Mobadarat
Hala Abdullahi
Iman Abugargah
Tuesday
24-25-
Hani W. Fawzi
TOT
SMSB/SLG/OGSS
02/2015
Doctors Union
John Duthie
Hall , Nile street
Moawia Alsadig
8:00-2:00
Wisal Nabag
Somia Khairy
Tuesday
Pelvic Floor
Mohamed Siddig
Dysfunction
24/02/2015
SMSB/OGSS/SLG
Police Club
Reem Nasur
Abdel-Mahmoud Tahir
8:00-2:00
101
Abdelazim Hussien
Tuesday
24/02/2015
Laparoscopy
OGSS/SLG
Saad Abu Alelaa
Islam A/Mageed
Hospital
Mohamed Awad
8:00-2:00
Sahar Mageed
Randa Gaili
Wednesday
Pelvic Floor
SMSB/OGSS/SLG
Police Hospital
Mohamed Siddig
Dysfunction
25/02/2015
Reem Nasur
8:00-2:00
Abdel-Mahmoud Tahir
Abdelazim Hussien
Islam A/Mageed
Wednesday
Laparoscopy
OGSS/SLG
25/02/2015
Saad Abu Alelaa
Mohamed Awad
Hospital
Sahar Mageed
8:00-2:00
Randa Gaili
AbdelRahman Mageed
Wednesday
Clinical
SLG/IRC/SUA
To be confirmed
Reem Nasur
Governance
25/02/2015
Military Hospital
Nasr .A. Ramadan
8:00-2:00
Thursday
Abdalrazig Mustafa
PPH
SAMA/OGSS
Police Club
Mohamed Ibrahim
26/02/2015
Najwa Elfaki
8:00-2:00
Sami Mahmoud
Thursday
U.G Initiative for
EDC U.G
Mohamed Sanousi
Madani
Reem Nasur
Motherhood &
26/02/2015
Clinical
Childhood Safety
Governance
8:00-2:00
Friday
Somia Khalfallah
ALSO Instructor
ALSO faculty
Soba University
course
Sami Mahmoud
Hospital/or CPD
27/02/2015
Khartoum
8:00-2:00
Siddig Adam
Reem Nasur
Randa Omer Elsheikh
102
SCIENTIFIC PROGRAM
Day Two –Saturday 21 February 2015
First Session : Ultrasound in Obstetrics and Gynaecology
Chairperson : Prof Badreldeen Ahmed Rapporteur : Dr.Safia Noreldin
Time
Subject
Speaker
09:00-09:15
Perinatal Nutrition and supplementation
Dr Hisham Arab
09:15-09:30
None invasive pre-natal diagnosis
Dr.Mahir Maaita
09:30-09:45
Recent advance in ultrasound technology
Dr. Soha Farghal
09:45-10:00
Management of acute Postpartum Haemorrhage
Dr Rabih Chahine
10:00-10:15
5 Things Ob/Gyns Shouldn't Do
Prof Badreldeen
Ahmed
10:15-10:30
Antenatal management of selected fetal
Dr Wesam Kurdi
abnormalities
10:30-10:45
Management of placenta accreta
10:45–11:00
Panel discussion
11:00-11:15
BREAK
Dr . Saadeh S.Jaber
Second Session : Medical Disorders with pregnancy
Chairperson : Prof Omer Ahmed Mirghani
Rapporteur
Rapporteur :
Dr.Abdulrahim Hagaz
Time
Subject
Speaker
11:15-11:30
Hypertensive Disorders Of Pregnancy Based On
Dr. Mamoun M E
ACOG Guidlines
Awad
11:30-11:45
Management of severe complications of eclampsia
Dr.Mahir Maaita
11:45-12:00
Role of Ultrasound in the management of diabetes
Prof Badredin
in pregnancy
Ibrahim
12:00-12:15
Fetal Obesity
Dr Hisham Arab
12:15-12:30
Assisted Conception and Multiple Pregnancy
Dr. Elsamawal El
Hakim
12:30 12:45
Pregnancy outcomes in women with diabetes
Dr.Hiba Satti,
treated with metformin, insulin or both- Qatar.
12:45-13:00
Panel discussion
13:00-13:30
Pray and coffee break
Third Session :
Miscellaneous
Rapporteur:
Rapporteur Dr. Durya
Chairperson : Dr Hisham Arab
Rayis
Time
Subject
Speaker
13:15-13:30
Uterine transplantation
Dr M Elamin Elhindi
13:30-13:45
Oral Contraceptive a recent update
Dr Ashraf Kortam
13:45-14:00
FGM- UK perspective and guidance to professional
Dr.A. Abdelmageed
103
14:00-14:15
The Role of cervical length assessment in management
Dr. Khalid Yassin
of preterm labour
14:15-14:30
14:30-14:45
Laparoscopic Surgery in a Regional Hospital Eastern
Dr.Safa Ahmed &
(Gadarif) Sudan
S.Eldirdiri
The role of Community Health Workers Obstetrical
Rwanda case
emergencies
14:45-14:55
Management of women with obesity in pregnancy
14:55-15:10
Panel discussion
Dr. Reem Nasur
Day three –Sunday 22 February 2015
FIRST SESSION:
SESSION FIRST TRIMESTER COMPLICATIONS
Chairperson : Prof Bushara Hag Elfadul
Sumyia Kheri
Time
Subject
09:00-09:15
Rapporteur : Dr.
Speaker
Diagnosis of Ruptured Ectopic Pregnancy is still a Challenge in
Dr.AbdelAziem A. Ali
Eastern Sudan
09:15-09:30
Expectant Management of Ectopic pregnancy Is it Safe?
Mr. M A Siddig
09:30-09:45
Cesarean Section Scar Ectopic Pregnancy, Seven Years' Experience
Dr.Mohamed
Reflection
E.Ibrahim
09:45-10:00
Scope of medical management in early pregnancy complication
Dr.Randa Omer
10:00-10:15
H. pylori seropositivity and stool Antigen in patients with
Dr.Somia A. Fadel
hyperemesis gravidarum
Elmoula
Emergency management of first trimester miscarriage in Kosti
Dr.Muna A.
materninty hospital
mohamed
10:15-10:30
10:30-11:00
PANEL DISCUSSION
11:0011:00-11:30
BREAK
SECOND SESSION : OBSTETRIC HAEMORRHAGE
Chairperson : Prof Mohamed A.A. Elshiekh
TIME
11:30-11:45
11:45-12:00
Rapporteur : Prof Gamal Khalid
Subject
Speaker
B- Lynch suture for the control of postpartum hemorrhage: an
Dr Ahmed
alternative to caesarean hysterectomy?
Abelkariem
Management & outcome of Placenta Previa in Khartoum Maternity
Dr.Siddig Bamsica
Hospitals
12:00-12:10
Massive intraperitoneal haemorrage due to uterine fibroid in
Dr. Moawia Elsadig
pregnancy Case report
12:10-12:30
Prevention and Treatment of Postpartum Hemorrhage –Project to
Dr..Mohamed
Sudan
Ibrahim
12:30-12:45
Development of Maternity services in Kosti
Dr. A.Muhamedain
12:45-13:00
Updates in management of Postpartum Hemorrhage
Prof Omayma Idres
13:00-13:15
PANEL DISCUSSION
13:15-13:30
Break
104
THIRD SESSION :
MATERNAL MORTALITY AND MORBIDITY
Chairperson : Prof Taha Umbelli
Rapporteur :Dr Amira
Burhan
TIME
Subject
Speaker
13:30-13:45
Gezira Initiative Safe motherhood and childhood (2005-2015)
Gezira Initiative
13:45-14:00
ICU HDU for hypertensive pregnant women
Dr. S.Abdrahman
14:00-14:15
Risk factors and management patterns for emergency obstetric
Dr.Wisal Nabag
hysterectomy over 3years
14:15-14:30
Maternal Death due to delayed management of sigmoid Volvulus
Dr. Gamal Khalid
14:30-14:45
Maternal mortality and near miss at Omdurman maternity hospital
Dr. Rawiya Eltayeb
14:45-15:00
Risk Management & Patient Safety in Obstetrics & Gynaecology
Dr. Ahmed Eltigani
15:00-15:15
Discussion & close
Adam
Day Four –Monday 23 February 2015
LABOUR AND ITS COMPLICATIONS
person: Dr.Morwan Ebrahim
Chair person
Rapporteur: Dr.Salma Geris
TIME
Subject
Speaker
09:00-0915
Maternal and neonatal complications associated with caesarean
Prof Taha Umbeli
section in the second stage of labour at Omdurman maternity
hospital
09:15-09:30
Cerebral Venous Sinus Thrombosis an imitator of Eclampsia .
Dr Moawia E
09:30-09:45
Primary caesarian section in El-obeid North Kordofan ,
Dr Khidir Elamin
09:45-10:00
Mangement of emergency C/S in Kosti Maternity Hospital
Dr S. Adam
10:00-10:15
Time series analysis of waiting time before definitive intervention
Dr. Khalid Bayoumi
Hummeida
in Obstetric emergencies in OMH
10:15-10:25
Assessment of maternal risk factors of preterm labour
Ahmd K. Mohmed
10:25-10:35
Vitamin D defiency and pregnancy outcome
Dr.Salma Geris
10:35-11:00
Discussion
11:00-11:30
Break
Second Session : Business meeting
Chairperson : Prof Osman Mahmoud
11:30-
Rapporteur
: Dr.A/Rahman Khalid
CLOSING
01:00
Round table discussion ( by invitation)
Date
TIME
Subject
Facilitators
22/2/2015
08:00-09:00
Use of MgSo4 at community level
Prof Mawia Elsadig
23/2/2015
08:00-09:00
Use of misopristol at community level Prof A.A/ Ashmaige
105
POSTER PRESENTATION
TIME
Subject
Speaker
Available
The age at Menarche on primary, secondary Dr.Mohamed A.Bagi A. &
All
and high schoolgirls Khartoum state Sudan
Pro.Mohamed Ali Elshiesh
conference Assessment of umbilical artery Doppler Dr Sara Foud Richard,
days
Ultrasound
findings
in
patient
with Dr Kameel Kamal Kamil
preeclampsia
Large solitary luteinized follicle cyst of Moawia Elsadig
pregnancy and puerperium Case Report
Prevalence
of
antenatal
amongmultigravidae at
Soba
Hummeida, Ali abdel Satir
depression Dr. Rania D. Eltaher E lgack
University & Dr. Bashir Algaily
Hospital
Primary
Cesarean
Section
Indication, Dr. Elameen Khougli & Dr.
Maternal and Fetal Outcome
Nada Gaafar
Role Of Sweeping In Initation Of Labour In DR. Sarah Musaad .&
Post-
Date
Maternity
Pregnancy
Hospital
In
Omdurman Prof.Taha Umbeli,
(January-November
2012)
Review of predictive Factors and the
Dr. Nafisa Ibrahim & Dr.
Outcomes of VBAC
Mohammed H. Idris
Maternal
And
Fetal
Outcome
Of Dr.Nahid Sulieman
Grandmultiparity In Omdurman Maternity Professor A/Slam Gerais
Hospital
Advance Maternal Age and Late Pregnancy Dr.Shireen Abdalla ahmed
Outcome At Omdurman New Hospital
& Dr.Khalid Yassin
Ginger For Nausea And Vomiting In Sudanese
Dr.Isam M. Babiker & Prof.
Pregnant Ladies During Early Pregnancy
Moawia E.Hummeida
Cinical presentation and Treatment Outcome
Dr. Mohammed Ibrahim
of Genito-Urinary Fistula in El-Obeid
& Dr. Khidir Elamin
Hospital
Postpartum
Rupture
of
subcapsular Moawia E Hummeida,
Haematoma of the liver, Case report
Magdi Lwis, Durea Erayes,
Ismail Omer
106