Pregnancy, obstetric and neonatal outcome after assisted reproduction in Nigerians.

PURPOSE: To evaluate the pregnancy, obstetric and neonatal outcome after assisted reproduction in Nigerians. METHODS: Case control study of all confirmed pregnancies following assisted reproduction managed at the Havana Specialist Hospital (HSH), Lagos over a 7 year period. RESULTS: Adverse obstetric and neonatal outcome occurred in 30.8% of pregnancy following assisted reproduction compared to 12.6% in spontaneously conceived pregnancy (p = 0.0003). Multiple pregnancy (<0.001), preterm delivery (p < 0.000), placenta praevia (0.00002), antenatal admission (0.02), early pregnancy bleeding (0.04), miscarriage (0.001) and caesarean delivery (<0.001) were significantly commoner in the assisted reproduction group. After adjustment for confounding variables, preterm delivery (OR: 5.95), miscarriage (OR: 5.84), multiple pregnancy (OR: 4.58), placenta praevia (OR: 4.13), caesarean delivery (OR: 3.57), early pregnancy bleeding (OR: 2.18) and antenatal admission (OR: 2.01) retained their significance. CONCLUSION: This study has provided the first evidence from our part of the world showing that assisted pregnancy is associated with poorer obstetric outcome when compared with spontaneously conceived pregnancy.

Uterine incision closure at caesarean section: a randomised comparative study of intraperitoneal closure and closure after temporary exteriorisation.

BACKGROUND: The safety of the technique of uterine exteriorization at caesarean section though popular among obstetricians, remains controversial. OBJECTIVE: To evaluate the influence of exteriorization of uterus during uterine repair on caesarean morbidity. METHODS: A randomized comparative study of 136 women undergoing primary caesarean delivery at Havana Specialist Hospital Lagos Nigeria. Data on operation time, estimated blood loss, postoperative morbidities were collected and analysed with comparison between the two groups using chi square, Fischer's exact test and t-test as appropriate. RESULTS: The mean operative time, estimated blood loss, transfusion rate and postoperative anemia rate were significantly less in the exteriorized group than the intraperitoneal group (p = 0.000, 0.009,0.048 0.038 and 0.028 respectively), but not in other outcome measures. CONCLUSION: With shorter operative time, less blood loss and similar morbidity profile exteriorization of uterus during caesarean section seems to be preferred except where it is not possible because of adhesions and surgeons inexperience.

Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P<0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.

Poor obstetric performance of teenagers: is it age- or quality of care-related?

We studied prospectively the effect of antenatal care on the obstetric performance of teenagers seen at a university teaching hospital over a 14-month period. When the obstetric complications among the teenagers were compared to their older counterpart, there were significantly higher complication rates, especially anaemia, preterm delivery, low birth weight and neonatal admission. After controlling for utilisation of antenatal care, significant differences were observed only in the incidence of low birth weight babies. In conclusion, this study has shown that the poor obstetric outcome of teenage pregnancy is related to non-utilisation of prenatal care rather than their biological age.

Vaginal misoprostol induction of labour: a Nigerian hospital experience.

We reviewed our experience with vaginal misoprostol induction of labour in 339 consecutive women with a live fetus and intact fetal membrane using 100 mcg 12-hourly until labour was established. The labours were monitored using the WHO partograph protocol. Two hundred and sixty-five women had a successful induction while 74 had an emergency caesarean section because of cephalopelvic disproportion (63.5%), fetal distress (14.9%), prolonged labour (12.2%), antepartum haemorrhage (6.8%) and other indications (2.8%). The induction delivery interval among the women who had successful induction ranged from 3 hours 42 minutes to 26 hours 15 minutes with a mean of 9 hours 23 minutes (SD 2 hours 41 minutes). Most (73.6%) of these patients delivered within 12 hours of starting induction, the majority (95.3%) requiring only 100 mcg to go into established labour. Complications recorded in this series include fetal distress in 32 (9.4%), postpartum haemorrhage in 23 (6.8%), hyperstimulation in six (1.8%), uterine rupture in one (0.3%), birth asphyxia in eight (2.5%), admission in neonatal intensive care ward in five (1.5%), neonatal death in one (0.3%) and maternal death in one (0.3%) patient. In conclusion, misoprostol was found not only to be efficacious but relatively safe in comparison to other methods of induction in use in our hospital.

Delivery outside hospital after antenatal care: prevalence and its predictors.

Over a period of 5 years (1994 - 1998), of 9519 women who booked for antenatal care at the two tertiary hospitals of the Obafemi Awolowo University Teaching Hospital Complex, Ile Ife,-Nigeria,12.8% (1220) defaulted from hospital delivery. The casenotes of these patients were retrieved from the medical records department and were sorted into two groups of defaulters and non-defaulters from hospital delivery. Information obtained from the casenotes includes sociodemographic characteristic, past obstetric and present obstetric history. Bivariate analysis revealed six potential predictors; however, following adjustment by multiple logistic regression, only history of previous delivery outside the hospital (OR = 3.13, CI = 2.06 - 4.67), planned elective caesarean section in current pregnancy (OR = 2.03, 1.66 - 2.75), caesarean section in last delivery (OR = 1.93, CI = 1.57 - 2.76) and objection to admission in the current pregnancy (OR = 1.33, CI = 1.04 - 1.65) remained as significant predictors.