Management of Eclampsia at AKTH: Before and after Magnesium Sulphate

Eclampsia contributes significantly to maternal and perinatal morbidity and mortality in Nigeria. The world Health Organisation recommended Magnesium Sulphate as the most effective; safe and low cost drug for the treatment of eclamptic seizures and for prophylaxis in severe pre-eclamptic.This study is aimed to evaluate the effect of the introduction of magnesium sulphate for the management of eclamptic seizures on maternal and fetal indices in Aminu Kano Teaching Hospital [AKTH]; Kano. A retrospective study of all patients who presented with eclampsia in AKTH; Kano. The study period included 3years prior to introduction o magnesium sulphate [January 2002- December 2004] and 3years after its introduction [January 2005 - December 2007]. During the study period; the prevalence of eclampsia was1.02[1: 97 deliveries]. Sixty six [50.5] of the patients were aged 19 and below. Approximately 62of the patients were primigravida and 87were unbooked. Thirty eight [29] were treated with diazepam while ninety three[71] were treated with magnesium sulphate. 39.4of those treated with diazepam died compared to 15of those treated with magnesium sulphate. Approximately ninety percent of those that died had no antenatal care. Overall perinatal mortality rate in this study was 312 per 1000 births [41]. 368.4per 1000 births among those treated with diazepam and296.7 per 1000births in the magnesium sulphate group. Approximately nine percent of those treated with magnesium sulphate develop toxicity [85.5renal and12respiratory] This study is in support of the findings that magnesium sulphate is superior to diazepam in the reduction of maternal morbidity and mortality

The Use of Magnesium Sulphate for the Treatment of Severe Pre-Eclampsia and Eclampsia

Background : Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Method : In this article; a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. Results : The drug is administered by the Pritchard or Zuspan regimen; although modifications in the two protocols have been reported. Conclusion : A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Outcome of delivery among HIV positive mothers at Aminu Kano teaching hospital; Kano

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8 received a combination of antiretroviral drugs while 4 received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4 by elective CS and 1.6 by emergency CS. There was no maternal death but 3.2 of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Outcome of Delivery among HIV Positive Mothers at Aminu Kano Teaching Hospital

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8received a combination of antiretroviral drugs while 4received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4by elective CS and 1.6by emergency CS. There was no maternal death but 3.2of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT

Outcome of Delivery among HIV Positive Mothers at Aminu Kano Teaching Hospital

BACKGROUND: If a HIV positive mother delivers in a health facility; interventions can be effected to reduce the risk of transmission of HIV to the baby. The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive; giving a prevalence rate of 2.54. Most (75.2) of the patients received Nevirapine alone in labour; 20.8received a combination of antiretroviral drugs while 4received none because their records were not available. Majority (88) of the patients had spontaneous vaginal delivery; 10.4by elective CS and 1.6by emergency CS. There was no maternal death but 3.2of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced; as it is more effective for PMTCT