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Expectant Management of Preterm Ruptured Membranes before 34 Gestational Weeks at the University Hospital of Kinshasa, a Tertiary Referral Hospital in the Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2022年第7期12卷 633-648页

作者： Roger mbungu Mwimba anselme mbungu mulaila Joëlle Lumaya Ambis Andy Mbangama Muela Adrien Tandu Umba Berry Kinkenda Nsiangangu Malka Salamo Azama Thérèse Biselele Bakambuvua Kahindo P. Muyayalo Department of Obstetrics and Gynecology University of Kinshasa Kinshasa Democratic Republic of the Congo Neonatal Unit Department of Pediatrics University Hospital of Kinshasa Democratic Republic of the Congo Institute of Reproductive Health Center for Reproductive Medicine Tongji Medical College Huazhong University of Science and Technology Wuhan China

Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.

关键词： Premature Rupture of Membranes Gestational Age Expectant Management Pregnancy Outcomes D. R. Congo

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Knowledge and Practice in Emergency Obstetric and Neonatal Care (EmONC) Providers in Kinshasa, Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology 2022年第9期12卷 979-992页

作者： Joëlle Ambis Lumaya Roger Mwimba mbungu Andy Muela Mbangama Patrick Muyayalo Kahindo Berry Nsiangangu Kinkenda Guillaume Bisinkam Malingisi anselme mulaila mbungu Jean Tshitadi Mukendi Freddy Nkongolo Muamba Jésual Banza Lotoy Bienvenu Nkashama Kazadi Adrien Umba Tandu Christian Otem Ndesanzim Gérard Mubengabantu Kabatantshi Department of Obstetrics and Gynaecology University Clinics Kinshasa Democratic Republic of Congo

Context: Maternal and newborn mortality remains a public health concern worldwide. Although its ratio decreased by around 44% from 1990 to 2015, this rate remains high in developing regions, particularly in sub-Saharan Africa. Objectives: To evaluate the level of knowledge and practice of Emergency Obstetric and Neonatal Care (EmONC) of health providers in maternity hospitals in Kinshasa and to identify the causes of the non-practice of EmONC. Methods: A descriptive study was conducted from September 1, 2016 to January 31, 2017 in 21 medical facilities drawn from the 6 health districts of the city of Kinshasa. We analyzed data obtained by interviewing 675 healthcare providers from different professional categories working in gynecology departments and in delivery rooms. The 50% acceptability criterion was set to assess their knowledge and practice. Results: Among the providers, 385 of them (57%) had already heard of EmONC and most of them were general practitioners with a rate of 55.8% of all participants, but specialists were the ones who defined them well. Supervision by trained colleagues was the main source of information on EmONC with 32.5%, while structured training only concerned 24% of our providers and 43% of providers had no training in EmONC. The level of knowledge was deemed satisfactory with 56.4% for the whole population but below the average for general practitioners. 32.2% of our sample did not practice the EmONC and the lack of training was the main reason for this non-practice. Conclusion: EmONC as a strategy in the fight against maternal mortality is not known. Its functions are known within the framework of basic training and current practice. Structured training only concerned 24% of our service providers and 43% of them had no training in EmONC.

关键词： Obstetric and Neonatal Care Emergency Maternity Kinshasa

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Knowledge and Practice in Emergency Obstetric and Neonatal Care (EmONC) Providers in Kinshasa, Democratic Republic of Congo

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Open Journal of Obstetrics and Gynecology（妇产科期刊） 2022年第9期

作者： joëlle ambis lumaya roger mwimba mbungu andy muela mbangama patrick muyayalo kahindo berry nsiangangu kinkenda guillaume bisinkam malingisi anselme mulaila mbungu jean tshitadi mukendi freddy nkongolo muamba jésual banza lotoy bienvenu nkashama kazadi adrien umba tandu christian otem ndesanzim gérard mubengabantu kabatantshi

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