Multidisciplinary approach to obstetric disseminated intravascular coagulopathy management in low-income country: A survey.

OBJECTIVE: To assess the uptake of a multidisciplinary team approach in obstetric disseminated intravascular coagulopathy (DIC) management in a low- to middle-income country. METHODS: A cross-sectional observational study, in which a semi-structured and pre-tested questionnaire was used to collect data on the uptake by Nigerian obstetricians of the multidisciplinary team approach to obstetric DIC management. RESULTS: A total of 171 obstetricians responded, 82 (48.0%) were consultants and 89 (52.0%) were specialist registrars. Most (165; 96.5%) practiced in tertiary healthcare facilities and the multidisciplinary team approach was the most preferred (162; 94.7%) management approach. In all, 142 (83.0%) supported the invitation of hematologists always in the management whereas 115 (67.3%) participants recommended that involvement of specialists in the treatment should be when clinical presentation was suggestive of DIC. No significant association existed between years of obstetric practice and adoption of a multidisciplinary team-based approach (χ2 = 9.590; P = 0.252). CONCLUSION: A multidisciplinary approach is widely adopted in the management of obstetric DIC, with hematologists being a key member of the team.

Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings.

Background: Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS). Aim: To determine Obstetricians' approach in diagnosing and treating obstetrics DIC in a RLS. Method: A semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC. Results: A total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient's financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC. Conclusion: DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.

Combined insulin-like growth factor binding protein-1/interleukin-6 (Premaquick) versus fetal fibronectin for predicting preterm delivery among women with preterm contractions.

OBJECTIVES: To compare accuracy between Premaquick (combined test for native insulin-like growth factor binding protein-1 (IGFBP-1), total IGFBP-1, and interleukin-6) and fetal fibronectin (Ffn) in predicting preterm delivery. METHODS: Prospective study among women at 28-36+6 gestational weeks with threatened preterm labor attending Federal Medical Center, Owerri, Nigeria, from August 2017 to February 2019. Cervico-vaginal fluids were collected and tested by Premaquick and Ffn tests. The women were followed for 14 days. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive value for delivery were compared between the tests. RESULTS: Among 213 women assessed for eligibility, 183 were enrolled and 175 completed the study. The sensitivity, specificity, PPV, NPV, and accuracy of the Premaquick versus Ffn tests were, respectively, 96.3% versus 51.9%, 97.6% versus 98.4%, 89.7% versus 87.5%, 99.2% versus 90.3% and 97.3% versus 90.0% for preterm delivery within 14 days. Ffn had higher specificity (98.5% vs 97.8%; P>0.99), but Premaquick had higher PPV (92.7% vs 90.9%; P>0.99). CONCLUSION: Both tests seem to have high utility in predicting preterm delivery, but Premaquick showed higher accuracy in terms of sensitivity and PPV. Premaquick might be a feasible alternative to Ffn for predicting preterm delivery among symptomatic women in a low-income setting.