Determination of antioxidant status of pre-eclamptic and normotensive sub-rural Nigerian pregnant women at the Irrua Specialist Teaching Hospital, Irrua, Edo State.

OBJECTIVES: To determine the antioxidant levels of subrural Nigerian population where pre-eclampsia and eclampsia is the leading cause of maternal mortality. METHODS: Prospective case control study done at Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria. Plasma level of vitamin C and E were evaluated in 80 pre-eclamptic patientswhich were compared with normotensive 80 pregnant women matched as controls. RESULTS: Pre-eclampsia was associated with significant reduction in levels of vitamin C and E (p < 0.05). However, the correlation between the blood pressure (severity) and reduction in antioxidants level was not statistically significant. CONCLUSION: Pre-eclampsia at Irrua in Nigeria is associated with significant reduction in plasma antioxidants level similar to some reports from the other parts of the world.

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome.

BACKGROUND: Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Its removal is commonly associated with complications. To prevent or control the occurrence of this complication requires the understanding of the factors associated with the complications. OBJECTIVE: To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in southwestern Nigeria. METHODS: Study was carried out at two large tertiary hospitals in the south west region of Nigeria. Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine women with uterine leiomyoma seen and managed surgically in South-Western Nigeria were the participants. RESULTS: The common presenting complaints were menstrual irregularities (47.7%), abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with multiple leiomyomata. The commonest anatomical position of the nodules were multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively. Myomectomy was performed in 54.7% of cases. Postoperative complications occurred in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and postoperative anaemia (10.4%) been the most common complications. CONCLUSION: Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.

Eclampsia in Irrua Specialist Teaching Hospital: a five-year review.

OBJECTIVE: The contribution of Eclampsia to maternal mortality in Nigeria is well documented. In Irrua it accounts for over 25% of maternal deaths. Addressing Eclampsia is therefore a priority programme of the Irrua Safe motherhood Initiative. AIM: The aim of this study is to determine the incidence of eclampsia, its clinical correlates and outcome. Finally strategies will formulate programme implementation. MATERIALS AND METHODS: This is a retrospective study of cases of eclampsia in Irrua Specialist Teaching Hospital, Edo state; over a five-year period. Information was retrieved using a structured proforma. Statistical analysis was done using the excel statistical package and the Epi info 2002 statistical software. RESULTS: Seventy eight (78) were admitted in the 5 year study. This accounted for 2.52% of total labour ward admission. However only 74 case notes were available for analysis. 70/74 of the patients were unbooked emergencies. Among the unbooked patients. 38/70 (54.29%) of the unbooked had not received any antenatal care whatsoever. The incidence was disproportionately higher in younger women and teenagers as well as in primigravida. 55/74 (74.32%) had preceding headache while 21.62% had a prior history of blurred vision, 14.86% had epigastric pain.16.22% had restlessness while 10.81% had nausea and vomiting each. The perinatal mortality rate was 28.38% while the maternal mortality ratio was 22.97%. Maternal mortality was associated with poor urinary output (0.0003), history of native medication (0.0199), number of fits (0.00209). Platelet count below 50,000/ml, highest systolic blood pressure above 200 mmhg (0.000018) and pulmonary oedema (0.000558). CONCLUSION: Addressing Eclampsia in Irrua will include community campaigns, capacity building, retraining of staffs within the hospital and improved facilities for the management of cases.

Myomectomy during second trimester pregnancy: a case report.

The prevalence of leiomyoma during pregnancy is reported as approximately 2%. Although during pregnancy leiomyomas usually remain asymptomatic, they may complicate its course. The management of leiomyoma during pregnancy is medical, but in certain circumstances surgical intervention and myomectomy may be required. This 28-year-old primigravida presented with progressively worsening lower abdominal pain at 14 weeks gestational age. Ultrasonography demonstrated a large fundally sited multi lobulated fibroid extending up to the right hypochondrium. There was an intrauterine gestation compatible with her menstrual dates. Laparotomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. She was admitted at 34 weeks gestation with a diagnosis of antepartum haemorrhage. She was managed conservatively in the ward until 37 completed weeks gestation when she had an elective caesarean section and delivered of a live male neonate with a birth weight of 2.7 kg. She had type III placenta praevia.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua, Nigeria.

BACKGROUND: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographic characteristics of patients with maternal deaths with associated delay. METHODS: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p < 0.05 RESULTS: The mortality ratio in the study period is 1747/ 100,000 live births. Delay was associated with 77.8% of all maternal deaths. Type I delay was the major problem contributing 57.1%. Identified risk factors for delay in this study are; unbooked status, low socioeconomic status and marital status. CONCLUSION: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua; Nigeria

Background: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographiccharacteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital; Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p 0.05 Results: The mortality ratio in the study period is 1747/100;000 live births. Delay was associated with 77.8 of all maternal deaths. Type I delay was the major problem contributing 57.1. Identified risk factors for delay in this study are; unbooked status; low socioeconomic status and marital status. Conclusion: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested

Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods.

Obstructed labour is a common obstetric complication in Nigeria associated with poor fetal and maternal outcome. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. The purpose of this study was to examine and compare the morbidity and mortality associated with two methods of delivery of the impacted fetal head at caesarean section for obstructed labour (the push method and the pull (reverse breech) method). This study is a prospective study of cases of obstructed labour admitted into the labour ward of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between 1 June 1998 and May 31 2000. One hundred and eight women with obstructed labour at term with live fetus undergoing caesarean section were assigned randomly to either of the methods of admission. The maternal and fetal outcomes were analysed and compared between groups. Patients in the push group had statistically significant higher rates of maternal morbidity (longer operation time, more blood loss, extension of uterine incision, endometritis, longer hospital stay and higher hospital bills) than the pull method (P < 0.05). Also the fetal morbidity was worse in the push group. The 'pull' method of delivery of impacted fetal head at caesarean section for obstruction is safer and faster than the 'push' method.