ABSTRACT
Aims: To determine the patterns of obstetric decisions based on Cardiotocography (CTG) findings and the effect of these decisions on labour outcomes. Study Design: Retrospective observational audit. Place and Duration of Study: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo. Data were obtained from all intrapartum CTG tracings done from January 2016 to December 2018. Methodology: A consecutive sampling technique was used and the case files, delivery register and follow up records of all included CTG tracings were used to obtain maternal and perinatal data. Data were analyzed using the SPSS version 21.0. Numerical data were expressed as mean ± standard deviation (SD). The Chi-square test was used to compare categorical variables while the independent T-test was used to compare means of groups studied. Binary logistic regression was used to assess the factors related to maternal and perinatal outcomes. The level of statistical significance was be set at p-value of <0.05. Results: There were 756 deliveries, but only 436 CTGs met the inclusion criteria. The prevalence of abnormal CTG was 130/436 (29.8%); 93/436(21.3%) were suspicious while 37/436 (8.5%) were pathological. On the basis of CTG; 300/436 (68.8%) of the parturients had intermittent fetal heart tone auscultation, 100/436 (22.9%) had continuous Electronic fetal monitoring (EFM) while labour was stopped in 36/436 (8.3%). The 5th minute APGAR score did not depend on the admission CTG finding (0.55), the decision to stop or continue labour (p=0.26) or the use of continuous EFM (P=0.66). Maternal near miss (MNM) was not a consequence of the decision to stop labour (P=0.98) or the use of continuous EFM (P=0.19). The mode of delivery outcome was however a consequence of decisions to continue or stop labour (P <0.001, AOR=0.202, 95%CI=0.153-0.265). Pregnancy risk was a consistent determinant of maternal outcomes; occurrence of MNM (P <0.001, AOR=0.002, 95%CI=0.000-0.032) and mode of delivery (P <0.001, AOR=0.015, 95%CI=0.005-0.043). Conclusion: Decisions based on admission CTG was associated with a high rate of operative deliveries, without any significant effect on fetal or maternal outcomes. CTG in labour should be restricted to pregnancies adjudged as high risk based on obstetric factors and CTG should be used as an adjunctive triaging instrument.
ABSTRACT
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