Diagnosis and treatment of obstetrics disseminated intravascular coagulation in resource limited settings

Abstract

Background: Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS).
 Aim: To determine Obstetricians’ approach in diagnosing and treating obstetrics DIC in a RLS
 Method: A semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.
 Results: A total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient’s financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.
 Conclusion: DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.
 Keywords: Investigations; DIC; Obstetrician; diagnosis; treatment.

Occupational Stress among Nurses in Referral Hospitals in Botswana: Controlling the Risk to Health

“…World Health Organization has considered stress as a global epidemic, which has recently been observed to be associated with 90% of visits to physicians [1]. Work-related stress is one of the most important workplace health risks for employees worldwide [2].…”

“…The cost of health care [1]. Excessive occupational stress has been found to reduce the quality of nursing care [7].…”

“…The nature of the nursing profession and the health care system are some of the contributors to work-related stress [10,11,1]. Research findings have also indicated that the sources of occupational stress, its levels, and its effects vary depending on local factors such as the nature of work, work setting, and cultural orientation.…”

Sexual reproductive health, NCDs and infectious diseases

“…This is followed by papers on cancer and other neoplasms in women 11 – 16 . Then comes the section on pregnancy and its outcomes and complications 17 – 23 , as well as the importance of midwifery 24 .…”