Obstetrics and Gynecology

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Perspectives of Obstetricians and Gynecologists in Ethiopia Towards Female Sexual.
(Addis Ababa Uinverstiy, 2026) Dr. Medina Barsenga; Dr. Endalkachew Mekonen; Dr. Salih Hassen
Background: Female sexual dysfunction (FSD) is a common yet often neglected health problem in Ethiopia. Although obstetricians and gynecologists are the primary providers of sexual and reproductive healthcare, their perspectives on FSD have not previously been assessed. Objective: To assess the knowledge, attitudes, and clinical practices regarding female sexual dysfunction and to identify factors associated with clinical practice among obstetricians and gynecologists in Ethiopia in 2025. Methods: An analytic, nationwide cross-sectional study was conducted among 245 obstetricians and gynecologists recruited through convenience sampling via professional networks and social media platforms. Data were collected using a structured, self-administered questionnaire. The data were summarized using frequencies and percentages, medians and interquartile ranges, and graphical presentations. To identify factors associated with good practice, binary logistic regression analysis was performed at p < 0.05, and results were reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Out of 245 participants, 40.8% demonstrated adequate knowledge and 41.2% had favorable attitudes, but only 10.2% exhibited good clinical practice, while 61.2% were categorized as having poor practice. Most specialists correctly identified core types of FSD, such as decreased sexual desire (96.3%), but fewer than half were aware of standardized assessment tools such as the Female Sexual Function Index (46.1%). The most prominent barriers reported were lack of formal training (79.6%), absence of clinical guidelines (64.5%), and cultural or religious factors (59.6%). In multivariate analysis, factors significantly associated with good practice included more than 5 years of professional experience (AOR = 2.59, 95% CI: 1.25–5.37, p = 0.010), formal sexual and reproductive health (SRH) training specially on FSD (AOR = 10.01, 95% CI: 2.40–41.78, p = 0.002), adequate knowledge (AOR = 5.80, 95% CI: 3.01–11.19, p < 0.0001), and favorable attitude (AOR = 4.11, 95% CI: 2.14–7.87, p < 0.0001). Conclusion: Ethiopian obstetricians and gynecologists demonstrate moderate knowledge and generally favorable attitudes toward female sexual dysfunction; however, clinical practice remains limited. The tenfold increase in good practice among trained providers, together with the high proportion of specialists identifying lack of training as a major barrier, highlights an ix important opportunity for improvement through targeted training and supportive policies that strengthen clinicians‟ skills and translate willingness into effective clinical practice.
Prevalence, patterns and Treatment outcomes of abnormal semen parameters among infertile couples in Ethiopia: A Four-Year Retrospective study.
(Addis Ababa Uinverstiy, 2026) Dr. Nuredin Awel; Dr. Mahlet Yigeremu; Dr. Eyasu Mesfin
Background: Infertility is a substantial public health burden in sub-Saharan Africa, yet evidence on assisted reproductive technology (ART) outcomes, particularly those related to male factor infertility, remains limited in Ethiopia. Semen analysis is a cornerstone to male fertility assessment; however, its prognostic significance for treatment success with intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) in low-resource settings is not well established. Despite expanding access to ART, data on the prevalence, patterns, and clinical relevance of abnormal semen parameters in Ethiopia are scarce. This study provides the first large-scale analysis of semen profiles and their association with ART outcomes among infertile couples in Ethiopia. Objective: This study aimed at describing the prevalence and patterns of abnormal semen parameters and determining their association with fertility treatment outcomes between IUI and ICSI among infertile couples undergoing first-cycle ART at two private fertility centers in Addis Ababa, Ethiopia. between July 2021 and June 2025. Methods: A four-year retrospective cross-sectional study was conducted among 1,242 consecutive infertile couples who underwent their first ART cycle (IUI or ICSI) between July 2021 and June 2025. Data were extracted from semen analysis records and treatment outcome registries, with semen analysis standardized per WHO 2021 criteria. The primary outcome was clinical pregnancy. Data were analyzed using SPSS version 26. Descriptive statistics were used to assess prevalence and patterns of semen abnormalities. Associations between semen parameters, reproductive characteristics, and clinical pregnancy were evaluated using chi-square tests and multivariable binary logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: The mean age of male partners was 40.07 ± 7.78 years, while female partners had a mean age of 34.43 ± 11.69 years. Primary infertility accounted for 64.1% of couples where as Secondary infertility comprised 35.9%. Abnormal semen parameters were highly prevalent, observed in 55.6% (691/1242) of couples with a clinical pregnancy rate of (n=93, 13.5%). The most common isolated abnormalities were suboptimal motility (n=404, 32.5%), suboptimal count (n=347, 27.9%), and atypical morphology (n=221, 17.8%). Azoospermia (0 sperm/mL 11 accounted for n=12, with a prevalence of 1.0% of all men. During the study period treatment distribution was, 685 couples (55.2%) underwent IUI and 557 (44.8%) underwent IVF/ICSI, with corresponding clinical pregnancy rates of 7.7% and 19.0% respectively, yielding an overall clinical pregnancy rate of 12.8% (95% CI: 11.0–14.7%). In multivariable analysis, after adjustment for covariates, abnormal semen parameters were not independently predictive of clinical pregnancy. However, female age ≥35 years was associated with a 56% reduction in the odds of pregnancy compared to age <30 (AOR = 0.44, 95% CI: 0.27–0.74, p = 0.002). IVF/ICSI treatment conferred 3.65 times higher odds of success than IUI (AOR = 3.65, 95% CI: 2.31– 5.78, p < 0.001). Conclusion: More than half of infertile men presenting to private fertility centers in Ethiopia have at least one abnormal semen parameter. However, clinical pregnancy outcomes were primarily influenced by female age and treatment modality rather than semen abnormalities per se. The findings from this study suggest that semen analysis categories alone have limited prognostic role for predicting ART success in this setting. Recommendation: Rather than depending just on semen parameter classifications, clinical counseling and treatment selection for IUI or ICSI should take a holistic, couple-centered approach that gives priority to female age and the overall clinical context. Prospective research is necessary to improve evidence-based classification of infertile couples receiving ART and to better understand the prognostic role of semen abnormalities in ART outcomes.
A Four- Year Survival Outcome of Ovarian Cancer Patients at Tikur Ambessa Specialized Hospital, Addis Ababa, Ethiopia.
(Addis Ababa Uinverstiy, 2026) Dr.Motuma Gutu; Dr Yirgu G/Hiwot,; Dr Dawit Dessalegn,
Introduction: Ovarian cancer poses a major public health issue in Ethiopia, yet its clinical characteristics within the local population are not well-studied. Thus, it is important to understand the ovarian cancer clinical features and survival outcomes in Ethiopia to get crucial insights into the disease's progression. It also helps to guide targeted interventions for early disease detection, treatment, and patient care strategies. Objective of the study: To investigate the survival outcomes of ovarian cancer patients in Addis Ababa, Ethiopia. Methodology: Retrospective cohort study was done on consecutive patients treated for ovarian cancer from 2020-2023 in TASH. A demographic and clinical information were collected using structured questionnaire. Kaplan-Meier survival curves were generated to assess survival outcomes, and Cox proportional hazards regression was used to identify prognostic factors associated with survival. Result: The ovarian cancer median age of diagnosis was 45 yrs (with IQR of 38 - 55yrs) and ranging from 14 to 80 yrs. The median duration of symptoms was 3 months (with IQR of 2-6 month). The histologic distribution shows epithelial tumors of 80.7% including borderline tumors 6.4%, GCT 5.5% and SCST 11%. The median OS for epithelial ovarian cancer was 36.6 months. The first, second- and third-year epithelial ovarian cancer over-all survival was 85.8%, 67.3% and 47.5% respectively. The progression free survivals (PFS) at 1st and 2nd year were 67.8% and 39.6% respectively with median progression free survival of 24.5 months. In cox proportional hazard regression, presence of residual disease (HR = 3.19; 95% CI: [1.22-8.34]; p = 0.018) and those patients treated with only chemotherapy as primary treatment (HR = 4.48; 95% CI: [1.80-11.13]; p = 0.001) were statistically associated with overall survival. Patients treated with interval debulking surgery were associated with shorter progression free interval as compared to PDS (HR= 2.11; 95% CI: [1.06- 4.21]; p = 0.033). Conclusion: Collectively, these findings illustrate both strengths and critical gaps in ovarian cancer care delivery. The high primary surgical rate is a positive indicator of institutional capacity, yet frequent distant recurrences, and very limited secondary surgical intervention point to opportunities for improvement.
Magnitude of Long-Acting Reversible Contraceptive use and Associated Factors After Elective Cesarean Delivery at three Teaching Hospitals of Addis Ababa: A Cross Sectional Hospital-Based study 2025.
(Addis Ababa University, 2025) Adugnaw Getachew; Abera Bedada; Ashebir Getachew
Background: - Cesarean Section (CS) deliveries are becoming increasingly common worldwide, and women who deliver via CS may have unique contraceptive needs and preferences. The immediate postpartum period, particularly during the period of hospital stay following an elective CS, presents a valuable opportunity to counsel and initiate long-acting reversible contraception. Objective: To evaluate the use and utilization of immediate postpartum long-acting reversible contraceptive methods and associated factors among pregnant women who gave birth by elective CS in the three teaching hospitals of Addis Ababa. Methods: A facility-based cross-sectional study design was conducted, and 422 post-elective CS-delivered women were planned by a systematic random sampling method from those delivered by elective cesarean section. Data were collected using a structured questionnaire and entered and analyzed by SPSS version 25 for further analysis. The impact for the uptake of LARC was measured by logistic regression. Those variables having a 𝑃-value < 0.25 in the bivariate logistic analysis were entered into the multivariate logistic regression model to identify the association of independent variables with the outcome variable. In the multivariable analysis, a 𝑃 value of < 0.05 was used to declare the statistical significance, and AOR with 95% CI was calculated to determine association. Results: - Only 22.9% of participants were using immediate postpartum LARCs. Among users (n=95), Implanon was the most common method (64.2%), followed by IUCDs (20%) and Jadelle (15.8%). Multivariate analysis showed that women residing in rural areas were 3.8 times more likely to use LARCs compared to those in urban areas (AOR = 3.8, 95% CI: 1.88–16.57). Women with a college education or higher had 3.1 times higher odds of LARC use compared to those who were illiterate (AOR = 3.1, 95% CI: 1.41–23.56). Additionally, larger family size (>4 members) (AOR = 6.3), grand multiparty (AOR = 8.8), being the main decision-maker for contraception (AOR = 9.6), and having a favorable attitude toward LARCs (AOR = 20.2) were all significantly associated with increased postpartum LARC use. Conclusion: The utilization of immediate postpartum LARCs was low despite their proven benefits. Strengthening education, male involvement, counseling services, and addressing misconceptions are critical to improving postpartum LARC uptake
Prevalence and Associated Factors of Postural Puncture Headache After Spinal Anesthesia for Cesarean Section at three Teaching Hospitals in Addis Ababa, Ethiopia; 2024/25 G.C
(Addis Ababa University, 2025) Tadiwos Mekonnen; Ahmed Abdella
Background: - Post-Dural puncture headache (PDPH) is one of the major complications of spinal anesthesia. It occurs in 32% of patients carrying a considerable morbidity. Also, the associated symptoms last for several days, at times severe enough to impair patient’s quality of life. Several risk factors contribute for the development of post-Dural puncture headache which varies with characteristics of individual patients, the type of spinal needle and the technique or approach used. Objective: - To assess the prevalence and associated factors of post-Dural puncture headache after spinal anesthesia for caesarean section at three teaching hospital in Addis Ababa, Ethiopia. Method: - An institution based cross-sectional study was conducted at 3 teaching hospitals of Addis Ababa university. Consecutive sampling technique was used to include 904 study participants of post-operative women during the study periods of December 15, 2024 G.C. – May 31, 2025 G.C. The data were coded, entered, and analysed by using SPSS version 25. Descriptive statistics were used to describe the study variables. Logistic regression analysis was used to assess associated factors of post-Dural puncture headache. A p-value of < 0.05 was considered statistically significant. Results: PDPH was observed in 38.4% of patients (n=347), with the majority reporting a mild headache (76.9%). Most headaches developed within the first 1–2 days post-procedure (72.3%). Associated symptoms included neck stiffness (85.9%) and tinnitus (38.3%). Significant risk factors identified included age ≥35 years (AOR: 2.7), ASA class III status (AOR: 1.9), previous spinal anesthesia (AOR: 3.1), high gravidity (≥5), and emergency cesarean section (AOR: 2.7). Technical factors such as increased number of cerebrospinal fluid drops (AOR for three drops: 3.3) and multiple puncture attempts (AOR for three attempts: 31.6) greatly increased PDPH risk. Procedures performed by residents and anesthesiologists were also associated with higher PDPH incidence. Conclusion: More than one-third of the study participants developed post-Dural puncture headache (PDPH) following spinal anesthesia. Younger age, previous PDPH, higher gravidity, emergency cesarean section, multiple cerebrospinal fluid drops, repeated puncture attempts, and anesthesia administered by less experienced providers were independently associated with increased risk.
Prevalence of Postpartum Depression and Associated Factors among Post Cesarean Section Women Visiting Postnatal Clinic.
(Addis Ababa Uinverstiy, 2025) Zebiba Ashenafi; Sisay Teklu
Background: One of the biggest health issues in the world, postpartum depression (PPD), can negatively impact mothers, their babies, and their families. Unfortunately, psychological issues have received little attention in developing nations like Ethiopia when it comes to screening, diagnosis, and treatment. Objective: To assess the prevalence and associated factors of postpartum depression among post cesarean women visiting postnatal clinic at three teaching hospitals, Addis Ababa, Ethiopia. Methods: A cross-sectional study was carried out in a hospital. A structured questionnaire administered by an interviewer was used to gather data between January 1st, 2025, and March 31st, 2025. Depression symptoms were measured using the Edinburgh Postnatal Depression Scale, which was locally pre-validated. SPSS version 26 was used to enter and analyse the data. Using descriptive analysis, the prevalence of postpartum depression was determined. Bivariate and multivariable regression analyses were employed to determine the variables associated with postpartum depression. P-values below 0.05 will be considered significant. The 95% confidence interval (CI) and odds ratio (OR) were computed. Results: Postpartum depression was found to be 38% common in women who had caesarean sections. PPD was significantly correlated with a number of factors. Compared to women aged 18–24, those aged 25–34 had a lower risk of developing PPD (AOR = 0.49, 95% CI: 0.25–0.95). Women who were illiterate (AOR = 1.4, 95% CI: 1.29–4.59), had unintended but desired pregnancies (AOR = 5.3, 95% CI: 1.08–26.64), were multiparous (AOR = 5.5, 95% CI: 2.82–10.64) or grand multiparous (AOR = 5.9, 95% CI: 2.41–14.61), had mothers who gave birth to female babies (AOR = 2.8, 95% CI: 1.74–4.65), and had low social support (AOR = 3.4, 95% CI: 1.15–10.28) were all associated with increased odds of PPD. Conclusion: The high prevalence of PPD among women delivered by CS indicates the need for routine mental health screening during the postnatal period. Special attention should be given to women with limited education, unplanned pregnancies, high parity, gender-related stress, and inadequate social support. Targeted interventions and integrated maternal mental health services are essential to address this critical public health issue.
The Practice and Determinants of Labor Analgesia Among Obstetric Care Providers Working in Three Teaching Hospitals.
(Addis Ababa Uinverstiy, 2025) Mekonnen Gebre; Dawit Desalegn
Introduction: Uterine ischemia and intricate neuro-hormonal processes are the causes of labor pain, which is a physiological and psychological phenomenon. For childbirth experience to be positive, effective pain management is essential. Despite the existence of international policies and guidelines aimed at improving maternal care, including the management of labor pain, their actual implementation is still restricted. Finding the variables that affect medical professionals' decisions and practices around managing labor pain is a common focus of this field of study. Objective: To assess the practice and determinants of labor analgesia among obstetric care providers serving in three academic hospitals located in Addis Ababa, Ethiopia. Methodology: Institution based cross-sectional study was employed in three teaching hospitals of Addis Ababa between November 1/2024 - February 30/2025 G.C. The study subjects were selected using convenience method and 202 obstetric care workers were proportionally allocated to respective health facilities. The data was collected by self-administered structured questioner. The data was entered and analyzed by SPSS version 26.00 for clearing and analysis and Logistic regression analyses was employed to identify factors associated with the practice of analgesia. Using 95% CI variables with a p-value <0.05 was identified as statistically significant factors. Results: Just 19.8% of the obstetric care providers in this study demonstrated good labor analgesia practices. Being female (AOR = 3.3, 95% CI: 1.45–7.60), having more professional experience (AOR = 3.2, 95% CI: 1.81–12.49), having a positive attitude toward labor analgesia (AOR = 3.2, 95% CI: 1.81–12.49), and exhibiting sufficient knowledge about labor analgesia (AOR = 1.9, 95% CI: 1.47–5.12) were all factors that were significantly associated with better practice. Recommendation: - In order to improve the quality of labor pain management, this finding highlights the need for focused interventions that improve obstetric providers' attitudes and knowledge while also increasing training opportunities, particularly for male and midwife providers
Success rate, Maternal and Perinatal outcome, and Associated Factors of Induction for Prelabour Rupture of Membrane in three Teaching Hospitals.
(Addis Ababa Uinverstiy, 2025) Samson Kehali; Ahmed Abdella; Salih Hassen
Prelabour rupture of membranes refers to the loss of integrity of fetal membranes prior to the onset of clinically apparent labour contractions. The major issue in managing a woman with PROM at term is whether to follow her expectantly or proceed for delivery. Among the factors to consider are possibility of failed induction, caesarean delivery, length of labour, cost, length of hospitalization and risk of maternal and neonatal complications. Objective: the objective of the study is to assess the success rate, maternal and perinatal outcomes, and factors affecting of induction for prelabour rupture of membrane in the three teaching Hospitals of Addis Ababa University. Methods: Facility based cross-sectional study was employed in the three affiliate teaching hospitals of Addis Ababa University. The study subjects were recruited sequentially until the calculated sample size of 374 is achieved. The data were collected by interview & reviewing participants‘ clinical records. The data were entered, clearing and analysis by SPSS version 25. Logistic regression analyses were employed to identify factors associated with the outcome variable. Using 95% CI, variables with a p-value <0.05 were identified as statistically significant factors. Result: Sixty seven percent (n= 250) of 374 participants with PROM had a successful induction of labor. Multiparity (Odd‘s ratio= 14.0, 95% CI: 3.78, 52.16), term PROM (Odd‘s ratio= 4.9, 95% CI: 1.04, 23.29), and absence of intrapartum complications (Odd‘s ratio= 15.0, 95% CI: 13.37, 65.13) were significantly associated with higher odds of successful induction. Maternal complications occurred in 6.4% (n= 24) of participants, mainly postpartum hemorrhage (n= 21, 5.6%) and surgical site infection (n= 3, 0.8%). Poor perinatal outcomes were observed in 18% (n= 67) of neonates, with 16% (n= 59) requiring NICU admission and a neonatal mortality of 2.7% (n= 10). Multiparous women had a better perinatal outcomes (Odd‘s ratio= 0.39, 95% CI: 0.17, 0.92), while hypertensive disorders (Odd‘s ratio= 13.4, 95% CI: 1.03, 44.92) and non-spontaneous deliveries, OVD (Odd‘s ratio= 28.2, 95% CI: 2.73, 91.31) and CS (Odd‘s ratio= 6.2, 95% CI: 2.58, 14.96) significantly increased the risk. Conclusion and recommendation: The success of induction was good, and is comparable to the findings of studies done in other centers. Multiparity, term PROM, and absence of intrapartum complications were associated with successful induction. Strengthen antenatal risk assessment to identify women at higher risk for poor outcomes; those with hypertensive disorders and primigravidity is important to improve the outcome
Factors Associated with Surgical Site Infection After Cesarean Deliveries.
(Addis Ababa Uinverstiy cesarean delivery superficial surgical site infection, 2025) Lulit Fekadu; Yirgu Gebrehiwot
Surgical site infection is a common major complication after cesarean sections worldwide. Post-CS SSI incidence varies the income level of the country. The magnitude of morbidity and mortality related to post-CS SSI still remains major despite improvements in surgical techniques and preventive strategies. Objective: -To determine factors associated with surgical site infection after cesarean deliveries in TASH, ZMH and GMH, Addis Ababa, 2025 G.C. Method: -Hospital based case control study was conducted at three hospitals of Addis Ababa University (TASH, GMH and ZMH). A total of 366 participants were included with 1:2 ration of SSI and non-SSI participants from January1/2024 to May 30/2025.Study participants wereselected using random sampling method. Descriptive statistics were used for determining the associated factors of SSI. Presence and degree of association between outcome and independent variables were computed through bivariate logistic regression analysis. For factors having P value of ≤ 0.05, the multivariate logistic regression analysis were used. Result: -The study identified several significant predictors of SSI. Women who underwent emergency cesarean sections were 3.6 times more likely to develop SSI compared to those whhad elective procedures (AOR = 3.6; 95% CI: 1.97–13.74). Similarly, participants residioutside Addis Ababa had a 2.2-fold increased risk (AOR = 2.2; 95% CI: 1.88–5.62). The presence of maternal comorbidity increased the risk by 3.2 times (AOR = 3.2; 95% CI: 1.50–6.67), while clinical chorioamnionitis was associated with a 6.3-fold rise in SSI risk (AOR = 6.3; 95% CI: 1.06–37.92). Cesarean sections performed during the second stage of labor were 2.6 times more likely to result in SSI (AOR = 2.6; 95% CI: 1.13–6.09). Additionally, women with grade III meconium-stained amniotic fluid had a 10.9 times higher risk of developing SSI compared to those with grade I meconium (AOR = 10.9; 95% CI: 1.97–13.74). Conclusion:Conclusion: Multiple maternal, clinical, and procedural factors were independently associated with increased risk of SSIs following cesarean sections. Targeted interventions focusing on improved intrapartum care, infection control measures, and surgical training are essential to reduce the incidence of SSIs.
Stage At Diagnosis and Factors Contributing For Delay In Diagnosis And Treatment of Cervical Cancer Patients
(Addis Ababa Universtity, 2025) Fikrie Wondie; Eyasu Mesfin
Cervical cancer is still the fourth most frequent disease worldwide and one of the most common cancers in women, with over 604,000 new cases reported and 342 000 deaths annually. It is the third most prevalent cancer among women in low- and middle-income countries (LMICs), where it accounts 85% and 90% of morbidity and mortality respectively. It is the primarycause of death for females among all gynecologic malignancies. Objective:To assess the factors contributing for delayed diagnosis and treatment of cervical cancer patients atTASHand determine stage at diagnosis Method – An institutional cross-sectional study was conducted in the gynecology and oncology inpatient and outpatient departments of Tikur Anbessa Specialized Hospital. With 195 patients participating in the research out of the 202 intended participants, a response rate of 96.5% was achieved. Study participants were added using the consecutive sampling procedure until the necessary sample size was reached. SPSS Version -25 was used to analyze the data that had been gathered. An independent variable was deemed significant if its p-value was less than 0.05. Result: - In this investigation 22% and 29% of the study participants were delayed in the diagnosis and treatment of cervical cancer respectively. The predictor variables for delay in the diagnosis were Age>55 years have 8.2 folds increase its DID compared to those of age 25-35 years (AOR=8.2), Education level of unable to read and write (AOR=2.6), first visit of private health facility were 9.4 folds increase its DID (AOR=9.4) and those not heard about cervical cancer were 16.2 times increase in DID (AOR=16.2).Conversely, though the statistically significant predictor of delay in treatment of cervical cancer were age of >55 years have 5.1 folds increase its DIT (AOR=5.1), residency of out of Addis Ababa were 1.5 folds increase its DIT (AOR=1.5), monthly income of <5000 birr was 2.4 folds increase its DIT (AOR=2.4), Those having 1-4 children had 80% less likely of having DIT (AOR=0.20) and didn’t ever heard about cervical cancer were 5.3 times increase in DIT (AOR=5.3).
Maternal Outcome of Women with Cardiac Disease During Intrapartum and Postpartum Periods at TASH, A 3 Years Retrospective Cross-Sectional Study.
(Addis Ababa University, 2024-10-18) Mezgebu Gietnet; Mahlet Yigeremu; Eskinder Kebede
Background: Heart disease affects between 1% and 4% of pregnancies and continues to be a leading cause of maternal death worldwide, affecting women in both highincome and low- to middle-income countries. The maternal mortality rate due to cardiac conditions is approximately 9% in developed nations and 36% in developing regions. However, there is limited research in Ethiopia to fully understand the impact of heart disease on pregnant women and its effect on maternal outcomes. Objective: The purpose of this research is to evaluate how cardiac disease affects maternal outcomes in women with heart conditions during labor, delivery, and the postpartum period up until they are discharged from the hospital. The ultimate goal is to enhance their health and overall well-being. Methods: The study retrospectively enrolled 92/127 women with cardiac illness, who received labor and delivery service at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from Jan 1st, 2021 to Dec 31, 2023. Census sampling method was applied to include study participants. The data entered and analyzed using Epi-info version 7.0 and SPSS version 25.0. Bivariable regression done and variables with p-value ≤ 0.25 analyzed withmultivariable logistic regression with a level of significance <0.05. Results: In this study, 92 participants that fulfill the inclusion criteria were enrolled following review of their medical charts. Majority of the study participants (65.2%) found in the age group of 25-34 years with mean ±SD of 28.1±5.2. Almost one-third of the participants were primiparous and 63% were from the rural area. This study shows the significant cause of heart disease is acquired causes (84.8%, n=78). Majority of patients (40.2%, n=37) have a functional status of NYHA class II. Mitral valve is the most commonly affected valve with 80.5% (n=74) contribution. Majority (46.7%, n=43) of deliveries were via operative vaginal deliveries and 34.8% (n=32) were delivered via C/S. Composite adverse maternal outcome was found in 28%, (26/92) participants. Heart failure and pulmonary edema were the two most common acute cardiac events each contributing 10.9% respectively.
Magnitude and Determinants of Primary Cesarean Section Among Women who Give Birth At 37 & Above Weeks of Gestational Age in three Teaching Hospitals of Addis Ababa University in Addis Ababa, Ethiopia: Cross Sectional Study
(Addis Ababa University, 2024-09-16) Dawit Mekonnen; Mahlet Yigeremu; Dawit Desalegn
Background: The use of cesarean section has expanded to low-, middle-, and high income nations along with notable advancements in clinical obstetric care and better surgical procedure safety. According to Ethiopia Demographic and Health Surveys (DHS), the national population-based cesarean section rate climbed from 0.7 percent in 2000 to 1.9 percent in 2016, with rises throughout seven of the country's eleven administrative areas. Studies done in Addis Ababa public hospitals showed that the rate of cesarean section ranges between 21% and 38%. The rate of primary cesarean sections, however, has never been researched and no data is available. To lower this concerning cesarean section rate, it is crucial to look at decision-making processes and put in place a safe prevention strategy for primary cesarean section practice, as advised by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine in their obstetric care consensus recommendation. Objectives: To assess the magnitude and determinants of primary cesarean section among women who gave birth at term in three teaching hospitals of Addis Ababa University in Addis Ababa, Ethiopia. Methods: A hospital-based cross-sectional study was conducted from January 01 to April 30, 2024. Systematic random sampling was used to select 422 participants. The structured, pretested, and anonymous questionnaire was used, and data were entered into Epi-Data version 3.1 and will be exported analysis to SPSS version 23. Descriptive statistics were performed, and then used tables and figures to present the findings. A P-value of <0.05 will be considered statistical significance. Result: Four hundred twenty-two women’s medical charts were included in this study, making 100% response rate. Our research finding indicates that 25.83% of women underwent a primary cesarean section. The most frequent indications for primary cesarean section were fetal distress (55%), mal-presentation (19.3%), failed induction (11.9%), and CPD (11%). Our research findings indicate that parity, gestational diabetic mellitus, chronic medical disease, fetal presentation, fetal membranes status and liquor status were variable statistically significantly associated with Primary CS with p-value <0.05. Conclusion: The magnitude of primary cesarean section in this study was high. Our study emphasizes the need for careful monitoring and management of women with gestational diabetic mellitus, chronic medical conditions during pregnancy, and the importance of monitoring the status of the fetal membranes during labor. The results indicate that most neonates had favorable outcomes. Furter research could explore interventions that address factors, potentially reducing the overall rates of cesarean deliveries while ensuring safety for both mothers and infants.
Incidence, Perinatal and Maternal Outcome and Associated Factors of Antepartum Hemorrhage at AAU
(Addis Ababa University, 2025-07-16) Biniyam Denekew; Eskinder Kebed; Tesfaye Adem
Background:-Antepartum hemorrhageisanobstetricemergencyoccursin2-5%of pregnancies. itissignificantcontributortoperinatalandmaternalmorbidityand ecauses.mortality.APHtakes30%ofmaternaldeathsofwhich50%ofthedeathsareduetopreventabl Objective:-TomeasureAntepartum hemorrhage’sincidence,perinatalandmother ix outcomes,andcontributingvariablesatAAU,2024/5 Methods:-AProspectivecrosssectionalstudywasusedinAddisAbaba’s3teaching hospitals.Allwomenwhoexperiencedantepartum hemorrhagemettheinclusion criteri awerechoosenunlessthemaximum samplesizeof422isreached.Thedata werecollectedbyinterviewandchartreviewmethod.SPSSversion25.00wasusedfor entryandanalysisofdata.Inordertoidentifyfactorsthathavebeenlinkedtothe dependentvariable,logisticregressionanalysiswasimplemented.Variableswithap valueoflessthan0.05werechosenasstatisticallysignifi interval cantusing the 95%confidence Result:-TheincidenceofAPHwas4.4%.Mostaffectedwomenweremultiparous (66.4%).MajorityoftheAPHwerecausedbyAP(61.2%)followedbyPP(30.4%). Maternalcomplicationsoccurred in 22.2% ofAPH cases,withanemia(76.1%), postpartum hemorrhage(26.1%),andhypovolemicshock(18.1%)beingthemost common.Cesareandeliverywasperformedin78.4%ofcases.Determinantsofpoor maternaloutcomesincludedruralresidence(AOR=1.8),grandmultiparity(AOR=67),hypertensivedisordersduringpregnancy(AOR=1.9),abnormalvitalsignsatadmission5th(AOR=12.2),andmaternalage≥35years(AOR=2.4).Poorcompositeperinataloutcomeswereobservedin36%ofcases.Amongthese,4.5%werestillbirths.FirstandminuteAPGARscorewereLowin11%and2.9%oflivebirths,respectively.Lowbirthweightaffected23.9%ofneonates,and30%requiredNICUadmission,mainlydueto prematurity (40.1%)and low birth weight(39.4%).NICU mortality was12.4%.Determinantsofpoorperinataloutcomesincludedmaternalhypertensivedisorders(AOR=1.6),abnormalmaternalvitalsigns(AOR=6.3),maternalhemoglobin<11g/dL(AOR=2.9),andadversematernaloutcomes(AOR=3.8). Conclusion:APH posesasubstantialrisktobothmaternalandperinatalhealth. Effectivescreeningandearlyintervention,particularlimprovingoutcomes.
Age at Onset of Natural Menopause and Associated Factors in Women, Addis Ababa, Ethiopia
(Addis Ababa University, 2024-04-29) Belay Betemariam; Eyasu Mesfin
Background: Menopause is defined as 12-month of amenorrhea after the final menstruation. It is the permanent cessation of menstruation. During menopausal period most women experience hot flashes, sleep disorders, sweating, vaginal atrophy and related sexual dysfunctions which all affect woman’s health. Symptoms and relating it to menopause may not be known and most feel embarrassed to draw attention for support and worsen in developing countries. They are at increased risk of developing cardiovascular diseases and osteoporosis in early menopause and breast, endometrial and ovarian cancers in late menopause, respectively. They are also crucial for family well-being in terms of social aspects of life, particularly in Africa. Objectives: The aim of the study was to know the timing of menopause and prevalence of associated symptoms and explore the existing gap of postmenopausal women health needs. Methods: A cross-sectional study was conducted from February to March 2024. Data was collected using pretested standardized questionnaire of menopausal women from four Hospitals in Addis Ababa. Patient visitors and attendants at the four Hospitals age 30 to 60 yrs who fulfill the inclusion criteria were included in the study. Data was analyzed using SPSS version 20. Result: Data was collected from 408 participants who fulfill the eligibility criteria. The mean age of participants was 51.78 ± 5.43 years. The mean age of menopause was 45.05 (±4.65) years. Premature menopause was reported in 10.0% of them. Only 1.5% had late menopause (≥55 yrs) while 47.3% (193) had menopause at ages 45-49 years and 12.5% at age of 50-54 years. Hot flush was the commonest peri-menoausal symptom experienced by almost half, 202 (49.5 %), of the participants. Night sweating 199 (48.8%), mood change 147 (36.0%), history of perimenoausal weight gain 158 (38.7%) and sleep disturbance 128(31.4%) were among the symptoms reported by participants. Although only 56 (27.7%) of those with hot flush were treated all improved after treatment. In the majority of the symptomatic cases only less than one third of cases were seeking treatment from health provider. Multiparity and implant use were significantly associated with age at menopause. Multiparity was associated with 3.4 times iii higher odds of age of menopause of ≥ 45 yrs (AOR= 3.4, 95%CI=1.138-9.796) and also Previous implant contraceptive use (AOR= 2.05, 95%CI=1.033-4.058). Conclusion: The mean age of menopause in our study was 45.05 years. The prevalence of pre mature menopause in the current study was 10.0% which is higher than prior reports. Hot flush was thecommonestmenopausal symptom. Only less than a third of women who had menopausal symptoms sought care from a health provider.Thispotentially is duetolackof knowledge on availability of treatment for menopausal symptoms. Parity and use of Implants D were significantly associated with age at menopause of ≥ 45yrs. Recommendation: Awareness creation on menopause in the populationshould be done to increase their health seeking behavior. Large population based studies are recommended to better identify factors associated with lower mean age at menopause and high prevalence of premature menopause in our set up.
Clinicopathologic Characteristics, Management Out Come and its Associated Factors among Patients Managed with Uterine Cancer in Tikur Anbessa Specialized Hospital: Addis Ababa Ethiopia: A Retrospective Cohort Study
(Addis Ababa University, 2024-08-11) Esubalew Berihun; Esayas Birhanu; Abera Bedada
Background: -: Most cases of endometrial cancer are found at early stage and have a good outcome overall. But about one-third of patients had a diagnosis of advanced disease. Patients who report with advanced stage or aggressive histologic subtypes have a higher rate of recurrence and, consequently, lower survival times, despite favorable outcomes in early-stage cancer. Over the last 20 years, the number of deaths from EC has climbed by more than 100%, with type II EC accounting for up to 40% of cases. The type of treatment was linked to a 36% lower chance of mortality or relapse. Since there is no studies that evaluate the treatment outcome of uterine cancer in our country this study was conducted. Objective: -To assess Clinicopathologic characteristics, management outcome and its associated factors among patients with uterine cancer treated at Tikur Anbessa specialized Hospital: A five years retrospective cohort study, 2024. Method; - Facility based retrospective cohort study design was conducted. Using a 2 months study period a five years data was recruited. 128 uterine cancer cases managed at TASH from Jan 1st 2015 to Dec 30th 2019 were involved. Data was gathered through the perusal of patient charts. Collected data was checked for completeness, consistency, clarity, and missed values and was entered into SPSS version 25 for data management and further statistical analysis. The clinicopathologic characteristic were described using symptoms, signs, and pathological findings related to a specific disease or condition. The management outcome was measured using logistic regression.. 95% confidence intervals were used to correlate the outcome variable with its independent variable. The threshold for statistical significance wasestablished at p-value < 0.05 for all tests. Result: - In this study 128 charts were reviewed and out of this 59(46.1%) of the study participants were in the age group 51-65 years with a mean and SD of 55.5±9.3 years respectively117(91.4%)ofthe participantswere menopause and 64(50%) of the participants had presenting signs andsymptoms ofvaginal bleeding only and 37(28.9%) had vaginal bleeding and discharge. 53(41.4%) of the study participants had a symptom of 6-12 months duration and 19(14.8%) of the participants had ascites based on imaging. The study found that great majority (87.5%) of uterine cancer cases were endometrial cancer, and the rest is smooth muscle and mesenchymal cancer. The average age at diagnosis was 56 and 54 respectively. Metastasis occurred in 20.3% of cases, predominantly in the peritoneum (19.2%). Recurrent metastases were observed in 33 patients, with 57.6% having both distant and localmetastases. During the final follow up from 128 cancer cases 22% were were died. The determinant factor of patient death at last hospital follow up outcome were age of >60 years (AOR=1.3, 95%CI=1.11, 16.37), having metastasis (AOR=3.1, 95%CI=1.21, 7.69), tumor size of >2cm (AOR=1.4, 95%CI=1.18, 10.33) and provisional FIGO stage IV (AOR=16.3, 95%CI=1.23, 32.45). Conclusion and recommendation- The study found that great majority (87.5%) of uterine cancer cases were endometrial cancer, and the average age at diagnosis was 56 and 54 respectively. Recurrent metastases were observed in 33 patients, with 57.6% having both distant and local metastases. During the final follow up from 128 cancer cases 22% were were died.Old age, metastasis, increasing tumor size and increasing the stage of disease are statistically significant factor for the death of the study participants. Further study is needed to address the final outcome of patients.
Client Satisfaction on Antenatal Care and its Associated Factors among Pregnant Women in three Teaching Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2025-10-14) Bush Kumbi; Seid Arage; Namus Muhajir
Introducti On-Within The Spectrum Of Maternity Care, Antenatal Carei Giventopregnantmothers.Cli Entsatisfacti Samedicalservice On is used toevaluatethequalityofservi Renderedinrel Ationtotheprovi Der-Cl Ientrel Ationshi P,Theinsti Provider.Thesuccessoftheadoptedpoli Happyclienti Tuti Ces On,Andthehealthcare Cyisde monstrated by client sati Smore likely toad here to medicalprofessi Treatmentplans,Tousethesamefacil Sfac On.AOnals'recommendationsandNthefuture,AndtoreferotherpeoplItyagainiNeedofmedicalcaretothehospitalthattreatedthem. Objective-ToassessthelevelofsatiSfactiOnwithantenatalcareserviAssociated factrsamongpregnantmothersatthreeteachi 2025G.C Ein Cesandits Nghospital,Addi Sababa,In Methods:Fromdecember2024tofebruary2025,325pregnantwomeninthreeteachingHospital Sinaddisababaparticipatedinahospital-BasecrossOnalstudy.Random nateShare AdministeredQuestionnai Re.Thedatawascodedandenteredintospssversion20.BivariateandMultivari Ateanalysiswith95%Ciwasemployed.Variablesfoundtohaveap-Value
Caesarean Section Rates and Adverse Perinatal Outcomes among Robsons Ten Groups of Women: A Step towards A Multidimensional Audit
(Addis Ababa University, 2025-10-19) Berhan Habtom; Ashebir Getachew; Merga Negeri
Background :Cesarean section (CS) rates are rising globally, with wide variation across populations. The World Health Organization recommends the Robson classification system for standardized monitoring. However, little is known about its association with maternal morbidity and adverse perinatal outcomes (APO) in Ethiopian referral hospitals. Methods: We conducted a hospital-based cross-sectional study among 1,100 deliveries across three referral hospitals in Addis Ababa. Deliveries were classified into the ten Robson groups. Maternal morbidity and APO (including low Apgar score, NICU admission, advanced resuscitation, stillbirth, and early neonatal death) were assessed. Logistic regression was applied to identify independent predictors of APO. Results :Of the 1,100 deliveries, 566 (51.5%) were by CS. Groups 5 (32.2%), 1 (18.9%), 2 (10.6%), 3(9.4) and 10 (8.8%) were the largest contributors. Maternal morbidity occurred in 25.8% of CS deliveries, highest in Group 10 (68.0%) and Group 4 (55.9%). The overall APO rate was 19.3%, with Group 10 (56.0%), Group 6 (47.6%), and Group 8 (36.7%) most affected. In multivariable regression, gestational age was protective (AOR 0.83 per week, 95% CI 0.75–0.92, p<0.001), while hypertensive disorders with intrauterine growth restriction (HDP with IUGR) (AOR 6.19, 95% CI 2.34–16.38, p<0.001) and residence outside Addis Ababa (AOR 4.51, 95% CI 1.3515.07, p=0.02) were significant predictors of APO. Conclusion :The study demonstrates that high CS rates alone do not equate to poor or good outcomes. Instead, prematurity, HDP with IUGR, and delayed referral drive adverse results. Robson Groups 10, 6, and 8 carried the greatest perinatal risks, while Groups 4 and 10 had the highest maternal morbidity. Implementing Robson-based CS audits, strengthening antenatal surveillance for HDP and IUGR, and improving neonatal care and referral systems are critical to reducing adverse outcomes.
Incidence, Perinatal and Maternal Outcome and Associated Factors of Antepartum Hemorrhage at AAU
(Addis Ababa University, 2025-07-10) Biniyam Denekew; Eskinder Kebede; Tesfaye Adem
Background:-Antepartum hemorrhageisanobstetricemergencyoccursin2-5%of pregnancies.itissignifi cantcontributortoperinatalandmaternalmorbidityand ecauses.mortality.APHtakes30%ofmaternaldeathsofwhich50%ofthedeathsaredueto preventabl Objective:-TomeasureAntepartum hemorrhage’sincidence,perinatalandmother ix outcomes,andcontributi ngvariablesatAAU,2024/5 Methods:-AProspectivecrosssectionalstudywasusedinAddisAbaba’s3teaching hospitals.Allwomenwhoexperiencedantepartum hemorrhagemettheinclusion criteriawerechoosenunlessthemaximum samplesizeof422isreached.Thedata werecollectedbyinterviewandchartreviewmethod.SPSSversion25.00wasusedfor entryandanalysisofdata.Inordertoidentifyfactorsthathavebeenlinkedtothe dependentvariable,logisticregressionanalysiswasimplemented.Variableswithapvalueoflessthan0.05werechosenasstatisticallysignifiinterval.cantusingthe 95%confidence Result:-TheincidenceofAPHwas4.4%.Mostaffectedwomenweremultiparous (66.4%).Majori tyoftheAPHwerecausedbyAP(61.2%)followedbyPP(30.4%). Maternalcomplicationsoccurred in 22.2% ofAPH cases,withanemia(76.1%), postpartum hemorrhage(26.1%),andhypovolemicshock(18.1%)beingthemost common.Cesareandeliverywasperformedin78.4%ofcases.Determinantsofpoor maternaloutcomesincludedruralresidence(AOR=1.8),grandmultiparity(AOR=6.7),hypertensivedisordersduringpregnancy(AOR=1.9),abnormalvitalsignsatadmission5th(AOR=12.2),andmaternalage≥35years(AOR=2.4).Poorcompositeperinataloutcomeswereobservedin36%ofcases.Amongthese,4.5%werestillbirths.FirstandminuteAPGARscorewereLowin11%and2.9%oflivebirths,respectively.Lowbirthweightaffected23.9%ofneonates,and30%requiredNICUadmission,mainlyduetoprematurity (40.1%)and low birth weight(39.4%).NICU mortality was12.4%.Determinantsofpoorperinataloutcomesincludedmaternalhypertensivedisorders(AOR=1.6),abnormalmaternalvitalsigns(AOR=6.3),maternalhemoglobin<11g/dL(AOR=2.9),andadversematernaloutcomes(AOR=3.8). Conclusion:APH posesasubstantialrisktobothmaternalandperinatalhealth. Effectivescreeningandearlyintervention,parti cularlimprovingoutcomes
Screening for Pelvic Organ Prolapsed without Physical Examination:Validation of the Pelvic Organ Prolapse Simple Screening Inventory (POPSSI)
(Addis Ababa University, 2014-09) Worku Dawit; G/Hiwot Yirgu
INTRODUCTIONPelvic organ prolapse occurs with descent of one or more pelvic structures: the uterine cervix or vaginal apex, anterior vagina (usually with bladder, cystocele),posterior vagina (usually with rectum, rectocele), or peritoneum of the cul-de-sac(usually with small intestine, enterocel .Howeve, a specific definition of whatconstitutes clinically significant prolapse remains elusive[1].POP results from relaxation of the pelvic floor muscle and is estimated to have aprevalence of 30-50% among women aged 50and over[1].Although mortalityresulting from POP is not significant it has a huge impact on the daily activities ofwomen afflicted by this condition, often disruptingand decreasing their quality oflife[2].POP and its complications impose a considerable economic burden on the personand it has been estimated that about 11% of women undergo surgery for POPbefore the age of 79 and with29.2% require repeated surgery[3],[4],[5].Highparity is the single most important risk factor for prolapse in rich and poorwomen in both more and less developed countries[6].Many women with pelvic floor disorder do not seek medical advice and thismakes determining its incidence very difficult.In 1996, International Continence Societydefined a system of pelvic organprolapsequantification (POP-Q) demonstrating high inter and intra observerreliability. It allows researchersto report findingsin standardized, easilyreproduciblefashion. Prolapse in each segment is measured relative to thehymen, which is a fixedanatomic landmark that can be identified consistently. Accordingly, it is stage one when the leading prolapsed part ismore than one centimeters above the hymenal ring; stage twowhen it isbetween one centimeter above and one centimeter below thehymenal ring;stage threewhen it is more than one centimeter below thehymenal ringbut less than total vaginal length(TVL) minus two centimeters, and stage fourif itis more than (TVL-2) cm below the hymenal ring[7].In Ethiopia, where accesstoobstetric care is very limited(institutional delivery being only 10 %) and thefertility rateis high(5.5 children per woman) little is known aboutthe prevalenceand risk factors for pelvic floor disorders.
Factors Associated with Success of VBAC in three Teaching Hospitals in Addis Ababa, Ethiopia: A casecontrol study
(Addis Ababa University, 2010-08) Birara Malede; Gebrehiwot Yirgu
Background:Vaginal delivery after previous one cesarean section for a non recurring indication has been described with many evidences as a safe practice and success rate of 60-80%.Hence many centers are offering VBAC for candidates leaving the century old dictum of once cesarean alwayscesarean. But predicting success of VBAC after TOL is still a difficult problem with lack of a validated tool of prediction world wide. Studies on predictors of success are fewand most of them conducted in developed countries and difficult to generalize. Therefore assessing factors associated with successful VBAC is very important to counsel mothers onVBAC.ObjectiveTo assess demographic, past and present obstetric factors associated with successfulVBAC In three teaching HospitalsinA. Methods:A casecontrol studywasconducted to compare the factors associated with successfulVBAC in teaching hospitals in Addis Ababa in one year period. The cases were thosesuccessfully delivered vaginally and the controlswerethose with failed VBAC and delivered byC/S. The sample sizewas101vaginal deliveries and the controls were 103 failed VBAC patientswhich made the case to control ratio of 1:1.In this study the factors associated with success ofVBAC wereprim parity, history of still birth, historyof successful VBAC in thepast, ruptureofmembrane at admission, cervical dilatation at admission, presenceof meconium and presence ofmalposition.Also 66 % of the failed VBAC patients had indications for the second C/S whichcould have been corrected by augmentation if there was no scar.. CONCLUSIONS and RECOMMENDATIONSBit: is possible to prepare a decision tool onthe success of VBAC by taking important past and present obstetric and reproductiveperformance history as predictor..

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