Decision-to-delivery interval and obstetric outcomes of emergency caesarean sections in a Nigerian teaching hospital

Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients' relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foetomaternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutesas a benchmark.

Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

An evaluation of the perinatal mortality surveillance system in Gwanda District, Matabeleland South Province, Zimbabwe

Background. A preliminary review of perinatal mortality surveillance data (January - August 2017) suggested an under-reporting of perinatal deaths in Gwanda District, Matabeleland South.Objective. To evaluate the effectiveness of the perinatal mortality surveillance system in Gwanda District, Matabeleland South, Zimbabwe.Methods. This descriptive cross-sectional study interviewed 50 healthcare workers employed in the district using pretested intervieweradministered questionnaires. The sample was drawn from 16 randomly selected healthcare facilities. Records for perinatal mortality cases were reviewed and data were analysed.Results. Only 32% of healthcare workers knew the case definition of perinatal death. Approximately two-thirds of participants (68%) knew who should complete notification forms and ~half (52%) of the respondents cited fear of blame as the reason for a low perinatal death report rate in the district. Although 50% of participants reporting having participated in perinatal death reviews and 78% reporting using the data for planning community health programmes, there was no recorded evidence in support. Perinatal mortality case notification forms were not in stock at 13 of the 16 sampled healthcare facilities.Conclusion. Poor knowledge of the perinatal mortality surveillance system was found among participants. The low reporting rate suggests that the system does not function effectively in the district. Healthcare workers feared blame, which suggests management intervention is required to create a trusted reporting environment

Neonatal macrosomia and associated morbidities in Sagamu, Nigeria

Background:The incidence of neonatal macrosomia is on the increase in many parts of the world. The impact of the condition on babyand child health has not received adequate research attention.Objective:To determine the prevalence,babyandmaternal characteristics, the pattern of neonatal morbidity and perinatal outcome of macrosomia.Methods:A retrospective study of all singleton deliveries with birth weight ≥4.0 kg was conducted at a tertiary facility in the south-western part of Nigeria between January 2013 and December 2014.Results:Eighty-eightnewbornbabies were macrosomic out of 1854 deliveries, resulting in a prevalence rate of 4.7%. The male-to-femaleratio was 2:1, while the mean (±SD)birth weight was 4.2 ± 0.3kg. There was no significant difference in the mean birth weights of the male and female babies(t=1.24, p=0.218). The meanmaternal age was 31.7 ± 5.1 years. Multiparous mothers had the highest proportion of macrosomic babies, whilemajority of mothers (77.3%) were either overweight or obese. One-minute Apgar score <7 was observed among28 (31.8%) babies.Twenty-three (26.1%) babieswere hospitalized for further management. Birth asphyxia, hypoglycaemia and hyperbilirubinaemiawere the leading morbidities. The perinatal mortality rate for macrosomic babies was 102.2 per 1000total births.Conclusion:The incidence of neonatal macrosomia is relatively low in our study population but falls within the range of prevalence rates reported from other parts of the country.Birth asphyxia, hypoglycaemia and hyperbilirubinemia are common morbidities among affected babies

Incidence and outcome of umbilical cord prolapse: experience in a tertiary health facility south eastern Nigeria

BACKGROUND: Umbilical cord prolapse is a rare obstetric emergency with adverse perinatal outcomes. The incidence has been on the decline, hence necessitating the need for periodic evaluation in order to document its contribution to perinatal indices. We sought to determine the incidence, predisposing factors and fetal outcome of umbilical cord prolapse.METHODS: This was a retrospective descriptive study carried out in Federal Medical Centre(FMC), Umuahia over a 5-year period from January 1, 2009 to December 31, 2013. Data was analyzed using WinPepi version 11.65. Statistical analysis was done using Chi-squared test with level of significance set at P < 0.05. RESULTS: The incidence of umbilical cord prolapse was 0.3%. The mean age was 31.8 ± 5.1 years. Multiparous women constituted 80% of those diagnosed with the condition while 84% of the women were unbooked. Although multiple risk factors were noted in the parturient, multiparity ranked highest (80%) while artificial rupture of membrane contributed the least (4%). Most (84%) of the women were delivered by emergency cesarean section. The perinatal mortality rate was 12%. CONCLUSION: Umbilical cord prolapse remains a high risk condition to the fetus. Therefore, early presentation to the health care facility in the event of membrane rupture may improve its outcome

Mortalité périnatale aux cliniques universitaires de Kinshasa de 1991-2010

Contexte et objectifs. Les données sur la mortalité périnatale dans les pays d'Afrique subsaharienne demeurent peu connues. L'objectif de la présente étude était de décrire la fréquence et les causes de la mortalité périnatale dans notre milieu. Méthodes. Nous avons conduit une étude documentaire sur la mortalité périnatale survenue aux Cliniques Universitaires, entre les 1er janvier 1991 et 31 décembre 2010. La population d'étude était constituée de parturientes porteuses d'une grossesse d'au moins 28 semaines et disposant d'un dossier complet. Les paramètres d'intérêts étaient: âge maternel ; parité ; niveau socio-économique ; suivi de consultation prénatale ; âge gestationnel à l'accouchement; mode d'accouchement ; poids de naissance. Le test de chi-carré de Pearson a été utilisé pour comparer les proportions. Résultats. 22.431 nouveaux-nés ont été enregistrés des 21.978 accouchées (âge moyen 26 ± 9 ans, une parité moyenne de 4 ± 2, 72,1 % de niveau socioéconomique modeste). Le taux de mortalité périnatale a été de 87‰ La prématurité a été la cause principale (22%). Dans 37,8% des cas, la cause était inconnue. Les mères âgées de 25 à 29 ans avaient un taux de mortalité périnatale de 7,7%, tandis que celui des primipares : était de 13,7%. Entre les mères à niveau de vie modeste et celles de niveau de vie élevé, le taux de mortalité périnatale était significativement différent (p < 0,001). Le taux de mortalité périnatale était significativement différent (p < 0,001) pour les nouveau-nés de césarienne et de ventouse. Conclusion. La mortalité périnatale reste importante dans cet hôpital tertiaire avec un taux élevé de causes non élucidées

Maternal and perinatal outcomes in women undergoing expectant management of early-onset pre-eclampsia: A retrospective cohort study

Background. Expectant management of early-onset pre-eclampsia, with the aim of improving perinatal outcomes, may increase the risk of maternal morbidity. Objective. To study the maternal and perinatal outcomes and their association with various risk factors in women undergoing expectant management for early-onset pre-eclampsia. Methods. A retrospective cohort study was carried out in a tertiary centre in south India between April 2014 and June 2015. We studied 201 women with singleton pregnancies with pre-eclampsia diagnosed between 28 and 34 weeks' gestation. Demographic data, medication and treatment details, and delivery data were extracted from maternal charts. The primary outcomes were: (i) composite maternal outcomes, defined as the development of any of eclampsia, abruptio placentae, pulmonary oedema or renal failure; and (ii) perinatal mortality. Logistic regression was used to assess the independent association risk factors with primary outcomes, after adjusting for other variables. Results. Sixty-nine women (34.3%) had one or more of the composite adverse maternal outcomes, and there were 74 (36.8%) cases of perinatal mortality. The presence of imminent symptoms (odds ratio (OR)=2.35) and multiparity (OR=2.31) were associated with composite adverse maternal outcomes, whereas low birth weight and breech vaginal delivery were associated with perinatal mortality. Perinatal mortality was higher in women with pre-eclampsia diagnosed between 28 and 30 weeks. Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity. Conclusion. Expectant management in early-onset pre-eclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes, based on the available neonatal facilities in low-resource settings

Césarienne à Lubumbashi, République Démocratique du Congo II: facteurs de risque de mortalité maternelle et périnatale

Introduction: l'objectif était d'analyser les facteurs de risque de mortalité maternelle et périnatale de la césarienne à Lubumbashi, République Démocratique du Congo (RDC).Méthodes: étude multicentrique de 3643 césariennes réalisées entre le 1er janvier 2009 et le 31 décembre 2013 sur un total de 34199 accouchements dans cinq formations hospitalières de référence à Lubumbashi (RDC). Les données sociodémographiques, les indications, l'environnement obstétrical et la morbi-mortalité maternelles et périnatales ont été analysés au logiciel Epi Info 2011. Les fréquences calculées sont exprimées en pourcentage et les moyennes avec leurs écart-types. Le test de Chi-carré et le test exact de Fisher lorsque recommandés ont été utilisés pour la comparaison des fréquences. L'odds ratio a été calculé avec l'intervalle de confiance de 95% de Cornfield grâce à un modèle de régression logistique pour déterminer la puissance de facteurs de risque. Le seuil de signification a été fixé à p < 0,05.Résultats: la fréquence de la césarienne était de 10,65%. L'âge moyen des césarisées était de 28,83±6,8 ans (extrêmes: 14 et 49 ans). La parité variait de 1 à 16 avec une moyenne de 2,6. De ces opérées, une sur neuf (10,9%) était porteuse d'un utérus cicatriciel de césarienne antérieure et 22,3% étaient des évacuées obstétricales. Les taux de létalité maternelle et périnatale étaient respectivement de 1,4% et 7,07% lors de la césarienne. L'analyse des facteurs de risque montre que la grande multiparité (≥5), l'absence de surveillance de la grossesse, le caractère urgent de l'indication opératoire influent significativement sur la mortalité maternelle. A ces facteurs s'ajoutent pour la mortalité périnatale l'âge maternel avancé (> 35 ans), l'évacuation comme mode d'admission et l'immaturité fœtale.Conclusion: cette étude montre que la césarienne dans nos conditions de travail est couplée à une forte mortalité maternelle et périnatale. Les facteurs de risque identifiés sont en grande partie évitables, surtout à tort ou à raison imputés à l'opération masquant ipso facto les circonstances souvent irrationnelles de sa pratique

A retrospective analysis of eclampsia as a major cause of maternal and perinatal mortality in Sagamu

Background: While eclampsia remains a leading cause of maternal death in the developing world, the prevalence and case fatality of the condition in the developed world has reduced due to early detection and prompt treatment. The understanding of the factors associated with eclampsia may reduce the burden and enhance the quality of foeto-maternal outcome.Objective: To determine the prevalence of eclampsia and the associated foeto-maternal outcome. Methods: A retrospective study of patients who presented with eclampsia at the Olabisi Onabanjo University Teaching Hospital (OOUTH) between January 2008 and December 2012 was carried out. The hospital records were retrieved and the data extracted included the age, parity, gestational age at presentation, booking status, mode of delivery, outcome of baby and mother, and the total delivery in the hospital over the period.Results: The prevalence of eclampsia over the period was 1.1%. Eclampsia was common among women aged 25years and below (64.3%), nulliparous women (78.6%) and unbooked (100.0%). Caesarean section was carried out on 63.0% of the patients on account of unfavourable cervix, while 22.2% of patients had spontaneous vagina delivery. Most (96.4%) received magnesium sulphate (MgSO4) therapy but 22.2% convulsed while receiving it. Maternal mortality was 7.1% while perinatal mortality rate was 250/1000 live birth.Conclusion: Eclampsia remains a cause of maternal morbidity and preventable death in the understudied community. Early antenatal booking and the use of MgSO4 are effective in reducing the burden

Trends in Perinatal Health Indices in the Amajuba District; KwaZulu-Natal; South Africa; 1990-2012

Background. In order to address the high perinatal mortality rate; South Africa (SA) commenced a number of interventions from 1995. These included the abolition of user fees; basic antenatal care; on-the-spot diagnosis and treatment of syphilis; and the prevention of mother-to-child transmission of HIV. However; there is a dearth of information on the long-term effect of these programmes on perinatal indicators in district hospitals; where most births and deaths occur.Objective. To determine the levels and trends in maternal and neonatal indicators in Amajuba District; KwaZulu-Natal Province; SA; and to ascertain the dynamics of these indicators vis-a-vis the transformation of healthcare in SA. Methods. The study location was Madadeni Hospital and its nine feeder maternity clinics. Information pertaining to all deliveries and their outcome from these health facilities from 1990 to 2012 was extracted from the clinical registers. Data were analysed using SPSS version 15.0 (IBM; USA). Quantitative variables were summarised as means; while qualitative data were expressed as proportions and percentages. The trends for each outcome variable for the entire study period (1990 - 2012) were analysed and presented as line graphs and tables. Results. There were 154 821 live births and 4 133 stillbirths from 1990 to 2012. The overall mean values for stillbirth rate; perinatal mortality rate; neonatal mortality rate and maternal mortality ratio were 26.3 (standard deviation 5.6); 40.9 (9.6); 16.8 (4.7) and 114 (56.6); respectively. There was a general improvement in all the perinatal health indices in the early 90s; followed by a general worsening until the early 2000s; after which a consistent decline was noted. Conclusion. The perinatal health indices in Amajuba District have followed a pattern similar to that found in the rest of SA: an increase during the late 90s to early 2000s; followed by a decline from the late second half of the first decade of this century

Analyse situationnelle de la mortalite perinatale au CHU de Bouake: resultats d'une etude portant sur le 1er semestre 2011

Contexte la mortalite perinatale represente une situation frequente malheureusement peu analysee; alors qu'elle constitue un parametre important dans l'evaluation de la qualite des soins. Objectif : Analyser la situation de la mortalite perinatale afin d'en preciser les facteurs favorisants. Patientes et methode : il s'agissait d'une etude retrospective descriptive exhaustive qui s'est deroulee a la maternite du CHU de Bouake; couvrant le 1er semestre de l'annee 2011. Elle a concerne tous les cas de deces feotaux enregistres directement dans le service apres accouchement et les enfants evacues en pediatrie qui y sont decedes. Nous avons analyse les caracteristiques epidemiologiques des meres; les circonstances de l'accouchement et les facteurs pouvant expliquer les deces fotaux Resultats : la mortalite perinatale representait 122 des accouchements de la periode d'etude. Cent vingt six enfants; soit 68;9; etaient morts pendant le travail. En pediatrie; vingt cinq nouveau-nes (13;70) y etaient morts. L'age moyen des patientes etait de 30 ans et la tranche d'age la plus representee etait celle des adolescentes avec un taux de 29;5. Il s'agissait aussi en majorite des femmes au foyer (86;3); primipares (26;8); avec antecedents de deces neonataux (38;8); un age variant de 25-34 ans (44;8); et provenant de la ville de Bouake (61;2). Les patientes etaient a 84;7 admises apres une evacuation dont les principaux motifs etaient la dystocie mecanique (24;6) et les metrorragies (13;66). L'accouchement des fotus morts s'etait realise par la cesarienne et par la laparotomie dans respectivement 39;3 et 14;8 des cas. Les indications de cesarienne etaient essentiellement l'epaule negligee et le syndrome de pre-rupture uterine a un taux identique de 20;83; et l'hematome retro-placentaire dans 19;4 des cas. En l'absence d'autopsie; les causes les plus probables des deces etaient le travail prolonge (38;89); l'hypertension arterielle (10;92).Conclusion : la mortalite perinatale est elevee au CHU de Bouake. Les causes sont essentiellement les dystocies mecaniques; dont la prise en charge adequate devrait permettre de reduire sa prevalence

Pregnancy Outcome in Asymptomatic Women with Abnormal Vaginal Flora Without any Treatment and After Treatment with Vaginal Clindamycin and Clotrimazole: A Randomised Controlled Trial

Aims. To study the role of screening for and treatment of abnormal vaginal flora in early pregnancy; and its correlation with pregnancy outcome.Methods. Eight hundred asymptomatic women seen at the antenatal clinic of Lok Nayak Hospital; New Delhi; India; at 12 - 24 weeks' gestation were screened for abnormal vaginal flora by means of examination of vaginal fluid smears on Gram-stained slides. Two hundred and forty-two women with abnormal vaginal flora were allocated randomly to receive either treatment (vaginal clindamycin and clotrimazole) or no treatment. The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage; premature rupture of the membranes (PROM) and puerperal sepsis.Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention in women with abnormal vaginal flora was associated with a decrease in the rate of preterm delivery (30.3 v. 18.6; relative risk 1.65; 95 confidence interval 1.04 - 2.63; p0.05). The advantage did not extend to late miscarriage; PROM or puerperal sepsis; as the decrease in these outcomes did not attain statistical significance.Conclusions. Screening for and treatment of asymptomatic abnormal vaginal flora in early pregnancy significantly reduces the rate of preterm delivery and consequent perinatal morbidity and mortality

Breech Deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto; Northwestern Nigeria: a 10-Year Review

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24;160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto; Sokoto; over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7. Breech deliveries occurred more in the primigravidae. Most babies (69.1) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P 0.05). Similarly; perinatal deaths were more common in unbooked than in booked patients (P 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina

Breech Deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto; Northwestern Nigeria: A 10-Year Review

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24;160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto; Sokoto; over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7. Breech deliveries occurred more in the primigravidae. Most babies (69.1) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P 0.05). Similarly; perinatal deaths were more common in unbooked than in booked patients (P 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina

The Effect of Maternal HIV Status on Perinatal Outcome at Mowbray Maternity Hospital and Referring Midwife Obstetric Units; Cape Town

Objectives. To study the effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary-level hospital in Cape Town) and its satellite community midwife obstetric units. Design. A retrospective descriptive and comparative study.Setting. Public sector maternity facilities serving historically disadvantaged populations. Subjects. All deliveries at Mowbray Maternity Hospital and its referral midwife obstetric units from January to December 2008. Outcome measures. Stillbirth; early neonatal death; perinatal mortality and neonatal encephalopathy rates in HIV-positive and HIVnegative subjects. Results. There was a total of 18 870 deliveries at the units studied; 3 259 (17.2) of them to HIV-positive mothers. The stillbirth rate in the HIV-positive population was 17.1/1 000 births; compared with 8.3/1 000 in the HIV-negative population (odds ratio (OR); 2.07; 95 confidence interval (CI) 1.5 - 2.8). The early neonatal death rate in the HIV-positive population was 4.6/1 000 live births; compared with 3.1/1 000 in the HIV-negative population (OR 1.46; 95 CI 0.8 - 2.6). The perinatal mortality rate in the HIV-positive population was 21.7/1 000 births; compared with 11.7 in the HIV-negative population (OR 1.91; 95 CI 1.4 - 2.5). A comparison of the pattern of primary obstetric causes of perinatal mortality showed that infection; intra-uterine growth restriction (IUGR) and antepartum haemorrhage (APH) were significantly more common as causes for perinatal death in the HIV-positive population. The risk of neonatal encephalopathy in the HIV-exposed population was 4.9/1 000 live births compared with 2.07 in the HIV-negative group (OR 2.36; 95 CI 1.28 - 4.35). The 1 643 women (8.7 of total deliveries) who were not tested for HIV were at particularly high risk of adverse perinatal outcome. This group included women who had either declined testing or not attended for antenatal care. Conclusion. The perinatal mortality rate in the group of HIV-exposed mothers was significantly higher than that in the HIV-negative group due to a higher stillbirth rate. Infection; IUGR and APH were significantly more common obstetric causes for mortality in the HIV-infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV-positive population

Birth Preparedness and Complication Readiness among Women in Mpwapwa District; Tanzania

Abstract:Avoidable mortality and morbidity remains a formidable challenge in many developing countries like Tanzania. Birth preparedness and complication readiness by mothers are critical in reducing morbidities and mortalities due to these complications. The aim of this study was to assess knowledge and practices with respect to birth preparedness and complication readiness among women in Mpwapwa district in Tanzania. A total of 600 women who became pregnant and or gave birth two years preceding the survey were interviewed. Among them 587 (97.8) attended antenatal clinic (ANC) at least once during their last pregnancy. Two thirds of those who attended ANC made four or more visits. The median gestation age at booking for antenatal care was 16 weeks. However; 73.9 the women booked after 16 weeks of gestation. Two thirds of the women were 20-34years old and had at least primary education level. Three hundred and forty six (57.7) had parity between two and four. Only 14.8 of the women knew three or more obstetric danger signs. The obstetric danger signs most commonly known included vaginal bleeding during pregnancy (19); foul smelling vaginal discharge (15) and baby stops moving (14.3). The majority (86.2) of the women had decisions made on place of delivery; a person to make final decision; a person to assist during delivery; someone to take care of the family and a person to escort her to health facility. Majority (68.1) of the women planned to be delivered by skilled attendant. One third of the women planned to deliver at home in the absence of a skilled birth attendant. In the bivariate analysis; age of the woman; education; marital status; number of ANC visits and knowing ?3 obstetric danger signs were associated with birth preparedness and complication readiness. In multivariate logistic regression analysis; women with primary education and above were twice more likely to be prepared and ready for birth and complications. Women who knew ?3 obstetric danger signs were 3 times more likely to be prepared for birth and complications. In conclusion; women with higher level of education and those who knew obstetric complications were more prepared for birth and complications. Further studies are recommended to find out why women do not prepare for birth or complications especially that need blood transfusion

Prospective Audit of Perinatal Mortality among Inborn Babies in a Tertiary Health Center in Lagos; Nigeria

Background: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition; and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable; thus making it important to identify the risk factors in each health environment. Objective: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. Materials and Methods: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days postdelivery. Results: There were 51 (8.5) perinatal deaths made up of 43 (7.1) stillbirths (15 fresh and 28 macerated) and 8 (6.1) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age; parity; antenatal care booking and the hospital where the mother was booked for antenatal care; number of previous child deaths; and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation; birth weight; and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done; only the Apgar score at 5 min; birth weight; and parity were significant risk factors. Conclusion: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min; low birth weight; and high parity

Timing of Spontaneous Birth and the Risk of Adverse Perinatal Outcome

The study aspired to assess the impact of time of birth on spontaneous onset of labour and delivery. A retrospective descriptive study was conducted from the Empangeni Hospital delivery registry on 9;397 infant births between January to December 2005; weighing more than 1;000 g. Logistic regression; adjusting for birth weight and for gender was used to estimate the relationship between spontaneous birth and timing of birth. A higher proportion of births (59) occurred between 10h00 and 22h00 of the day. Estimating the hourly births; we found that the daytime peak is 5.3and occurred at 10h00 while the night-time peak is 4.9and occurred at 20h00. Maternal age was significantly associated with the timing of spontaneous births (p 0.05). A higher proportion of preterm babies was born during the day (6.4) and early night (3.4) compared to late night births (1.6). There were significant differences between multiple births and low birth weight infants born during the day (1.1; 6.9) and night (0.8; 6.3). However; low birth weight babies were born mostly during early night rather than late night (4vs. 2.3; p 0.05). Adverse pregnancy outcome; measured by estimating the perinatal mortality rate; was the same for day and night and was equally distributed between early and late night. Timing of birth of infants did not influence the negative outcomes of pregnancy among this study population

Perinatal Outcome of Macrosomic Births in Port Harcourt

Background: Macrosomic babies are at increased risk of adverse perinatal outcome and therefore constitute a high risk group of neonates and the incidence appears to be rising. The objective was to determine the incidence of fetal macrosomia; and the perinatal outcome of macrosomic babies; compare with matched term; appropriate weight neonates in the booked antenatal population of the UPTH. Methods: It was a- one year prospective study of the perinatal outcome of singleton babies whose birth weights were 4000g and above (macrosomia) delivered to booked antenatal mothers in UPTH between 1st October 2003 and 30th September 2004; comparing them with term appropriate (2500-3999g) weight babies. The birth weight; sex; perinatal and maternal complications documented from direct observations; questioning and other information extracted from patients' case notes; were entered into a personal computer; analysed and presented as frequency tables; percentages; Chi-square x2; calculated as appropriate using Epi info version 3.4.3 statistical soft ware. P 0.05 was considered statistically significant. Results: Fetal macrosomia occurred in 354 out of 2417 singleton term deliveries; giving an incidence of 1in 7 deliveries or 14.65.The birth asphyxia (7.90vs 2.60; p= 0.011); Neonatal admission (29.54vs 2.85; p= 0.001) and perinatal mortality (48/1000 vs 23/1000 births; p=0.001); caesarean delivery (55.70vs18.64; p=0.001) rates were significantly higher in the macrosomic than the control group. Conclusion: There is a high incidence of fetal macrosomia in Port Harcourt with associated relatively higher adverse perinatal outcome compared to singleton term normal weight babies