The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

BACKGROUND: Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. METHODS: This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. RESULTS: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. CONCLUSION: The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Effectiveness of Glycated Haemoglobin in the Diagnosis of Gestational Diabetes Mellitus among Pregnant Women in Port Harcourt, Nigeria.

Background: Gestational Diabetes Mellitus (GDM) is a common metabolic complication in pregnancy with a broad range of adverse foetal and maternal outcomes if not properly managed. Due to the difficult nature of the Oral glucose tolerance test (OGTT), the utilization of the Glycatedhaemoglobin (HbA1c) test as a simpler and acceptable alternative has been suggested. The aims were to determine the GDM prevalence, the diagnostic accuracy, the optimal cut-off point and the validity of the HbA1c in diagnosing GDM using OGTT as the gold standard in the University of Port Harcourt Teaching Hospital (UPTH). Methodology: This was a prospective cross-sectional study involving a cohort of 250 antenatal attendees at 24-28 weeks of pregnancy in the UPTH from 1st February 2018 - 30th April 2018. Socio-demographic data and results of the OGTT and HbA1c tests were analysed using SPSS 21.0 for windows® statistical software. The area under the Receiver Operating Characteristics (ROC) curve was used to determine the diagnostic accuracy of HbA1c. The Youden index was used to get the optimal cut-off point for HbA1c. The validity of the HbA1c was determined using sensitivity, specificity, positive predictive value and negative predictive value. The P-value at p<0.05 was set as the level of significance. Results: Out of the 250 women, 36 (14.4%) had GDM hence in this study, the GDM prevalence was 14.4%. Area under the curve (AUC) = 0.649; 95% confidence interval: 0.550 - 0.748; p-value = 0.004. The optimal cut-off point for HbA1c was 5.18% with a sensitivity of 63.9%, a specificity of 59.3%, a positive predictive value of 20.9% and a negative predictive value of 90.7%. Conclusion: The HbA1c at the Optimal cut-off point of 5.18% in our environment cannot replace the OGTT in the diagnosis of GDM because of its low sensitivity and specificity but will be useful in the screening for GDM because of its high negative predictive value at 24-28 weeks gestation. This will reduce the count of gravidae who undergo the cumbersome OGTT.

Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: results of a multicenter trial.

AIM: The study investigated the effectiveness of sublingual misoprostol when used as primary treatment of primary post-partum hemorrhage (PPH) in a low-income country. METHODS: Maternity care providers in three Nigerian hospitals administrated 800 µm sublingual misoprostol to women experiencing PPH. The outcome variables were estimated blood loss and the need for additional uterotonic drugs after initial treatment with misoprostol. Entry criteria included women in term spontaneous labor, while exclusion criteria were women with operative delivery and those experiencing PPH not due to atonic uterus. RESULTS: One hundred and thirty-one women with PPH were treated over 6 months. Estimated blood loss ranged 500-2500 mL. Twenty women (15.3%) required additional uterotonic drugs to control continuing blood loss. There were no maternal deaths, while seven perinatal deaths were recorded. CONCLUSION: We conclude that although sublingual misoprostol is effective in reducing blood loss due to PPH, it does not effectively treat all forms of PPH. Additional uterotonics and other ancillary treatments would be required.

Cervical Cancer: Overview and Prevention

BACKGROUND.Cervical cancer though a preventable disease; still has an estimated mortality of 80% from invasive cervical cancer in developing countries. The aim of this paper is to present an overview of cervical cancer and the various modalities available for screening and prevention of cervical cancer.METHODOLOGY: Google search and review of the literature of published works on overview of cervical cancer and its various modalities for screening and prevention were utilised.RESULTS.The incidence; aetiology; risk factors; clinical features; management and prevention of cervical cancer in Nigeria and as compared worldwide is presented. The reduction in incidence and mortality of cervical cancer in developed countries is related to the fact that cervical cancer screening is well institutionalized.CONCLUSION.Cervical cancer is the commonest genital tract malignancy in Nigeria. It is a sexually transmitted infection caused by the HPV. It is preventable! Vaccination against HPV is available worldwide and in Nigeria. It is thus imperative that the general public and medical personnel in particular appreciate the clinical importance of cervical cancer; and effectively outline the modalities for preventing cervical cancer; and thus advocate for institutionalizing cervical cancer screening activities in the Nigerian setting