Sleep disorders in women attending antenatal care at a tertiary hospital in Nigeria.

AIMS AND OBJECTIVES: To determine the prevalence of sleep disorders in a population of Nigerian women during pregnancy and to evaluate the frequency of these sleep disorders according to the three trimesters of pregnancy. SUBJECTS AND METHODS: A prospective cross-sectional design. Participants' were interviewed at the antenatal clinic with a questionnaire to evaluate their sleep during and before pregnancy and to appraise disturbance in their sleep according to the trimester. RESULTS: Two hundred and three pregnant women participated in the survey and were evaluated at one of three points in pregnancy: 1st trimester (n=57), 2nd trimester (n=71) and 3rd trimester (n=75). Overall, the prevalence of sleep disorder in the population surveyed was 35.5% (72/203), more women experienced sleep disturbances in the first (42.1%) and third (40%) trimester of pregnancy compared to the second (25.3%). In terms of types of sleep disorders; 96(47.3%) reported insomnia, 32(15.8%) sleep breathing disorders, 86(42.4%) excessive daytime sleepiness, 172(84.7%) mild sleepiness and 64(31.5%) significant specific awakenings. The most common reason for specific awakening was frequent urination (78.6%). These sleep disorders were more common in the third trimester of pregnancy but only insomnia and specific awakenings showed statistical significance, p=0.007 and 0.031 respectively. Logistic regression model showed that nulliparity, increased BMI and previous adverse obstetric events had significant independent associations with sleep disorders. CONCLUSION: Sleep disorders are common in pregnancy, notably in the first and third trimesters.

Partograph as a tool for team work management of spontaneous labor.

It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non-obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4-h action line, but other workers have attempted with 2- and 3-h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.

Early onset pregnancy-induced hypertension/eclampsia in Benin City, Nigeria.

CONTEXT: Pregnancy - induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focused on early onset pregnancy induced hypertension/eclampsia in Nigerian women. OBJECTIVES: To determine the incidence, clinical features and outcome of cases of early onset pregnancy-induced hypertension /eclampsia in a Nigerian tertiary hospital, and compare maternofetal outcome in early and late onset disease. Methods : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital. MAIN OUTCOME MEASURES: Severity of disease, rates of induction of labour, caesarean section rate, maternal mortality, abruptio placenta, still births, severe birth asphyxia and early neonatal deaths. RESULTS: Early onset pregnancy induced hypertension/eclampsia contributed 6.3% of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate was 34.0%. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia, having induction of labour and worse perinatal outcome than late onset disease. CONCLUSION: Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease.

Early Onset Pregnancy Induced Hypertension/Eclampsia in Benin City; Nigeria

Pregnancy induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focussed on early onset pregnancy induced hypertension/eclampsia in Nigerian women To determine the incidence; clinical features and outcome of cases of early onset pregnancy induced hypertension /eclampsia in a Nigerian tertiary hospital; and compare maternofetal outcome in early and late onset disease. : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital. : Severity of disease; rates of induction of labour; caesarean section rate; maternal mortality; abruptio placenta; still births; severe birth asphyxia and early neonatal deaths. : Early onset pregnancy induced hypertension/eclampsia contributed 6.3of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3) The disease was severe at presentation or rapidly progressive in 39 cases (84.8) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7of cases. The perinatal survival rate was 34.0. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia; having induction of labour and worse perinatal outcome than late onset disease. : Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease

Abruptio placenta following sexual intercourse: case report.

This is a case of Abruptio Placenta resulting from sexual intercourse. Pelvic Examination revealed active bleeding per vaginam. The pregnancy resulted into intra-uterine foetus death. The foetus membranes were ruptured and labour progressed. A still born male baby was delivered.

A comparison of two adjunctive treatments for intrauterine adhesions following lysis.

OBJECTIVES: To assess which treatment modality has a better outcome: the use of an intrauterine contraceptive device or the Foley catheter balloon, for the adjunctive treatment of intrauterine adhesion (IUA) in patients presenting with infertility. METHODS: In a 4-year initial period, patients with intrauterine adhesion were treated with the insertion of an intrauterine contraceptive device (IUCD) after adhesiolysis. In the next 4 years, a pediatric Foley catheter balloon was used after adhesiolysis instead of the IUCD. The postoperative treatment was the same throughout the 8 years. While the IUCD was removed after three consecutive withdrawal vaginal bleedings, the Foley catheter was removed after 10 days. Hysterosalpingography was repeated in all patients after the third withdrawal vaginal bleeding, and the procedure was repeated if the intrauterine adhesion still persisted. The chi2-test was used for analysis. RESULTS: There were 51 cases of IUA treated with the IUCD and 59 cases treated with the Foley catheter balloon. In the Foley catheter group, 81.4% of the patients had restoration of normal menstruation compared with 62.7% in the IUCD group (P<0.05). Persistent posttreatment amenorrhea and hypomenorrhea occurred less frequently in the Foley catheter group (18.6%) than in the IUCD group (37.3%) (P<0.03), and the conception rate in the catheter group was 33.9% compared with 22.5% in the IUCD group. The need for repeated treatment was also significantly less in the Foley catheter group. CONCLUSION: The Foley Catheter is a safer and more effective adjunctive method of treatment of IUA compared with the IUCD.