A five-year retrospective review of the maternal and feotal outcome of obstructed labour and its determinants in a tertiary hospital in Nigeria.

Background: Obstructed labour is one of the common obstetric emergencies in Nigeria which is associated with an increased maternal and foetal complications. Objective: To determine the maternal and foetal outcome of obstructed labour and its determinants in a tertiary hospital in Ebonyi State University Teaching hospital Abakaliki. Methods: A retrospective review of all women with obstructed labour managed at Ebonyi State University Teaching hospital Abakaliki between January 2007 and December 2011 was carried out. Results: The prevalence rate of obstructed labour was 3.4% (95%CI 3.37 - 3.42) for the period under review. Women in their second and third decade of life formed 91.6% (196/214) of patients in the study. Majority of obstructed labour occurred in primiparous women (92/214, 42.9%) and the commonest cause of obstructed labour was cephalopelvic disproportion (106/214, 49.6%). The commonest maternal complication was wound infection accounting for 23.2% (48/214) of all the complications. Most of the babies delivered had a good Apgar score as was noted in 60.3% (129/214) of cases. Being unbooked, para 3 and above, maternal age of 30 and above, having no formal education and rural residence were strongly associated with parturient having maternal complication (P > 0.05) and abnormal APGAR score. The maternal and perinatal mortality rate was 191/100,000 live births and 168/1000 deliveries respectively. Conclusion: The commonest cause of obstructed labour in our review is cephalopelvic disproportion occurring more in primiparous women. Wound infection is the commonest maternal complication with majority of the neonates having a good outcome. Provision of free antenatal care services, education of women on the importance of antenatal care, early presentation in the hospital and early use of broad spectrum antibiotics would help to reduce the associated complications.

Fetal Fibronectin as a Predictor of Preterm Delivery: A Nigerian Cohort Study.

Background: Fetal fibronectin is a useful biomarker in the diagnosis and management of preterm labour. Objectives: To evaluate the relationship between cervical fetal fibronectin and preterm delivery and the association between cervical fetal fibronectin level and gestational age at delivery. Materials and Methods: A prospective cohort study was performed in a tertiary hospital in Nigeria, involving equal number of pregnant women with (96) and without (96) preterm labour. Fetal fibronectin assay was done using solid-phase immunogold assay. The data were analysed using IBM SPSS version 24. Descriptive and inferential statistical analyses were done. The level of significance was p-value <0.05. Results: Less than half (47.9%) of the women in the study group had preterm delivery while 13.09% of the women in the control group delivered preterm. Fetal fibronectin test had a sensitivity, specificity, positive predictive value and negative predictive value of 78%, 86.5%, 71.9%, and 89.0%, respectively, a positive likelihood ratio and negative likelihood ratio of 5.76(95% CI, 3.67 - 9.64) and 0.26(95% CI, 0.16 - 0.41), respectively. Conclusion: The findings in our study value of fetal fibronectin in predicting preterm delivery. Its use will support less intervention for patients with negative results.

A randomised controlled trial of tranexamic acid versus misoprostol in reducing blood loss during caesarean section.

Objective: To determine the efficacy of intravenous tranexamic acid versus rectal misoprostol in decreasing intraoperative blood loss during caesarean section (C/S). Design and Setting: Randomised controlled study involving pregnant women undergoing C/S at Alex Ekwueme Federal University Teaching Hospital, Abakaliki in Nigeria. Participants and Interventions: Five hundred and fourteen women undergoing elective C/S were assigned randomly (257 patients per group) to receive either pre-operative 1000 µg rectal misoprostol or 1000mg intravenous tranexamic acid after spinal anaesthesia. Data from 248 patients were analysed in the misoprostol group, while data from 250 patients were analysed in the tranexamic acid group. Sixteen patients were excluded from analysis; nine had incompletely filled proforma, while seven were lost to follow-up. Main outcome: Intraoperative blood loss. Results: The mean intraoperative blood loss was not significantly different between the misoprostol group and the tranexamic acid group (547 ± 183.75ml vs. 551.66 ± 21.74ml, P = 0.157). The mean difference in pack cell volume (PCV) changes was not significant between the groups (2.41±0.95% vs. 2.36±0.56%, P = 0.474). The side effects profile was similar for both groups except for shivering, which was statistically higher among the misoprostol group (RR = 0.70; 95%CI 0.40 - 0.91, P = 0.028). Conclusion: Intravenous tranexamic acid was comparable to rectal misoprostol in the reduction of blood loss during C/S. Tranexamic acid could act as a good alternative to misoprostol for prophylaxis for blood loss during elective C/S. Funding: None declared.

Correlation of platelet parameters with adverse maternal and neonatal outcomes in severe preeclampsia: A case-control study.

BACKGROUND: Pre-eclampsia (PET) is a potentially devastating multi-systemic disorder resulting in the generation of oxidative stress. Platelet activation causes vasoconstriction and release of inflammatory cytokines, resulting in an intensified inflammatory response, endothelial damage, and coagulopathy which culminate in adverse pregnancy outcomes. AIM: To compare the platelet parameters between preeclamptic and normotensive pregnant women and their relationship to adverse outcomes in women with pre-eclampsia. MATERIALS AND METHODS: This was a case-control study of platelet indices of 60 pre-eclamptic and 60 normotensive pregnant women recruited at 28 weeks and followed till delivery. A blood sample was collected at entry into the study and just before delivery. The sample was analyzed within 1 h of collection using the Mythic 18 hematological auto-analyzer. Data were analyzed using IBM-SPSS version 22. A P-value of <0.05 was considered statistically significant. RESULTS: The mean platelet count, Platelet distribution width (PDW), plateletcrit were statistically significantly different between normotensive and severe preeclamptic participants (p= <0.001). Statistically significant differences were not present in any of the platelet parameters between mild and severe PET. The odds of developing eclampsia was low at higher mean platelet count and plateletcrit levels above 161.36 ± 73.74 × 109/L [p = 0.02, AOR = 0.27, 95% CI (0.08-0.88)] and 0.13 ± 0.05% [p = 0.001, AOR = 0.22, 95% CI (0.08-0.58)] respectively. Eclampsia was strongly associated with P-LCR (platelet-large cell ratio) above 23.15 ± 4.92% [p = 0.004, AOR = 11.00, 95%CI (1.48-89.02)]. Abruptio placentae had low odds at lower levels of mean plateletcrit. Pre-term birth was significantly lower at mean plateletcrit levels above 0.14 ± 0.05%; admission into neonatal intensive care unit was strongly associated with a mean PLC ratio above 22.73 ± 5.91%. CONCLUSION: This study demonstrated significant differences in platelet count, plateletcrit, platelet distribution width, and P-LCR between pre-eclamptic and normotensive women. Increase in P-LCR is a risk factor for eclampsia although the effect size is low.

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

INTRODUCTION: Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. MATERIAL AND METHODS: This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. RESULTS: Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P < .05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. CONCLUSIONS: Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

Maternal and Neonatal Outcome following Day Two versus Day Five or Seven Discharge after an Uncomplicated Elective Caesarean Section: A Randomized Control Study.

BACKGROUND: In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources. OBJECTIVE: To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS. MATERIALS AND METHODS: Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1st October 2018 and 30th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5th or 7th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22. RESULTS: Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge (χ 2 = 0.95, P = 0.329). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group (χ 2 = 1.65, P = 0.649). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge (χ 2 = 16.64, P = 0.0001, OR = 0.857, 95%CI = 0.59-1.25). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 (χ 2 = 4.45, P = 0.108). Early hospital discharge did not have any significant negative impact on neonatal health (χ 2 = 1.063, P = 0.303). CONCLUSION: Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS.

Coronavirus disease 2019: Knowledge, attitude, and practice of pregnant women in a tertiary hospital in Abakaliki, southeast Nigeria.

OBJECTIVE: To determine the knowledge, attitude, and practice of antenatal attendees towards COVID-19 in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. METHODS: A cross-sectional survey was carried out among 430 consenting pregnant women attending antenatal clinics between March 1 and May 30, 2020, using pretested questionnaires. RESULTS: The mean age and mean gestational age of the respondents were 30.04 years (95% confidence interval [CI] 28.9-31.1) and 26.3 weeks (95% CI 23.3-29.3), respectively. More than four-fifths (82%) of the women believed that COVID-19 is real and their main source of information was mass media. The majority had adequate knowledge of COVID-19. More than half of the respondents said COVID-19 is a curable disease and that chloroquine can be used. The majority showed a good attitude and preventive practice of COVID-19 disease; however, one-fourth (24%) thought that infected individuals should be killed to prevent the spread of the virus. CONCLUSION: The study population has good knowledge, attitude, and practice of COVID-19 disease. However, it is worrisome that some respondents thought that infected individuals should be killed. Proper education must be given to the populace to avert these negative attitudes while promoting a positive preventive attitude. The study population has adequate knowledge, good attitude, and preventive practice of COVID-19; however, community education is needed to reduce anxiety among the populace.

Age at menarche, menstrual characteristics, and its associated morbidities among secondary school students in Abakaliki, southeast Nigeria.

BACKGROUND: Menstruation has a variable pattern. Knowledge of age at menarche and providing accurate information to adolescent girls is necessary to allay anxiety, treat menstrual morbidities, and improve their quality of life. OBJECTIVE: To determine the age at menarche and menstrual characteristics of adolescent secondary school girls in Abakaliki. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted in seven secondary schools in Abakaliki among 960 female students. A total of 450 girls were randomly selected for the study. A pretested self-administered questionnaire was used in data collection. Four hundred questionnaires were properly filled and used for the final analysis. RESULTS: The age range of the students was between 10 - 21years. The mean age of the respondents was 16.2 ± 1.7years. The average age at menarche was 13 ± 1.0 years. Urban dwellers had menarche 0.2years earlier than rural dwellers. There is an association between menarche and social class (X [2] 372.9 (2), p = 0.001). About 87.75% of the respondents had an average cycle length. Most (88.3%) of the respondents had a menstrual flow duration of 3-5 days. Dysmenorrhoea was present in 82% of respondents and was severe enough to cause absence from school in 56.5% of students. Oligomenorrhea and menorrhagia occurred in 8.5 % and 6.25 % of the student studied. Mothers (80.0%), friends (75.0%) and teachers (74.5%) accounted for the bulk of the information on menstrual health. CONCLUSION: The average age at menarche was 13 ± 1.0 years. Dysmenorrhea is a major cause of morbidity amongst this age group and should be empathically addressed. It is therefore important that the students, their parents, and school managers in the study area be educated on the issues of menstrual problems that can occur in an adolescent.

The Effect of Ultrasound-Measured Preinduction Cervical Length on Delivery Outcome in a Low-Resource Setting.

BACKGROUND: Induction of labour is not without risk, and it calls for a method that will be sensitive enough to predict successful labour induction. AIM: This study aims to evaluate the role of transvaginal ultrasonographic cervical length measurement at term in the prediction of successful induction of labour (IOL). MATERIALS AND METHODS: This prospective study was carried out in the Department of Obstetrics and Gynaecology of Federal Teaching Hospital Abakaliki between 1st of July and 30th of November 2015. Preinduction Bishop score and cervical length were assessed before induction of labour. Intracervical, cervical, extraamniotic Foley catheter was used to improve the Bishop score. The data were analyzed using the IBM SPSS Statistics 20. RESULTS: The mean maternal age of the study group was 30.68 ± 6.38 years with a range of 19-43 years. The mean gestational age and parity were 39.57 ± 1.49 and 1.85 ± 0.63, respectively. All the women studied had successful induction of labour with mean induction delivery time of 8.1 ± 3.0 hours and mean duration of labour of 7.4 ± 2.9 hours. Preinduction cervical length is a good predictor of a short duration of labour (P = 0.001). Parturient with a preinduction cervical length of less than 3 cm was likely to have labour lasting less than 6 hours (RR = 4.20 (95% CI 1.85-9.529). CONCLUSION: Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of duration of labour following the induction of labour. It is recommended that IOL should be considered and success anticipated in a parturient with a cervical length less than 3 cm.

Female genital mutilation and obstetric outcome: A cross-sectional comparative study in a tertiary hospital in Abakaliki South East Nigeria.

BACKGROUND: Female genital mutilation (FGM) is an assault on womanhood. OBJECTIVE: To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation. MATERIALS AND METHODS: This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05. RESULTS: The mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17-2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05). CONCLUSION: The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

The experience of women following caesarean section in a tertiary hospital in SouthEast Nigeria.

OBJECTIVE: To explore maternal experience following caesarean section. METHODS: The study was a cross-sectional prospective study involving 250 women. RESULTS: The mean age of the study population was 27.2 ± 5.5 years with fifty-three per cent (53.1%) of the women between the ages of 20-9 years. Majority of the participants (67.1%) were multiparous and 37.4% of the parturient had secondary school education. The majority (67.1%) were in social class 3-5. Emergency caesarean section accounted for 74.5% of the caesarean section and the commonest indication was foetal distress. One hundred and forty-four participants (59.3%) were satisfied with their caesarean section experience which was significantly associated with health care attention and foetal outcome. More than half of the study population would not accept caesarean section when indicated in a future pregnancy. The health care attention [AOR 0.53, 95% CI (0.32, 0.88)] and maternal age [AOR 3.05, 95%CI (1.43, 6.49)] were significant predictors. CONCLUSION: Majority of the women were satisfied with their caesarean section experience which is influenced by the hospital care and foetal outcome. Improvement in maternal caesarean section experience through quality health care is important in increasing uptake when indicated.