Platelet Indices and Erythrocyte Sedimentation Rate are useful Parameters in the Assessment of a Cohort of Nigerian Women with Preeclampsia.

BACKGROUND: The study compared some haematological parameters in normotensive pregnant women with those of women with pre-eclampsia (PE) to identify those parameters that may reinforce the occurrence and severity of PE. METHODS: The study was a case-control study involving 40 pre-eclamptic women as subjects and 40 normotensive pregnant women as controls. The subjects were classified into mild and severe based on their blood pressure of >140/90 mmHg and >169/100 mmHg, respectively. Full blood count (FBC) was done using a haematology autoanalyzer, D-dimer and fibrinogen were assessed by enzyme-linked immunosorbent assay (ELISA) method, while Prothrombin Time (PT) and activated plasma thromboplastin time (aPTT) were done manually. RESULTS: The mean PCV was higher while the mean WBC was lower in PE but the differences were not statistically significant. The ESR was significantly higher (50.48 ± 2.90mm/hr vs 41.05 ± 3.74mm/hr, p < 0.049). The mean neutrophil (59.38 ± 7.77% vs 64.95 ± 6.68%; p < 0.001) and lymphocyte (31.35±7.67% vs 7.63±7.47%, p = 0.031) counts were significantly lower and higher, respectively, in PE. Although the mean platelet count in PE was lower, the plateletcrit, mean platelet volume (MPV), and platelet distribution width (PDW) were significantly higher in PE (p = 0.01, 0.04, 0.001, respectively). The D-dimer was significantly higher in the women with PE (p < 0.001), while the PT, aPTT and fibrinogen concentrations were not statistically different between the two groups. CONCLUSION: It may be concluded that low platelet count, high MPV, PDW, PCT and ESR in PE women may reinforce the diagnosis while a high MPV may, in addition, discriminate between severe and mild Pre-eclampsia.

CONTEXTE: L'étude a comparé certains paramètres hématologiques chez des femmes enceintes normotendues à ceux de femmes atteintes de pré-éclampsie (PE) afin d'identifier les paramètres qui peuvent renforcer l'occurrence et la gravité de la PE. MÉTHODES: Il s'agissait d'une étude cas-témoins impliquant 40 femmes pré-éclamptiques comme sujets et 40 femmes enceintes normotendues comme témoins. Les sujets ont été classés en légers et sévères sur la base de leur pression artérielle de > 140/90 mmHg et >169/100 mmHg respectivement. La formule sanguine complète (FBC) a été réalisée à l'aide d'un auto-analyseur d'hématologie, les D-dimères et le fibrinogène ont été évalués par la méthode ELISA (enzymelinked immunosorbent assay), tandis que le temps de prothrombine (PT) et le temps de thromboplastine plasmatique activé (aPTT) ont été réalisés manuellement. RÉSULTATS: Le VPC moyen était plus élevé tandis que le nombre moyen de globules blancs était plus faible dans l'EP, mais les différences n'étaient pas statistiquement significatives. L'ESR était significativement plus élevé (50.48 ± 2.90mm/hr vs 41.05 ± 3.74mm/hr, p < 0.049). Les numérations moyennes des neutrophiles (59,38 ±7,77 % contre 64,95 ± 6,68 % ; p < 0,001) et des lymphocytes (31,35±7,67 % contre 27,63±7,47 %, p = 0,031) étaient respectivement plus faibles et plus élevées de manière statistiquement significative dans l'EP. Bien que la numération plaquettaire moyenne dans l'EP soit plus faible, le critère plaquettaire, le volume plaquettaire moyen (VPM) et la largeur de distribution plaquettaire (LDP) étaient significativement plus élevés dans l'EP (p = 0,01, 0,04, 0,001 respectivement). Le D-dimère était significativement plus élevé chez les femmes atteintes d'EP (p < 0,001), tandis que les concentrations de PT, aPTT et fibrinogène n'étaient pas statistiquement différentes entre les deux groupes. CONCLUSION: On peut conclure qu'une faible numération plaquettaire, un VPM élevé, un PDW, un PCT et un ESR chez les femmes atteintes d'EP peuvent renforcer le diagnostic, tandis qu'un VPM élevé peut, en outre, faire la distinction entre une pré-éclampsie grave et une pré-éclampsie légère. Mots clés: Prééclampsie, Numération plaquettaire, Indices plaquettaires, ESR, D-Dimères, Gravité.

Impact of Parity on Cardiac Structure and Function in Apparently Healthy Pregnant Nigerian Women.

BACKGROUND: There are few and conflicting reports in the literature about the relationship between parity and maternal cardiac function. The study aimed to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria. METHODS: This was a cross-sectional study carried out in 3 tertiary centers in Kano, and 1 in Ile-Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation, and their cardiac structure and function assessed using echocardiography. Left ventricular (LV) systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling and tissue Doppler velocities. RESULTS: LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects, respectively. Age (p= <0.0001), left atrial (LA) size (P<0.0001), interventricular septal thickness at end diastole (IVSD) (p= 0.005), posterior wall thickness at end diastole (PWTD) (p=0.004) and QRS duration (p= <0.0001) all increased progressively with higher parity, while tricuspid annular systolic excursion (p=0.320) decreased with higher parity. There was significant positive correlation between parity and age (r= 0.475, p= <0.0001), LA size (r=0.332, p= <0.0001), IVSD (r=0.264, p= 0.005) and PWTD (r= 0.343, p= <0.0001). LV systolic function was not significantly associated with parity. CONCLUSION: Our findings suggested that parity was significantly associated with myocardial remodeling in apparently healthy pregnant women.

CONTEXTE: Il existe peu de données contradictoires dans la littérature sur la relation entre la parité et la fonction cardiaque maternelle. L'étude visait à évaluer l'impact de la parité sur la structure et la fonction cardiaques chez des femmes enceintes apparemment en bonne santé au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans 3 centres tertiaires à Kano et 1 à Ile-Ife, au Nigeria. 112 femmes enceintes apparemment en bonne santé ont été recrutées consécutivement entre la 28* et la 38* semaine de gestation, et leur structure et fonction cardiaques ont été évaluées par échocardiographie. La dysfonction systolique du ventricule gauche (VG) a été définie comme une fraction d'éjection du VG inférieure à 50 %, et la dysfonction diastolique a été graduée en utilisant le remplissage mitral et les vitesses Doppler tissulaires. RESULTATS: Un dysfonctionnement systolique VG et un dysfonctionnement diastolique ont été trouvés chez 6 (5,4 %) sujets et 20 (17,9 %) sujets respectivement. Âge (p=<0,0001), taille de l'oreillette gauche (LA) (P<0,0001), épaisseur du septum interventriculaire en fin de diastole (IVSD) (p=0,005), épaisseur de la paroi postérieure en fin de diastole (PWTD)(p=0,004) et La durée du QRS (p = <0,0001) a augmenté progressivement avec une parité plus élevée, tandis que l'excursion systolique annulaire tricuspide (p = 0,320) a diminué avec une parité plus élevée. Il y avait une corrélation positive significative entre la parité et l'âge (r = 0,475, p = <0,0001), la taille LA (r = 0,332, p = <0,0001), IVSD (r = 0,264, p = 0,005) et PWTD (r = 0,343, p=<0,0001). La fonction systolique VG était associée à la parité. CONCLUSION: Nos résultats suggèrent que la parité est significativement associée au remodelage du myocarde chez les femmes enceintes apparemment en bonne santé. n'était pas significatif. Mots clés: Grossesse, Parité, Structure Cardiaque, Registre peace.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians.

BACKGROUND: Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women. MATERIALS AND METHODS: Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant. RESULTS: The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19-44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e' velocity at the septal margin but a progressive increase in a' velocity were also observed (P < 0.05). CONCLUSION: Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

FEMALE GENITAL MUTILATION: ARE WE WINNING?

BACKGROUND: For more than 25 years, efforts have been geared towards curtailing the practice of female genital mutilation (FGM) in countries like Nigeria. This study was designed to see if all these efforts have made any impact in reducing the prevalence of FGM appreciably in the south-West of Nigeria. OBJECTIVE: To determine the prevalence of female genital mutilation and profiling the trends of FGM affected patients. DESIGN: A prospective study based on direct observation of the external genitalia by health-care workers . SUBJECTS: Five hundred and sixty five females less than 15 years of age. SETTING: The children emergency and gynaecological wards of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st of January to December 31s 2007. RESULTS: Forty one point nine percent of the patients examined had female genital mutilation, 93.2% of these had the procedure before attaining the age of one year. Type 2 FGM predominated (58.22%). The procedure was performed predominantly (64.6%) by traditional birth attendants. The decision to have the procedure done was influenced in 78% of cases by mothers and grandmothers. In 35.4% of cases, there were immediate and short term complications. Demands of tradition predominated (59.1%) as the most important reason for the practice of female genital mutilation. CONCLUSION: The practice of FGM appears to be still highly prevalent and resistant to change probably due to deep rooted socio-cultural factors. Strategies such as public education campaigns highlighting its negative impact on health and disregard for human rights should be evolved.

HELLP syndrome: the experience at Ile-Ife, Nigeria.

Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0-5 and the estimated gestational age from 18-41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

Evaluation of health workers' training in use of the partogram.

OBJECTIVE: To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers. METHODS: Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months. RESULTS: A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs. CONCLUSION: Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants.

Re-usable low density polyethylene arm glove for puerperal intrauterine exploration.

OBJECTIVE: To design a long arm glove that can be used within a puerperal uterus to prevent the health-care worker contracting HIV from an infected patient. The designed long arm glove should be cheap (affordable) and readily available in low resource centres and must have proven sterility assurance and tensile strength to confer protection for the health worker. DESIGN: Prospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st December 2006 to 31st May, 2007. SUBJECTS: Fifty medical students of both sexes were selected randomly and the average length from the styloid process to the mid upper-arm of each was measured and the average length was later determined. This was to determine the length of the low density polyethylene long arm gloves to be made from virgin polyethylene material. Consecutive cases of patients with retained placentae in the puerperium who were scheduled for manual removal of the placenta within the period. RESULTS: Packs of low density polyethylene (LDPE) long arm gloves were made from virgin polyethylene material. When subjected to bacteriological analysis, three out of four glove packs were contaminated with Staphylococcus, Bacillus and Klebsiella species of bacteria. Gamma irradiation ranging from 28.133 to 83.35 kiloGray of gamma-irradiation (kGy) sterilised all the gloves as postirradiation glove specimens showed no bacterial contamination. However, at doses up to 50 kGy gamma irradiation caused "strengthening" of the polyethylene gloves. While at doses greater than 50 kGy, gamma irradiation caused "embrittlement" of the material. Thus, 50 kGy of gamma irradiation was found to be an ideal dose to strengthen and to sterilise the glove for usage. The sterilized gloves were found to be effective when used in consecutive cases of retained placenta in protecting the health care workers (HCW) from contamination by possibly HIV contaminated blood. CONCLUSION: There is a risk of contracting HIV for the health-care worker while carrying out a procedure within the puerperal uterus. The low density polyethylene arm glove was designed to prevent this in low resource centres as it would be affordable, available, with proven sterility assurance and mechanical properties to confer protection for the health care worker.

Caesarean section: intra-operative blood loss and its restitution.

OBJECTIVES: To determine the rate of blood loss and its restitution during Caesarean section and make recommendations to improve our practice. DESIGN: Prospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st January 2005 to December 2005. SUBJECTS: All term Caesarean sections performed during the period. RESULTS: Six hundred and forty one patients met the inclusion criteria. The mean maternal age was 30.42 years +/- 5.5 (Range 16-44 years). Fifty seven patients (8.9%) were transfused. Major blood loss (>1000 ml) was reported in 7.6% of the patients. The main causes of major blood loss during surgery were placental disorders and pre-eclampsia. The main indications for transfusion were placental disorders, pre-eclampsia and breech presentation. The packed cell volume, status of the anaesthetist and the ASA grading were other factors, which had statistical association with blood transfusion. The risk of major blood loss and transfusion were negligible in patients presenting for foetal distress, cephalo-pelvic disproportion and breech presentation. CONCLUSION: The rate of blood transfusion during Caesarian section is high. Antepartum haemorrhage and pre-eclampsia were predictable indications for major blood loss and transfusion. Major blood loss and transfusion rate were negligible in patients presenting with foetal distress, cephalo-pelvic disproportion and breech presentation.

Determinants of antenatal booking time in a South-Western Nigeria setting.

BACKGROUND: Utilisation of antenatal services and early booking are important factors in the reduction of maternal mortality and morbidity and these are influenced negatively by social, cultural and religions factors. OBJECTIVE: To determine factors that influence the booking time in South Western Nigeria with the intention of identifying areas needing educational intervention. METHODS: A descriptive cross-sectional study of 327 antenatal patients done between January to March 2005. Using both structured and semi-structured questionnaires information were collected on the socio-demographic and complete medical history. RESULTS: Two hundred and forty-six (90.4%) out of the 272 women who met the inclusion criteria were interviewed. The mean (SD) age of patients was 30.47 (5.52) years, of which 60% of the mothers were educated beyond secondary school level and 44.3% of the patients booked late. Late booking was thrice as common in multiparae as in nulliparae. Variables that were significantly associated with time of booking included educational level of the husband (P = 0.005), parity (P = 0.012), previous miscarriage (P < 0.001) and medical problem in the index pregnancy. Stepwise regression analysis showed the latter two factors as predictors of booking time. (Beta of -0.566 and -0.643, respectively). 57.3% of pregnant mothers felt that women should book by the first trimester but half of them actively booked late. Early detection of problems was the commonest reason for the choice of time of booking. CONCLUSION: The socio-cultural and religious determinants of health-seeking behaviours need to be researched further and unless these are modified by interventional campaigns good education may not easily translate to optimum utilisation of antenatal services.

Changes in sexual practices and responses among ante-natal clinic attendees in a Nigerian teaching hospital.

A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

Effect of prolonged birth spacing on maternal and perinatal outcome.

BACKGROUND: Researchers have held varied opinions on the effect of prolonged birth spacing on maternal and perinatal outcome. OBJECTIVES: To determine the reasons for prolonged birth spacing and to compare the maternal and perinatal outcome compared to shorter normal birth spacing. DESIGN: Comparative case - controlled study between January 1st, 2001 to December 31st, 2002. SETTING: Obstetric Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: Fifty cases consisted of multiparae with prolonged birth spacing (> or =6 years) and controls consists of similar number of multiparae with shorter normal birth spacing (2 - 5 years) matched for age, parity and socio-economic status. MAIN OUTCOME MEASURES: Labour outcome, Apgar scores, operative and vaginal delivery rates, perinatal and maternal outcome, reasons for prolonged birth spacing. RESULTS: There was no significant difference observed with respect to spontaneous onset of labour, induction or argumentation of labour, duration of labour, spontaneous vaginal delivery rates, Caesarean section rates, instrumental vaginal deliveries, analgesic requirement, postpartum haemorrhage, and Apgar scores in both groups. There were no perinatal or maternal deaths. The commonest reason adduced for prolonged birth spacing is failed contraception (56%), followed by secondary infertility (24%) and to a lesser extent re-marriage, improved income and sheer desire. CONCLUSION: There was no significant difference in maternal and perinatal outcome in pregnancy between women with prolonged birth spacing and those with normal shorter birth spacing.

Evidence for increased metabolism of chloroquine during the early third trimester of human pregnancy.

OBJECTIVE: To examine the possibility of a different extent of chloroquine (CQ) metabolism in human pregnancy by determining blood level profiles of the drug and its major metabolite, desethylchloroquine (CQM). METHODS: Five women in the early third trimester of pregnancy and five non-pregnant women received each a single 600 mg oral dose of CQ and blood samples were collected at pre-determined intervals following drug administration. Plasma concentrations of CQ and CQM were analysed by an established HPLC method. RESULTS: The C(max) and AUC(0-48 h) of CQM were significantly higher in the pregnant than the non-pregnant group (P = 0.009). The ratio AUC(CQ)/AUC(CQM) ranged from 0.09 to 0.35 among pregnant women, and from 1.70 to 4.81 among non-pregnant women. CONCLUSION: Results from this preliminary study indicate an occurrence of induction of metabolism of CQ in the early third trimester of pregnancy. In view of toxicological importance of CQ metabolites, it is suggested that caution should be exercised in evaluation of higher dosage regimen of CQ in pregnant women.

Orofacial injuries in eclamptic Nigerians.

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.

Risk factors for preterm delivery in south western Nigeria.

This was a case-control study to determine the risk factors of preterm delivery among Nigerian women seen at Obafemi Awolowo University teaching hospital, Ile-Ife, Nigeria over a period of 9 months. All women delivering preterm were recruited into the study, with two consecutive term deliveries after each preterm delivery serving as controls. Information obtained from the women includes socio-demographic characteristics, past reproductive and present pregnancy history and outcome. Laboratory investigations were conducted as necessary. Bivariate analysis revealed 21 potential risk factors, however, following adjustment by multiple logistic regression only previous preterm delivery (OR 4.68, 2.24-6.31), previous second trimester spontaneous abortion (OR 4.48, 2.32-8.54), heavy and stressful occupation (OR 3.56, 1.05-6.45), premature rupture of fetal membrane (OR 3.46, 1.04-6.45), maternal medical disorders (OR 3.13, 1.56-5.16), body mass index at delivery of less than 23 (OR 3.01, 1.56-5.43), antepartum haemorrhage (OR 2.73, 1.18-6.34), maternal febrile illness (OR 2.84, 1.32-4.52), intrauterine growth retardation (OR 2.14, 0.98-2.34) and multiple pregnancy (OR 1.98, 1.02-2.68) remained as significant factors.

Goitre prevalence in pregnant women attending antenatal clinic in a teaching hospital.

This study aimed to determine goitre prevalence in pregnant women. Seven hundred pregnant women attending the antenatal clinic at Wesley Guild Hospital, Ilesa, were interviewed and examined. The mean age of the subjects was 27.8 years, with mean parity of 2.65. Mean gestation was 28.5 weeks. A total of 97.4% were resident in Ilesa and surrounding towns and villages. Well or stream was the main water supply for nearly all the subjects. Only 7.3% of the subjects showed no thyroid enlargement. Early enlargement (1(a) and 1(b)) occurred in 441 (63%) patients, Grade 2 enlargement in 166 (23.2%) and a grossly enlarged goitre in 40 (5.7%). The goitre rate was correlated with the age and parity of the patients.

Gestational thrombo-embolic disorders.

Even though it appears that pulmonary embolism might be an infrequent cause of maternal mortality in our environment it could be rapidly fatal when it occurs. As many as 10% of asymptomatic females with deep venous thrombosis can develop pulmonary embolism. Pregnancy being a hypercoagulable state could predispose to the disorder in the presence of other factors. Making a categorical diagnosis could however be problematic especially in Sub-Saharan Africa where necessary facilities might not be available. This present review was undertaken to provide an update in diagnosis and management of the disorder in pregnancy with the aim of guiding clinical decision-making with respect to diagnosis, management modalities, evaluation and preventive measures.

Determinants of mission house delivery among booked patients in a Nigerian teaching hospital.

This study examines the determinants of Mission House Delivery among booked patients in Ile-Ife, Nigeria. During the 12 months of the study (1 May 199930 April 2000) 196 booked patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife who delivered at mission houses were analysed. All ages and parity groups, educational level and social classes were involved. The majority (73%) were of low socio-economic class. The reasons for mission house delivery included financial constraints (41%), fear of possible caesarean section (46%), industrial action by health-care workers (39%), transport difficulty at night (26%), previous deliveries in mission houses (16%) and communal feud (12%). Four maternal deaths occurred (MMR 978/100 000 births) and 20 perinatal deaths (PNMR 118/1000 total births). Reduction of hospital user fees, provision of transportation and efficient telecommunication facilities at all times, conflict resolution and proper remuneration of health care workers are urgent needs to be addressed. Legislation against delivery in unsafe places and establishment of appropriate facilities by churches interested in maternity services is highly recommended.

Decision-caesarean delivery interval in a Nigerian university hospital: implications for maternal morbidity and mortality.

This is a 5-month prospective study to determine the decision emergency caesarean delivery interval in a Nigerian tertiary hospital, the factors responsible for the delays and the consequent maternal and perinatal complications. One hundred and thirty-four emergency caesarean deliveries were analysed and the main indications were failure to progress/ prolonged labour (35.4%), previous caesarean-section/failed trial of scar (27.9%), cephalopelvic disproportion (26.8%), fetal distress (19.5%), pre-eclampsia/eclampsia (15.3%) and obstructed labour/ruptured uterus (14.7%). The mean decision-caesarean delivery interval was 4.4 +/- 4.2 (SD) hours (range 0.5-26 hours), median 3.2 hours and mode 2 hours. Bottlenecks within the maternity unit were responsible for delays in 31.7% of cases. Unavailability of paediatrician (19.6%), non-availability of anaesthetic coverage (13.6%), unreadiness of the operation theatre (11.9%) and seeking second opinion (6.4%) were other major causes of delay. There were 15 perinatal deaths, five of whom were directly linked to the delays i.e. a perinatal mortality rate of 3.7%. Four maternal deaths were directly attributable to delay, a maternal mortality rate of 3%. Other direct consequences of the delays were severe haemorrhage (10.3%), uterine rupture (2.3%) and disseminated intravascular coagulopathy (1.5%). Suggestions on how to minimise delays in emergency services and overall improvement in quality assurance control are discussed.