Association between Abnormal Serum Lipid Levels in Early Pregnancy and Development of Preeclampsia.

BACKGROUND: Accurate early biomarkers of oxidative stress, placenta perfusion and vascular resistance and endothelial platelet interaction for prediction of preeclampsia have not been shown to be beneficial for routine clinical use. The study of association between abnormal lipid levels in early pregnancy and preeclampsia is thus necessary in a bid to reduce the progression and severity of complications of preeclampsia. OBJECTIVE: To determine the association between abnormal lipid levels in early pregnancy and the development of preeclampsia. MATERIALS AND METHODS: A prospective longitudinal study involving 184 pregnant women with singleton pregnancy who met the inclusion criteria and recruited from the antenatal clinic at gestational age of < 20weeks. Their fasting blood samples were collected for the measurement serum lipid profile. They were monitored until delivery for the development of preeclampsia. The mean values of serum lipid profile were analyzed for association with pre-eclampsia using the statistical package for social sciences (SPSS) version 21.0 and P value of < 0.05 was considered statistically significant. RESULTS: Out of 184 participants, 3 had spontaneous miscarriage and were excluded while 5 were lost to follow up. This left a total of 176 participants who completed the study, 11 of which developed preeclampsia. There was a statistically significant increase in the levels of total cholesterol (TC) and low-density lipoprotein (LDL) in the preeclamptic group. The mean serum lipid levels were 4.8 mmol/L for total cholesterol, 1.87 mmol/L for total triglycerides, 1.3 mmol/L for high-density lipoprotein and 2.67 mmol/L for low-density lipoprotein. Age and parity also showed a causal association with development of preeclampsia. CONCLUSION: There was an association between elevated serum total cholesterol and low-density lipoprotein with development of preeclampsia later in pregnancy.

CONTEXTE: Les biomarqueurs précoces précis du stress oxydatif, de la perfusion et de la résistance vasculaire du placenta et de l'interaction endothéliale-plaquettaire pour la prédiction de la prééclampsie ne se sont pas révélés avantageux pour l'utilisation clinique courante. L'étude de l'association entre les taux anormaux de lipides en début de grossesse et la prééclampsie est donc nécessaire pour réduire la progression et la gravité des complications de la prééclampsie. OBJECTIF: Déterminer l'association entre des taux de lipides anormaux en début de grossesse et le développement de la pré- éclampsie. MATÉRIEL ET MÉTHODES: Une étude longitudinale prospective impliquant 184 femmes enceintes avec une grossesse unique qui répondaient aux critères d'inclusion et qui ont été recrutées à la clinique prénatale à l'âge gestationnel de < 20 semaines. Des échantillons de sang à jeun ont été prélevés pour mesurer le profil lipidique sérique. Elles ont été suivies jusqu'à l'accouchement pour le développement de la pré-éclampsie. Les valeurs moyennes du profil lipidique sérique ont été analysées pour leur association avec la pré-éclampsie à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 21.0 et une valeur P de < 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Sur les 184 participantes, 3 ont fait une fausse couche spontanée et ont été exclues, tandis que 5 ont été perdues de vue. Il restait donc un total de 176 participantes qui ont terminé l'étude, dont 11 ont développé une prééclampsie. On a constaté une augmentation statistiquement significative des taux de cholestérol total (CT) et de lipoprotéines de basse densité (LDL) dans le groupe prééclamptique. Les taux moyens de lipides sériques étaient de 4,8 mmol/L pour le cholestérol total, 1,87 mmol/L pour les triglycérides totaux, 1,3 mmol/L pour les lipoprotéines de haute densité et 2,67 mmol/L pour les lipoprotéines de basse densité. L'âge et la parité ont également montré une association causale avec le développement de la prééclampsie. CONCLUSION: Il y avait une association entre un taux élevé de cholestérol total sérique et de lipoprotéines de basse densité et le développement de la prééclampsie plus tard dans la grossesse. Mots clés: Association, Prééclampsie, Cholestérol sérique, Lipoprotéines de basse densité, Lipoprotéines de haute densité, Triglycérides, Lipides sériques.

Daily versus twice daily dose of ferrous sulphate supplementation in pregnant women: A randomized clinical trial.

BACKGROUND: The International Nutritional Anaemia Consultative Group has recommended a twice daily dose of 65 mg elemental iron supplementation in pregnant women living in areas where anaemia is prevalent contrary to the World Health Organization (WHO) universal recommendation of a daily dose of 60 mg. Whether twice or daily dose schedules proffer a better outcome is a subject of on-going research. OBJECTIVE: To compare the effectiveness of the once versus twice daily doses of ferrous sulphate in the prevention of iron deficiency anaemia in pregnancy. METHODS: There are about one hundred and eighty two (182) pregnant women at gestational ages of 14-24 weeks with haemoglobin (Hb) levels ≥10 g/dl but ≤14.5 g/dl were recruited during the antenatal booking clinic. They were randomized into receiving either once daily dose (65 mg of elemental iron) or twice daily dose (130 mg of elemental iron) of ferrous sulphate. Pre and post- supplementation haemoglobin, serum iron and ferritin levels were assessed at recruitment and at 37 weeks gestation respectively. RESULTS: Eighty-four (84) and 80 women respectively in the once and twice daily dose groups were analysed. The serum haemoglobin was significantly lower (P = 0.002) among those on once daily than those on twice daily supplementation. The side effects were however, significantly higher in the twice daily group (P = 0.005, P = 0.043 and P = 0.004 respectively). There were no differences between the serum ferritin levels pre and post supplementation in both groups just as they were no reported significant differences in both birth weight of neonates (P = 0.936) and average gestational age at delivery (P = 0.469) between the two groups. CONCLUSION: Once daily (65 mg elemental iron) ferrous sulphate is as effective as twice daily (130 mg elemental iron) dose regimen in prevention of Anaemia in pregnancy in a developing economy like Nigeria. Once daily dose possesses fewer side effects and guarantees better compliance in this study.

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory.

OBJECTIVE: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. MATERIALS AND METHODS: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. RESULTS: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. CONCLUSION: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory

Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053; P = 0.035). Intermittent preventive treatment was used by 15.9 of the respondents. Insecticide-treated net ownership was 42.6; however; its use declined from 28.5 before pregnancy to 24.6 during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy; but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions

HIV prevalence amongst clients attending antenatal clinic at the Federal Medical Centre, Makurdi.

BACKGROUND: Evidence from the 2005 National HIV Seroprevalence Sentinel Survey showed that Benue state has the highest seroprevalence rate of HIV infection in the country. Seroprevalence rate amongst antenatal women is a reflection of what is happening in the larger society. Knowledge of seroprevalence rate amongst pregnant women would help in targeting intervention strategies for prevention of mother to child transmission (PMTCT) of HIV. OBJECTIVE: The objective of the study is to determine the seroprevalence rate of HIV infection amongst clients attending antenatal clinic at the Federal Medical Centre Makurdi. METHODS: Cross-sectional study of 262 randomly selected women that booked for antenatal care at the Federal Medical Centre Makurdi between 1st January 2007 to 30th April, 2007 was carried out. Information regarding age, parity, gestational age at booking, educational status and HIV sero-status of the clients were looked into. RESULTS: A total of 50 women out of the 262 women studied were positive, giving a seroprevalence rate of 19.1%. The highest seroprevalence rate was amongst 25-29 years age group (40.8%). Women of parity 1-4 constituted the highest group (53.4%). Majority of them (45.5%) had secondary school education while 60 (22.9%) had tertiary education. One hundred and ten (42%) booked in the 3rd trimester while only 34 (13%) booked in the 1st trimester. CONCLUSION: HIV seroprevalence is high amongst antenatal women in Makurdi and intervention strategies should be scaled up for prevention of vertical transmission of the virus.

Pregnancy outcome in eclamptics at the University of Abuja Teaching Hospital, Gwagwalada, Abuja: a 3 year review.

BACKGROUND: Eclampsia remains one of the major causes of maternal morbidity and mortality especially in the developing countries. In Nigeria, it is the 3 rd commonest cause of maternal mortality. The high maternal morbidity and mortality due to eclampsia in the developing countries has been ascribed to late referral, delay in hospitalization, lack of transport, unbooked status of patients and multiple seizures prior to admission. OBJECTIVE: To review the presentation and management of eclampsia at the University of Teaching Hospital (UATH), the factors associated with it, the maternal and perinatal outcome and make recommendations on how to reduce maternal and perinatal morbidity and mortality from eclampsia. METHODOLOGY: The case notes of all the patients that had eclampsia between 1 st May 2005 and 30 th April 2008 were retrieved and analyzed. The informations sought for include age of the patients, parity, booking status, type of eclampsia and blood pressure at presentation. Other informations include level of proteinuria, anticonvulsants used, mode of delivery, maternal complications and perinatal outcome. RESULTS: There were 4471 total deliveries within the period, out of which 59 had eclampsia, giving an incidence of 13 per 1000 deliveries. There were 5 maternal deaths, giving a case fatality rate of 8.5%. Eclampsia was commonest amongst the age group of 20-24 years (34.8%). Primigravidae constituted 60.9% of the cases. Majority of the patients (89.1 %) were unbooked. Antepartum eclampsia (73.9%) was more than intra-partum (19.6%) and postpartum (2.2%) combined. Thirty two patients had severe hypertension on admission (diastolic BP= 110 mmHg) while 11 (23.9%) had mild hypertension (diastolic BP 90- < 110mmHg). Twenty patients (47.8%) were managed with diazepam alone while 19 patients (41.3%) were managed with magnesium sulphate alone. Five patients were managed with both. Thirty nine (84.8%) were delivered through caesarean section while 5 (10.8%) were delivered vaginally. Maternal complications include 6 cases of acute renal failure and one case of visual impairment. Thirty seven babies were delivered live while 8 stillbirths were recorded. Six babies (13.0%) had very low birth weight, 14 (30.4%) had low birth weight and 16 (34.8%) had normal birth weight. CONCLUSION: Eclampsia still remains a major cause of maternal morbidity and mortality in Nigeria. More awareness and enabling factors should be created for more women to access antenatal facilities. Information about danger signs of pre-eclampsia/eclampsia should be made available to antenatal clients. Government should be committed to providing emergency obstetric case facilities in our hospitals for effective management of eclampsia.

HIV prevalence amongst clients attending antenatal clinic at the Federal Medical Centre, Makurdi

Background: Evidence from the 2005 National HIV Seroprevalence Sentinel Survey showed that Benue state has the highest seroprevalence rate of HIV infection in the country. Seroprevalence rate amongst antenatal women is a reflection of what is happening in the larger society. Knowledge of seroprevalence rate amongst pregnant women would help in targeting intervention strategies for prevention of mother to child transmission (PMTCT) of HIV. Methods:The objective of the study is to determine the seroprevalence rate of HIV infection amongst clients attending antenatal clinic at the Federal Medical Centre Makurdi. Methods:Cross-sectional study of 262 randomly selected women that booked for antenatal care at the Federal Medical Centre Makurdi between 1 January 2007 to 30 April; 2007 was carried out. Information regarding age; parity; gestational age at booking; educational status and HIV sero-status of the clients were looked into. Results:A total of 50 women out of the 262 women studied were positive; giving a seroprevalence rate of 19.1. The highest seroprevalence rate was amongst 25-29 years age group (40.8). Women of parity 1-4 constituted the highest group (53.4). Majority of them (45.5) had secondary school education while 60 (22.9) had tertiary education. One hundred and ten (42) booked in the 3 trimester while only 34 (13) booked in the 1 trimester. Conclusion:HIV seroprevalence is high amongst antenatal women in Makurdi and intervention strategies should be scaled up for prevention of vertical transmission of the virus

Elective caesarean section at the Federal Medical Centre Makurdi, north central Nigeria.

BACKGROUND: Elective caesarean section is associated with less risk of adverse events compared to emergency caesarean section. Paradoxically, emergency caesarean deliveries continue to form the bulk of caesarean deliveries in our facility. The aim of this study is to determine the caesarean section rate, ascertain the trend of elective caesarean section, indications for elective caesarean section and elective caesarean mortality. METHODS: A retrospective analysis of the clinical records of all patients that had caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi was conducted. RESULTS: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5%. The elective caesarean sections accounted for 69(16.4%) while emergency caesarean sections accounted for 351(83.6%) of all caesarean sections. The rate of elective caesarean section increased from 10.3% in 2004 to 22.8% in 2006 of all caesarean sections. Two or more previous caesarean sections were the commonest indication for elective caesarean section accounting for 23.2% of cases, followed by HIV infection in pregnancy accounting for 21.7% of cases. No maternal death occurred with elective caesarean section. CONCLUSION: There is a rising trend of elective caesarean section presently accounting for 1 out of every 6 caesarean sections in the centre. The commonest indication for elective caesarean section was two or more caesarean sections, followed by retroviral disease in pregnancy. Elective caesarean section remains safer than emergency caesarean section in our facility.

Survival of infants and children born to women who died from pregnancy and labour related complications.

OBJECTIVE: In response to concern raised on the high rate of maternal mortality in developing countries, this cross-sectional survey was conducted to assess the survival of infants born to mothers who died during the process of child birth. METHODOLOGY: The survey was conducted in Gwoza and Konduga Local Government Areas of Borno State, Nigeria over a 12 week period; January to March, 1996. RESULTS: Sixty four live-born infants of 76 deceased mothers were studied. The majority of the infants were either nursed by the deceased's sister or mother. Alternative or donor breast milk by a surrogate mother (usually the deceased close relation), goat or cow milk were the common form of feeding from birth to 6 months of age followed by groundnut enriched pap. Twenty (31.3%) of the infants survived upto 5 years of age while 44 (68.6%) did not. Factors favouring infant survival include nursing, up-bringing and breast-feeding by a surrogate mother (who is usually either the deceased's sister or mother), infant feeding with goat's or cow's milk, Immunization, hospital treatment of aliments, hospital delivery or maternal death in the hospital and finally when the caretaker is of low party and upper social class status. Factors responsible for infant death included prematurity, cause of maternal death was due to sepsis as a result of prolonged labour or premature rupture of fetal membranes, birth asphyxia, tetanus, respiratory problems, fever, convulsions, diaorrhea and vomiting and malnutrition. CONCLUSION: These babies are readily accepted by the society because it is believed that the caretaker would receive a lot of blessing from God. On the other hand, the death of such babies is considered a double loss even though there is a low expectation for their survival.

Dysmenorrhoea and menstrual abnormalities among postmenarcheal secondary school girls in Maiduguri Nigeria.

Four Hundred and fifteen post menarcheal secondary school girls selected randomly from six secondary schools in Maiduguri metropolis were interviewed with the aid of questionnaires to find out their ages at menarche and associated menstrual problems, regularity of menstrual cycle, menorrhagia and dysmenorrhoea within the first two years following menarche. Their ages ranged between 12 and 21 years. Twenty six students were three months post menarche, 187 were 4-12 months post menarche.'The mean menarcheal age was 13.6 years. Menorrhagia was a very rare form of menstrual abnormality. Early menarche especially between the ages of 12 to 14 years was found to be associated with higher frequency of irregular menstrual cycles while this improves with late onset menarche. About 45% had one form of menstrual abnormality, amenorrhoea (4.6%), oligomenorrhoea (18%) and polymenorrhoea (21%). These were almost uniformly associated with all groups. Over 80% had attained menarche by age of 14 years. Dysmenorrhoea was just slightly commoner by the ages of 15 and 16 years when it occurs more frequently.