Stillbirths at the Jos University Teaching Hospital: Incidence; Risk; and Etiological Factors

Introduction: Death of a fetus in-utero or intrapartum is both devastating to the couple and of concern to the clinician. Identifying the etiological and risk factors of stillbirths will help in the prevention or reduction of its occurrence. Materials and Methods: This was a prospective observational study of all stillbirths over a 16-month period (from January 2006 to April 2007) at the maternity Unit of Jos University Teaching Hospital. Information on maternal socio-demographic details; history of antenatal complications of the index pregnancy; and maternal medical history were obtained by personal interview of all mothers who had a stillbirth. For each stillbirth; information was obtained on the type of stillbirth; estimated gestational age at delivery; sex of baby; and the mode of delivery. These characteristics were subjected to analysis. Etiological causes were assessed using the clinico-pathological approach advocated by Baird-Pattinson. Results: There were a total of 3;904 deliveries with 158 stillbirths during the study period; giving a stillbirth rate of 40.5 per 1;000 total births. There were 84 (53.2) macerated and 74 (46.8) fresh stillbirths. Of the 3;904 total deliveries; there were 2;022 (51.8) males and 1;882 (48.2) females. There were 84 male and 74 female stillbirths; giving stillbirth rates of 41.5 per 1;000 and 39.3 per 1;000 total deliveries for male and female deliveries; respectively; which was not statistically significant (X2 = 4.6865; P 0.3564). The major causes were abruptio placentae (17.7); hypertensive disorders of pregnancy (12.7) and maternal HIV infection 10.7of stillbirths. Other causes were cord accidents (7.0); placenta praevia (3.8); and anemia in pregnancy (3.8). Forty-six (29.1) of the stillbirths were unexplained. The main risk factors identified were lack of antenatal care; poor antenatal clinic attendance; home delivery; and late presentation of complicated labor to the facility. Conclusion: The stillbirth rate in our centre is high; major causes being abruptio placenta and maternal medical conditions. Maternal HIV infection has emerged as a major contributor to stillbirths in this study

Postpartum Maternal Morbidity in Jos; North-Central Nigeria

Introduction: Postpartum maternal morbidity is a serious public health problem. Major acute and long-term obstetric morbidities affect the life and reproductive career of women. Objective: To determine the incidence; pattern and associated factors of postpartum maternal morbidity in the Jos University Teaching Hospital (JUTH) and offer suggestions on various interventions to reduce this postpartum morbidity. Materials and Methods: This was a 3-year prospective observational study at the JUTH between April 2005 and March 2008. All patients who delivered or were treated in the hospital for postpartum morbidity were recruited for the study. Results: A total of 9056 women delivered; of which 246 (2.72) were treated for postpartum morbidity. Most of the patients (32.9) were between 25 and 29 years old. A majority of the women (58.5) were of Parity 2 to 4. House officers and senior house officers supervised most (43.5) of the deliveries. The most common postpartum maternal morbidity was primary postpartum hemorrhage (35.4). This was followed by hypertensive disorders (24.8) and genital tract sepsis (16.7). There was a statistically significant relationship between accoucher and postpartum maternal morbidity. Conclusion: The incidence of postpartum morbidity was high; with hemorrhage; hypertensive disorders and genital tract sepsis being common problems. It is hoped that supervision of deliveries by skilled medical personnel and active management of the third stage of labor will reduce the incidence of postpartum hemorrhage

Analysis of Cases of Rape as Seen at the Jos University Teaching Hospital; Jos; North Central Nigeria

Objective: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Materials and Methods: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. Results : During the study period; 2;135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape; representing 5.6of the total cases seen. However; only 105 case notes were available for analysis. Of these; 63.8of the alleged rapes were in children; with the infantile age group accounting for 26.7. 36.2of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3) accounted for most of the infectious agents. Emergency contraception was dministered to the victims when indicated. Conclusion: Women under 16 years of age were at an increased risk of being raped; possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims; which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped

Risk Factors for Placenta Praevia in Jos; North Central Nigeria

Background: Placenta praevia; a major cause of obstetric haemorrhage; is potentially lifethreatening to the mother and frequently results in high perinatal morbidity and mortality. Several epidemiological and clinical studies report disparate data on the risk factors associated with this condition. Although several studies on risk factors for placenta praevia have been published; data obtained from the sub-Saharan Africa remains scanty. Our objective is to describe the spectrum of risk factors for placenta praevia in Jos; North Central Nigeria. Methods: This was a retrospective cohort study of 96 women delivered form January; 1999 to December; 2002 at Jos University Teaching Hospital; Jos; Nigeria. Data on total number of deliveries; maternal age; parity; and past obstetrics history and abortion were carefully extracted from medical records and analyzed using the Epi Info 3.4.1 (CDC; Atlanta; Georgia). Results: The prevalence of placenta praevia was 0.89. Previous uterine evacuation was documented in 35.4of cases; while previous caesarean section scar occurred in 5.2of cases. About half (44.8) of the cases had no known risk factor. Conclusion: Uterine scaring following abortion management is an important risk factor for placenta praevia. However; majority of patients with placenta praevia in this work have no identifiable risk factor