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.

Association between maternal lipid profile and gestational diabetes mellitus

Background: Dyslipidemia is the third component of metabolic syndrome and is a wellknown cardiovascular risk factor. However, the association of dyslipidemia with gestational diabetes mellitus is still a subject of ongoing research in Nigerian obstetric populations.Objective: To determine the relationship between second trimester maternal fasting plasma lipid constituents and gestational diabetes mellitus.Methods: This was a prospective nested case control study that enrolled 288 pregnant women out of which 36 women with GDM (cases) where matched with 72 without GDM (controls) following results of oral glucosetolerance testing and plasma fasting lipid profiles done between 24 28 weeks. The patients were followed up until delivery to document maternal and fetal outcomes. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in percentages while continuous variables were expressed as means (±Standard Deviation). Student ttest and Chisquare test or Fishers exact test were used for comparing variables between the two groups. A value of <0.05 at 95%confidence interval was considered statistically significant.Results: The overall mean plasma lipid levels for the four lipid constituents in the study population were 187.9mg/dL, 163.5mg/dl, 49.1mg/dL and 108.1mg/dL for TC, TG, HDLc and LDc respectively. The mean plasma triglyceride was significantly higher in cases compared to the controls: 187.0±67.7mg/dL vs. 151.7±66.4mg/dL, (p = 0.01). Abnormaltriglyceride was significantly associated with GDM (AOR:4.8, 95% CI (1.6-14.4), (p= 0.005).Conclusion:Maternal dyslipidemia (abnormal triglyceride) was shown to be significantly associated with GDM in this study and it appeared to be causally related

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.

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria.

BACKGROUND: Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility. OBJECTIVE: The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation. MATERIALS AND METHODS: A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted. RESULTS: During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure. CONCLUSION: The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.

Ruptured uterus in a booked patient.

Ruptured uterus, a life-threatening obstetric complication, is a rare event among booked patients. We present a case of uterine rupture in a 28-year-old Gravida 2.para 1 +0 , 1 alive with previous lower segment Caesarean scar due to neglected obstructed labor from fetal macrosomia. She presented in labor at 40 weeks of gestation after declining the advice for an elective Caesarean section (C/S) and also signed against medical advice to receive care from a traditional birth attendant. She returned 30 hours later with a ruptured uterus. Findings at operation included a macerated stillbirth weighing 4.30 kg and a lower segment transverse scar rupture. Subtotal hysterectomy and peritoneal lavage were performed.

Family planning practice in a tertiary health institution in north-western Nigeria.

BACKGROUND: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymous with population control. OBJECTIVE: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information and methods of preference among others. MATERIALS AND METHODS: The record cards of all clients who attended the family panning clinic between January 1st 1998 and December 31st 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuation were extracted and analysed. Comparative percentage was used for the analysis. RESULT: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum.Over 75% of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were their main source(s) of information about family planning services. CONCLUSION: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious/traditional leaders along with improved dissemination of information using the mass media may go along way to increase contraceptive up take.

Awareness and utilization of insecticide treated mosquito nets among pregnant mothers at a tertiary health institution in north-western Nigeria.

INTRODUCTION: Malaria in pregnancy is a formidable misery in Africa and contributes significantly to maternal death in Nigeria. The use of insecticide treated mosquito bed nets is one of the strategies of the Roll Back Malaria initiative. It is a form of vector control measure but there exists discordance between awareness and utilization of insecticide treated nets in Nigeria. This study set out to assess the level of awareness and utilization of insecticide treated nets among pregnant mothers attending antenatal clinic. METHODS: Using a structured questionnaire, a cross sectional study of 250 consecutive pregnant mothers attending antenatal booking clinic in Usmanu Danfodiyo University Teaching Hospital Sokoto between January and March 2008 was conducted. RESULTS: Seventy four percent of the clients were aware of Insecticide treated nets. Awareness of insecticide treated nets was significantly higher in clients with post primary education (66.8%) compared to those with at most primary education (33.2%); p < 0.05. Thirteen percent of the clients were using insecticide treated nets while 67.6% were not. The main reason for non-utilization of insecticide treated nets were non availability of the nets (58.8%) and inconvenience of the barrier to the clients (29.4%). CONCLUSION: There is high level of awareness of insecticide treated nets among the study population but very low utilization largely due to non availability. For Nigeria to achieve the millennium development goal target in combating the menace of malaria in pregnancy, more effort is required to increase the availability of insecticide treated nets. In addition, proper education on the benefits of insecticide treated nets may increase its utilization.

Abdominal pregnancy with a full term live fetus: case report.

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

Cervical ripening: how long can the Foley catheter safely remain in the cervical canal?

This was a prospective study involving 85 patients admitted for induction of labour with unfavourable cervix at Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria. A size 16-20 Foley catheter was passed transcervically into the extra-amniotic space under aseptic technique and the balloon inflated with 30-50 mls sterile water. Each patient was placed on prophylactic antibiotics. The balloon was expelled within 12 hours in 22 (39%) patients. Twenty eight patients expelled the balloon in 12-24 hours, 14 in 25-48 hours, 6 in 49-72 hours and 4 after 72 hours. The average duration of catheter placement when the gestational age was 20-27 weeks was 44.8 hours, which was significantly longer than 19.6 hours obtained for term pregnancies (p < 0.05). Induction of labour was successful in 77 (91%) patients and there was no significant maternal morbidity. The results of our study suggest that the balloon of the Foley catheter can safely remain in the extra-amniotic space longer than 24 hours for cervical ripening if the cervix is unfavourable, provided the membranes are intact and the feto-maternal conditions remain satisfactory.