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.

An unusual presentation of choriocarcinoma co-existing with pregnancy, successful delivery, and treatment: A case report and literature review.

Choricarcinoma co-existing with pregnancy is rare often misdiagnosed with great potential for hemorrhagic complications and death. We present a case of a 34-year-old woman diagnosed with choriocarcinoma in her 3rd pregnancy with vaginal and pulmonary metastasis. Her first episode of vaginal bleeding was in the third trimester which was misdiagnosed. She had spontaneous vaginal delivery at 34 weeks of a healthy neonate. She was refered to gyneoncology unit of our hospital 5 weeks into puerperium from a nearby State hospital due to continouos vaginal bleeding and a growth from the postero-lateral wall of the lower third of the vagina. She had five courses of EMA-CO regimen. Her beta-human chorionic gonadotropin (hCG) has fallen from pretreatment value of 168,266 mIU/ml to <5 mIU/ml by the 5th course and the metastaic lesion regressed. She however developed WHO Stage III Oral Mucositis (with Oroesophageal Candidiasis) due to the side effects of chemotherapy which was co-managed successfully with the oral medicine specialist. She was subequently discharged home with follow-up visits. The quantitative beta-hCG has remained undetectable during her follow-up visits. Choriocarcinoma co-existing with pregnancy is rare, diagnosis often missed and confused with antepartum hemorrhage. Early and correct diagnosis can be life saving. High index of suspicion is needed to make the diagnosis. The role of chemotherapy and close follow-up with quantitative beta-hCG assays are key to survival.

Plasma cytokine levels and human papillomavirus infection at the cervix in rural Nigerian women.

INTRODUCTION: We conducted a study to test the hypothesis that systemic dysregulation of Th1/Th2 cytokine levels was associated with detection of carcinogenic or overall human papillomavirus (HPV) at the cervix among 964 women residing in a rural village in Nigeria. METHODS: Levels in plasma were measured for 19 cytokines, including Th1-like cytokines IL-2, IL-12 (p40), TNF-a, IFN-g; Th2-like cytokines IL-4, IL-5, IL-6, IL-10, IL-13; innate/inflammation cytokines IL-1a, IL-1b, IL-8, eotaxin, MCP-1, MIP-1a, and IL-7; and cell development cytokines G-CSF, VEGF, and IL-17. Analysis was restricted to 5 cytokines, TNF-α (Th1), IL-8 (Th2), eotaxin and MCP-1 (innate/inflammation), and G-CSF (cell development), whose levels were detected in 80% or more of the samples measured as well as had a coefficient of variation of <30%. RESULTS: Strong correlations were noted between levels of eotaxin and TNF-α (r=0.75), IL-8 and MCP-1 (r=0.60), eotaxin and G-CSF (r=0.44), and G-CSF and IFN-γ (r=0.43). Detection of carcinogenic or non-carcinogenic HPV DNA was unrelated to cytokine levels, except for levels of eotaxin and TNF-α, which were inversely correlated, albeit weakly, with detection of any carcinogenic HPV (P=0.048 and P=0.067, respectively). In analyses stratified by age group, levels of eotaxin were inversely correlated with detection of any HPV DNA (P=0.026) and carcinogenic HPV (P=0.042) in older, but not younger, women. CONCLUSIONS: Our results do not support the hypothesis of association between systemic cytokine dysregulation and detection of HPV at the cervix in Nigerian women, but subgroup analyses raise questions about inverse associations between eotaxin and TNF-α in older women.

Post partum haemorrhage in a teaching hospital in Nigeria: a 5-year experience.

OBJECTIVES: The aim was to determine the incidence, causes and the maternal mortality associated with postpartum haemorrhage in a tertiary centre in Nigeria. METHODS: Case records of all patients that had postpartum haemorrhage after vaginal delivery at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife unit over a 5-year period (January 1st, 2002 to December 31st, 2006) were reviewed and analysed. Post-partum blood loss was calculated by estimating blood loses in graduated containers and in bed lines and gauze packs. RESULTS: 112 women had postpartum haemorrhage during the period under review. 76(67.86%) had primary postpartum haemorrhage and 36(32.14%) had secondary postpartum haemorrhage. The commonest cause of post partum haemorrhage was retained products of conception due mismanagement of the third stage of labour, this occurred in 88 women (78.57%) of cases. Other causes were uterine atony 12(10.71%), genital tract laceration 9(8.04%), disseminated intravascular coagulopathy 1(0.8%) puerperal sepsis 1(0.8%) and broken down episiotomy, 1(0.8%). The maternal mortality during the period was 90 out of which 6 were due to postpartum haemorrhage. CONCLUSION: Retained products of conception resulting from mismanagement of the third stage of labour is the most common cause of post partum haemorrhage in our centre.

A review of clinical pattern and outcome of vesicovaginal fistula.

OBJECTIVES: The aim of this study was to determine the incidence, sociodemographic parameters, and outcome of surgical repairs of obstetric fistula in our center. METHODS: Case files of patients managed for genital tract fistula over a 10-year period (January 1, 1997 to December 31, 2006) were retrieved and analyzed. RESULTS: Fifty-five patients with of genital tract fistula were managed in the period under review, constituting 1.17% of total gynecological admissions. Obstetric fistula accounted for 51 (93%) of genital fistula, and 92.7% of cases were caused by prolonged obstructed labor. The most common form of fistula was the midvaginal type, and 89% of affected women were married with primiparous women mostly affected (43.6%). Menstrual function was lost in 51% of the patients, while obstetric palsy complicated 18.2% of the cases. Half of the women (51%) were abandoned by their spouses, and surgical repair was successful in only 32% of the cases. CONCLUSION: Obstetric fistula continues to show the deficiency in women's general health status occasioned by poor childbirth attendance in developing countries. Affected women suffer double jeopardy as a result of dearth of appropriate experts in fistula repair.