Atherogenic Index, Cardiovascular Risk Ratio, and Atherogenic Coefficient as Risk Factors for Cardiovascular Disease in Pre-eclampsia in Southeast Nigeria: A Cross-Sectional Study.

BACKGROUND: Pre-eclampsia is a key trigger for maternal and perinatal morbidity and mortality. Current evidence suggests an association between dyslipidemia and atherosclerosis. Thus, the importance of evaluating some indices of atherosclerosis during pregnancy cannot be over-emphasized. AIM: To evaluate the effect of some lipid profile indices as risk factors for developing cardiovascular disease (CVD) among women with pre-eclampsia in Enugu, Southeast Nigeria. MATERIALS AND METHODS: A cross-sectional study of two groups of eligible pregnant women between 20 and 40 weeks of gestation selected at three healthcare facilities in Enugu, Nigeria was carried out. The case group consisted of 160 women with pre-eclampsia, while the control group consisted of 160 normotensive pregnant women. Participants' fasting blood samples were analyzed for different fractions of lipids and their atherogenic indices were calculated. RESULTS: There were significantly higher mean levels of total cholesterol (TC), low-density lipoprotein (LDL), and triglyceride (TG) [P < 0.001] in pre-eclampsia than in normal pregnancy. The atherogenic index of plasma (AIP), cardiovascular risk ratio (CRR), and atherogenic coefficient (AC) were significantly higher in pre-eclampsia than in normal pregnancy (P < 0.001) and there was a significant positive correlation between mean arterial pressure (MAP) and AIP (r = 0.421), CRR (r = 0.416) and AC (r = 0.634) for women with pre-eclampsia. CONCLUSION: Pre-eclampsia is associated with an increased risk of CVDs. Determining the atherogenic indices and assessing the AIP level in pre-eclamptic women may predict disease risk and help in early management and measures for its prevention.

Incidence, Determinants, and Outcomes of Spontaneous Preterm Birth at Tertiary Hospitals in Enugu, Southeast, Nigeria: A Cross-Sectional Study.

BACKGROUND: In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment. AIM: This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria. METHODS: This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp. RESULTS: The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each. CONCLUSIONS: The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage.

The Impact of Infertility on the Sexual Life of Infertile Women in Enugu, South East Nigeria.

BACKGROUND: Infertility is a common gynecological problem in sub-Saharan Africa, including Nigeria. It tends to affect the sexual life of couples and may affect their quality of life. OBJECTIVE: The study was aimed to assess the impact of infertility on the sexual life of women with infertility seeking care in Enugu, South-East Nigeria. METHODS: A questionnaire-based, multicenter cross-sectional study of women with infertility managed at the Gynecology units of the two government-owned tertiary hospitals in Enugu over a 2 months period. The relevant data were obtained and analyzed using SPSS version 20.0. RESULTS: Three hundred and sixty female respondents participated in the study. Their mean age was 35.23 ± 5.7 years. The majority of them were married (98.3%) and attained a tertiary level of education (69%). The number of respondents that reported adequate sexual intercourse dropped from 33.9% before the diagnosis of infertility to 12.2% after the diagnosis. Almost two-thirds of the respondents (65%) reported that they no longer enjoy sex with their husband/partner, whereas 38.9% of them feel they were no longer attracted to their partners. CONCLUSION: Infertility seems to have a negative effect on the sexual life of women. Addressing this identified negative effect may improve the outcome of infertility management and also may improve the quality of life of women with infertility in the region.

Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country.

BACKGROUND: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. AIM: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. SUBJECTS AND METHODS: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. RESULTS: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). CONCLUSION: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.

Maternal risk factors for singleton preterm births and survival at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

CONTEXT: Risk factors for and survival of singleton preterm births may vary according to geographical locations because of socioeconomic differences and lifestyle. AIMS: The aim was to describe maternal risk factors and survival-to-discharge rate for singleton preterm births at the University of Nigeria Teaching Hospital and determine the relationship between maternal risk factors and the survival of singleton preterm babies. SUBJECTS AND METHODS: A comparative retrospective review of singleton preterm and term births from January 2009 to December 2013 was carried out. Statistical analysis involved descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences (SPSS) version 15 for Windows. P≤0.05 was considered significant. RESULTS: A total of 784 births including 392 singleton preterm births (aged 26-36+6) and 392 singleton term births were studied. The mean age of mothers who delivered singleton preterm babies did not differ significantly from that of mothers who delivered singleton term babies (30.2±4.9 years vs. 30.8±4.7; P=0.06). Lack of antenatal care (adjusted odds ratio [aOR]=2.63; 95% confidence interval [CI] 1.92, 6.07), Previous preterm birth (aOR=5.06; 95% CI: 2.66, 9.12), having pregnancy complications including antepartum hemorrhage, preeclampsia/eclampsia or premature rupture of membranes (aOR=5.12; 95% CI: 2.4, 11.8), being unmarried (aOR=2.41; 1.56, 3.71) and nulliparity (aOR=2.08, 95% CI: 1.22, 4.91) were independent risk factors for singleton preterm births. The average survival-to-discharge rate for preterm babies during the period was 38.4%. The mean duration of admission for singleton preterm babies was 16±5.8 days (range: 2-75 days). Whereas survival was dependent on, gestational age at birth (P<0.001) and mode of delivery (P=0.01), it was not dependent on maternal risk factors of parity, marital status, complications of pregnancy, and antenatal care. CONCLUSIONS: There was a low rate of survival of singleton preterm babies at the study center and survival was dependent on gestational age at birth and mode of delivery, but not on maternal sociodemographic risk factors for singleton preterm births. Active collaboration between the obstetrician and the neonatologist in deciding when and how to deliver these babies may provide improved chances of survival.

Surgical Proficiency of Obstetrics and Gynaecologic Residents in Nigeria.

BACKGROUND/OBJECTIVE: The aim of residency training is to produce competent and professional experts in their areas of specialty. Surgical proficiency is required to be able to offer patients a genuine choice of treatment options and safety of procedures performed. We assessed self-reported level of proficiency for common major gynaecological surgeries among trainee gynaecologists. METHODS: Pretested self- administered questionnaires were distributed to senior residents at the West African College of Surgeon's revision course in Obstetrics and Gynaecology. RESULTS: They were 42 respondents from 15 institutions in Nigeria; 66.7%were males. The mean number of years in residency was 5±1 years.The most commonly performed surgeries were salpingectomy, ovarian cystectomy, myomectomy where approximately 60%, 30% and 33% of residents had performed 10 or more of these surgeries respectively. The least performed surgeries were vaginal hysterectomy, fistula repair and laparoscopic surgeries because each of these surgeries had never been performed more than 60% of residents. These commonly performed surgeries were associated with self-reported average or more proficiency. Reported challenges to attaining surgical proficiency were trainer incapability (92.5%), theatre/hospital logistics (75%), inadequate cases (65%) and trainer unavailability (55%). CONCLUSION: Our findings suggest that majority of the senior residents of Obstetrics and Gynaecology assisted and performed insufficient number of gynaecological surgeries to attain proficiency in these procedures. A formal training curriculum needs to be utilized in the training of surgical residents.

Reducing maternal deaths in a low resource setting in Nigeria.

OBJECTIVE: To assess the impact of the adoption of evidence based guidelines on maternal mortality reduction at Enugu State University Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective review of all maternal deaths between 1 st January, 2005 and 31 st December, 2010 was carried out. Evidence based management guidelines for eclampsia and post-partum hemorrhage were adopted. These interventions strategy were carried out from 1 st January, 2008-31 st December, 2010 and the result compared with that before the interventions (2005-2007). MAIN OUTCOME MEASURE: Maternal mortality ratio (MMR) and case fatality rates. RESULTS: There were 9150 live births and 59 maternal deaths during the study period, giving an MMR of 645/100 000 live births. Pregnant women who had no antenatal care had almost 10 times higher MMR. There was 43.5% reduction in the MMR with the interventions (488 vs. 864/100 000 live births P = 0.039, odds ratio = 1.77). There was also significant reduction in case fatality rate for both eclampsia (15.8% vs. 2.7%; P = 0.024, odds ratio = 5.84 and Post partum hemorrhage (PPH) (13.6% vs. 2.5% P value = 0.023, odds ratio = 5.5. Obstetric hemorrhage was the most common cause of death (23.73%), followed by the eclampsia. CONCLUSION: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.

Angiosarcoma of the cervix: a case and literature review.

BACKGROUND: Generally, sarcomas of the female genital tract are rare and angiosarcomas are extremely rare. They usually have poor prognosis and pose serious diagnostic challenges requiring special techniques namely special stains and immunohistochemistry for proper elucidation. METHOD: A case report of a 65 old para 8 (4 alive) widow, 17 years postmenopusal, who presented with history of foul smelling brownish vaginal discharge, progressive weight loss and cervical lesion. She had examination under anaesthesia and biopsy. RESULT: Histopathological result showed features in keeping with angiosarcoma of the uterine cervix. CONCLUSION: Although angiosarcoma of the cervix is very rare, it is occasionally seen in black women in Nigeria.

Anaemia in pregnancy: a public health problem in Enugu, southeast Nigeria.

The aim of the study was to determine the prevalence of anaemia in pregnancy at booking and to determine factors associated with its occurrence in order to proffer solutions. This was a 12-month cross-sectional study of pregnant women attending the antenatal clinic for the first time (booking visit) at ESUTTH, Enugu, Nigeria from 1 April 2009 to 31 March 2010. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration and HIV status of the women were determined and the results were analysed. The prevalence rate of anaemia in pregnancy was 64.1%. Based on severity, 94.6%, 4.3%, 1.1% of them had mild, moderate and severe anaemia. The mean age of the anaemic women was significantly lower than that of the non-anaemic women (p = 0.0001). Those that had no formal education and those that booked for antenatal care in the 3rd trimester had a significantly higher prevalence of anaemia. HIV-positive pregnant women had a significantly higher prevalence of anaemia than HIV-negative pregnant women (p = 0.0072, odds ratio 2.37). It was concluded that the prevalence of anaemia in pregnancy from the study is unacceptably high. To achieve Millennium Development Goals 4 and 5, efforts must be geared towards its prevention to ensure a healthy baby and mother.

HIV sero-prevalence among pregnant women in a resource constrained setting, South East Nigeria.

INTRODUCTION: HIV infection and AIDS is a public health problem worldwide, particularly affecting the populace in resource constrained settings like in sub-Saharan Africa. Women of reproductive age are most affected and infected with the disease. METHODOLOGY: A descriptive study of pregnant women presenting for the first time at the obstetrics booking clinic of ESUTTH, Parklane from 1st April, 2009 to 31st March, 2010. Socio-demographic characteristics, sexual behavior, pregnancy history and STI related symptoms were obtained using already prepared proforma. HIV Screening test was conducted in a serial two step approach using Determine HIV test kits and Stat- Pak HIV kits after obtaining an informed consent. Discordant results were subjected to Western blot for confirmation. Data were entered and analyzed using Epi-info statistical software. P Value < 0.05 were assessed as statistically significant at 95% confidence interval. RESULT: A total of 1306 women were recruited, 66 women were HIV positive, giving a prevalence rate of 5.1%. Their mean age was 28.79 +/- 5.06 years. Majority of them were married (9%). The mean gestational age at booking was 26.2 +/- 6.8 weeks. Alcohol intake, history of 3 or more sexual partner in the last 5 years, abnormal vaginal discharge in the last 12 months, history of genital ulcer in last 12 month, had a statistically significant association with prevalence of HIV infection (p value < 0.005). CONCLUSION: HIV infection prevalence rate in among antenatal attendants in Enugu is still high. A multi-sectoral approach is required for effective prevention and control of the disease to ensure achievement of Millennium development Goals 5&6.

Large vulvar lipoma following episiotomy: a case report.

Vulvar lipomas are rare few cases have been reported in the world literature. We document a case of large soft vulvar mass following episiotomy in a 23-year-old primipara. The mass was excised and histologic examination confirmed lipoma.

Obstetric outcome following free maternal care at Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, South-eastern Nigeria.

This study aims to determine the impact of free maternal care on the utilisation of the available delivery services and to evaluate the obstetric outcome. All deliveries at ESUTH, Parklane within the 4 months of free maternal care from 1 September to 31( )December 2008 were studied and compared with deliveries that took place 4 months before and after the free services. The results were analysed using Epi-info statistical software version 3:2:2. There was an 88% rise in the number of deliveries with the introduction of free maternal services and a 30% drop within 4 months of its termination. The maternal mortality ratio (MMR) dropped slightly, but morbidity increased significantly, as well as stillbirth rate (77/1,000 births), especially intrapartum stillbirth. Cost barrier limits women's access to healthcare in developing countries and must be addressed if we aim to achieve Millennium Development Goals (MDGs) 4 and 5.

Maternal mortality in a transitional hospital in Enugu, south east Nigeria.

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100,000 live births as a specialist hospital, with a decline to 625/100,000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies