Case records and commentaries presented in partial fulfillment for the award of the degree of masters of medicine of obstetrics and gynaecology of Makerere University Kampala.

Abstract

New Mulago Hospital, the national referral hospital o Uganda is situated 3 kms from the centre of the capital city Kampala. Opened in 1962 by the royal highness the Duchess of Kent, it was thereafter amalgamated with Mulago Hill dispensary to form Mulago Hospital Complex. However, the latter has lately been transformed into the assessment centre as well as tasking on some departments like pediatrics and orthopedics. Lower Mulago (Formerly new mulago) will strictly remain a national referral hospital, teaching centre for Makerere medical school and a centre for provision of support supervision to the district health services and health sector at large and consultative services to the ministry of health on important health issues like diabetes, cardiovascular lesions, post abortal care, cancer, malaria, etc. The hospital was a bed capacity of 600 had actual occupancy stretching to 1200, now accommodates the departments of internal medicine, pediatrics, obstetrics/ gynecology and surgery. Each department offers specialists services but interdisciplinary consultation takes place. THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY This is located on the fifth floor of the six floor hospital complex. Comprised there in are the administrative offices of the department, the wards, the labour suite and the operating theatre. The department also runs ward 6D and E for private patients, OMMC, Two Family planning clinics, the voluntary surgical contraception (VSC) unit. It also runs out-patient clinics and one on 2nd floor for private patients. The department is managed by professors and government consultants assisted by registrars, senior and junior house officers, Nursing staff and other support staff such as data and laboratory assistants and secretaries.

THE WARDS The man power is organized into three firms A, B and C and each running a ward named after it, i.e 5A, 5B and 5C respectively. Each ward is headed by a consultant and divided into three sections, antenatal, gynecology and post natal with a capacity of 25 beds in each. The antenatal side holds patients with problems in pregnancy while post natal holds those who have had operative delivery like caesarean section or those who delivered vaginally but still need observation and treatment. Gynecology side holds pre and post operative patients with gynecology problems and those on chemo/radiotherapy or those with gynecological cancers. Each of the wards has a specialized unit attached 5A accommodates the emergency gynecology ward (5a Annex). 5B has neonatal special care unit for babies who require special care e.g. pre-matures and those with low Apgar scores. It is however, under pediatrics 5C has mother’s club for those whose babies are admitted in special care unit. LABOUR WARDS: The complex has three labour wards: The main labour suite located on 5th floor, covered by the various firms on a rotational basis over 24 hour’s period. The manpower coverage includes a specialist, a senior and junior house officer and the nursing staff. Ward 6D+E: This labour ward caters for private patients being managed by a team comprised as in (i) above. Old Mulago maternity centre (OMMC): This labour ward is for delivering low-risk mothers and these are kept for a period of 24 hours post delivery for observation. A supervisory team comprising a registrar and junior house officer oversees the mid-wives who run the unit.

GYNAECOLOGY EMERGENCY WARD (5A ANNEX) It has a capacity of 15 beds, though more are usually accommodated. Emergencies are commonly handled here including ectopic pregnancies, abortions, acute pelvic inflammatory disease, febrile illness in early pregnancy and other complications of pregnancy occurring before 28 weeks of gestation. There is an examination room and a minor operating theatre. OPERATING THEATRE: There are three theatres one of which is reserved for minor procedures like EUA-both elective and emergency. The remaining two handle major operations with one handling elective surgery and the other emergency operations. Each firm has specific days for elective surgery. OUT PATIENT CLINIC: Each firm runs an antenatal and gynecological clinic every week. Infertility clinic runs every Friday. Family planning and MCH clinics run daily throughout the week. There are two of them- One in old mulago run by family planning nurses supervised by a registrar and another in institute of public health ran by the midwives assisted by a senior and junior house officer. VOLUNTARY SURGICAL CONTRACEPTION CENTRE This is located in OMMC (part of the assessment centre). Services offered include, long term contraception methods such as Norplant and removals and tubal ligations and vasectomies to women and men respectively that opt for permanent methods of contraception. The centre is manned by a coordinator and ran by consultants, registrars and junior house officers on rotational basis. RECORDS: There is a records section for maternal health records in the department