Antenatal cardiotocography: experience in a Nigerian tertiary hospital.

OBJECTIVES: To compare selected perinatal characteristics between infants of mothers with reactive and non-reactive antenatal cardiotocography (non-stress test) results. PATIENTS AND METHODS: The medical records of all women who delivered within one week of a non-stress test were retrieved. The indication, test result, gestational age at delivery, Apgar score at 5 minutes, perinatal complications and neonatal ward admission were documented. RESULTS: One hundred and twelve women met study criteria among whom 51 tests were reactive and 61 were non-reactive. Post-datism, intra-uterine growth restriction, hypertensive disorders of pregnancy, and premature rupture of membranes were the commonest indications for the test. Post-datism was more commonly associated with a non-reactive test result. Women with non-reactive tests were almost twice as likely to be delivered by emergency Caesarean section, compared with women with reactive tests; although the test result did not significantly influence the mode of delivery. A non-reactive test was significantly associated with a higher perinatal mortality (p = 0.04). Although the reactive test was associated with a three-fold reduction in the incidence of low Apgar scores compared with the non-reactive test, this difference was not statistically significant (p = 0.18). A non-reactive test was significantly associated with small for gestational age infants (p = 0.01). CONCLUSIONS: Non-reactive non-stress test may be associated with higher perinatal mortality. When appropriately utilised, the test is a valuable tool for early detection of foetal compromise. Antenatal cardiotocography has a place in obstetric practice in low-resource settings for improving perinatal care.

Evaluation of criteria-based clinical audit in improving quality of obstetric care in a developing country hospital.

Study evaluated criteria-based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before (Phase I) and after (Phase II)' audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p = 0.00), obstructed labour (81.7 to 93.5%, p < 0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries.

Evaluation of criteria-based clinical audit in improving quality of obstetric care in a developing country hospital

Study evaluated criteria­based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before (Phase I) and after (Phase II)' audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p=0.00), obstructed labour (81.7 to 93.5%, p<0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries (Afr J Reprod Health 2008; 12[3]:59-70)

Attitude of health-care workers to HIV/AIDS.

The current 5% prevalence rate of HIV in Nigeria represents a significant population of people living with HIV/AIDS (PLWHA). Discrimination against PLWHA has profound impact on the care and support required for their optimal management particularly in resource-constrained settings. The study sought to assess the knowledge of health-care providers about HIV/AIDS, determine the potential for discrimination in the provision of services based on patients' HIV sero-status and review the factors that may contribute to such attitude. Self-administered semi-structured questionnaires were administered to respondents who were selected by multi-stage sampling technique. The questionnaires explored the respondents' knowledge about HIV and their attitude and practice regarding PLWHA. Three hundred and forty-five questionnaires were completed. Only 77.1% correctly identified breastfeeding as a source of HIV transmission; 5.2%and 2.6% respectively thought transmission was possible through mosquito bite and handshake. About 10% and 15% respectively among trained nurses and auxiliary nurses were unaware that HIV could be transmitted to the child during delivery. Some 13.9% and 12.7% of respondents respectively were unwilling to take vital signs and carry out physical examination on PLWHA. Compared to physicians, trained nurses and auxiliary nurses were more likely to deny services based on HIV sero-status. Negative attitude was more likely if the source of the HIV infection was from homosexual exposure or bisexual indiscretion. The health-care workers studied manifested certain attitudes that are potentially discriminatory of PLWHA. Well-coordinated continuing education of HIV/AIDS for all categories of health-care workers is recommended as a vital strategy in the crusade against the epidemic.

Experience with intravaginal misoprostol in the management of intra-uterine fetal death.

This collaborative study between the departments of Obstetrics and Gynaecology of the University College Hospital, Ibadan and Federal Medical Centre, Abeokuta assessed the value of intravaginal misoprostol in the management of intra-uterine fetal death. Fifty-six women at gestational ages between 17 weeks and term admitted for intra-uterine death with no contraindications to misoprostol received 400mcg of misoprostol administered intravaginally 12-hourly, until the establishment of effective uterine contractions. The mean gestational age was 27.9 weeks+/-7.1(SD) and the mean Bishop score was 2.7+/-2.4(SD). The mean duration of onset of contractions was 5.0 hours+/-8.4 (SD); the mean induction-delivery interval was 17.5 hours+/-6.3(SD). Ninety three percent of the women had expelled within 48 hours. Successful induction was achieved in all women. Prophylactic vacuum aspiration was performed (lower gestation only) in 19.6% of cases. Fever, nausea and vomiting were the commonest side effects (7.1%). Neither gestational age nor the cervical score significantly affected the insertion-contraction or induction-delivery intervals. Intra-vaginal Misoprostol at the dosage administered is safe, effective and reduces staff workload.

Heterotopic pregnancy following ovulation stimulation with clomiphene: a report of three cases.

Heterotopic pregnancy was a medical rarity, prior to the use of ovulation inducing drugs and advent of assisted reproduction technology. Three cases were encountered in the course of clinical practice in a teaching hospital, over a period of six and a half years. Two of them occurred in association with ovulation induction with CLOMIPHENE and the third case with no identifiable underlying cause. We postulate dizygotic twinning, highest among the Yoruba race of Nigeria as a possible aetiological factor. One of the two cases following CLOMIPHENE has been highlighted in more details, together with a review of literature. Diagnosis in all cases was made in retrospect following surgical intervention for the ruptured ectopic components. All the patients presented with persistent pregnancy symptoms, with sonographic confirmation of viable intrauterine fetuses which were carried to term.

Socio-cultural factors in adolescent septic illicit abortions in Ilorin, Nigeria.

One hundred and ninety-two adolescents (aged 12-18 years) with septic illicit abortions were interviewed to assess socio-cultural factors associated with illegally induced septic abortions at Ilorin, Nigeria. They were mostly unmarried schoolgirls who were ignorant of contraception. Inadequate parental supervision contributed largely to unplanned pregnancies, while poor economic state of these patients influenced the occurrence of illegal septic abortions. Wide-spread availability of an acceptable family-life education, with improved socio-economic state of the adolescents would most probably reduce the socio-cultural factors favouring illicit septic induced abortions in this community.

PIP: In 1987-1989, researchers interviewed 192 adolescents admitted to University of Ilorin Teaching Hospital (UITH) in Nigeria for septic illegal abortions to determine the sociocultural factors of septic illegal abortions among adolescents and the effects of these abortions on the population. The 2 major complications resulting in the patients being admitted to UITH were hemorrhage (42.2%) and septicemia (30.7%). The abortion rate at UITH stood at 94.6/1000 deliveries representing an increase. Adolescents made up 74.4% of all induced abortions which accounted for 60.3% of all gynecological admissions. Most patients (72.5%) were between 15-19 years old. Just 12.5% lived with both parents--an example of the break down of the family which traditionally prepared children for integration into adult society. 81.3% had a primary education, but only around 30% of parents had a primary education. School officials expelled 50% of the patients thereby making expulsion from school the leading social consequence of adolescent septic illegal abortion. Indeed neither the education system nor the family were prepared to teach family life education to prevent these unwanted pregnancies. In Nigeria, since abortion is considered immoral, the adolescents had little choice but to seek a clandestine abortion. Moreover, many adolescents were poor so they opted for free abortion services which were often provided by charlatans. A shift from a rural society to an urban society also contributed to an increase in abortions. The government must emphasize maternal and child health services, especially liberalization of abortion. Further, it must make family planning education and services available to adolescents. In addition, the mass media should be exploited to spread information about the adverse consequences of adolescent illegal abortions.