Near Miss and Maternal Mortality at the Jos University Teaching Hospital.

BACKGROUND: Some women who enter pregnancy in a healthy state may survive with serious complications while others may die. This study sets out to determine the frequency of maternal near-miss (MNM) and maternal death. It also intended to identify common causes and determinants. MATERIALS AND METHODS: This was a cross-sectional study from June 2012 to May 2013 that involved women who were admitted for delivery, within 42 days of delivery or termination of pregnancy and those who died from pregnancy, childbirth, or puerperal complications. Data obtained were analyzed using Epi info 2002. RESULTS: There were 105 maternal near misses and deaths. Nineteen of them were mortalities, whereas 86 were MNMs. The maternal mortality ratio over the period was 806/100,000 live births and near miss was 3649/100,000 live birth. Hypertensive disorders in pregnancy were the leading cause of maternal deaths (47.36%) and MNMs (47.7%). Maternal deaths (57.9%) and near misses (43%) were the highest among those that treatment was instituted after 60 min and within 30-60 min of diagnosis, respectively. The consultants were the highest level of expertise involved in the management of 73.3% and this group recorded the least maternal death and highest MNM. CONCLUSION: Hypertensive disorder was the leading cause of MNM and mortality. Involving the highest level of expertise in patient management and reducing the time interval between diagnoses and instituting definitive treatment is essential for a better outcome. Health institutions will benefit from the evaluation of their quality of obstetric care by including near miss investigations in their maternal death enquiries.

An Audit of Perineal Trauma and Vertical Transmisson Of HIV.

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.

Labial adhesion in children at the Jos University Teaching Hospital.

BACKGROUND: Labial adhesion is one of the most common reasons for gynaecologic consultations in children. We sought to determine the prevalence of labial adhesions, mode of presentation and treatment in children at the Jos University Teaching Hospital. MATERIALS AND METHODS: A retrospective study of labial adhesions in children from January 2004 to December 2013. Data on paediatric gynaecological consultations, and labial adhesions were retrieved from the gynaecological clinic and the theatre records. The case notes of those with labial adhesions were retrieved and the relevant data extracted. RESULTS: The total number of paediatric patients seen at the gynaecology clinic over the study period was 379 and 25 had labial adhesion (6.6%). The majority (88%) presented in the first 2 years of life, all the patients were asymptomatic, and 2 (8%) had surgical separation of the adhesions while the rest were managed conservatively. A total of 5 (20%) came for follow-up. While 2 (8%) came a week later following surgical management, 3 (12%) came back more than 6 months later due to recurrence following conservative management. CONCLUSION: Labial adhesions account for significant proportion of paediatric gynaecologic consultations. They are usually asymptomatic, occur in the first 2 years of life and frequently managed conservatively.