Case fatality and factors associated with Maternal mortality in patients with eclampsia: A retrospective review of 761 cases in a tertiary institution in Nigeria.

To determine the case fatality and factors associated with maternal mortality in patients with eclampsia in UMTH, we conducted a retrospective review of 761 consecutive cases of eclampsia managed UMTH, Nigeria, from 2005 to 2020. Case fatality was 7.6%, most being unbooked primigravidae with no formal education. Common causes of death identified were aspiration, cerebrovascular accident, and haemorrhage. Admission delayed >10 hours was found to be independently associated with maternal death, and Caesarean delivery.

A shortened versus standard matched postpartum magnesium sulphate regimen in the treatment of eclampsia: a randomised controlled trial.

Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia Between January and June 2011, 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart. The maternal and fetal outcomes were compared. The primary outcome measure was recurrence of fits. The recurrence of fits and other maternal complications were similar in the two groups. The total dosage of magnesium sulphate in the shortened group was reduced by 40% in 66% of patients. The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia.

Nigerian lawyers and reproductive health rights: a survey of knowledge, practices and opinions on law reforms among the bar and bench in north eastern Nigeria.

The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population- based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries.

A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria.

OBJECTIVE: To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. METHODOLOGY: Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. RESULTS: Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had a higher case fatality of 24.0% compared to 15% among book cases, while those with formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11 (21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. CONCLUSION: Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria.

OBJECTIVE: To determine the trend and indications for the use of caesarean delivery in our environment. METHOD: A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. RESULTS: During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. CONCLUSION: Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate.

Trends in maternal mortality in a tertiary institution in Northern Nigeria.

OBJECTIVE: To look at the trends in maternal mortality in our institution over 5 years. METHODS: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. RESULTS: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (chi2=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with chi2=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (chi2=64.69, P =0.00000; and chi2=18.52, P =0.0000168, respectively). CONCLUSION: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.

Child labor and sexual assault among girls in Maiduguri, Nigeria.

OBJECTIVE: To determine the relationship between child labor and sexual assault among girls in Maiduguri, Nigeria. METHODS: Face-to-face interview using a validated questionnaire of a randomly selected sample of employed girls. RESULTS: Out of 350 girls, 316 were successfully interviewed for a response rate of 90.3%. Mean age of the girls was 14.9+/-2.3 years and mean workday was 8.5+/-3.8 hours/day. In 33.4% of cases the girls had no formal education, and 78.5% were not currently going to school. The sexual assault rate was 77.7%, and in 38.6% of cases the assailant was a customer. Sexual assault was more likely in girls who were younger than 12 years (OR 3.54; 95% CI, 1.38-9.14), had no formal education (OR 4.80; 95% CI, 1.63-14.16), worked for more than 8 hours/day (OR 4.43; 95% CI, 1.60-12.30), or had 2 or more jobs (OR 16.09; 95% CI, 1.20-61.70). CONCLUSION: To reduce the risk of sexual assault, if girls are employed they should be older, work for limited hours, and not have more than one job at a time.

Prevalence, associated factors and effects of malaria parasitaemia in pregnancy in a tertiary hospital in northeastern Nigera

Background: About 30 million women living in malaria endemic area become pregnant each year. We determined the prevalence; determinants and consequences of malaria parasitemia in pregnancy in Maiduguri; North-eastern Nigeria. Method: Four hundred healthy pregnant women were randomly selected for the study. Packed cell volume estimation and blood film examination for malaria parasite were done at booking and delivery. Cord blood and placental tissue were also examined for malaria parasite. Risk factors and consequences of malaria parasitemia were determined. Results: The prevalence of malaria parasitemia at booking was 60.3with mean parasite density of 701.04+382.22 parasite/?l. These dropped to 28.8and 405.17+310.43 parasite/?l; respectively at delivery. The factors associated with malaria parasitemia were young maternal age (p0.001); low parity (p0.001); late booking (pCl = 2.2-5.5); preterm delivery (OR = 2.5; 95Cl = 1.12-5.2); low birth weight (OR = 10.5; 95Cl = 4.4-25.1); placental malaria (OR = 6.00; 95Cl = 3.7-9.6) and cord parasitemia (OR = 16.9; 95Cl = 8.5-33.6). Conclusion: There were high prevalence of malaria parasitemia and parasite density in pregnancy at booking. However; both declined remarkably at delivery as a result of intermitten preventive therapy

Polygamy and the use of contraceptives.

OBJECTIVES: To compare contraceptive use among women in monogamous and polygamous marriages in Nigeria. METHODS: Structured questionnaires administered to married women enquired about their marriage type, sociodemographic characteristics, and contraceptive use. RESULTS: Of the 532 respondents, 33.6% were in polygamous marriages. There was a statistically significant association between monogamy and nonutilization of contraception (P=0.03); however, women in polygamous marriages were more likely not to use contraception when they were older than 35 years, had 4 or more living children, had no male child, had 3 or more female children, or lived in rural areas. There was also a statistically significant association between nonutilization of contraception and number of male children of co-wives (P=0.003), number of female children of co-wives (P=0.05), and use of contraception by co-wives (P=0.002). CONCLUSION: Polygamy influences contraceptive use and the role of co-wives in this regard merits further study.