Adherence to Guidelines in Postpartum Management of Hypertensive Disorders in Pregnancy in Tertiary Health Facilities in Nigeria: A Multi-centre Study.

Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal morbidity and mortality. Available guidelines for their postpartum management are expected to be optimally utilized. This study aimed to determine adherence to guidelines in selected Nigerian tertiary hospitals. It was nested in a cohort of women with HDPs who delivered in eight facilities between October 2017 and June 2018. Nine weeks after delivery, their cases were evaluated on prespecified indicators and supplemented with interviews. The level of adherence to the guidelines was determined using descriptive analyses, including frequencies, percentages, means, and standard deviations, as well as charts. Of the 366 participants, 33 (9%), 75 (20%), 200 (55%), and 58 (16%) had chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, respectively. Only about a third had their blood pressure measured between postpartum days three and five. Similarly, a third of those with persistent hypertension (≥140/90 mmHg) were not on antihypertensive medications within the first week postpartum. In addition, 37% and 42% of participants were not counseled on contraceptives and early subsequent antenatal visits, respectively. Among those with preeclampsia/eclampsia, 93% were not offered postpartum screening for thromboprophylaxis. Although all women with preeclampsia/eclampsia remained hypertensive two weeks after discharge, only 24% had medical reviews. Overall, only 58% and 44% of indicators were adhered to among all HDPs and preeclampsia/eclampsia-specific indicators, respectively. Level of adherence to guidelines on postpartum management of HDPs in Nigerian tertiary hospitals is poor. It is recommended that institutionalization of guidelines be prioritized and linked to the entire continuum from preconception through longer term postpartum care.

Determination of Accuracy of Fetal Weight Using Ultrasound and Clinical Fetal Weight Estimations in Calabar South, South Nigeria.

Information on fetal weight is of importance to obstetricians in the management of pregnancy and delivery. The objective of this study is to compare the accuracy of clinical and sonographic methods of predicting fetal weights at term. This prospective comparative study of 200 parturients was conducted at the University of Calabar Teaching Hospital, Calabar. The study participants were mothers with singleton term pregnancy admitted for delivery. The mean absolute percentage errors of both clinical and ultrasound methods were 11.16% ± 9.48 and 9.036% ± 7.61, respectively, and the difference was not statistically significant (P = 0.205). The accuracy within 10% of actual birth weights was 69.5% and 72% for both clinical estimation of fetal weight and ultrasound, respectively, and the difference was not statistically significant (P = 0.755). The accuracy of fetal weight estimation using Dare's formula is comparable to ultrasound estimates for predicting birth weight at term.

Awareness of birth preparedness and complication readiness in southeastern Nigeria.

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ(2) = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ(2) = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted.