Heterotopic gestation with subsequent live birth in a Jehovah s Witness: a case report.

Heterotopic gestations occurring in spontaneous conception cycles are rare. An incidence of in has been documented. However there is a rising rate mostly attributed to ovulation induction and assisted reproduction techniques where it occurs in to of all clinical pregnancies. A high index of suspicion and use of ancillary investigations will aid diagnosis. The management of this condition in a Jehovah s Witness presents an uncommon challenge as surgical intervention aims to salvage the intrauterine pregnancy whilst giving scrupulous attention to haemostasis. This is because blood transfusion is precluded in the management of haemorrhage in members of this sect. We present a case of heterotopic gestation that occurred spontaneously in a Jehovah s Witness she had emergency salpingectomy and subsequently had spontaneous vertex delivery of a live baby at term.

Umbilical cord prolapse in Kaduna, northern Nigeria: a study of incidence.

CONTEXT: Prolapse of the umbilical cord is a live threatening obstetric emergency for the fetus-infant. OBJECTIVE: To determine, the incidence of cord prolapse in the hospital. METHODS AND MATERIALS: A-12 1/2 year retrospective study of all women who presented with cord prolapse in labour at a university teaching hospital. RESULTS: During the period there were 16633 deliveries and 34 women presented with cord prolapse, giving an incidence of 2.0 per 1000 (1 in 504 deliveries). Highest incidence occurred in women of 35 years and above (5.0 per 1000); in the 25-29 years group 2.3 per 1000 and in those less than 20-years-old 1.3 per 1000. The highest incidence of cord prolapse was in the para 5 and over, 2.4 per 1000; para 0, 2.0 per 1000 and paras 14, 1.9 per 1000. The incidence of cord prolapse in the unregistered women was 5.2 per 1000, and in the registered 1.5 per 1000. The highest incidence was in the Hausa/Fulani ethnic group 3.4 per 1000; the Yoruba ethnic group, 2.1 per 1000; the Northern minority ethnic group, 2.0 per 1000; the Ibo ethnic group, 1.0 per 1000. No case of cord prolapse was recorded among women of Southern minority ethnic group. The incidence of cord prolapse among preterm births was, 62.7 per 1000, breech, 32.5 per 1000; shoulder, 133.3 per 1000, twin births. 16.8 per 1000 and cesarean births, 11.4 per 1000. CONCLUSION: Cord prolapse is an uncommon obstetric complication, the incidence of which is determined by the influence of various factors acting individually or in synergy.

Fetal outcome following umbilical cord prolapse in Ahmadu Bello University Teaching Hospital, Kaduna (ABUTHK), northern Nigeria.

BACKGROUND: Umbilical cord is a clinical condition that calls for emergency decision making and action especially with a live and mature fetus. The objective of this study is to determine, fetal outcome and how various factors influence it. METHODS: This is a 12 1/2 year retrospective study of all 34 fetuses who suffered from cord prolapse at Ahmadu Bello University Teaching Hospital. RESULTS: There were 34 cases of cord prolapse, 23 perinatal deaths and a perinatal mortality rate of 67.64%. About 55% of babies of registered women died, while about 92% of the unregistered died. Eleven babies of the 22 women admitted with cervical dilatations of 7 cm and less, died and all the babies of women with cervical dilatations of 8 cm and above died. All 19 babies delivered vaginally and 3 of the 14 delivered abdominally, died. About eighty eight percent of the low-birth weight, and 37.5% of normal size babies died. Seventeen (51.5%) of the 33 babies delivered, had Apgar score 0. All babies with Apgar scores 1-4 died, 40% with Apgar scores 5-7 and 16.7% with Apgar scores 8-10 died. Maternal age, parity, ethnicity, gestational age, presentation and sex of the fetus did not influence outcome.

Perinatal mortality associated with eclampsia in Kaduna, Northern Nigeria.

BACKGROUND: Eclampsia is an obstetric disorder with serious materno-fetal consequences. The objective of this study is to determine perinatal mortality rate associated with eclampsia in Kaduna Northern Nigeria. METHOD: A retrospective study of 27 perinatal deaths associated with 61 cases of eclampsia in the Ahmadu Bello University Teaching Hospital, Kaduna (ABUTHK) from 1st January 1990 to 31st December 2000 was done. Resource materials were the admission records, case files, delivery and neonatal case files of women and their babies. The records were reviewed for relevant bio-social, obstetric and neonatal data. RESULTS: Perinatal mortality rate associated with eclampsia was 409/1000 births. It was highest amongst women in the age group 35 years and above, in the two extremes of parity, in those not registered for care, in women with poor control of eclampsia fits and those with ante partum eclampsia.Perinatal mortality rate decreased as gestational age rose. The perinatal mortality rate for those delivered vaginally was 706/1000, and 150/1000 for those delivered abdominally with a (P<0.05). CONCLUSION: Perinatal mortality rate associated with eclampsia is very high. Making prenatal care available to all, improving the quality of care, early resort to caesarean section and use of perimorterm caesarean section in carefully selected women may reduce the deaths.

Childbirth in Germany and Nigeria compared.

BACKGROUND: A look at childbirth processes in both countries may lead to understanding of the differences between them and may perhaps open up new arrears of research in human reproduction. The objective of this paper is to compare some childbirth parameters in Nigerians and Germans and to adduce possible reasons for the differences. METHOD: This is prospective study using data collected from 1055 consecutive deliveries that took place in Nigeria which was analyzed and compared with that of 56690 deliveries that took place in the German state of Hesse. RESULTS: Preterm labor was more common among Nigerians (12.1%) than in Germans (6.7%). There is no significant difference in the day and time of birth in the two countries (p >0.05). Precipitate labor occurred in 12.5% of Germans, as against none in Nigerians. Within 30 minutes, more than 90% of women in both countries complete the second stage of labor. Doctors attend to more deliveries in Germany (99.3%), as against 63.1% in Nigeria. Episiotomy was performed in 71% of Germans as against 49% Nigerians. Primary cesarean section rate in Germany was 8.5% and in Nigeria 5.6%. Retained placenta was more common in Germans (2.5%) than in Nigerians (1%). Sepsis was more common in Nigerians (1.3%) than in Germans (0.0%). Blood loss greater than 1000ml was more common in Nigerians (2.9%) than in Germans (0.6%). Within 24 hours of delivery 74.8% of Nigerians leave hospital as against 4.0% of Germans. CONCLUSION: It would appear that biological and socio-economic factors play differential roles in the final process of childbirth in different populations while meteorological cum cosmic factors appear to exact the same influence in the two populations.

Knowledge, attitude and practice of family planning amongst community health extension workers in Kaduna State, Nigeria.

A self-administered opportunistic questionnaire was given to 232 community health extension workers (Chews) in Kaduna state, Nigeria. Seventy-eight were male and 154 female. All could recall at least one modern method of family planning. The oral contraceptive pill (OCP) (85.8%), injectable contraceptives (85.3%), and the intra-uterine contraceptive device (IUCD) (56.0%), were most widely known about. Emergency contraception was not known about. A high percentage of female Chews have practised family planning: 115 (74.7%) have used at least one method and this is more among the married women. Methods ever used included injectable contraceptive (57.4%), OCP (47.0%), and IUCD (22.6%). Fifty percent of females were current users. Non-current users were likely to be between the ages of 25 - 29 years especially when not married, and 35 - 39 years when married. Reasons for the non-use of family planning by female Chews were side effects, not being married, not being sexually active and religious beliefs.

Dying undelivered.

This paper aims to stimulate discussion and awareness of this double tragedy of obstetric practice in the tropics. This was an 8-year retrospective review of all the patients who died undelivered in a tertiary health care institution serving a population of over a million people. The incidence of dying undelivered was 141/100 000 deliveries and this was highest in the extremes of age and parity. Patients who died undelivered contributed 28.30% of all the maternal deaths in the hospital during the period of study. The maternal mortality rate in the unbooked patients who died undelivered was three times that for the booked. Severe hypertension and ruptured uterus were the greatest association in patients who died undelivered. More than 46% of the fetuses were alive for more than 6 hours from the time of admission to the time of demise of their mothers. Most of the deaths, both maternal and perinatal, were avoidable. Dying undelivered is a significant aspect of maternal deaths in the tropics. The right of the helpless, unborn fetus of a moribund mother should be protected as much as possible. More reports are needed urgently to create awareness about the place of post mortem caesarean section.

Eclampsia in Kaduna State of Nigeria--a proposal for a better outcome.

A review of eclampsia at a University Teaching Hospital in Nigeria is presented with the objective of determining the incidence, clinical features and management outcome and to make recommendations for better outcome. Antepartum eclampsia occurred in 60% of the patients. The most important symptom was headache (100%), while hypertension (88.88%) and fever (42.22%) were the most common signs. Fit control was achieved in 66.6% of the patients with diazepam. Abdominal delivery occurred in 53.3% of the patients. There were 19 maternal and 20 perinatal deaths. There were 45 cases of eclampsia and 10,572 deliveries during the period of study. The incidence of eclampsia was 0.42% (1/235 deliveries); it was highest in the less than 20 years age group (1.68%), the nulliparae (1.27%) and the unbooked patients (1.23%). Eclampsia remains a serious obstetric disorder in tropical obstetric practice. Provision of good quality antenatal care, improving the emergency capability of hospitals and the establishment of Intensive Care Units for the care of eclamptic patients are recommended.