[Show abstract][Hide abstract] ABSTRACT: Background: Pregnancy in a setting of mechanical heart valve constitutes high risk for thrombosis with implications for fetal-maternal outcomes.
Materials and Methods: Prospective review of 5 pregnancies involving 2 nulliparous women who had mechanical heart valves (St. Jude) and preconception counseling.
Results: The patients who were aged 22 and 42 years had 14 and 21 years duration of mechanical heart valve implantations, respectively. Preconception anticoagulation was with warfarin (5-10 mg daily; INR = 1.7-3.7). The young patient is currently Para 1 + 0 while the older one is Para 4 + 0. Pregnancies were first reported at gestation age ranging from 5 to 12 weeks when the patients were still on warfarin. Warfarin was substituted with subcutaneous unfractionated heparin (UFH) 10,000-15,000 IU 12 hourly (Patient: Control PTTK ratio = 1.8-2.2) during the first trimester. UFH was converted back to warfarin (5-7.5 mg daily; INR = 2.1-3.0) after the first trimester until by 36 weeks of gestation. UFH 12,500-15,000 IU 12 hourly (Patient: Control PTTK ratio = 1.9-2.4) was given from 36 weeks until 24 h postpartum with omission of the dose preceding induction of labor. Warfarin therapy (7.5 mg) was subsequently recommenced. Intra pregnancy abdominal scan revealed no fetal congenital anomaly and all pregnancies were managed by planned vaginal deliveries through induction of labor except one assisted vacuum delivery. Infective endocarditis prophylaxis was given in all deliveries. The new-born were free of congenital anomaly. No maternal morbidity or mechanical valve abnormality was observed.
Conclusion: Management of patients with mechanical heart valves in pregnancy is multidisciplinary and challenging in Africa with culture of large family size.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Eclampsia is a major cause of maternal mortality especially in low resource setting. Limited data exists on the perception of the cause of this condition among relations of patients who suffered from it. The information may be relevant in reducing the overall burden of eclampsia and any measure or investigation that would assist in reducing the incidence would be worthwhile.
Objectives: To determine what the relations of patients with eclampsia perceived as the cause of the disease and to document the ‘first aid’ treatment given to patients with eclampsia at home before hospital care.
Method: A prospective study conducted at the eclampsia ward of a tertiary hospital. Relations of patients admitted with eclampsia were interviewed within 24-48 hours of arrival using a semi-structured interview guide. Analysis was by the EPI INFO computer package.
Results: One hundred and fifty nine (159) relations of 56 patients with eclampsia were interviewed, mean age was 43 years. Most of the relations had no formal education (80%; 127), 59% (N=75) attributed eclampsia to ‘iskoki’ (evil spirit) while 20% (N=32) had no idea of the cause of eclampsia. Only 6% correctly related eclampsia to elevated blood pressure. Of the 56 patients with eclampsia, 71% of (N=40 received ‘first aid’ treatment in the form of ‘rubutu’ holy water; ‘hayaki’ and herbs orally. The case fatality in this study was 23%. There was no association between the use of home first aid treatment and maternal deaths (p>0.05).
Conclusion: Poor understanding of the aetiology of eclampsia exists among patients’ relations and this may have implication on the immediate care given to the patient. Public enlightenment campaigns to educate people on the cause and complications of eclampsia are necessary.
[Show abstract][Hide abstract] ABSTRACT: Objectives: To determine the feto-maternal outcome in patients with eclampsia.
Materials: The study was conducted at the maternity unit of Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria; 1027 women who had been managed for eclampsia over a 10-year period were studied.
Methods: It was a retrospective study. Patients' clinical data were extracted from their records and analysed using Epi- info computer package. Test of significance between proportions was done using chi square. A p-value less than 0.05 was considered significant
Results: 23,266 deliveries were conducted and 1027 cases of eclampsia were managed within the 10-yr period giving an incidence of 4.4%. 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%. 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%. Maternal deaths were significantly more amongst the multiparous eclamptics (23.3%) than the primigravidae (16%); mortality was also more in eclamptics who had no antenatal care (18.7%) than those who had (5.9%), p < 0.05. 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. Case fatality in the two years (2006/2007) preceding the routine of magnesium sulphate was 18.2% which was not significantly different from the 20.0% recorded in the two years (2008/2009) when the drug was used as the sole anticonvulsant agent. P > 0.05.
Conclusions: 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 to prevent the occurrence of eclampsia since outcome in some settings is not very favorable when it occurs.
KEYWORDS: eclampsia, maternal mortality , perinatal death.
[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.
No preview · Article · Jun 2012 · African journal of medicine and medical sciences
[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: 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.
Full-text · Article · Jul 2009 · Reproductive Health
[Show abstract][Hide abstract] ABSTRACT: So much has been written on vesicovaginal fistula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence.
The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling.
One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate.
Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence.
Preview · Article · Jun 2009 · Annals of African medicine
[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.