Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) 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. METHODS: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO). RESULTS: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH. CONCLUSIONS: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. FUNDING: The original research that generated the data for this secondary analysis, and the publication of 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 cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.

Health workers' knowledge on future vascular disease risk in women with pre-eclampsia in south western Nigeria.

BACKGROUND: Pre-eclampsia progressing to eclampsia is one of the major causes of maternal death in Nigeria. Since there is long term association of pre-eclampsia with cardiovascular disease, cerebrovascular disease, renal disease, short life expectancy and mortality, it is essential to obtain obstetric history for better counseling and long term monitoring. The study assessed the knowledge of health workers about the association of pre-eclampsia with future cardiovascular disease and offering any risk-reduction counseling to women with pre-eclampsia. METHODS: During a training workshop, a validated questionnaire on the association between pre-eclampsia and cardiovascular risk was distributed among health care workers working at the infant welfare and family planning clinics in Osun State. Data were analysed using descriptive and inferential statistics. RESULTS: One hundred and forty-six out of 150 health workers approached participated in the study (response rate 97.3%). Mean age of respondents was 35.6 ± 9.1 years. Median age of practice was 7 years, ranging from 1-40 years. They were medical doctors (60.3%), community health workers (26.7%) and nurses/midwives (13.0%). Most participants had good knowledge on future cardiovascular risk of pre-eclampsia. The medical doctors had better knowledge compared to nurses/midwives and community health workers (78.4 vs. 57.9 vs. 53.8%; p < 0.05). Below half (45.9%) offered risk-reduction counseling. CONCLUSION: Knowledge of the cardiovascular risk factors was lower among the nurses/midwives and community health workers. Risk reduction counseling was quite low across all the health workers. There is need for continuous medical education and possible review of the training curriculum of the lower cadres of health workers.

Characteristics of patients presenting with complications of abortion in a tertiary health facility in south-west Nigeria

Objectives: Abortion is associated with significant health problem with short- and long-term complications that affect the quality of life of those who are fortunate enough to escape mortality. This study evaluated the population of patients with complications of abortion; identified the abortion providers and the pattern of contraceptive usage in these patients managed in our hospital; and suggests strategies on the required heath intervention.Design: The design was a descriptive study of cases of abortions with complications. Setting and subjects: We reviewed all (225) cases of abortions with complications managed at Ladoke Akintola University of Technology Teaching Hospital; Osogbo; Nigeria; over a five-year period. Outcome measures: Records of patients managed for abortion-related complications were retrieved; data were extracted and analysis was carried out for socio-demographic factors and other abortion-related characteristics. Results: The study showed a more common occurrence of abortions among middle-aged (64.4); multiparous (53.3) women with a low socio-economic background (62.6); and they were performed mostly by medical doctors in private settings (37.8). The low usage of contraception (11.1) was of significance. Conclusion: This study provided considerable insight into the complications of abortion in a tertiary institution in Nigeria. Most of the patients were aware of contraception; but usage; which mainly constituted emergency contraception; was low. Despite prophylactic antibiotics; sepsis was the most common observed complication. Healthcare intervention should be re-focused through the encouragement of the adoption of effective methods to prevent unwanted pregnancies. Healthcare providers should re-appraise their antibiotics regimen

Progestogen-only injectable contraceptive: experience of women in Osogbo, southwestern Nigeria.

BACKGROUND: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. OBJECTIVES: To determine the characteristics of women accepting the method, complications and indications for discontinuation. MATERIALS AND METHODS: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January, 2001 and 31 st December, 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05. RESULTS: A total of 1,967 women used contraception during the study period and 433 (22.1%) made progestogen-only injectable their method of choice. 199(45.96%) used NET-EN, while DMPA was used by234 (54.04%) women. Many of the women (197, 45.5%) used the method for terminal fertility control. Menstrual abnormality was the commonest (264, 71.4%) complaint about progestogen-only injectable contraceptive, of which amenorrhea was experienced by constituted 176(66.7%). Eighty-three (22.4%) women had discontinued the contraceptive, and menstrual abnormality was the commonest reason for the discontinuation (68, 81.9%). No pregnancy was reported among the women that came for follow up while on the method. CONCLUSION: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities, hence the need for effective education of the women about this side effect, thus increasing the acceptance and continuation rate of the contraceptive method.

Progestogen-only injectable contraceptive: experience of women in Osogbo, southwestern Nigeria

Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months; depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To determine the characteristics of women accepting the method; complications and indications for discontinuation. Materials and Methods: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January; 2001 and 31 st December; 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05.Results: A total of 1;967 women used contraception during the study period and 433 (22.1) made progestogen-only injectable their method of choice. 199(45.96) used NET-EN; while DMPA was used by234 (54.04) women. Many of the women (197; 45.5) used the method for terminal fertility control. Menstrual abnormality was the commonest (264; 71.4) complaint about progestogen-only injectable contraceptive; of which amenorrhea was experienced by constituted 176(66.7). Eighty-three (22.4) women had discontinued the contraceptive; and menstrual abnormality was the commonest reason for the discontinuation (68; 81.9). No pregnancy was reported among the women that came for follow up while on the method. Conclusion: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities; hence the need for effective education of the women about this side effect; thus increasing the acceptance and continuation rate of the contraceptive method

Health workers' knowledge of and experience with female genital cutting in Southwestern, Nigeria

Female genital mutilation with its attendant complications has been a harmful traditional practice that is difficult to eliminate despite all efforts by various government and non-governmental agencies in Nigeria. The aim of this study is to assess the experience and the knowledge of the health workers practicing in our environment on Female genital cutting (FGC). Two hundred and fifty were interviewed with self-administered structured questionnaire. Their mean age was 35.2±8.3 years. Type I 82(66.6%) was the commonest FGC seen by the health workers, type II 31(25.2%), type III 9 (7.3%) and type IV constituted 0.8%. Two hundred and two (202) (80.0%) of the respondents admitted to having sufficient knowledge in preventing FGC while 42 (16.8%) did not have. One hundred and twenty one (121) (48.4%) had been asked to perform FGC. It was concluded that female genital cutting is still a major health problem in Nigeria. There is need for all concerned to step up efforts in the elimination of the practice

Outcome of Breech Deliveries at a Tertiary Health Institution in Southwestern Nigeria

The aetiology of breech presentation is not clear, however, several factors had been found to be associated with increased risk of breech presentation. The mode of delivery of breech presentation for optimum neonatal outcome had been a subject of controversy over the years. The present study is a retrospective analysis of the outcome of singleton breech delivery at a tertiary health institution. The incidence of singleton breech delivery during the study period was 2.9%. The maternal age ranged between 16 and 44years with a mean age of 30.05±5.53; primiparous were 32(37.2%), while multiparous were 54(62.8%). External cephalic version was attempted, but failed in one case; assisted vaginal breech delivery was conducted in 19(22.0%) cases, 47(54.7%) were delivered by emergency Caesarean section, and 20(23.3%) had elective Caesarean section. Asphyxia was present in 14(77.8%), 31(66.0%)and 8(40.0%), of babies , delivered by assisted vaginal breech delivery, emergency Caesarean section, and elective Caesarean section, respectively (df = 2, p= 0.042). This study showed that elective Caesarean delivery gives the best neonatal outcome for breech presenting fetuses. Booking status positively impart fetal outcome, therefore provision and utilization of good quality antenatal care will go a long way to reduce the incidence of unbooked emergencies that significantly contribute to the poor neonatal outcome in breech deliveries

Pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital.

AIMS: A descriptive study to determine the pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital, and to know the factors that determine the pattern as well as the outcome of such consultations. MATERIAL AND METHODS: The case notes of all the patients that attended the gynaecology clinic between 1st January 2004 and 31st December 2005 were studied. RESULTS: Two hundred and fifty patients attended the gynaecology clinic during the study period, however, 208 (83.2%) case notes were available for analysis. Most of the patients that had gynaecological consultations during the study period were married (88.0%), and infertility (48.1%) was the commonest reason for the consultations. Many of the patients (60.1%) did not receive definitive treatment for their consultation. CONCLUSION: Infertility being the commonest reason for gynaecological consultations, and tubal factor the commonest cause of infertility, there is need to establish assisted reproductive technology in public health institutions to render services at a highly subsidized rate in helping this population of patients who could not afford this treatment which is presently being offered by private health institutions.

Booking status and caesarean section outcome in LAUTECH teaching Hospital, Osogbo.

INTRODUCTION: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. Quality of care varies across health facilities; the booking status of the women who deliver would have influence on the pregnancy outcome. METHOD: A comparative study of caesarean section outcome among the booked and unbooked mothers delivered at Ladoke Akintola University Teaching Hospital, Osogbo. RESULTS: Mean age of the women was 29.7 +/- 5.9 years. The booked mothers were older than the unbooked mothers. All the maternal deaths were among the unbooked mothers. There were higher rates of preterm birth, neonatal asphyxia and neonatal admissions to intensive care units among the babies delivered by unbooked mothers compared to the booked mothers. CONCLUSION: Unbooked women and their babies are at higher risks of caesarean section complications than the booked mothers.

Pattern of contraceptives choice among the married women attending the family planning clinic of a tertiary health institution.

BACKGROUND: Rampart population growth is the most fundamental problem of our times. It affects adversely the advancement of nations and the wellbeing of all peoples. The fertility rate in Nigeria remains high at a national average of about 5.2 children per woman. When a woman effectively uses a modern method of contraceptive she is less likely to be exposed to the hazards of grand multiparity and also unlikely to resort to dangerous illegal abortion. METHOD: This is a retrospective study, a review of the records of the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo was undertaken. These were new clients coming for the first time to the family planning clinic of the institution from January, 2001 to December 2006. RESULT: A total of 1355 married women were coming for the first time to the family planning clinic within the study period, and their age range between 18 and 51 years with a mean of 33.5+/-6.1 years. 170 (12.5%) were Para 1, Para 2-4 were 855 (63.1%), while Para 5 and above were 330 (24.4%). The clients source of information about family planning was: family planning clinic personnel 1039 (76.7%), media (print and electronic) 152 (11.2%), friends and relatives 127 (9.4%), and community health workers 37 (2.7%). Intrauterine contraceptive device was the most chosen method by the clients 1011 (74.6%), while condom was the least chosen 3 (0.2%); 264 (19.5%), and 77 (5.7%) clients chose injectables and pills, respectively. CONCLUSION: An increase in the level of knowledge on modern contraceptive methods through mass and interpersonal communications could be one of the key strategies to increase the utilization rate of modern contraceptive methods.

Feto - maternal haemorrhage in parturients: Incidence and its determinants.

This prospective study of parturients at a tertiary health institution in south-western Nigeria aims to identify the incidence, severity and obstetric factors predisposing to feto - maternal haemorrhage (FMH) in our population. The exclusion criteria were haemoglobinopathy and patient's refusal of consent to participate in the study. The prepared slide was processed as in the acid elution test described by Kleihauer - Betke. The FMH was calculated using Mollison formula (Mollison 1972). Baseline data included maternal biodata, blood group, RhD and haemoglobin electrophoresis, route/mode of delivery, duration of labour, obstetric interventions, fetal blood group and birth weight. Data generated were analysed with Statistical Package for Social Scientists (SPSS) version 11 software. Frequency tables, cross-tabulations and correlations were performed. Pearson's correlation was applied to continuous variables, while Spearman's correlation was utilised for discrete variables. Level of statistical significance was set at p < 0.05. A total of 163 parturients were studied, of which eight were multifetal gestations. There were no significant differences in maternal age, parity, estimated gestational age at delivery and birth weight, in both groups of parturients with and without FMH. A total of 17 parturients (10.43%), four of which were multifetal gestations (2.45%), had demonstrable FMH. Large FMH (>15 ml fetal cells) were noted in 10 (6.14%) parturients, of which, four were RhD-negative mothers. A total of 9.8% and 11.5% parturients in the vaginal and caesarean delivery groups, respectively, had significant FMH (p = 0.736). Incidence of large FMH was similar with each of the routes of delivery. Antepartum complications of pregnancy, delivery manoeuvres and episiotomy were not significant determinants of FMH. Multiple gestations, fetal birth weight and complications in labour were significantly associated with risk of FMH. Risk-based approach to management, in RhD negative pregnant women, might lead to under-treatment, with attendant increased incidence of isoimmunisation. At least in all RhD-negative women, the cord blood should be tested to determine the baby's blood group and if RhD-positive, Kleihauer - Betke test should be done to determine the degree of FMH and anti-D immunoglobulin dose administered appropriately. Further studies are necessary to establish the determinants/risk factors for FMH.

Booking status and caesarean section outcome in LAUTECH teaching hospital, Osogbo

Background: To assess the clinical features; diagnosis; and treatment of patients having chronic otitis media (COM) with cholesteatoma seen in the ENT/Head and Neck Surgery Clinic at the University Clinical Center; Prishtina; Kosovo. Method: A systematic review of the medical records of all patients admitted to the ENT clinic having COM with cholesteatoma between January 1999 and December 2003. Results: During this period; 223 patients suffering from COM with cholesteatoma underwent surgical treatment. There were 123 (55) male and 100 (45) female patients. Their mean age was 30.7 years; ranging from youngest patient (7-year-old girl) to oldest (73-year-old lady). Thirty-three patients developed complications: 17 patients extracranial complications (EC) and 16 intracranial complications (IC). Leading pathogens in this series were Proteus mirabilis in 52of cases; Proteus vulgaris in 14and Staphylococcus aureus in 12. All patients underwent surgical treatment: 10 patients (4.5) a canal-wall up (CWU) procedure and 213 (95.5) a canal-wall down (CWD) procedure. No deaths occurred in this series. Conclusion: Because of possibility of developing life-threatening complications; patients with COM with cholestatoma must diagnosed in time and followed as soon as possible to the center that performs ear surgery; as only adequate treatment option for these patients

Pattern of contraceptives choice among the married women attending the family planning clinic of a tertiary health institution

Background: Rampant population growth is the most fundamental problem of our times. It affects adversely the advancement of nations and the wellbeing of all peoples. The fertility rate in Nigeria remains high at a national average of about 5.2 children per woman. When a woman effectively uses a modern method of contraceptive she is less likely to be exposed to the hazards of grand multiparity; and also unlikely to resort to dangerous illegal abortion. Method: This is a retrospective study; a review of the records of the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital; Osogbo was undertaken. These were new clients coming for the first time to the family planning clinic of the institution from January; 2001 to December 2006. Result: A total of 1355 married women were coming for the first time to the family planning clinic within the study period; and their age range between 18 and 51 years with a mean of 33.5+6.1 years. 170 (12.5) were Para 1; Para 2-4 were 855 (63.1); while Para 5 and above were 330 (24.4). The clients source of information about family planning was: family planning clinic personnel 1039 (76.7); media (print and electronic) 152 (11.2); friends and relatives 127 (9.4); and community health workers 37 (2.7). Intrauterine contraceptive device was the most chosen method by the clients 1011 (74.6); while condom was the least chosen 3 (0.2); 264 (19.5); and 77 (5.7) clients chose injectables and pills; respectively. Conclusion: An increase in the level of knowledge on modern contraceptive methods through mass and interpersonal communications could be one of the key strategies to increase the utilization rate of modern contraceptive methods

Knowledge and attitude of female health workers towards prenatal diagnosis of sickle cell disease.

BACKGROUND: Sickle cell disease individuals who get pregnant constitute a high risk group during pregnancy and in the peurperium. Females experience various complications of sickle cell disease in pregnancy, hence female health workers who are thought to be aware of these complications, and who would be involved in information dissemination about prenatal diagnosis were studied to know how their knowledge would affect their attitude to early termination of affected pregnancy detected by prenatal diagnosis. METHODOLOGY: Structured questionnaires were administered to all categories of female health workers at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria. RESULT: One hundred and seventy-six responses were obtained. Fifty-seven (32.4%) were single, while 119 (67.6%) were married. One hundred and fifty-three (86.9%) were Christians, while 23 (13.1%) were Moslems. Ninety-seven (55.1%) of the respondents were nurses, 14 (8.0%) doctors, and other health workers were 65 (36.9%). The mean score of the knowledge of the complications of sickle cell disease in pregnancy for the unmarried respondents was 4.60 +/- 1.6, and for the married 4.03 +/- 2.0. The mean score for the doctors was 5.29 +/- 0.73, for the nurses 4.42 +/- 1.63, and for the other health workers 3.66 +/- 2.18. Three (21.4%) of the doctors would accept early termination of affected pregnancy, while 31 (32.0%) and 21 (32.3%) of the nurses and the other health workers, respectively, would accept termination of affected pregnancy. CONCLUSION: Despite the knowledge of the complications of sickle cell disease in pregnancy by the health workers, they are opposed to the early termination of affected pregnancy detected by prenatal diagnosis; therefore, emphasis should be on genetic counseling as a means of controlling sickle cell disease.

Antepartum myomectomy with a live term delivery--a case report.

We report a case of successful myomectomy in pregnancy. The patient, a 27 year old nulliparous, presented with 2 year history of progressive abdominal swelling and 13 weeks of amenorrhoea. Abdomino-pelvic ultrasonography revealed a viable intrauterine pregnancy at 18 weeks and 3 days; there was also a huge mass with cystic component, extending from the pelvis to the whole of the abdomen, with associated dilatation of the renal calyces bilaterally; sonographic diagnosis of ovarian mass in pregnancy was made. At exploratory laparotomy, a huge subserous leiomyoma coexisting with pregnancy was found; myomectomy was done. The rest of the pregnancy was uneventful, and the patient had spontaneous vertex delivery of a live infant at term.

A ten-year review of breech deliveries at Ibadan.

An audit of all breech deliveries at the University College Hospital, Ibadan over a ten-year period was done to determine the most important contributors to perinatal morbidity and mortality in breech deliveries. The data were obtained from the birth register and individual case records of patients seen at the hospital during the period. The audit revealed the occurrence of 263 breech deliveries out of a total 9,966 deliveries, giving an incidence of breech presentation of 2.6%. Breech presentation was commonest among primigravidae (32.0%) and decreased with increasing parity. Caesarean section was the commonest mode of delivery (46.1%) at term. The fresh stillbirth rate was 10.5%. Low birthweight and prematurity were noted in 31.0% and 35.2%, respectively. The corrected perinatal mortality rates for pre-term and term breech were 450.0 per 1000 and 62.5 per 1000, respectively. Caesarean section appeared to confer an advantage over vaginal delivery at term. Low birth-weight and prematurity remain significant predisposing factors to the high perinatal morbidity and mortality attending breech births.