[Show abstract][Hide abstract] ABSTRACT: Eclampsia is a major cause of maternal and perinatal morbidity and mortality. The objectives of this study were to determine pregnancy outcome in women with eclampsia especially the maternal and perinatal deaths and the various contributory factors.
A retrospective analysis of demographic and clinical data of patients with eclampsia over a ten-year period (2000-2009) with particular reference to fetal and maternal outcome. Statistical analysis was by Epi- info computer package while test of significance between proportions was done using chi square. Ap value less than 0.05 was considered significant.
23,266 deliveries were conducted and 1027 cases of eclampsia were managed within the 10-yr period giving an incidence of 4.4%. The patients were mainly primigravidae (76%, N=778) with no antenatal care (93.4%, N=959); mean age was 21 years. Intrapartum eclampsia accounted for 62.6%, (N=643). About 45% (N=643) delivered spontaneously, 28.7% (N=277) had instrumental delivery while 19.6% (N=189) had caesarean section. Of the 621 maternal deaths for the period, eclampsia contributed to 29.4% (184) with a case fatality rate of 17.9%. Case fatality in the two years (2006/2007) when magnesium sulphate was used only on eclamptics with repeat fits (because of limited supply) was 18.2% which was not significantly different from the 20.0% fatality recorded in the two years (2008/2009) the drug was used routinely as the sole anticonvulsant agent P > 0.05. Maternal deaths were significantly more amongst the multiparous women with eclampsia (23.3%) than the primigravidae (16%); mortality was also more in eclamptics who had no antenatal care (18.7%) than those with care (5.9%), p <0.05. Major maternal complications were aspiration pneumonitis (23.9%) and pulmonary oedema (16.3%), hyperpyrexia (17.9%), acute renal failure (11.4%), and cerebrovascular accidents 9.8%. Total perinatal deaths were 392 with 81.1% (318/392) still births and 18.9% (74/392) early neonatal deaths mainly from severe birth asphyxia. Perinatal mortality ratio was 406/1000.
The incidence of eclampsia in the study group was high. It was a major direct cause of maternal and perinatal deaths. Maternal outcome was also poor even with the introduction of magnesium sulphate. Interventions for reduction of maternal and perinatal mortality must emphasize on strategies that prevent the occurrence of eclampsia since outcome in some settings is still not very favorable when it does occur.
African journal of medicine and medical sciences 06/2012; 41(2):211-9.
[Show abstract][Hide abstract] ABSTRACT: Menarche, the first menstrual period, is influenced by many factors including socio-economic status and rural or urban dwelling. The aims of the study were to compare the age at menarche between rural and urban girls and evaluate the anthropometric indices at menarche.
A cross-sectional study of rural secondary school girls and urban school girls. A structured questionnaire was used to obtain information on their age at menarche and other relevant data. Their weights and heights were measured using computerized scales and calibrated walls.
Two hundred and twenty eight (228) rural girls and four hundred and eighty (480) urban girls that had attained menarche within a year were studied. Mean age at menarche for all the girls was 15.26 years. Mean menarcheal age for the rural and urban girls were 15.32 years and 15.20 years, respectively. Mean weight and height were 47.6 kg and 156.76 cm, respectively for the rural girls and 48.12 kg and 156.8 cm, respectively for the urban girls. There was no significance difference in age of menarche among the groups (P > 0.05).
The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required.
[Show abstract][Hide abstract] ABSTRACT: Robust evidence of the bioeffects of ultrasound is available from animal studies but human studies are less convincing. Nevertheless, it is disturbing that the only response to safety issues is a twenty-year old principle known as ALARA (As Low As Reasonably Applicable). Using experience from obstetrics and toxicology, and drawing information mainly from two recent systematic reviews and meta-analysis that extensively covered the subject of ultrasound safety, this review captures the current knowledge of ultrasound bioeffects and suggests that it may be time for an international, multidisciplinary meeting on ultrasound safety to decide how to provide the evidence (available data) to patients and sonographers in a succinct manner.
[Show abstract][Hide abstract] ABSTRACT: Malaria parasitemia among pregnant women is associated with complications to mother and the unborn fetus. There is paucity of data on asymptomatic malaria parasitemia, particularly in the northwest region of Nigeria. The objectives of this study were to determine the prevalence of malaria parasitemia in asymptomatic pregnant women and to estimate the packed cell volume (PCV) of this group of pregnant women.
This was a cross-sectional, descriptive study of only well pregnant women recruited consecutively at the time of booking for antenatal care. Thick film microscopy and qualitative immunoassay test for malaria parasite (MP) were performed for all the women. PCV estimation was also done using the micro-centrifuge method and comparison was made for women with parasitemia with those without MP. Some socio-demographic variables were also analyzed. Chi-square test was used to test for significance and a P-value less than 0.05 was considered statistically significant.
Two hundred and twenty-five healthy pregnant women were studied. Seven women (3.1%) had MP by direct microscopy while 11 (4.8%) were MP positive with the qualitative immunoassay test. One hundred and eighty-five (82%) of the women were literate while 128 (57%) used insecticide treated mosquito nets in their homes. The mean PCV of the women with positive MP was 30.57 ± 2.26 as against 32.89 ± 2.45 for those without parasitemia (P < 0.05).
The prevalence of asymptomatic malaria parasitemia in the study group was low but there was associated anemia in those with parasitemia. The use of intermittent preventive treatment is recommended for all pregnant women including those who are asymptomatic to forestall complications like maternal anemia.
[Show abstract][Hide abstract] ABSTRACT: Background/Objectives: It is possible that not all women would want the disclosure of fetal gender by the sonologist during a prenatal scan. The objectives of this study were to determine the proportion of women who do not want fetal gender disclosure at the time of prenatal ultrasonography and document their reasons. Method: A cross-sectional survey of women that were 20 weeks or more pregnant that had prenatal ultrasound at a private health facility in January 2006. The sonologist asked each of the women during the procedure whether they wanted to know fetal sex or not. Those that consented had disclosure of fetal sex while those that declined gave their reasons, which were documented. Results: Two hundred and one (201) women were studied within the study period. Most of the women (82%) were of the Hausa/Fulani ethnic group and were predominantly of the Islamic faith (90%). One hundred and ninety women (94.5%) consented to disclosure of fetal gender, while eleven (5.5%) declined. The main reason for not wanting to know fetal sex was: ′Satisfied with any one that comes′ . Conclusion: Most of the pregnant women (94%) would want disclosure of fetal gender at prenatal ultrasound scan. Only 5.5% of the women would not want fetal sex disclosure because they were satisfied with whichever that was there. It is advisable for the sonologist to be discrete on what to say during the procedure especially as it relates to fetal sex so as not to hurt those that do not want disclosure.
[Show abstract][Hide abstract] ABSTRACT: Continuing the administration of magnesium sulphate for 24 hours after the last fit in patients with eclampsia is at best empirical. The challenge of such a regimen is enormous in low-resource countries. The objective of this study was to assess the effectiveness of an ultra-short regimen of magnesium sulphate in eclamptics.
This was a prospective, cohort study of eclamptic patients admitted between July 2007 and June 2008 that were given 4 grams magnesium sulphate intravenously and 10 grams intramuscularly (5 grams in each buttock) as the sole anticonvulsant agent. Main outcome measure was the absence of a repeat fit. Other aspects of eclampsia management were as in standard practice. One hundred and twenty one (121) patients were managed with this regimen. There were 29 ante partum, 76 intrapartum and 16 post partum cases of eclampsia. Most of the patients were primigravidae (100; 83%) with an average age of 18.7 years. There were nine cases (7.4%) of recurrent fits that occurred within four hours of the loading dose. One recurrent fit occurred in the ante partum group, seven in the intra partum and one in the post partum group. There were 12 maternal deaths giving a case fatality rate of 9.9%.
Limiting the dosage of magnesium sulphate to 14 grams loading dose (4 grams intravenous and 10 grams intramuscular) was effective in controlling fits in 92.6% of cases in the study group. A properly conducted, randomized controlled trial is needed to test our proposed regimen.
[Show abstract][Hide abstract] ABSTRACT: The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria.
The primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country.
This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.
Overall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria. EXPECTED OUTCOMES: The outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.
Reproductive Health 07/2009; 6:8. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The third United Nations Process Indicator for emergency obstetric care is the proportion of all births that take place in maternity or obstetric facilities. This is in conflict with the concept of skilled attendance at delivery. Here, a case is made for emphasis to be on who conducts the delivery and not necessarily where.
Tropical Doctor 02/2009; 39(1):61. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine the proportion of women that wanted to know fetal gender at ultrasound, characterize them and document reasons for wanting to know fetal gender.
[Show abstract][Hide abstract] ABSTRACT: The basic component of the new World Health Organization (WHO) antenatal care model prescribes reduced number of clinic visits and limited investigations for low-risk pregnant women. The objectives of this study were to determine the proportion of pregnant women seeking antenatal care in a Nigerian teaching hospital who qualify for the basic component and to document difficulties that may arise with the classifying form. In December 2004, 234 pregnant women who had initiated antenatal care were enrolled for the study. Using the classifying form, 157 (67%) were eligible for the basic component, 41 (18%) for special care, but 36 (15%) women could not be classified. Those that did not know the birth weight of their last babies accounted for most (89%) of the unclassified group. The WHO antenatal care model was the most appropriate and relevant method for our hospital where a large percentage (67%) of prenatal women were eligible for the basic component. However, we consider that the classifying form should be adapted to accommodate all pregnant women.
Tropical Doctor 02/2008; 38(1):21-4. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The occurrence of eclampsia in an extra uterine pregnancy is a very rare entity. We report a case of a patient with eclampsia and advanced extra-uterine pregnancy. The fits were controlled with diazepam and the patient had laparotomy for the evacuation of the fetus from the abdominal cavity. She had an uneventful post operative recovery and was discharged home in good health after 10 days.
Nigerian journal of clinical practice 01/2008; 10(4):343-5. · 0.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable.
To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction.
Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor.
Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture.
Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.
Nigerian journal of clinical practice 10/2007; 10(3):234-7. · 0.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the pattern of eclampsia between 1995 and 2004 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, northwestern Nigeria.
A retrospective cohort of all deliveries and eclamptics seen from 1st January 1995 to 31st December 2004. Clusters of eclampsia were identified using purely temporal scan statistics.
Of 15,318 deliveries during the period, 657(4.29%) had eclampsia. The yearly incidence of eclampsia at the beginning of the study period (1995) was 0.39% but this had increased to 7.0% in 2004 at a background exponential rate best described by quadratic curve fitting prediction model and a forecast curve that predicts an incidence of eclampsia of at least 32.4% of total deliveries by 2009. Temporal clusters occurred in 1996, 2001 and 2003-2004.
The incidence of eclampsia is unusually high and is increasing. It has shown 3 clusters in the last 10 years.
International Journal of Gynecology & Obstetrics 02/2007; 96(1):62-6. · 1.84 Impact Factor