Rupture of the Gravid Uterus: A Two-Decade Experience at a University Teaching Hospital in South-West, Nigeria.

BACKGROUND: Uterine rupture is an obstetric emergency associated with significant maternal and perinatal mortality and morbidity, especially in resource-constraint countries such as Nigeria. OBJECTIVE: To determine the incidence and feto-maternal outcome of uterine rupture in a Nigerian teaching hospital. METHODS: This was a retrospective review of all cases of uterine rupture managed over 21 years. The case notes of all affected women were retrieved, and information on sociodemographic and obstetric characteristics, clinical presentation, intraoperative findings, and fetal and maternal outcomes were extracted. Data were analyzed using SPSS version 23.0 and descriptive statistics were computed. Factors associated with maternal deaths secondary to rupture of the gravid uterus were determined using binary logistic regression analyses. Statistical significance was reported at P<0.05. RESULTS: There were 31,616 deliveries during the review period, out of which were 182 cases of uterine rupture giving an incidence of 5.76 per 1,000 deliveries. Most of the cases of uterine rupture (65.2%) were treated by uterine repair. Maternal and fetal deaths were recorded in 8.1% and 82.7% of cases respectively. Women aged at least 35 years (P=0.035), women who had laboured at home or traditional birth attendant's (TBA) place (P=0.002), women who had multiple sites rupture (P=0.049) and those who developed hypovolemic shock (P=0.002) were more likely to die from uterine rupture. CONCLUSION: Ruptured uterus remains a significant cause of maternal and perinatal morbidity and mortality in Nigeria. Strategies for prevention include effective health education of the masses, the conduct of labour in a well-equipped health facility, and prompt referral of at-risk women.

CONTEXTE: La rupture utérine est une urgence obstétrique associée à une mortalité et une morbidité maternelles et périnatales significatives, en particulier dans les pays à ressources limitées comme le Nigeria. OBJECTIF: Déterminer l'incidence et l'issue fœto-maternelle de la rupture utérine dans un hôpital universitaire nigérian. MÉTHODES: Il s'agit d'une étude rétrospective de tous les cas de rupture utérine pris en charge sur une période de 21 ans. Les notes de cas de toutes les femmes concernées ont été récupérées et des informations sur les caractéristiques sociodémographiques et obstétriques, la présentation clinique, les résultats peropératoires et les issues fœtales et maternelles ont été extraites. Les données ont été analysées à l'aide de la version 23.0 de SPSS et des statistiques descriptives ont été calculées. Les facteurs associés aux décès maternels consécutifs à la rupture de l'utérus gravide ont été déterminés à l'aide d'analyses de régression logistique binaire. La signification statistique a été rapportée à P<0,05. RÉSULTATS: Il y a eu 31 616 accouchements pendant la période examinée, dont 182 cas de rupture utérine, soit une incidence de 5,76 pour 1 000 accouchements. La plupart des cas de rupture utérine (65,2 %) ont été traités par réparation utérine. Les décès maternels et fœtaux ont été enregistrés dans 8,1% et 82,7% des cas respectivement. Les femmes âgées d'au moins 35 ans (P=0,035), les femmes ayant accouché à domicile ou chez une accoucheuse traditionnelle (P=0,002), les femmes ayant eu des ruptures multiples (P=0,049) et celles ayant développé un choc hypovolémique (P=0,002) étaient plus susceptibles de mourir d'une rupture utérine. CONCLUSION: La rupture de l'utérus reste une cause importante de morbidité et de mortalité maternelles et périnatales au Nigeria. Les stratégies de prévention comprennent une éducation sanitaire efficace des masses, la conduite du travail dans un établissement de santé bien équipé et l'orientation rapide des femmes à risque. Mots-clés: Rupture utérine, Lagos, Mortalité maternelle, Mortalité périnatale, Incidence, Ligature tubaire bilatérale.

Seroprevalence of Hepatitis B, and C Viruses and HIV Infections among Antenatal Women in a Secondary Health Facility in Lagos, Nigeria.

BACKGROUND: Hepatitis B and C viruses and HIV infections contribute a significant proportion to maternal and perinatal morbidity and mortality in low and middle-income countries. While the burden of hepatitis B and C viruses is higher in low and middle-income countries, Nigeria also has the second largest burden of HIV. OBJECTIVES: To determine the seroprevalence of hepatitis B and C viruses and HIV infections among antenatal women who sought care at a secondary health facility in Lagos. METHODS: This was a retrospective review of patients managed in the antenatal clinic of 68 Nigerian Army Reference Hospital over one year. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. RESULTS: A total of 347 women attended prenatal care during the study period, however, only 329 cases with complete data were included in the final statistical analysis. The prevalence of HIV in our study was 6.4%, while HBV and HCV accounted for 6.2% and 1.8% respectively. Hepatitis B, and hepatitis C viruses and HIV Infections occurred in 3 (0.9%) of our patients, 6 (1.8%) of the women had HIV-HBV co-infection while 1 (0.3%) was infected with HIV-HCV. CONCLUSION: Our study re-emphasizes the public health importance of HBV, HCV and HIV screening in our antenatal clinics. This knowledge is very important for the implementation of effective prevention and control measures that will further decrease the mother-to-child transmission of these viruses.

CONTEXTE: Les virus de l'hépatite B et C et les infections par le VIH contribuent pour une part importante à la morbidité et à la mortalité maternelles et périnatales dans les pays à revenu faible et intermédiaire. Alors que le fardeau des virus de l'hépatite B et C est plus élevé dans les pays à revenu faible et moyen, le Nigeria a également le deuxième plus grand fardeau du VIH. OBJECTIFS: Déterminer la séroprévalence des virus de l'hépatite B et C et des infections par le VIH chez les femmes en période prénatale qui ont consulté dans un établissement de santé secondaire de Lagos. MÉTHODES: Il s'agit d'une étude rétrospective des patientes prises en charge dans la clinique prénatale de 68 références de l'armée nigériane sur une période d'un an. Un formulaire d'étude a été utilisé pour recueillir les données pertinentes qui ont été saisies et analysées à l'aide du progiciel statistique pour les sciences sociales IBM (SPSS Statistics) version 23. RÉSULTATS: Un total de 347 femmes ont suivi des soins prénataux pendant la période d'étude, cependant, seuls 329 cas avec des données complètes ont été inclus dans l'analyse statistique finale. La prévalence du VIH dans notre étude était de 6,4%, tandis que le VHB et le VHC représentaient respectivement 6,2% et 1,8%. Les virus de l'hépatite B et de l'hépatite C ainsi que le VIH étaient présents chez 3 (0,9%) de nos patientes, 6 (1,8%) des femmes avaient une co-infection VIHVHB tandis qu'une (0,3%) était infectée par le VIH-VHC. CONCLUSION: Notre étude souligne à nouveau l'importance pour la santé publique du dépistage du VHB, du VHC et du VIH dans nos cliniques prénatales. Ces connaissances sont très importantes pour la mise en œuvre de mesures de prévention et de contrôle efficaces qui permettront de diminuer davantage la transmission mère-enfant de ces virus. Mots clés: Hépatite B, VIH, Hépatite C, Séroprévalence, Coinfection, Lagos.

Maternal Outcomes of Eclampsia at the Lagos University Teaching Hospital: A Six-Year Retrospective Review.

BACKGROUND: Eclampsia is one of the leading causes of maternal morbidity and mortality. OBJECTIVES: To determine the incidence as well as the maternal outcomes of eclampsia at the Lagos University Teaching Hospital (LUTH). METHODS: This was a retrospective review. RESULTS: During the six-year review period, 4182 women gave birth at our facility, out of which 67 cases of eclampsia were diagnosed (16 per 1000 deliveries). Four women died constituting a case fatality rate of 5.9%. Fifteen women were admitted to the intensive care unit, 6 women had acute kidney injury while 5 had abruptio placentae. Further comparison of our data with previous studies from our institution decades ago showed a continuous decrease in total number of eclamptic cases presenting to our facility (572 eclamptics in 1977 - 1986, 299 ECLAMPTICS IN 1986 - 1995, 165 IN 1996-2005 AND 67 IN 2015-2020). CONCLUSION: The case fatality rate from eclampsia is still high in our hospital. Increased utilisation of antenatal care may play an important role in improving the maternal outcomes from this life-threatening obstetric condition. There is need for maternal education and increase awareness on the importance of antenatal care and early referral to tertiary level of care in order to reverse this trend.

CONTEXTE: L'éclampsie est l'une des principales causes de morbidité et de mortalité maternelles. OBJECTIFS: Déterminer l'incidence ainsi que les issues maternelles de l'éclampsie à l'hôpital universitaire de Lagos (LUTH). METHODES: Il s'agissait d'une revue rétrospective. RESULTATS: Au cours de la période d'examen de six ans, 4182 femmes ont accouché dans notre établissement, dont 67 cas d'éclampsie ont été diagnostiqués (9,5 pour 1 000 accouchements). Quatre femmes sont décédées, soit un taux de létalité de 5,9 %. Quinze femmes ont été admises à l'unité de soins intensifs, 6 femmes avaient une lésion rénale aiguë tandis que 5 avaient un décollement placentaire. Une comparaison plus poussée de nos données avec des études antérieures de notre institution il y a des décennies a montré une diminution continue du nombre total de cas d'éclampsie se présentant à notre établissement (572 éclamptiques en 1977­1986, 299 éclamptiques en 1986-1995, 165 en 1996-2005 et 67 en 2015­2020). CONCLUSION: Le taux de létalité de l'éclampsie est encore élevé dans notre hôpital. L'utilisation accrue des soins prénatals peut jouer un rôle important dans l'amélioration des résultats maternels de cette affection obstétricale potentiellement mortelle. Il est nécessaire d'éduquer les mères et d'accroître la sensibilisation à l'importance des soins prénatals et de l'orientation précoce vers le niveau de soins tertiaires afin d'inverser cette tendance. MOTS CLÉS: Éclampsie, issues maternelles, Grossesse, hypertension, Lagos.

Prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer.

AIMS: This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria. METHODS: This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model. RESULTS: This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (P = 0.009), serum carbohydrate antigen 125 levels (P = 0.018), median progression-free survival (PFS) (P < 0.001), 3-year median overall survival (OS) (P < 0.001), type of primary treatment (P = 0.002), extent of cytoreduction (P < 0.001), presence of ascites (P = 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.008), and histological type (P = 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75; P = 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27; P = 0.002). CONCLUSIONS: The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.

Association between Serum Homocysteine Levels in Preeclampsia and its Severity among Women in Lagos, South-West Nigeria.

BACKGROUND: Clinical evidence had suggested that hyperhomocysteinaemia features in hypertensive disorders of pregnancy. However, there is still conflicting evidence on the extent to which elevated maternal homocysteine contributes to this deadly complication of pregnancy. OBJECTIVES: This study investigated the impact of elevated maternal homocysteine levels in early pregnancy on preeclampsia and its severity among Nigerian women in Lagos. METHODS: This was a prospective cohort study conducted at the Lagos University Teaching Hospital. Participants were enrolled in the first trimester of pregnancy following which their sociodemographic data were obtained by interview. Venous blood samples were collected for measurement of homocysteine concentration using the ELISA method. Data on the occurrence of preeclampsia was obtained from the delivery records. Binary logistic regression model was used to study the effects of the major baseline characteristics on the development of preeclampsia. RESULTS: The final analysis included 167 patients; hyperhomocysteinaemia was recorded in 24 (24.6%) patients. Women with hyperhomocysteinaemia had no statistically significant risk of developing preeclampsia or severe preeclampsia, compared with women with a normal homocysteine concentration. CONCLUSION: The prevalence of hyperhomocysteinaemia in the study was relatively low. The absence of a significant association between maternal hyperhomocysteinaemia and preeclampsia reported in this study could create room for the conduct of a more robust, adequately powered longitudinal research needed to answer some of the major reservations that remain from the present study.

Seroprevalence of hepatitis B virus infection among pregnant women at the antenatal booking clinic of a Tertiary Hospital in Lagos Nigeria.

OBJECTIVES: The objectives were to determine the seroprevalence of hepatitis B virus (HBV) infection and assess the major risk factors among Nigerian pregnant women. SUBJECTS AND METHODS: This was a cross-sectional descriptive study carried out among pregnant women at the antenatal clinic of a Tertiary Hospital in Lagos, Nigeria. A total number of 150 consenting pregnant women were selected for the study. A structured pretested interviewer-administered questionnaire was used for the data collection. Sera were collected and tested for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg). RESULTS: Of the 150 women screened during the study, 11 (7.3%) were seropositive for HBsAg. Of these 11 women, 4 (36.4%) were also positive for HBeAg. There was no statistically significant difference in the mean ages of participants who were seropositive for HBsAg and those who were negative for the virus (P=0.888). There were statistically significant differences in the seroprevalence of HBsAg recorded among respondents with previous surgery (odd ratio [OR]-2.97; 95% confidence interval [CI]-1.08-16.67; P=0.046), previously affected sibling or spouse (OR-5.03; 95% CI-1.11-25.27; P=0.001) and those with two or more lifetime sexual partners (OR-4.11; 95% CI-2.85-9.22; P=0.024). CONCLUSION: The sero-prevalence rate of HBV infection and also its infectivity is high in Lagos, Nigeria. These findings thus support the need for a nationwide policy of routine and widespread HBV screening among pregnant women.

Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria.

Objectives. The study was to assess the level of knowledge of, perception of, and attitude towards uterine fibroids among women diagnosed with the condition. Methods. It is a cross-sectional descriptive study carried out among women diagnosed as having uterine fibroids in two gynaecological clinics in Lagos, Nigeria. Eligible women were recruited and a structured interviewer-administered questionnaire was used to collect the required information. Statistical analysis of data was done using EPI Info 2008. Results. Knowledge of fibroids was reported in 98.6% of the respondents and the information on uterine fibroids was obtained from radio, parents/relatives, health workers, and television in 29%, 27.3%, 18.7%, and 18.3%, respectively, by the respondents. Most of the women believed that being black, being nulliparous, or having positive family history predisposes women to having uterine fibroids. Up to 69.0% of the respondents believed that fibroid is a spiritual problem and many thought it requires spiritual healing. Fear of complications of surgery keeps most sufferers away from the hospital until fibroids become advanced or associated with complications. Conclusion. Awareness of uterine fibroids is high, but correct knowledge on aetiology and proper treatment is low. Intensive enlightenment of the populace using the mass media by trained personnel is recommended.