The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria.

INTRODUCTION: Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. AIM: This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. MATERIALS AND METHODS: This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. RESULTS: A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. CONCLUSION: Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment.

Obstetric morbidity and socio-cultural predictors of ruptured uterus among women in Southeast Nigeria.

This study determined the incidence, obstetric morbidity and the socio-cultural factors associated with ruptured uterus. A 6-year prospective review of ruptured uterus and an enquiry into socio-cultural barriers to specialised care was conducted. The incidence of ruptured uterus was 12 per 1000 deliveries. Occurrence was common in uneducated (78/116; 67.2%), unbooked (110/116; 94.8%) and rural women (112/116; 96.6%). The major causes were prolonged obstructed labour (104/116; 89.7%) and injudicious use of oxytocics (90/116; 77.6%). The maternal and perinatal case fatality rates were 18.1% and 96.6%, respectively. Complications resulted from haemorrhage and sepsis. Lack of birth plan (97/116; 79.3%) and unskilled birth attendance (110/116; 94.8%) were major socio-cultural risk factors. There was an association between education (p = 0.001), parity (p = 0.002), residence (<0.001), type of birth attendance (<0.001) and ruptured uterus. Women in low-income settings face threats of complications and death from uterine rupture, owing to preventable socio-cultural barriers of accessing specialised obstetric care.

Association of Intrauterine Device (IUD) and Cervical Neoplasia - A Study in a Poor Nigerian Population.

INTRODUCTION: Intrauterine Device (IUD) is a contraceptive method used by women of reproductive age group. However, there are conflicting reports on the association between IUD and cervical neoplasia. These controversies may further hamper the poor uptake of modern contraception in Nigeria. AIM: This study was therefore aimed at evaluating the association between IUD and cervical neoplasia. MATERIALS AND METHODS: This was a case control study in which Pap smear results of 156 participants on IUD were compared with those of 156 non-users of modern contraception. The participants who were found to have abnormal cervical smear cytology results were further subjected to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analysed with descriptive and inferential statistics at 95% level of confidence. RESULTS: Seven (4.5%) and 2(1.3%) of participants using IUD had Cervical Intraepithelial Neoplasia (CIN) 1 and CIN 2 respectively. Also, 5(3.2%) and 1(0.6%) of non-users of modern contraception had CIN 1 and CIN 2 respectively. The prevalence of cervical neoplasia among all the participants was 4.8%. Although, the proportion of women who had CIN was more among participants using IUD than non-users of modern contraception, the difference was not statistically significant. CONCLUSION: There was no significant association between IUD and cervical neoplasia in this study.

Profile and microbiological isolates of asymptomatic bacteriuria among pregnant women in Abakaliki, Nigeria.

BACKGROUND: Detecting and treating asymptomatic bacteriuria (ASB) prevents urinary tract infection and its consequences. The cost-effectiveness of routine screening for ASB in pregnancy is controversial. In populations with high prevalence, however, it is worthwhile and justifiable. AIM: To determine the profile, prevalence, microbiological isolates, and risk factors of ASB among booking antenatal clinic attendees in Abakaliki, Nigeria. MATERIALS AND METHODS: This was a cross-sectional study involving booking antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, who met the inclusion criteria. This study occurred between January and December, 2012. The midstream urine samples of these women were subjected to microscopy, culture, and sensitivity. RESULTS: A total of 300 randomly selected booking antenatal clinic attendees participated in the study; 74 of them had ASB, giving a prevalence of 24.7%. With the exception of rural residence, sociodemographic and obstetric characteristics did not influence the risk of ASB among the participants in this study. Staphylococcus aureus was the commonest organism isolated. The majority of the organisms were sensitive to ofloxacin and ceftriaxone. CONCLUSION: There is a high prevalence of ASB among pregnant women in Abakaliki. With the exception of rural dwelling, sociodemographic and obstetric characteristics did not significantly influence the risk of ASB among these pregnant women. Therefore, routine ASB screening of pregnant women is recommended in our environment.

Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting?

BACKGROUND: The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives. OBJECTIVE: To determine the association between hormonal contraceptives and cervical neoplasia. MATERIALS AND METHODS: This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence. RESULTS: A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were ≥35 years old (6% versus 1%, P<0.0001), rural dwellers (6% versus 3.5%, P<0.0001), unmarried (7.6% versus 3.5%, P<0.0001), unemployed (6.8% versus 3.5%, P<0.0001), less educated (6% versus 3.8%, P<0.0001), and had high parity (6.8% versus 3.6%, P<0.0001). There was no statistical significant difference in cervical neoplasia between the two groups of participants (7 [4.5%] versus 6 [3.8%], P=1.0). CONCLUSION: There was no association between hormonal contraceptives and cervical neoplasia in this study.

Evaluation of clinical breast examination and breast ultrasonography among pregnant women in Abakaliki, Nigeria.

BACKGROUND: Breast cancer in pregnancy accounts for 2%-3% of all breast cancers. The increased vascularity and lymphatic drainage from the breast during pregnancy potentiate the metastatic spread of the cancer to the regional lymph nodes. However, the increased breast density in pregnancy makes it difficult to detect breast lesions early. AIM: To evaluate and compare the detection rate of breast lesions using clinical breast examination (CBE) and breast ultrasonography among pregnant women. METHODOLOGY: A cross-sectional comparative study involving antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, was conducted between March 3, 2014, and December 31, 2014. CBE and breast ultrasonography were done in the participants at booking and repeated at 6 weeks postpartum. Fine-needle aspiration cytology and histology were done in women with suspicious breast lesions on CBE or breast ultrasonography or both. Data analysis was both descriptive and inferential at the 95% confidence level using the Statistical Package for the Social Sciences (SPSS) software version 17.0. Test of significance was done using chi-square test. A P-value of less than or equal to 0.05 was considered statistically significant. RESULTS: A total of 320 pregnant women participated in the study. Of these, 267 (83.4%) were aware of breast cancer. Although more lesions were detected with breast ultrasonography than by CBE, there was no statistically significant difference between them (25 versus 17; P=0.26). The histology of the lesions revealed 21 benign lesions and 4 normal breast tissues. The sensitivity of breast ultrasonography was 95.2%, while that of CBE was 66.7%. The specificity, positive predictive value, and negative predictive value were similar between CBE and breast ultrasonography. CONCLUSION: The detection rates of breast lesions by both CBE and breast ultrasonography were equivalent during pregnancy and 6 weeks postpartum, making CBE a convenient and very cost-effective method of detecting breast lesions in the low-risk population. However, both CBE and breast ultrasonography should be done in women with high risk of breast malignancy.

A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria.

BACKGROUND: The global rise in cesarean delivery rate has been a major source of public health concern. AIM: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. MATERIALS AND METHODS: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. RESULTS: Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. CONCLUSION: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction.

Perception of assent in biomedical research among medical specialists and trainees in Abakaliki, Nigeria.

BACKGROUND: Assent is the child's affirmative agreement to participate in research. Consent from parents and assent from children are required in research involving children. OBJECTIVE: To determine the knowledge, perception, and level of practice of assent in children among medical specialists and trainees in research work as well as the level of ethical norms observed during research. METHODS: A semistructural questionnaire was designed for a cross-sectional survey of medical specialists and trainees at the Federal Teaching Hospital Abakaliki at their different departments in the months of January and February 2013. The questionnaires were completed and analyzed. RESULTS: A total of 113 questionnaires were distributed, correctly completed, and analyzed. The mean age of the respondents was 36.2±5.9 years, with a range of 25-55 years. The mean duration of practice was 6.3±3.9 years, with a range of 3-20 years. The majority of respondents were trainees (106, 93.8%). There was no significant association between sociodemographic variables of the respondents and the practice of obtaining assent in research involving children (P>0.05). Ethical clearance was obtained by all medical specialists during their research, but none of those whose research involved children got assent from the children. The majority of medical specialists (80%) and trainees (65.1%) support the practice of assent as a mandatory prerequisite in ethical study. Most of the medical specialists (83.3%) and trainees (65.1%) agree that parents could be influenced by other considerations and benefits in enrolling their children in research. Assent after consent in research involving children in African setting was acknowledged as a necessity by 66.7% of medical specialists and 75.2% of trainees. CONCLUSION: Assent was observed as a necessary ethical issue in research involving children in this study; however, it is often not sought in our setting.

Seroprevalence and correlates of human T-cell lymphoma/leukemia virus type 1 antibodies among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

BACKGROUND: Human T-cell lymphoma/leukemia virus (HTLV)-1 is a retrovirus transmitted vertically from mother to child parenterally and sexually by infected lymphocytes. OBJECTIVE: The objective of this study was to determine the seroprevalence of HTLV-1 antibodies and associated risk factors for HTLV-1 infection among pregnant women in University of Nigeria Teaching Hospital, Enugu, southeast Nigeria. MATERIALS AND METHODS: A cross-sectional study was carried out from July to October 2010. Two hundred pregnant women were recruited consecutively from the antenatal clinic. Five milliliters of blood was collected from each of the participants into a plain sterile bottle and allowed to clot. The serum obtained was stored at -20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich enzyme-linked immunosorbent assay kit. Participants' demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17. RESULTS: The average age of the pregnant women was 28.94 years (standard deviation 4.17). The age-group with the highest representation was those between the ages of 26 and 30 years. Thirty-six percent of the population was above 30 years old. The result of the tests showed that only one respondent, a 31-year-old pregnant woman tested positive for HTLV-1 antibodies. Therefore, the seroprevalence of HTLV-1 antibodies among pregnant women attending the antenatal clinic at University of Nigeria Teaching Hospital was 0.5%, with a 95% confidence interval of 0%-2.8%. Some of the sociodemographic risk factors of HTLV-1 infection found to be applicable to the 31-year-old woman who tested positive included positive history of previous sexually transmitted diseases, high parity, low socioeconomic status, female sex, and age above 30 years. The pregnant women that participated in this study were exposed to risk factors and behaviors associated with HTLV-1 infection. Some of the pregnant women (17.5%) had contracted sexually transmitted diseases, and 80.5% did not use condoms during coitus. CONCLUSION: The seroprevalence obtained in this study was low, though it is 100% for anyone infected. More prospective and multicenter studies are required to determine the infectivity of HTLV-1 among pregnant women in Nigeria.

Increased prevalence of activated protein C resistance during pregnancy may implicate venous thrombo embolic disorders as a common cause of maternal mortality in Nigeria

Background: Acquired resistance to protein C in pregnancy has been established as one of the factors associated with thromboembolic phenomenon, an important cause of maternal mortality and morbidity. Objectives: To establish the mean levels of PCA ratio (measure of protein C resistance) of among our pregnant women since maternal mortality rate of the country is on the increase despite efforts to reduce this trend. Materials and Methods: A prospective study was carried out in a tertiary institution in Enugu State, Southeastern Nigeria over the 7 months period from May 2010 to November 2010. Two hundred pregnant women and 50 non pregnant female controls were recruited and PCA ratio, (coagulometric assay) were determined. Results: There was a non significant difference between the mean and standard deviation PCA ratio of the female non pregnant controls and pregnant women in 2nd trimester 4.32±0.4 and 4.30±0.4 respectively. A significant difference was noted between the controls and pregnant women in 3rd trimester 4.32±0.4 and 3.87±0.5 respectively also between the pregnant women in their 2nd and 3rd trimester 4.30±0.4 and 3.87±0.5 respectively. Conclusion: There is increased protein resistance C in our pregnant women. This may implicate thromboembolic disorders as one of the leading causes of increase maternal mortality despite a downward trend in the prevalence of post partum haemorrhage