Background Most studies on respectful maternity care (RMC) and mistreatment of women have focused on intrapartum care with limited information on how women are treated during induction of labor (IOL), pre-labor phase of the maternity care continuum. Emerging multi-country evidence indicates that nearly 30% of women who undergo IOL do not consent to the procedure and constitutes a violation of their rights to optimal maternal health. This study explored women’s lived experiences of respectful care and mistreatment during IOL in a tertiary setting in Ghana. Methods This was a qualitative phenomenological study conducted between September 2021 to October 2021 in Ghana. The eligibility criteria comprised women, aged ≥ 18 years who underwent IOL with singleton gestations. Purposive sampling was employed in recruiting the study participants (n = 17). Data analysis was performed based on thematic content using the inductive qualitative analytic framework approach. Results Nearly all the participants (94.1%) were first-timers to IOL. In general, we determined mixed findings relating to the experiences of RMC (respectful versus disrespectful care). Some women experienced respectful care including effective communication, optimal counseling and appropriate professionalism resulting in adequate client satisfaction with care. Conversely, we determined that some mothers experienced mistreatment of different types during labor induction and birth including verbal abuse, lack of privacy, neglect, ineffective communication, inadequate pain relief, non-consented care and inadequate professional standards. There were no reports of physical abuse. Mixed responses (positive and negative) were heartily described concerning future utilization of the health facility considering the quality of care they received. Personalized recommendations to improve the quality of care during IOL were provided by the affected women and these summed up to RMC (e.g. effective communication, adequate analgesia, shared-decision making). Conclusion Our study indicates that women experience varied forms of mistreatment during induction of labor and childbirth, and can be potentially traumatic psychologically considering their prolonged exposure to health facilities. Context specific strategies to expedite integration and adherence to RMC guidelines in maternity care are recommended to improve the quality of care during induction of labor and birth.

Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women's knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women's knowledge on IOL, women's experiences of care and women's difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by "psyching" themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women's experiences of care during labour induction and childbirth.

Massive subchorionic thrombohematoma (MST) is the presence of a large hematoma or thrombus confined to the subchorionic space. Sonographic findings vary and include placenta descriptions such as heterogeneous, homogeneous, hypoechogenic, or jelly-like mass, which can be differentiated from the normal placenta. Our case report highlights the serial sonographic features observed in a singleton pregnancy from 13 to 29 weeks of gestation. Ultrasound findings of the placenta changed from a 65 ml subchorionic hematoma at 16 weeks to a well-defined placental mass with cystic areas at 20 weeks to an amorphous gelatinous mass at 23 weeks which became primarily replaced by an anechoic lesion with internal septations at 27 weeks. She delivered a live female at 29 weeks. MST usually has a dramatic initial presentation, but these findings may be compatible with a favourable outcome. Serial ultrasound assessment of the placenta is helpful to define the perinatal prognosis and may demonstrate gradual changes and eventual resolution.

Objectives: Our main research aim was to describe the relative proportions and trend of direct causes of maternal death over a period of 20-years in the largest tertiary hospital in Ghana.Material and methods: This was a descriptive retrospective review of cases of maternal death for which autopsy examination was conducted at the KBTH mortuary from 1995 to 2014. Data on direct maternal deaths were collected on the age, local of death (coronerand permission), the anatomical site and diagnosis: 1) obstetric haemorrhage, (including abruptio placentae, placenta praevia, uterine atony, and retained products of conception, etc); 2) abortion, 3) hypertensive disorders in pregnancy (pre-eclampsia, eclampsia), 4) ruptured ectopic gestation, 5) ruptured uterus in labour, 6) amniotic fluid embolism, and 7) genital tract sepsis.Results: There were 1,846 maternal deaths of which 86.4% were classified as direct maternal deaths (P<0.0001). The mean age was 28.72 ±6.47 years. The majority, 1,346 (84.4%) were coroner cases (p< 0.0001). Abortion (27.4%), hypertensive disorders in pregnancy(27.3%), and obstetric haemorrhage (27.0%) were the common causes. There was a general declined in the trend of maternal deaths over the 20-year period, particularly those due to abortion, obstetric haemorrhage, ruptured tubal gestation and ruptureduterus in labour. However, deaths due to hypertensive disorders in pregnancy showed a relative rise over the period.Conclusion: Abortion, hypertensive disorders in pregnancy and obstetrics haemorrhage, were the major causes of maternal deaths. There was a general decline in the trend of maternal deaths over the study period.

Background:Induction of labour (IOL) remains an indispensable intervention in obstetric practice; however, it may be associated with significant untoward perinatal outcomes. This study determined the major adverse outcomes of IOL and the associated factors at a tertiary hospital in Ghana.Methods:Retrospective study involving women with singleton gestations, conducted at the Korle Teaching Hospital in Ghana. Multivariable logistic regression was used to explore the factors associated with adverse outcomes of IOL.Findings:A total of 195 women who had IOL were analysed with 161 (82.6%) and 34 (17.4%) undergoing vaginal and caesarean deliveries respectively. The main IOL methods used included Misoprostol (91.3%), Oxytocin (5.1%) and Foley's catheter (3.6%). Composite adverse perinatal outcomes occurred in 46 neonates (23.6%) comprising perinatal deaths (7.2%) and or NICU admission (21.0%). Caesarean delivery following IOL was significantly associated with nulliparity, gestational age <41 weeks, hypertensive disorders in pregnancy and birth weight ≥3.5kg. Gestational age <41 weeks and birth weight <2.5kg were significantly associated with adverse perinatal outcome. Five women (2.6%) had uterine rupture all of which occurred in the misoprostol group.Conclusion:Induction of labour may result in significant perinatal complications which are related to both maternal (nulliparity and hypertension) and fetal (gestational age and birth weight) factors. Strict selection criteria and continuous fetal-maternal monitoring are strongly recommended to improve the birth outcomes of IOL.

Objective: To ascertain the types of adolescent female genital tract congenital anomalies and their management in the Tamale Teaching Hospital in Northern Ghana.Methods: A cross-sectional study of adolescent female genital tract congenital anomalies that were managed at the Tamale Teaching Hospital from 1st January 2010 to 31st December 2012. Results: There were 19 cases of adolescent female genital tract congenital anomalies during the study period. The commonest female genital tract congenital anomaly was imperforate hymen 7(36.84%). Other congenital anomalies included transverse vaginalseptum 4(21.05%), vaginal atresia 2(10.53%), vaginal agenesis 4(21.05%), didelphus uterus 1(5.26)% andbicornuate uterus 1(5.26%). The management of the adolescent female genital tract congenital anomalies included surgical procedures in 14 (73.68%), dilation of vaginal pouch, counseling and psychological support in 6 (31.57%).Conclusion: While in resource limited settings, initial workup and management of adolescent female genital tract congenital anomalies may be done without sophisticated equipment, management of more complex cases are usually more challenging requiringreferral to more appropriately staffed and equipped centres.

Background: Globally, pregnancies that have gone beyond the expected date of delivery (EDD) contribute significantly to maternal and perinatal morbidity and mortality.Objective: This study aimed to determine the proportion, pregnancy outcomes, and associated characteristics of deliveries at EDD and beyond at the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana.Methods: This was a cross-sectional study conducted at the KBTH.Postpartum women who delivered at a gestational age of 40 weeks and beyond were selected from the labour wards, grouped according to gestational age, and followed up to their first postnatal visit.Data were collected on demographic, obstetric and postpartum health status.The association between study variables and delivery at and beyond EDD was determined using the F-test statistic and Chi-square test for continuous and categorical outcomes, respectively.A p < 0.05 was considered statistically significant.Results: Of the 300 participants, 44% (n = 132) delivered at 40 weeks plus 0 to 6 days (40 + 0 -6 weeks) of gestation, 44.7% (n = 134) at 41 + 0 -6 weeks, and 11.3% (n = 34) at ≥ 42 weeks.The proportion of deliveries at EDD and beyond was 9.9% (n = 300/304) of total deliveries during the period.The pregnancies ≥ 42 weeks were 1.1% (n = 34/3041) of total deliveries.Factors that were significant associations with women who delivered at ≥ 42 + 0 weeks were a referral from other hospitals (p < 0.017), labour induction (p < 0.001), a longer first stage of labour (p < 0.008), and a longer total labour duration (p < 0.009). Conclusion:The proportion of deliveries in which the pregnancies had progressed to the EDD and beyond and that of prolonged pregnancy at the KBTH were 9.9% and 1.1%, respectively.The duration of the first stage of labour and the total duration of labour was longer in women with pregnancies ≥ 42 weeks.

Objective: To determine the relative proportions of vaginal and caesarean deliveries, and the common caesarean indications among women with hypertensive disorders in pregnancy (HDP). Materials and methods: A cross sectional study conducted at the Maternity unit of Korle Bu Teaching Hospital in Accra from 1st January to 28th February 2013. Results: A total of 368 women with HDP were recruited with 168 (45.7%) and 200 (54.3%) having caesarean and vaginal deliveries respectively. Regarding the caesarean delivery, 31 (18.5%) had gone into labour prior to the surgery whiles 137 (81.5%) were not in labour. Among the 368 women 68 (18.5%) had induction of labour out of which 46 (67.6%) achieved vaginal delivery. The risk of caesarean section was significanty higher in preeclampsia [(adjusted odds ratio 2.898 (1.741-4.824), p-value <0.001] and chronic hypertension [(adjusted odds ratio 2.474 (1.194-5.128), p-value =0.015] with reference to gestational hypertension. The Common caesarean indications among women with HDP were previous caesarean birth (26.2%), unfavourable cervix (22.6%), fetal distress (14.9%), failure to progress (10.7%), fetal malpresentation (9.5%), failed induction (7.1%) and placental abruption (3.0%). A total of 65 (17.7%) women with HPD had had a prior caesarean birth. Conclusion: This study has determined a high caesarean birth rate in women with HDP with the highest and lowest caesarean rates occurring in chronic hypertension and gestational hypertension respectively. The common caesarean indications among women with HDP were previous caesarean birth, unfavourable cervix, fetal distress, failure to progress, fetal malpresentation, failed induction of labour and placental abruption.

Background: Globally, caesarean section (CS) rates are rising progressively in low- and middle-income countries (LMICs) similar to high-income countries creating huge clinical and public health concerns. The WHO recommends the use of Robson classificationsystem as a global standard in an attempt to understand the determinants of the increasing caesarean births.Objective: To determine baseline analysis of CS using Robson classification and to identify the trends and determinants of the rising CS rate.Methods: A cross sectional study was conducted with a pre-intervention (prior to implementation of Robson caesarean classification) and post-intervention (after implementation) phases at a tertiary maternity unit in GhanaResults: The study included 20270 deliveries comprising 9890 (48.8%) and 10380(51.2%) in the years 2012 and 2013 respectively with mean (±SD) maternal age of 28.6±5.8 years. Caesarean birth occurred in 8121 (40.1%). Caesarean rate was highest and lowest among Robson group 9 and 3 in both the preintervention (92.5% and 8.4%) and post-intervention (90.9% and 12.0%) phases respectively. Robson groups 5 and 9 had the highest (32.0%) and lowest (3.2%) relative contributions to the burden of CS in the preinterventionperiod respectively. There were mixed findings regarding the patterns of relative contribution of the Robson groups to the burden of CS with an increase in groups 1,3,6,7 and 10, and reduction in groups 2,4,5,8 and 9 in the post-intervention year. There was statistically significant increase in the CS rate in Robson groups 1 (17.2% to 26.5%; OR=1.735, 95%CI 1.482-2.031), group 3 (8.4% to 12.0%; OR=1.478,95%CI 1.237-1.768) and group 10 (33.8% to 38.7%; OR=1.236, 95%CI 1.056-1.449) in the post intervention phase.Conclusion: Implementation of Robson classification into the maternity care resulted in identification of characteristics of women associated with caesarean birth: nulliparous or multiparous women with spontaneous labour and no uterine scar (group 1 and 3)and preterm gestation including previous uterine scar (group 10). We recommend further research into the clinical integration of Robson’s caesarean classification with special focus on predicting maternal and perinatal outcomes.

Background: Ectopic gestation is a major cause of morbidity and mortality among women of reproductive age.The clinical presentations vary depending on whether it is ruptured or not.Understanding the various modes of presentation is therefore critical to early detection and management to reduce associated morbidity and mortality.We determined the patterns of presentation and outcomes of ectopic pregnancy in the Korle Bu Teaching Hospital (KBTH) of Ghana.Objective: This study aimed to determine patterns of presentation of ectopic pregnancy in the KBTH of Ghana and the outcomes for patients presenting with the condition. Methods:We collected data from pregnant women presenting to the Obstetrics and Gynaecology Department of the KBTH during the study period and diagnosed with ectopic pregnancy.A case of ectopic pregnancy was any woman diagnosed by an obstetrician/gynaecologist either by clinical features or pelvic ultrasound.Data were collected on sociodemographic characteristics, as well as clinical history, examination findings, treatment, and outcomes.Data were analyzed descriptively to determine the patterns of presentation of ectopic gestations.Results: A total of 104 ectopic pregnancies representing 8.81% (n = 104/1,180) of gynaecological emergencies were recorded during the study period.Of the 104 ectopic pregnancies recorded, 6.7% (n = 7) were diagnosed as unruptured.The mean (± standard deviation) gestational age at diagnosis of ectopic pregnancy was 7.2 ±1.9 weeks.About 94.2% (n = 98) of patients with ectopic pregnancy had visited a health facility before the visit at which the diagnosis was eventually made, and 76.9% (n = 80) of the ectopic cases had ruptured at diagnosis.For 1.9% (n = 2) of the participants, ectopic pregnancy was detected by ultrasound.The triad of amenorrhoea in 91.3% (n = 95), lower abdominal pains in 91.3% (n = 95) and irregular vaginal bleeding in 47.1% (n = 49) of the ectopic pregnancies were the main presenting symptoms of ruptured ectopic pregnancy. Conclusion:The incidence of ruptured ectopic pregnancy in the KBTH was high.Primary health care practitioners should rule out ectopic pregnancy in women of the reproductive age group who present with the triad of amenorrhoea, lower abdominal pain and irregular vaginal bleeding.

Background The preference for mode of childbirth by women is emerging as a global subject of interest to many researchers, especially with the steady increase in caesarean section (CS) rates with some countries exceeding the world health organization (WHO) recommended rate. This study explored the preferences of mode of childbirth and associated factors among pregnant women in Ghana. Methods A cross-sectional study was conducted among pregnant women at tertiary hospital in Ghana. Descriptive analysis and multivariate logistic regression were performed. Results Among the 415 pregnant women included, 357(86.0%) and 58(14.0%) preferred vaginal delivery and CS respectively. Majority (26%) attributed their preference for vaginal delivery to its being the natural way of childbirth. The most common reason why women preferred to deliver by CS was mainly influenced by medical indication such as doctors' remarks. Significant determinants influencing preference for CS were previous childbirth [aOR:0.21, 95%CI (0.05, 0.91)], previous caesarean [aOR:20.08, 95%CI (7.73, 52.19)] and urban settlement [aOR:2.51, 95%CI (1.01, 6.29)] Conclusion There was a clear preference for vaginal birth by pregnant women although a significant proportion preferred caesarean birth. Integration of women's preferred mode of childbirth into the clinical decision with appropriate counselling is recommended to improve women's pregnancy and childbirth experiences.

Background: Cardiotocography (CTG) provides important information about the interaction between fetal cerebral and cardiac activities which are both modified by hypoxia. The duration and severity of hypoxia and associated biochemical abnormalities allinfluence the manifestations of fetal heart rate abnormalities. Antenatal fetal heart rate monitoring with CTG has potential in preventing intrauterine fetal death.Aim: The aim of the study was to compare the maternal and fetal outcome of pregnancies with normal and abnormal antepartum CTG tracings.Methodology: This descriptive retrospective review compared 200 consecutive women with normal and 200 with abnormal CTG tracings. The study lasted six months and spanned a period of time from beginning of January to end of June 2011. Demographic, pregnancy and delivery outcome data were retrieved from participants' charts and simple descriptive analysis was performed. Means and their standard deviations of continuous variables were calculated and difference between group mean were compared using the student test. Categorical variables were summarized as proportions and the chi-square test used to test for difference between groups. A p-value < 0.05 was considered statistically significant.Results: Women with normal and abnormal CTG tracings were comparable in their demographic characteristics. Abnormal CTG tracings were associated with higher rate of preterm delivery (38.8% vs 18.8%, p = 0.001), caesarean section (77.9% vs 47.0%, p = 0.001)low birth weight (25.5% vs 9.1%, p = 0.001) and NICU admissions (36.5% vs 17.6%, p = 0.001). There was no difference in Apgar score or stillbirth rate between the two groups. Pregnancies with abnormal tracing were delivered about a week earlier than those with normaltracing. (37.8±2.9 vrs 38.3±2.6, p=0.001). Longer interval between tracing and delivery was associated with stillbirth.Conclusion: Abnormal antepartum CTG tracing was associated with higher preterm delivery, caesarean section, low birth weight and NICU admission. Longer interval between abnormal tracing and delivery was associated with higher stillbirth rate. Active and adequate resuscitation of babies with abnormal tracing can reduce perinatal morbidity.

Objective: To determine the prevalence of venous thromboembolism risk and thromboprophylaxis among obstetric inpatients, comparing prenatal and postnatal women. Methods: We assessed 546 obstetric inpatients at the Korle-Bu Teaching Hospital for the prevalence study. Out of this number, 223 were recruited, comprising 111 prenatal and 112 postnatal mothers. A structured interviewer-administered questionnaire was used to obtain data on participants' venous thromboembolism risk, which was categorized into high, intermediate, and low using the Royal College of Obstetricians and Gynaecologists guidelines. Data on thromboprophylaxis were also obtained and analyzed. Values were considered statistically significant at p < 0.05. Results: Overall venous thromboembolism risk among the study population was 82/223 (36.8%). All patients at high risk were prenatal, 59/112 (52.7%) of postnatal mothers were at intermediate risk, compared with 20/111 (18.0%) of prenatal women (p < 0.001). Prevalence of thromboprophylaxis was 5/82 (6.1%). All prenatal high-risk patients received thromboprophylaxis, whereas only 2/20 (10.0%) of women with intermediate risk received thromboprophylaxis. The incidence of venous thromboembolism was 3/546 (0.6%) in the obstetric inpatients. Conclusion: Our study found a high prevalence of venous thromboembolism risk among obstetric inpatients at the Korle-Bu Teaching Hospital. However, thromboprophylaxis was low. Further research is needed to audit recent practice of thromboprophylaxis and perinatal outcome.

Globally, unintended pregnancy represents an important public health challenge with significant social, economic and clinical repercussions which are worse in low-income and middle-income countries. Appropriate use of modern contraceptives averts significant proportions of unintended pregnancies and pregnancy complications. The objective of this study was to determine the prevalence and determinants of unintended pregnancy and explore modern contraceptive use among pregnant women A cross-sectional study was conducted among pregnant women receiving antenatal care at Korle-Bu Teaching hospital in Ghana using a face-to-face structured interview. Descriptive analysis was performed and multivariable logistic regression was used to assess the determinants of unintended pregnancy. Among the included 450 pregnant women receiving antenatal care, 155 (34.4%) had unintended pregnancy out of which 33 (21.3%) were using contraceptives prior to conception. In all, 14.2% (64/450) were using modern contraceptives. There was a significant difference between women and their partners regarding the perception of their index pregnancy as unintended (34.4% versus 31.6%, p-value <0.001). Significant determinants of unintended pregnancy include younger maternal age [aOR:5.706, 95%CI (1.860, 19.732)], unmarried status [aOR:5.238, 95%CI (2.882, 9.735)], previous childbirth [(aOR:2.376, 95%CI (1.460, 4.758], number of pregnancies ≥6 [aOR:2.640, 95%CI (1.210, 5.854)], number pregnancies ≤2 [aOR:0.417, 95%CI (0.252, 0.682)], previous caesarean birth [aOR:2.034, 95%CI (1.154, 3.306)] and contraceptive use prior to index pregnancy [aOR:2.305 95%CI (1.283-4.162)]. The prevalence of unintended pregnancy remains markedly high while prior contraceptive use was relatively low among women receiving antenatal care. Evidence-based interventions including specialized client education are vital in improving optimal use of contraceptive services. We recommend further research including community-based qualitative studies to better understand the factors associated with contraceptive uptake and outcomes of unintended pregnancy.

Preterm birth is highly prevalent in Ghana. It is a major public health concern because of the high burden as well as the associated immediate and long-term consequences including increased healthcare cost. Studies conducted in high-income countries may not be sufficiently generalizable in our context. Locally generated evidence-based interventions will be indispensable in improving the clinical management and prevention of preterm birth in the country. However, there are limited published literature on preterm birth and prematurity in the country. This review seeks to discuss the major challenges associated with preterm birth research in Ghana and proposes evidence-based strategies to improve biomedical and epidemiological research on preterm birth and prematurity. The limited high quality preterm birth research is partly attributable to a variety of challenges related to accurate gestational age estimation, research training, capacity and support including funding, efficient ethics committees, local and international collaboration as well as effective health management information systems. Other related challenges include unavailability of reliable internet connectivity, poor compensation for researchers and lack of conductive research environment. There is the need to expedite advocacy on implementation of practical interventions and strategies aimed at increasing high quality research in the area of preterm birth and prematurity in the country. A paradigm shift in preterm birth research with appropriate integration of concerted multidisciplinary research groups should be constituted to put basic science research to clinical practice as well as the prevention of preterm birth in the country.

Objectives To assess the role of the cerebro-placental ratio (CPR) in predicting adverse fetal outcomes among women with sickle cell disease (SCD). Methods A prospective cohort study at Korle-Bu Teaching Hospital, Accra, Ghana, between January and June 2016. Pregnant women with SCD at 34 gestational weeks or more underwent weekly fetal umbilical and middle cerebral artery Doppler assessment until delivery. Participants were categorized into two study arms based on CPR (<1.1 or >= 1.1). The primary outcome, a composite of adverse perinatal outcomes including intrauterine growth restriction, stillbirth, low birthweight, and neonatal intensive care unit admission, was compared between groups. Results Overall, 48 pregnant women with SCD were enrolled, and 5 had a fetus with CPR less than 1.1. Low CPR (<1.1) had a sensitivity and specificity of 29.4% and 100%, respectively, for predicting composite adverse perinatal outcomes. Sensitivity and specificity were, respectively, 100% and 93.5% for predicting stillbirth, and 40.2% and 97.4% for predicting low birthweight. Perinatal outcomes did not differ between the two major sickle cell genotypes (hemoglobin SS and hemoglobin SC). Conclusions Among women with SCD, CPR less than 1.1 was associated with adverse perinatal outcomes, particularly low birthweight and stillbirth.

Objectives To evaluate the knowledge and attitude of specialists towards HPV vaccination. Methods A Cross-sectional study employing a questionnaire was conducted during the West African College of Surgeons Conference in Dakar in January 2019. 400 questionnaires in English and French were distributed. 275 were returned and 10 were excluded. Descriptive statistics was used to analyze the data. Results Of the 265 participants, 147 (55.5%) had been specialists for over 10 years, 24 (9.1%) for less than 3 years. 204 (77.5%) were Christians, 52 (19.6%) were Moslems. 180(67.9%) of the participants responded to the number of HPV vaccine types: 48 (26.7%), 102 (56.7%) and 30 (16.7%) knew of three, two and one HPV vaccine types respectively. Of the 265 participants, 58 (21.9%) have had their children vaccinated while 183 (69.1%) had not. Among those whose children were not vaccinated, 4% claimed it was against their religion, 7% said the vaccines are expensive, 7% were unsure of the possible side effects, 17% were unaware of the vaccine while 65% reported other reasons. A third of the participants had recommended or administered HPV vaccine to any child before, and about half had recommended HPV vaccine to patients, friends or families before. There was a significant association between the respondent’s specialization and knowledge of HPV vaccine (P<0.001) and his willingness to recommend the vaccine to others. Conclusions There is a need for increased knowledge and awareness among healthcare professionals on HPV vaccination

INTRODUCTION:Preterm birth remains an important clinical challenge with significant short and long-term complications although its burden in the developing world is not adequately explored. This study determines the incidence, specific determinants and outcomes of preterm birth at a teaching hospital in Ghana.METHODS:Retrospective review of singleton births at Korle-Bu Teaching Hospital (KBTH) in Ghana between 1st January to 31st December, 2015.RESULTS:Preterm birth (PTB) occurred in 1478 (18.9%) out of 7801 single deliveries with etiological distribution of 879 (59.5%) spontaneous and 599 (40.5%) provider-initiated phenotypes. Gestational age categorization (WHO classification) of the preterm births included 68 (4.6%), 235 (15.9%) and 1175 (79.5%) below 28, between 28-31 and 32-36 weeks respectively. Adverse perinatal outcomes (low birth weight, perinatal deaths and poor Apgar scores) but not adverse maternal outcomes (cesarean and maternal deaths) were significantly higher in preterm compared to term births. Major factors associated with PTB include advanced maternal age (>35 years), poor antenatal care, hypertensive disorders and preterm premature rupture of membranes (PPROM) whiles obesity was protective. There were 156 stillbirths (105.6 per1000 births) comprising 93 macerated (62.9 per 1000 births) and 63 fresh stillbirths (42.6 per 1000 births), and perinatal mortality rate of 119.8 per 1000 births.DISCUSSION:Preterm birth is highly prevalent with significant adverse outcomes among singleton gestations at KBTH in Ghana, with disproportionately higher spontaneous etiology compared to provider-initiated phenotype. A paradigm shift in clinical management of preterm births/prematurity is urgently required with proactively dedicated multidisciplinary team and involvement of the global community.

ObjectiveTo evaluate the effect, on birth weight and birth weight centile, of use of the PrenaBelt, a maternal positional therapy device, during sleep in the home setting throughout the third trimester of pregnancy.DesignA double-blind, sham-controlled, randomised clinical trial.SettingConducted from September 2015 to May 2016, at a single, tertiary-level centre in Accra, Ghana.ParticipantsTwo-hundred participants entered the study. One-hundred-eighty-one participants completed the study. Participants were women, 18 to 35 years of age, with low-risk, singleton, pregnancies in their third-trimester, with body mass index <35 kg/m2at the first antenatal appointment for the index pregnancy and without known foetal abnormalities, pregnancy complications or medical conditions complicating sleep.InterventionsParticipants were randomised by computer-generated, one-to-one, simple randomisation to receive either the PrenaBelt or sham-PrenaBelt. Participants were instructed to wear their assigned device to sleep every night for the remainder of their pregnancy (approximately 12 weeks in total) and were provided a sleep diary to track their use. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants and the outcomes assessor were blinded to allocation.Primary and secondary outcome measuresThe primary outcomes were birth weight and birth weight centile. Secondary outcomes included adherence to using the assigned device nightly, sleeping position, pregnancy outcomes and feedback from participants and maternity personnel.ResultsOne-hundred-sixty-seven participants were included in the primary analysis. The adherence to using the assigned device nightly was 56%. The mean ±SD birth weight in the PrenaBelt group (n=83) was 3191g±483 and in the sham-PrenaBelt group (n=84) was 3081g±484 (difference 110 g, 95% CI −38 to 258, p=0.14). The median (IQR) customised birth weight centile in the PrenaBelt group was 43% (18 to 67) and in the sham-PrenaBelt group was 31% (14 to 58) (difference 7%, 95% CI −2 to 17, p=0.11).ConclusionsThe PrenaBelt did not have a statistically significant effect on birth weight or birth weight centile in comparison to the sham-PrenaBelt.Trial registration numberNCT02379728.

Background: Preterm birth (PTB) is a leading cause of infant morbidity and mortality worldwide. Every year, 20 million babies are born with low birthweight (LBW), about 96% of which occur in low-income countries. Despite the associated dangers, in about 40%-50% of PTB and LBW cases, the causes remain unexplained. Existing evidence is inconclusive as to whether occupational physical activities such as heavy lifting are implicated. African women bear the transport burden of accessing basic needs for their families. Ghana's PTB rate is 14.5%, whereas the global average is 9.6%. The proposed liftless intervention aims to decrease lifting exposure during pregnancy among Ghanaian women. We hypothesize that a reduction in heavy lifting among pregnant women in Ghana will increase gestational age and birthweight. Objective: To investigate the effects of the liftless intervention on the incidence of PTB and LBW among pregnant Ghanaian women. Methods: A cohort stepped-wedge cluster randomized controlled trial in 10 antenatal clinics will be carried out in Ghana. A total of 1000 pregnant participants will be recruited for a 60-week period. To be eligible, the participant should have a singleton pregnancy between 12 and 16 weeks gestation, be attending any of the 10 antenatal clinics, and be exposed to heavy lifting. All participants will receive standard antenatal care within the control phase; by random allocation, two clusters will transit into the intervention phase. The midwife-led 3-component liftless intervention consists of health education, a take-home reminder card mimicking the colors of a traffic light, and a shopping voucher. The primary outcome are gestational ages of <28, 28-32, and 33-37 weeks. The secondary outcomes are LBW (preterm LBW, term but LBW, and postterm), compliance, prevalence of low back and pelvic pain, and premature uterine contractions. Study midwives and participants will not be blinded to the treatment allocation. Results: Permission to conduct the study at all 10 antenatal clinics has been granted by the Ghana Health Service. Application for funding to begin the trial is ongoing. Findings from the main trial are expected to be published by the end of 2019. Conclusions: To the best of our knowledge, there has been no randomized trial of this nature in Ghana. Minimizing heavy lifting among pregnant African women can reduce the soaring rates of PTB and LBW. The findings will increase the knowledge of the prevention of PTB and LBW worldwide. Registered Report Identifier: RR1-10.2196/10095