Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Impact of Parity on Cardiac Structure and Function in Apparently Healthy Pregnant Nigerian Women.

BACKGROUND: There are few and conflicting reports in the literature about the relationship between parity and maternal cardiac function. The study aimed to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria. METHODS: This was a cross-sectional study carried out in 3 tertiary centers in Kano, and 1 in Ile-Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation, and their cardiac structure and function assessed using echocardiography. Left ventricular (LV) systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling and tissue Doppler velocities. RESULTS: LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects, respectively. Age (p= <0.0001), left atrial (LA) size (P<0.0001), interventricular septal thickness at end diastole (IVSD) (p= 0.005), posterior wall thickness at end diastole (PWTD) (p=0.004) and QRS duration (p= <0.0001) all increased progressively with higher parity, while tricuspid annular systolic excursion (p=0.320) decreased with higher parity. There was significant positive correlation between parity and age (r= 0.475, p= <0.0001), LA size (r=0.332, p= <0.0001), IVSD (r=0.264, p= 0.005) and PWTD (r= 0.343, p= <0.0001). LV systolic function was not significantly associated with parity. CONCLUSION: Our findings suggested that parity was significantly associated with myocardial remodeling in apparently healthy pregnant women.

CONTEXTE: Il existe peu de données contradictoires dans la littérature sur la relation entre la parité et la fonction cardiaque maternelle. L'étude visait à évaluer l'impact de la parité sur la structure et la fonction cardiaques chez des femmes enceintes apparemment en bonne santé au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans 3 centres tertiaires à Kano et 1 à Ile-Ife, au Nigeria. 112 femmes enceintes apparemment en bonne santé ont été recrutées consécutivement entre la 28* et la 38* semaine de gestation, et leur structure et fonction cardiaques ont été évaluées par échocardiographie. La dysfonction systolique du ventricule gauche (VG) a été définie comme une fraction d'éjection du VG inférieure à 50 %, et la dysfonction diastolique a été graduée en utilisant le remplissage mitral et les vitesses Doppler tissulaires. RESULTATS: Un dysfonctionnement systolique VG et un dysfonctionnement diastolique ont été trouvés chez 6 (5,4 %) sujets et 20 (17,9 %) sujets respectivement. Âge (p=<0,0001), taille de l'oreillette gauche (LA) (P<0,0001), épaisseur du septum interventriculaire en fin de diastole (IVSD) (p=0,005), épaisseur de la paroi postérieure en fin de diastole (PWTD)(p=0,004) et La durée du QRS (p = <0,0001) a augmenté progressivement avec une parité plus élevée, tandis que l'excursion systolique annulaire tricuspide (p = 0,320) a diminué avec une parité plus élevée. Il y avait une corrélation positive significative entre la parité et l'âge (r = 0,475, p = <0,0001), la taille LA (r = 0,332, p = <0,0001), IVSD (r = 0,264, p = 0,005) et PWTD (r = 0,343, p=<0,0001). La fonction systolique VG était associée à la parité. CONCLUSION: Nos résultats suggèrent que la parité est significativement associée au remodelage du myocarde chez les femmes enceintes apparemment en bonne santé. n'était pas significatif. Mots clés: Grossesse, Parité, Structure Cardiaque, Registre peace.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Maternal near-miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHOD: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal near-misses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. CONCLUSIONS: Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended. FUNDING: The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: Eclampsia is the leading cause of maternal death in Nigerian hospitals.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

OS033. Correlates of maternal health outcomes associated with a low-costintervention in secondary facilities across Kano state, Nigeria.

INTRODUCTION: Nigeria has one of the highest rates of maternal mortality in the world. Eclampsia is a major contributor to the deaths especially in Northern Nigeria where the culture of teenage marriage is common. Kano is the state with the highest population in Nigeria. Despite its effectiveness, magnesium sulphate was been used to treat eclampsia and severe preclampsia in only one of 35 general hospitals inthe state as at 2007. OBJECTIVES: In 2008, magnesium sulphate was introduced in 10 General Hospitals in Kano state of Northern Nigeria in a Population Council project funded by the MacArthur Foundation. The aim of the study was to determine if the maternal outcomes improved. METHODS: Doctors and midwives from the 10 hospitals were trained on the use of magnesium sulphate. The trained health workers later conducted step down trainings at their health facilities. Magnesium sulphate, treatment protocol, patella hammer and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analysed using SPSS. RESULTS: Within a year of the project, 1045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9% (95% CI 18.7-23.2) recorded before the project to 2.3% (95%CI 1.5-3.5) after the project. The perinatal mortality rate in those that received magnesium sulphate was 12.3% (CI 10.4-14.5) while the 5min APGAR score for 72.9% of the babies was 7 or more. CONCLUSION: Training of health workers on updated evidence based interventions and providing an enabling environment for their practice are key components to the attainment of the Millennium Development Goals in developing countries.

Introduction of an innovation for the reduction of maternal mortality in Kano State, northern Nigeria: a case study of magnesium sulphate.

In this project, sponsored by the McArthur Foundation and the Population Council, magnesium sulphate was introduced in February 2007 to 10 general hospitals in Kano State, northern Nigeria. Changes were monitored via data collected at the hospital. At an initial training of the trainers' workshop, 25 master trainers were trained. They then conducted step down trainings and trained 160 clinical providers. Within 12 months, 1045 patients were treated with magnesium sulphate. The attributable deaths from eclampsia fell by 42.4%. The community became aware of an improved outcome for eclampsia. The providers expressed satisfaction with the outcome of the treated patients. Four of the master trainers trained 30 clinical providers from the other 25 general hospitals. Initiatives for the reduction of maternal mortality should be evidence-based.

Management of eclampsia at AKTH: before and after magnesium sulphate.

BACKGROUND: Eclampsia contributes significantly to maternal and perinatal morbidity and mortality in Nigeria. The world Health Organisation recommended Magnesium Sulphate as the most effective, safe and low cost drug for the treatment of eclamptic seizures and for prophylaxis in severe pre-eclamptic. This study is aimed to evaluate the effect of the introduction of magnesium sulphate for the management of eclamptic seizures on maternal and fetal indices in Aminu Kano Teaching Hospital [AKTH], Kano. METHODS: A retrospective study of all patients who presented with eclampsia in AKTH, Kano. The study period included 3 years prior to introduction of magnesium sulphate [January 2002 - December 2004] and 3 years after its introduction [January 2005 - December 2007]. RESULTS: During the study period, the prevalence of eclampsia was 1.02% [1:97 deliveries]. Sixty six [50.5%] of the patients were aged 19 and below. Approximately 62% of the patients were primigravida and 87% were unbooked. Thirty eight [29%] were treated with diazepam while ninety three [71%] were treated with magnesium sulphate. 39.4% of those treated with diazepam died compared to 15% of those treated with magnesium sulphate. Approximately ninety percent of those that died had no antenatal care. Overall perinatal mortality rate in this study was 312 per 1000 births. 368.4 per 1000 births among those treated with diazepam and 296.7 per 1000 births in the magnesium sulphate group. Approximately nine percent of those treated with magnesium sulphate develop toxicity [85.5% renal and 12% respiratory]. CONCLUSION: This study is in support of the findings that magnesium sulphate is superior to diazepam in the reduction of maternal morbidity and mortality.

Management of Eclampsia at AKTH: Before and after Magnesium Sulphate

Eclampsia contributes significantly to maternal and perinatal morbidity and mortality in Nigeria. The world Health Organisation recommended Magnesium Sulphate as the most effective; safe and low cost drug for the treatment of eclamptic seizures and for prophylaxis in severe pre-eclamptic.This study is aimed to evaluate the effect of the introduction of magnesium sulphate for the management of eclamptic seizures on maternal and fetal indices in Aminu Kano Teaching Hospital [AKTH]; Kano. A retrospective study of all patients who presented with eclampsia in AKTH; Kano. The study period included 3years prior to introduction o magnesium sulphate [January 2002- December 2004] and 3years after its introduction [January 2005 - December 2007]. During the study period; the prevalence of eclampsia was1.02[1: 97 deliveries]. Sixty six [50.5] of the patients were aged 19 and below. Approximately 62of the patients were primigravida and 87were unbooked. Thirty eight [29] were treated with diazepam while ninety three[71] were treated with magnesium sulphate. 39.4of those treated with diazepam died compared to 15of those treated with magnesium sulphate. Approximately ninety percent of those that died had no antenatal care. Overall perinatal mortality rate in this study was 312 per 1000 births [41]. 368.4per 1000 births among those treated with diazepam and296.7 per 1000births in the magnesium sulphate group. Approximately nine percent of those treated with magnesium sulphate develop toxicity [85.5renal and12respiratory] This study is in support of the findings that magnesium sulphate is superior to diazepam in the reduction of maternal morbidity and mortality

HIV exposed infants: a preliminary report of the Aminu Kano Teaching Hospital experience.

UNLABELLED: To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano. PATIENTS AND METHODS: The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1. RESULTS: A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group. CONCLUSION: PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

The Use of Magnesium Sulphate for the Treatment of Severe Pre-Eclampsia and Eclampsia

Background : Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Method : In this article; a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. Results : The drug is administered by the Pritchard or Zuspan regimen; although modifications in the two protocols have been reported. Conclusion : A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug

Disseminated intravascular coagulation following induction of labour with misoprostol: a case report.

BACKGROUND: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness, low cost, stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect, uterine rupture and post partum haemorrhage (PPH) have been documented. METHOD: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use. RESULT: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100 microg of misoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously, then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. CONCLUSION: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC.

Maternal mortality in rural northern Nigeria.

We presented a study of maternal mortality over a 4-year period in a tertiary health facility in northern Nigeria. Increased effort is needed in order to meet the millennium development goals.

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Comparison of emergency caesarean section to misoprostol induction for the delivery of antepartum eclamptic patients: a pilot study.

BACKGROUND: Eclampsia has now emerged as one of the commonest cause of maternal mortality in Nigeria. There is need for research on best modality for delivery of eclamptics. METHODOLOGY: The pilot study was conducted on 50 eclamptic patients at the Federal Medical Centre, Azare. The patients were randomized for delivery either by caesarean section (CS) or induction of labour. The fetomaternal outcome of the two groups was compared. RESULTS: 25 of the patients had CS and 25 had induction of labour with misoprostol. The mean decision delivery interval was 4.1 hours and 13.08 hours for the CS and misoprostol groups respectively. Misoprostol failure was recorded in 4 (16%) patients and they were subsequently delivered by CS. The duration of admission was longer in the CS group (mean of 10.1 days) compared to the misoprostol group (mean of 6.08 days). There were more maternal complications and admissions of babies into the SCBU in the CS group. Maternal mortality in the two groups was similar (2% each). CONCLUSION: Misoprostol is cheap, available and safe for delivery of antepartum eclamptics. In the event of delay at caesarean section for antepartum eclamptics patients, misoprostol induction should be started. A multicenter study is called for.

Outcome of delivery among HIV positive mothers at Aminu Kano Teaching Hospital, Kano.

BACKGROUND: If a HIV positive mother delivers in a health facility, interventions can be effected to reduce the risk of transmission of HIV to the baby The study was done to evaluate the interventions offered to HIV positive women who delivered at Aminu Kano Teaching Hospital (AKTH) Kano. METHOD: Retrospective review of the case records of all HIV positive patients that delivered at AKTH over a 27 month period (October 2003 to December 2005) was used. RESULTS: There were 4922 deliveries out of which 125 were HIV positive, giving a prevalence rate of 2.54%. Most (75.2%) of the patients received Nevirapine alone in labour, 20.8% received a combination of antiretroviral drugs while 4% received none because their records were not available. Majority (88%) of the patients had spontaneous vaginal delivery, 10.4% by elective CS and 1.6% by emergency CS. There was no maternal death but 3.2% of the babies were stillbirths. All the babies received a single dose of Nevirapine. Most (96%) mothers chose exclusive breast milk substitute. CONCLUSION: HIV positive mothers need to deliver in health facilities to receive the full compliment of care they deserve. Highly Active Antiretroviral therapy (HAART) should be introduced, as it is more effective for PMTCT.

Use of protective eyewear among surgeons in a tertiary hospital in northern Nigeria.

The study was a prospective study during which a hand-held lens was used to examine the goggles of all surgeons who used them during surgery at Aminu Kano Teaching Hospital, Kano, Nigeria. Only 169 (54.8%) of the 308 surgeons used eye protection during surgery. There was at least a bloodstain on 70 (41.4%) of the goggles. There is need to enforce universal precautions during surgery to protect the eyes of surgeons from blood drops of the patient being operated.

Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria.

BACKGROUND/OBJECTIVE: To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. METHOD: A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. RESULTS: There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171 (82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116 (56%) of patients. The condition was antepartum in 68 (32.9%), intrapartum in 112 (54.1%) and postpartum in 27 (13%). 107 (51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180 (87%) of the babies were delivered alive while 27 (13%) died. CONCLUSION: Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.

Uterine prolapse following fundal pressure in the first stage of labour: a case report.

The use of fundal pressure to assist a woman in labor is a controversial procedure. Its benefits are yet to be scientifically confirmed and it is associated with complications such as perineal lacerations, uterine rupture and uterine inversion. A case is reported of a 28year old Gravida 5 Para ?? (3 Alive) who presented to Aminu Kano Teaching Hospital, (AKTH) Kano, Nigeria with uterine prolapse following fundal pressure done in the first stage of labor in a peripheral hospital. She was delivered by Cesarean section and the prolapse successfully reduced under general anesthesia. Health workers need education on the risks associated with fundal pressure. Alternative methods of aiding women in labor should be promoted.