Sickle Cell Disease in Pregnancy: Maternal and Fetal Outcome in Port Harcourt, Nigeria.

Background: Medical experts for many years have daunted the occurrence of pregnancy in homozygote sickle cell patients. This is because of associated high risk for mother and fetus. The aim of this study is to determine the prevalence and maternal and fetal outcome of pregnant mothers with sickle cell disease at the University of Port Harcourt Teaching Hospital, Nigeria. Materials and Methods: This was a retrospective descriptive study of medical case files of all booked pregnant mothers who attended the antenatal clinic of the University of Port Harcourt Teaching Hospital, Nigeria from January 2007 to December 2011. The parameters extracted from the folders included: age, level of education, hemoglobin genotype, full blood count, malaria parasite, urine analysis and culture, complications of pregnancy, Apgar scores and birth weight. Results: A total of 4,650 mothers were booked for antenatal care. Eight hundred and forty (18.1%) of them were HbAS, five (0.1%) were HbAC, nine (0.2%) were HbSS and 1(0.02%) HbSC. Age and gestation at booking were 18–42 years (mean 28.6± 2.1) and 9–34 weeks gestation (mean 16.6±3.3), respectively. Malaria and vaso-occlusive crisis were the commonest complications encountered in pregnancy. Twenty percent of women had induction of labour and 60% were delivered by emergency caesarean section. Twenty percent had postpartum haemorrhage. Forty four percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 50% of singleton pregnancies. Two neonates developed transient complications related to maternal opiate exposure postnatally. There were 2(20%) maternal and fetal losses from toxaemia of pregnancy. Conclusion: Pregnancy is uncommon among females with sickle cell disease in Port Harcourt, Nigeria. Sickle cell disease remains a severe complicating factor to pregnancy and associated with increased fetal and maternal losses.

Low Birthweight Delivery : Prevalence and Associated Factors as Seen at a Tertiary Health Facility

Background: Low birth weight deliveries are major causes of a huge health burden on poor economies around the globe. It is even more worrisome in developing countries. Materials and Methods: The obstetric records of all low birth weight (LBW) deliveries were reviewed from 1 st June 2005 to 30 th May 2009. Results: The prevalence of LBW deliveries was 8.3. Of the LBW babies; 68.4 were preterm; 53.6 were small for gestational age (SGA) and 12.6 were products of multiple gestations. Predominant factors associated with LBW delivery included nulliparity; low parities (1 and 2); parturient aged 25-35 years (80.6); hypertensive disorders of pregnancy; and short birth spacing (84.4). Conclusion: Most LBW babies were preterm delivered by low parity parturient aged 25-35 years with short inter-pregnancy intervals. Effective family planning and antenatal services provided particularly for these categories of potential parturient could help to curb the incidence

Clinical Presentation of Infertility in an Outpatient Clinic of a Resource Poor Setting, South-East Nigeria.

Aim: To identify the prevalence, common symptoms, signs, partner contribution, common diagnosis and outcome of infertility in a resource poor setting. Study Design: Descriptive retrospective study. Place and Duration of Study: Ebonyi state University teaching Hospital, Abakaliki south-east, Nigeria, in two years (1st January 2009 to 31st December 2010). Method: Case notes of patients who attended the infertility clinic over the study period were retrieved from the health services department of the hospital and analysed. Results: Infertility patients were 295 out of 1,913 new gynaecological cases during the period under review, forming 15.4% of the study population. The number of folders with complete information was 266 which were 90.2%. Primary infertility patients were 94(35.3%) of all infertility cases) while 172(64.7%) were secondary infertility. The age range was 19 to 47 years, with a mean value of 30.9±2.3 of two standard deviations across the mean. The mean parity was 1.4±0.8 and ranged between 0 – 7 children. Among those with previous deliveries, 68.2% had no living child. The predominant symptoms in the females were insomnia, inadequate coital exposure, galactorrhoea and vaginal discharge. The commonest demonstrable signs were galactorrhoea in 92(34.6%) patients, cervical excitation tenderness in 54(20.3%) and uterine mass in 65(24.4%).Some 44(16.5%) persons had no remarkable findings. Partner contributions were: 93 (34.9%) for females; 60(22.6%) males; 64(24.1%) both partners. Pelvic infections (75.5%) and tubal occlusion (16.9%) were the commonest aetiologic factors. Others were: endocrine disorders including polycystic ovarian diseases, uterine myoma, uterine synaechiae and tubo ovarian masses. The outcome of treatment was: 40(15.0%) pregnancies; 112(42.1%) still on treatment and counseling; 75(28.2%) referrals and 39(14.6%) patients lost to follow up. Conclusion: Astute history taking and physical examination helped in elucidating the cause of infertility in many of our patients. Secondary infertility as in other parts of our country takes upper hand thereby reinforcing the need for prevention of pelvic infection in women of reproductive age. Total cares of infertility couples require the cooperation of men, laboratory scientists, radiologists, and even clinical psychologists (it is multidisciplinary). Treatment outcome is still poor and may be improved through increased priority in public funding, equipment supply, and manpower training as well as health education.

Gestational Diabetes: Risk Factors, Perinatal Complications and Screening Importance in Niger Delta Region of Nigeria: A Public Health Dilemma.

Aim: The study identified the incidence of undiagnosed gestational diabetes and its consequences on maternal/neonatal mortality and highlighted screening importance in an African urban setting in the Niger Delta region in Nigeria. Study Design: Randomised study. Place and Duration of Study: Pregnant women attending antenatal clinics in one tertiary, six primary, six secondary, hospitals, and six maternity homes in the Niger delta area of Nigeria between May 2006 to May 2009. Method: A total of 1920 pregnant women were recruited into the study. While 956 received the oral glucose test and formed the study group, 964 declined from continuing in the study, and formed the control group. Results: Women with gestational diabetes were at increased risk for premature rupture of membranes, preterm birth; breech presentation and high birth weight adjusting for maternal age. Conclusion: The presence of gestational diabetes in pregnancy is predictive of poor pregnancy outcome as it remains undetected in conception resulting in unto wards maternal/neonatal complications.

Still Births in a Tertiary Hospital, Niger Delta Area of Nigeria; Less Than a Decade to the Millennium Developmental Goals.

Aims: To determine the prevalence and associated factors of stillbirths in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, south-south Nigeria. Study Design: Retrospective study. Place and Duration of Study: Data were obtained from the delivery registers in the theatre, labour and isolation wards and the records department of the UPTH between 1st January 2005 and 31st December 2010. Methodology: We included 580 stillbirths (316 males and 264 females) whose data were analyzed using Epi-Info software version 6.04 and SPSS version 11. Results: The prevalence of stillbirths was 45 per 1000 births. Fresh stillbirths (SB) (50.9%) were not significantly more than macerated SB (49.1%) p=0.792. Preterms (47.8%) were insignificantly more than term SB (41.5%) p=0.765. Unbooked mothers (86.7%), age 25-34 years (70%) and lower parities 1, 2 and 0 (43.4% and 29% respectively) were significantly associated with stillbirth delivery p<0.05. Places of antenatal supervision of the unbooked mothers were primary health centre (27%), traditional birth attendants’ (25%), churches, (22.3%), private maternities, (21.1%). Predominant pregnancy and labour complications associated with SB were prolonged labour (23.1%) abruptio placentae (14.1%), retained second twin (21.8%). Significantly more SB were delivered vaginally (66.9%) than abdominally (33.1%) p=0.026. Conclusion: Lack of booking, inadequate pregnancy and labour supervision, avoidable delays are major contributors to high prevalence of stillbirths in Nigeria.

A Pilot Study of the Normal Sonographic Measurements of the Liver in Normal Pregnant Women in the University of Port Harcourt Teaching Hospital; South South Nigeria

Background: The liver is affected by the various processes that occur during pregnancy. Ultrasound assessment of the intra abdominal organs during pregnancy is done on a daily basis. We want to determine the normal length of the liver by ultrasound scan in normal pregnant women in the University of Port Harcourt Teaching Hospital thus establishing normal and reference values and also to study the effect if any of the gestational age; parity and body mass index on the liver size. Materials And Methods: One hundred and fifty normal pregnant women were evaluated. The dimensions of the liver were measured in the midclavicular line. Other parameters such as the gestational age; parity and body mass index were obtained and a test of variance carried out. Results: The average longitudinal diameter of the liver (midclavicular line) was 14.21+1.82cm (median; 14.2 cm; range; 8.0-18.9 cm). Results of the multivariate analysis showed a positive correlation between the liver length and body mass index but not with the parity and gestational age. Conclusion: This study will be of importance in the daily practice in the radiology and other clinical department in the assessment of the liver in pregnant women