Clinical audit of the management and outcomes of preterm pre-labour rupture of membranes at Aminu Kano Teaching Hospital.

Introduction: preterm pre-labour rupture of membranes (PPROM) is one of the important causes of preterm birth that can result in high perinatal morbidity and mortality along with maternal morbidity. The purpose of the study was to audit the management of women presenting with Preterm pre-labour rupture of membranes in Aminu Kano Teaching Hospital (AKTH). Methods: this was a retrospective audit on patients admitted with PPROM in AKTH over a period of 24 months. Data was analysed using SPSS version 22 and presented using percentages and compared with the audit standard. Chi-squared test was used to test for association (p-value <0.05). Results: the mean gestational age was 33.27±2.42 weeks. Diagnosis was made on all patients through history and clinical examination. Almost all patients received a course of erythromycin (88%), corticosteroid (84%) and magnesium sulphate (86%). Vaginal delivery was achieved in 57%. About 60% of the neonates were premature, 78% had Apgar score >7 at 5 mins, 50% were admitted in the special care baby unit and 72% survived. Chorioamnionitis and puerperal sepsis occurred in 8% and 21.7% of the mothers. Prolonged PPROM of >24 hours was statistically significantly associated with puerperal sepsis (χ2=7.218; p = 0.007) and perinatal mortality (χ2= 11.505, p = 0.001). Conclusion: despite high fidelity to institutional clinical practice guidelines in Aminu Kano Teaching Hospital there seems to be poor maternal and neonatal outcome with high perinatal mortality. Thus the guidelines need to be reviewed in context of improving the outcome.

Monkeypox in human pregnancy: an overview.

Monkeypox is a viral zoonosis caused by the monkeypox virus, an enveloped, double-stranded DNA virus belonging to the Orthopoxvirus genus in the Poxviridae family. Monkeypox has become a disease of global public health significance. Pregnant women are unfortunately among the those at an increased risk for exposure to monkeypox because their immune system is altered during pregnancy. They may also be at risk for more severe disease or a worse outcome than others. During pregnancy or while breastfeeding when consideration is given for pre-exposure or postexposure vaccination, nonreplicating (Modivied Vaccinia Ankara - Bavarian Nordic) or minimally replicating (LC16, KM Biologics) vaccines are preferred. The ACAM2000 vaccine is contraindicated in pregnancy because it contains live virus particles that can cause fetal vaccinia and fetal death. There are no data to support the use of tecovirimat in pregnant women. However, no fetal adverse effects were noticed when tecovirimat was used in animal studies.