Diagnostic accuracy of random plasma glucose and random blood capillary glucose in detecting international association of diabetes and pregnancy study groups- defined hyperglycemia in early pregnancy.

BACKGROUND: Maternal hyperglycemia first diagnosed in pregnancy, previously referred to as gestational diabetes mellitus is associated with health consequences for both the mother and her fetus/baby, not only in the short term but also in the long term. Early screening helps to identify women with overt diabetes or those with early onset GDM. AIMS: The aim of this study was to determine the diagnostic performance of two screening tests (Random plasma glucose, Random capillary glucose) in relation to 75g Oral glucose tolerance test (OGTT) done before 24 weeks gestation. METHODS: This prospective longitudinal cohort study was carried out between 1st February, 2017 and 31st July, 2017, at two teaching hospitals in Nigeria. Two hundred and eighty one (281) pregnant women who met the inclusion criteria were selected and screened with both random plasma glucose (RPG) and random capillary glucose (RCG) before 24 weeks of pregnancy. They were then made to undergo 75g OGTT a week later. The diagnostic performance of the screening tests were determined. RESULTS: A total of 270 women had 75g OG. CONCLUSION: Random plasma glucose and Random capillary glucose performed poorly compared to 75g-OGTT in detecting hyperglycemia in early pregnancy.

Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success: a prospective observational study.

OBJECTIVE: To determine the outcomes and factors associated with postpartum haemorrhage (PPH) treatment with condom-catheter uterine balloon tamponade (C-UBT). DESIGN: Prospective observational study. SETTING: A secondary healthcare facility in Nigeria. POPULATION: Women with PPH refractory to first-line treatment. METHODS: Demographic and clinical characteristics were compared in women with successful and unsuccessful treatment. Univariate and multivariate logistic regression analyses were used to examine the association of these characteristics with successful treatment. MAIN OUTCOME MEASURES: The success rate of C-UBT, factors associated with success, and maternal morbidity rates in both successful and unsuccessful treatment groups. RESULTS: Overall, 203/229 (88.6%) women had successful treatment. Women with successful treatment had lower mean blood loss (1248.8 ± 701.3 ml versus 3434.6 ± 906.6 ml; P < 0.0001), lower occurrence of blood transfusion [139 (68.5%) versus 26 (100%); P < 0.0001], lower intensive care unit admission rates [5 (2.5%) versus 20 (76.9%); P < 0.0001], and lower occurrence of infectious morbidities [3 (1.5%) versus 7 (26.9%); P < 0.0001]. In the regression model with two factors, caesarean section (adjusted odds ratio, aOR 0.17; 95% confidence interval, 95% CI 0.07-0.40) was associated with lower success rates compared with vaginal delivery. In the regression model with three factors, advanced maternal age (aOR 0.31; 95% CI 0.11-0.90) and caesarean section (aOR 0.17; 95% CI 0.07-0.41) were associated with lower success rates in comparison with younger maternal age and vaginal delivery, respectively. CONCLUSIONS: Second-line PPH treatment with C-UBT is effective, and is associated with low maternal morbidity rates. Advanced maternal age and caesarean section are associated with lower success rates. TWEETABLE ABSTRACT: Condom-catheter tamponade is a useful second-line treatment modality for intractable postpartum haemorrhage.

Emergency Peripartum Hysterectomy: A Multicenter Study of Incidence, Indications and Outcomes in Southwestern Nigeria.

Objective To determine the incidence, indications and outcomes of emergency peripartum hysterectomy (EPH) in three tertiary institutions in south-west Nigeria between January, 2010 and December , 2013. Methods A retrospective review of all cases of EPH over a 4 year period was done. EPH was defined as hysterectomy performed at the time of delivery or within 24 h of delivery for uncontrollable postpartum bleeding not responsive to conservative measures. Relevant information was extracted from the hospital records and operation notes. Statistical analysis was done using SPSS software version 17.0. Statistical significance was set at p < 0.05. Results There were 102 EPHs performed among 39,738 deliveries within the study period, giving a rate of 2.6 per thousand deliveries. Indications were uterine rupture (44.1 %), uterine atony (37.3 %), morbidly adherent placenta (17.6 %) and extension of caesarean section incision involving the uterine arteries (1 %). Subtotal hysterectomy was performed in most cases (67.6 %).Maternal case fatality rate was 11.8 % and perinatal mortality rate was 55.9 %. Blood transfusion, severe postoperative anaemia, wound sepsis, febrile morbidity and acute kidney injury were common morbidities associated with the procedure. Following multivariate logistic regression, the unbooked status [odds-ratio 95 % CI = 12.80 (1.22-133.97) p = 0.03] was the only variable that significantly predicted maternal death. Conclusion The incidence of EPH from our study is high. Much more needs to be done in maternal health services, particularly provision of quality obstetric care to reduce the rates of EPH and the associated high maternal and perinatal morbidity and mortality.

Maternal understanding of fetal movement in third trimester: a means for fetal monitoring and reducing stillbirth.

BACKGROUND: Fetal movement, a sign of life, is widely considered as an indicator of fetal health status. Therefore, perceived alteration in regular fetal movement after the age of viability may signify impending adverse perinatal outcome. AIMS: This study aimed to determine maternal knowledge, behavior, and concerns about abnormal fetal movement in the third trimester of pregnancy. MATERIALS AND METHODS: A total of 225 women were surveyed using a self-administered questionnaire at the out-patient prenatal clinics of two tertiary health facilities in Nigeria between December 1, 2012 through January 31, 2013. Questions addressed knowledge, perception behavior, and concerns about experience of abnormal fetal movement. RESULTS: Correct Knowledge of excessive and decreased fetal movement was found in 47% and 31.1% of respondents, respectively. Majority of women (87.6%) either had no knowledge of normal parameters of fetal activity or did not recall being told that movement frequency and strength should increase in the third trimester. The proportion of women who expressed concern over excessive and decreased fetal movement was 31.1% and 21.8%, respectively. Maternal education was significantly associated with correct knowledge of decreased fetal movement ( P = 0.026). Almost 36% of respondents had knowledge of at least one potential consequence of abnormal fetal movement. CONCLUSION: Maternal educational level is an important factor in the early identification of abnormality of fetal movement. The unsatisfactory knowledge and poor perception behavior among respondents reflect the need for a guideline, particularly during antenatal care, on information and management of abnormal fetal movement in our setting to prevent avoidable stillbirth.

Evaluation of diagnostic performances of visual cervical inspection with acetic acid and colposcopy in Benin city, Nigeria.

OBJECTIVE: To determine the performance indicators of visual inspection with acetic acid (VIA) and colposcopy to detect cervical premalignant lesions. METHODS: A prospective cross-sectional study evaluating performance indicators of visual cervical inspection with acetic acid and colposcopy using directed biopsy for histopathology as the reference standard in a Colposcopy unit at a referral tertiary hospital in Nigeria. Consecutive sample of 212 apparently healthy, ambulant, asymptomatic women with an intact uterus and with no past history of cervical neoplasia were recruited. RESULTS: A total of 195 women had VIA and satisfactory colposcopy with directed biopsy. Overall test positivity was 29.7% for VIA, 36.9% for colposcopy and 32.8% for histology of colposcopically directed biopsy. Using CIN 2 as the disease threshold; the sensitivity, specificity, positive predictive value and negative predictive value of VIA were 70.8%, 67.0%, 29.3% & 94.9% while those of colposcopy were 87.5%, 97.7%, 84.0% &98.2%,respectively. CONCLUSION: Although the test characteristics of both VIA and colposcopy appear satisfactory in this study, the data suggests that colposcopy performs better than VIA in the diagnosis of cervical neoplasia. However, in view of its ease of administration and low logistic requirements, VIA still has a vital role to play in population-based screening in our environment.

Physical after effects and clients satisfaction following colposcopy and cervical biopsy in a Nigerian population.

BACKGROUND: Although Nigeria has a high prevalence of cervical cancer, screening services including colposcopy and directed cervical biopsy are not widely available. OBJECTIVES: A prospective study among 111 women who had colposcopy and cervical biopsy following an abnormal Pap smear result at the University of Benin Teaching Hospital in Nigeria. It explored physical after effects experienced and satisfaction of clients after the procedure. RESULTS: The mean age of the population was 49.5±8.7 years (range, 30 - 64 years) and majority (64.9%) had tertiary education. Overall, 69 women (62.2%) reported physical effects following the procedure. Common physical effects experienced included spotting blood per vaginam (65.2%), pain (34.8%) and vaginal discharge (17.4%). Spontaneous resolution of symptoms occurred within 48 hours in 90.9% of those who reported physical effects. Clients who experienced physical after effects were significantly older (p=0.002) and had tertiary education (p=0.019). Majority of the women (94.6%) were satisfied with the screening services and more than 97% were willing to accept a repeat procedure. CONCLUSIONS: Although majority of the clients who had colposcopy and cervical biopsy reported they experienced physical side effects, more than 97% were willing to have a repeat procedure. This information can assist colposcopic service providers in counseling clients.

Clinical correlates of women requesting labour epidural analgesia in a tertiary hospital in Nigeria.

OBJECTIVES: To evaluate the clinical correlates of women who received pain relief in labour with lumbar epidural analgesia and also investigate the labour outcome. MATERIALS AND METHODS: A hospital -based case-control study conducted in a tertiary care facility in Nigeria. The clinical characteristics and delivery outcome of women who had epidural analgesia in labour were compared to those without. RESULTS: The utilisation rate of labour epidural analgesia during the study period was 13/1000 women. Tertiary education was significantly higher among women who had epidural analgesia in labour (22.7% vs 3.4%, p=0.0009). There were no statistically significant differences between women who had labour epidural analgesia and the controls in terms of labour and delivery by caesarean section. The second stage of labour was prolonged in women who received epidural for pain relief in labour (p=0.005). The neonatal indices (Mean birth weight or Apgar score<7 in first minute) were similar. CONCLUSION: This study suggests that labour epidural analgesia is not associated with increased caesarean section and adverse foetal outcome. This is of value in increasing the acceptance of this service by pregnant women in Nigeria.

Pattern and risk factors for partner infection with hepatitis B virus in a prevention of mother-to-child transmission programme.

BACKGROUND: Hepatitis B virus (HBV) infection is horizontally and vertically transmitted. It is associated with high morbidity and mortality but is preventable with vaccine. There is paucity of data on pattern and risk factors for partner infection in prevention of mother-to-child transmission (PMTCT) programmes. OBJECTIVE: To determine the pattern and risk factors for partner infection with HBV in a PMTCT Programme. METHODS: This cross-sectional study evaluated the hepatitis B surface antigen (HBsAg) serostatus of partners of HBV-infected pregnant women in a PMTCT programme using rapid, third generation immunochromatographic test. Repeatedly reactive samples were confirmed using enzyme-linked immunosorbent assay. Patients' sociodemographic characteristics and behavioral risk factors were evaluated against their HBsAg-serostatus. The seropositive and seronegative subjects had liver function tests HBV vaccination respectively. RESULTS: Out of 3,907 pregnant women seen, 3,762(96.3%) and 73 (45.3%) partners of 161 HBV-infected women were screened. The HBsAg seroprevalence among the women and partners were 161(4.3%) and 5(6.8%) respectively; p<0.43. The sero-concordance and discordance were 6.8% and 93.2% respectively. Nulliparity (60.9%) associated with non-protective pre-marital sex and induced abortions (58.4%), history of blood transfusion (6.7%) and lack of vaccination (93.6%) were risk factors for HBV-infection. CONCLUSION: This study has revealed high prevalence of HBV infection among the couples and high serodiscordance rate. The risk factors for HBV infection were preventable. We recommend integration of couple counseling and testing backed with vaccination into antennal care services nationwide. Further study is required to assess the serostatus of female partners' of HBV-infected males to determine HBV feminization.

Iatrogenic urological injuries complicating obstetric and gynaecological procedures.

INTRODUCTION: Urinary tract injuries are known complications of pelvic surgeries. Although a few instances have been noted, they remain a source of great concern to surgeons due to their associated morbidity and occasional mortality. We report our experience with the management of iatrogenic urological injuries that complicated obstetric and gynaecological surgeries over a five-year period. METHODS: We reviewed all cases of urological injuries managed in our unit that were deemed to be of obstetric and gynaecological origins within the study period. RESULTS: A total of 16 patients were identified as having iatrogenic urological injuries following obstetric and gynaecological surgeries. Only four patients presented early. Five patients had injuries to the bladder, while 12 had ureteric injuries; one of the 16 patients had both types of injuries. Seven cases of ureteric injuries affected only the left ureter, while three were bilateral and two affected the right ureter. One patient with a vesicovaginal fistula (VVF) was successfully managed by urethral catheter drainage alone. Three patients had transabdominal repair of the VVF, while ten had ureteroureterostomy and one had diversion procedure. Simple nephrectomy was performed for one patient with a non-functioning kidney. CONCLUSION: Iatrogenic urological injuries are still common in our environment. In order to reduce the risk of injury, adequate preoperative preparation is recommended and meticulous surgical technique based on proper understanding of the anatomy of the urogenital system should be practised by the surgeon.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria.

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p=0.024) and unmarried women (p=0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

HIV-AIDS related maternal mortality in Benin City, Nigeria.

OBJECTIVE: To determine the causes and characteristics of maternal deaths in HIV-infected women. DESIGN: A retrospective study of maternal deaths in a cohort of HIV-infected women. SETTING: A facility-based maternal death review using case records and mortality summaries. METHODS: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4-year period. Causes and circumstances surrounding each maternal death were identified. RESULT: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancy-related sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. CONCLUSION: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.

Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population.

Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.

Influence of maternal height on mode of delivery in Nigerian women.

AIMS AND OBJECTIVES: To determine the influence of maternal height on the mode of delivery even when matched for maternal characteristics. The study is a prospective cohort study comparing the mode of delivery in 57 short stature women (d"150 cm) with age and parity-matched, taller control women (n = 57). MATERIALS AND METHODS: A total of 114 parturients were studied, 57 of whom had a height of 150 cm or lower and constituted the study group, while the other 57 taller women were matched with respect to parity (i.e. belonging to same parity group of either nulliparity, para 1-3, para 4+) and maternal age group (i.e. <20, 20-34, 35+ years) to the shorter women and constituted the control group. Patients were also matched by gestational age (28-37 weeks, 38-42 weeks, 42+ weeks) and birth weight (<2500g, 2500-3999g, 4000+) groupings. RESULTS: Caesarean section rate in the short women was higher (42.1%) than in taller women (21.1%), P= 0.016, as was the incidence of cephalopelvic disproportion (35.5% versus 10.3% respectively, P = 0.010). Nevertheless, neonatal outcome remains good; the 5-min Apgar score <7 was 21.1% versus 15.8% respectively, P =0.469, while the stillbirth rate was 10.5% versus 7.0), P = 0.508. CONCLUSION: Short stature is independently associated with an increased risk of intrapartum caesarean section in Nigerian women and advocate early recourse to caesarean section to avoid undue delay.

Induction of labour: determinants and implications of failure to keep an initial appointment in a developing country.

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the 'spousal factor' (23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.