A Kenyan Journalist Writing About Health

Archive for the month “May, 2014”

Warning Sins in Pregnancy: When to Call Your Doctor

During pregnancy, many women have lots of questions and queries. Some of them we ask our moms, our aunts, our friends, our colleagues, and some of us go to Facebook to seek answers :) . But, when does it become obvious that you need to call your doctor or midwife, or visit the health center immediately?

Dr. Stephen Mutiso, a consultant obstetrician/gynaecologist at KNH is our guest writer today and he lets us in on the warning signs –when a pregnant woman should seek a medic’s opinion as soon as possible.

*Antenatal care entails monthly visits to the clinic till 28 weeks gestation, then visits every two weekstill 36 weeks, and thereafter weekly visits till delivery –for those progressing well. However, sometimes there is variation from this schedule, and this depends on the needs of the expectant mother.

However there are certain situations when it becomes necessary to get in touch with your gynaecologist on an urgent basis before the next visit. This is especially when certain complications develop.

Complications during pregnancy and childbirth are common. Infact, approximately two out of every five pregnant women experience some complication during pregnancy, childbirth and postpartum period. 15 percent of pregnant women develop life-threatening complications. Most complications cannot be predicted and can happen at any point during the antenatal period, during delivery or post-delivery. Therefore, all pregnant women should be prepared to respond appropriately when complications arise by contacting their care givers immediately.

There are certain symptoms which if present denote that they could be serious complications hence need to act immediately. These symptoms are referred as danger signs. Knowledge of danger signs of pregnancy emergencies and appreciation of the need for rapid and appropriate response when they occur is important to avert fatal outcomes. At times, getting medical help early  makes the difference between survival and death.

The danger signs in pregnancy are: vaginal bleeding, severe headache, severe vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or absent fetal movements, gush of fluid, intense abdominal pain and contractions before 37 weeks. Danger signs indicate a woman needs immediate medical care.

Bleeding is a very serious complication. It causes most of the maternal and foetal deaths in Kenya. Any bleeding in pregnancy –irrespective of the amount is abnormal. When bleeding is present during pregnancy it may indicate that the placenta position is on the lower aspect of the womb (placenta praevia). Bleeding may also occur when there is premature separation of the placenta. This premature separation cuts off delivery of oxygen and other nutrients to the baby, and this could lead to the baby’s death. Other causes of bleeding in pregnancy include: rupture of the uterus and bleeding from the baby (though this is rare). Heavy bleeding after delivery may arise from different causes such as relaxation of the uterus (atony), injuries in the birth canal, incomplete expulsion of placenta and sometimes bleeding disorders.

Severe headache, swelling of hands and face, blurred vision, fits and difficulty in breathing indicate high blood pressure and need urgent attention. This complication is referred to as severe preeclampsia, and when fits are present it is called eclampsia. This disease is also deadly and delivery is the way out regardless of whether the baby is mature or not. Seekng immediate care from your gynaecologist is important.

Hotness of the body with or without vomiting may indicate presence of serious infection or malaria. Prompt treatment does save life.

When waters break it is important to call your doctor immediately, because there is a possibility that the baby’s cord can come out and get compressed by the baby’s head, thereby stopping blood supply to the baby. This can cause death of the baby. It is also very easy for infection in the uterus to set in once the waters break. This infection is life threatening. Urgent care is therefore crucial.

Pregnant mothers should be keen on foetal movements (kicks) throughout their pregnancy. Any decrease in baby’s movement may indicate that all may not be well with the baby, and so it is important for the woman to report this observation to her gynaecologist as soon as possible.

Intense abdominal pains require urgent evaluation by your doctor. Causes of severe abdominal pain include ectopic pregnancy; rupture of uterus, premature separation, infection of the kidney. At times, abdominal pain may be due to surgical diseases such as appendicitis, intestinal obstruction etc.

Contractions which occur before 37 weeks indicate premature labour. Babies born at this time could develop breathing difficulties which sometimes could prove fatal. Its advisable for expectant women to seek assistance when they start getting regular uterine contractions especially if there are more frequently than 10 minutes apart.

In conclusion, knowledge of danger signs is important because it improves complication recognition and ensures timely decision to seek care hence handling complications in good time and consequently saving lives and avoiding serious disabilities.*

Dr. Stephen Mutiso is based at the KNH Doctor’s Plaza, Suite 26/27. He provides a  wide range of  gynaecological services including: antenatal care, delivery (normal and caesarean),  infertility  treatment, fibroids, fistula surgery, screening for reproductive tract cancers and various  gynaecological operations.

Tel: 0722 678 002 or 0788 306 674

Website: Email:

What Are Pregnant Women Dying From?

What are pregnant women dying from? Here are the answers.

WHO pregnant_moms

I Was Healed of Fistula Which Had for Years Embarrassed And Caused Me Agony

When nine-month pregnant Yvonne Njoki’s water broke at 7pm one Monday evening in June 2009, she was delighted as this only meant that she would soon hold her newborn in her arms. Then aged 26 years, she knew all would go well as she it had been a relatively smooth pregnancy.

Yvonne had religiously attended her ante-natal clinics at a private hospital in Gilgil, Nakuru County. So when her waters broke, she made her way to the same hospital where upon examination, she was told she had only dilated 2 centimeters.

With labor progressing slowly, the nurses attending to her decided to fasten it by inserting a tablet in her vagina to help quicken her baby’s arrival. The medicines used for artificial induction usually help soften the cervix, help it to open up, cause the uterus to contract, or stimulate contractions.

Twelve hours later and with no progress in her labor, Yvonne was inserted another vaginal tablet.  Another twelve hours later and still no sign of baby, she was inserted yet another tablet.

The following day, Wednesday morning at 7am, the medics used another induction drug, this time putting Yvonne on a drip to hasten the now stalled labor. It had been 36 hours since her waters had broken. This one worked fast for two hours later, she gave birth to a healthy boy. His birth weight was 2.7 kg.

She was attended to by two nurses who helped deliver her baby and who also stitched her episiotomy. An episiotomy is a surgical cut in the area between the vagina and the anus (perineum) made during labor to enlarge the vaginal opening.

Yvonne Njoki.

Yvonne Njoki.

Following the successful delivery, Yvonne, together with her newborn were discharged from hospital the following day. A week later, her stitches had healed quite well and she had no complications.

All went well until one month later when Yvonne began noticing some traces of stool in her vaginal discharge. After searching the internet, she was distraught to learn that she could possibly have fistula. She immediately sought the opinion of a gynaecologist who, after examining her, ruled out the possibility of fistula.

“He told me that as long I was holding my urine and faeces well, then it could not be fistula,” she remembers.

Yvonne returned home relieved, but this relief was short-lived as traces of stool in her discharge continued. Infact, the quantity of stool increased, leading her to invest in black panties to camouflage the discharge. A few weeks later, she was forced to begin putting on panty liners which would help effectively absorb the discharge.

Two years after the birth of her son and many panty liners later, Yvonne’s worry intensified as she had assumed that by then the discharge would have disappeared. She feared that she did indeed have fistula, a condition she considered shameful. She never confided in anyone what she was going through.

“I was too ashamed and embarrassed. How could I be suffering from a condition like this where I leaked faeces? Who would understand?” this pharmaceutical technologist asked herself many times.

As for her sex life, “I was lucky to be in a long distance relationship so my sex life was inactive and I liked it that way,” she remembers.

A few months later, when she couldn’t take it anymore, Yvonne decided to consult another doctor. She saw a gynaecologist who discovered a small hole between her vagina and rectum. He diagnosed the condition as rectovaginal fistula.

It was bitter-sweet news for her.

“I was sad because my worst fears had been confirmed – I had fistula, a highly embarrassing condition. But it was good news because at least my problem had been diagnosed and I could be treated. No more panty liners and stool-laden discharge,” she remembers.

She was then referred to a fistula repair specialist in Nairobi.

“The doctor examined and confirmed that I had fistula, and he further informed me that it had to be repaired as soon as possible because the hole had been getting bigger with time. Which was true because by then the stool in my discharge had continued to increase in quantity. I was doing up to five full panty liners in a day!”

Two and a half years after the birth of her son, Yvonne underwent a successful fistula repair surgery at Kenyatta National Hospital (KNH).

But she wondered what had caused the fistula.

“I had no obstructed labor and my baby was only 2.7 kg’s at birth, so I wondered how I could possibly have developed fistula. But upon further enquiry, I was informed that it could be that my episiotomy was not repaired well. I later found out that the hospital I delivered in had some unqualified staff,” she says.

“My advice to women is that they should not be blown away by the lure of private hospitals and their luxurious facilities. Sometimes they do not have competent medics. Atleast with government facilities you are sure the staff are skilled,” She advises.

Yvonne also advises people to seek second, third or fourth opinions if uncomfortable about a diagnosis.

It has been almost three years since the operation, and she is completely healed.

“I have no more leakages and I now live my life fully. I can now wear white panties and I have never worn a panty liner since the operation,” she says, beaming with joy.

Yvonne's four year-old son.

Yvonne’s four year-old son.

What is Vaginal Fistula?

A vaginal fistula is an opening that allows urine or stool to pass into a woman’s vagina – in what is known as incontinence. Women with fistula suffer from constant leaking of urine and / or feaces. Fistula is mainly caused by a prolonged and or obstructed labor

According to the World Health Organization, between 50,000 to 100,000 women worldwide develop obstetric fistula each year. Most of these cases are in developing countries.

A 2010 study published in the BioMed Central Journal on select hospitals in Kenya found that some of the risk factors for developing obstetric formula included: delays in making decisions to seek delivery services after six hours of labor onset, taking more than two hours to reach a healthy facility, and labor duration of more than 24 hours.

Women with fistula face a myriad of problems. Leaking urine and faeces can in turn lead to other medical problems such as genitals sores or ulcerations, frequent infection, dehydration and kidney disease. A lot of stigma is also associated with women who have fistula. Because of the leaking urine or feaces, they emit a constant unpleasant odour, and it is this that makes people reject, isolate and abandon them. Furthermore, because of difficult sexual relations, some husbands leave their wives. Many such women live a sad life, sometimes leading to depression and in some cases, suicide.

Fistula also has economic repercussions. Many women with this condition often experience a disruption in their normal living. Because of the associated stigma, they soon find themselves cut off from their families and friends, finding it hard to attend family, community, religious or social gatherings. Many eventually find it hard to work and earn money, driving them into poverty.

Obstetric fistula is both preventable and treatable. One way is through strengthening health care systems, which should then be able to provide accessible and quality maternal health care by skilled attendants. Access to emergency obstetrics services to all women around the country should also be a priority.


*This is a story that I originally published in the County Newspaper. 

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