Determination of antioxidant status of pre-eclamptic and normotensive sub-rural Nigerian pregnant women at the Irrua Specialist Teaching Hospital, Irrua, Edo State.

OBJECTIVES: To determine the antioxidant levels of subrural Nigerian population where pre-eclampsia and eclampsia is the leading cause of maternal mortality. METHODS: Prospective case control study done at Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria. Plasma level of vitamin C and E were evaluated in 80 pre-eclamptic patientswhich were compared with normotensive 80 pregnant women matched as controls. RESULTS: Pre-eclampsia was associated with significant reduction in levels of vitamin C and E (p < 0.05). However, the correlation between the blood pressure (severity) and reduction in antioxidants level was not statistically significant. CONCLUSION: Pre-eclampsia at Irrua in Nigeria is associated with significant reduction in plasma antioxidants level similar to some reports from the other parts of the world.

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome.

BACKGROUND: Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Its removal is commonly associated with complications. To prevent or control the occurrence of this complication requires the understanding of the factors associated with the complications. OBJECTIVE: To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in southwestern Nigeria. METHODS: Study was carried out at two large tertiary hospitals in the south west region of Nigeria. Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine women with uterine leiomyoma seen and managed surgically in South-Western Nigeria were the participants. RESULTS: The common presenting complaints were menstrual irregularities (47.7%), abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with multiple leiomyomata. The commonest anatomical position of the nodules were multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively. Myomectomy was performed in 54.7% of cases. Postoperative complications occurred in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and postoperative anaemia (10.4%) been the most common complications. CONCLUSION: Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua, Nigeria.

BACKGROUND: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographic characteristics of patients with maternal deaths with associated delay. METHODS: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p < 0.05 RESULTS: The mortality ratio in the study period is 1747/ 100,000 live births. Delay was associated with 77.8% of all maternal deaths. Type I delay was the major problem contributing 57.1%. Identified risk factors for delay in this study are; unbooked status, low socioeconomic status and marital status. CONCLUSION: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua; Nigeria

Background: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographiccharacteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital; Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p 0.05 Results: The mortality ratio in the study period is 1747/100;000 live births. Delay was associated with 77.8 of all maternal deaths. Type I delay was the major problem contributing 57.1. Identified risk factors for delay in this study are; unbooked status; low socioeconomic status and marital status. Conclusion: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested

Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods.

Obstructed labour is a common obstetric complication in Nigeria associated with poor fetal and maternal outcome. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. The purpose of this study was to examine and compare the morbidity and mortality associated with two methods of delivery of the impacted fetal head at caesarean section for obstructed labour (the push method and the pull (reverse breech) method). This study is a prospective study of cases of obstructed labour admitted into the labour ward of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between 1 June 1998 and May 31 2000. One hundred and eight women with obstructed labour at term with live fetus undergoing caesarean section were assigned randomly to either of the methods of admission. The maternal and fetal outcomes were analysed and compared between groups. Patients in the push group had statistically significant higher rates of maternal morbidity (longer operation time, more blood loss, extension of uterine incision, endometritis, longer hospital stay and higher hospital bills) than the pull method (P < 0.05). Also the fetal morbidity was worse in the push group. The 'pull' method of delivery of impacted fetal head at caesarean section for obstruction is safer and faster than the 'push' method.