Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals.

OBJECTIVE: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. DESIGN: A secondary data analysis using a cross-sectional design. SETTING: Referral-level hospitals (48 public and six private facilities). POPULATION: Women admitted for birth between 1 September 2019 and 31 August 2020. METHODS: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. MAIN OUTCOME MEASURES: Prevalence of PPH and maternal and neonatal outcomes. RESULTS: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. CONCLUSIONS: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.

A randomized controlled trial of 12 hours versus 24 hours urinary catheter removal following uncomplicated caesarean section in Ekiti State, Nigeria.

Catheter-associated urinary tract infection (CA-UTI) is one of the common nosocomial infection. Minimizing the length of stay of indwelling urinary catheter has been reported as a key strategy in reducing the rate of the infection. This study compared the incidence of significant bacteriuria in patients who had removal of their urinary catheter in 12 hours compared to those removed after 24 hours following uncomplicated caesarean section. A total of 140 women were randomized into two groups of either 12-hour catheter removal (group A) or 24-hour catheter removal (group B) post-caesarean section. The socio-demographic characteristics, pre-operative and post-operative urine microscopy, culture and sensitivity, time of first ambulation, length of hospital stay and the cost of treatment for all the participants were analyzed using SPSS version 21. P value was set at 0.05. results showed the overall incidence of catheter associated significant bacteriuria was 26.3% in this study while participants in group A (20.9%) had lower incidence of microscopic bacteriuria compared to those in group B (31.8%) though not statistically significant [OR= 1.8: 95%CI (0.8-3.9); p=0.1]. The mean time of first ambulation was statistically lower in group A compared to group B (16.2 ± 7.7 hours versus 24.8 ± 4.3 hours, p<0.001 respectively). The socio-demographic characteristics, incidence of urinary retention, mean length of hospital stay and cost of treatment did not differ significantly between the groups, p >0.05. The study demonstrated that catheter removal at 12 hours post uncomplicated caesarean section can enhance early ambulation and reduce the incidence of post-operative microscopic bacteria. ClinicalTrials.gov identifier PACTR201912777385309.

Predictors of postpartum depression among an obstetric population in South-Western Nigeria.

BACKGROUND: Perinatal maternal depression is the most common mood disturbance associated with pregnancy. It has grave consequences on both maternal health and wellbeing of offsprings, albeit usually neglected in low- and middle-income countries. OBJECTIVE: To evaluate the relationship between antenatal depression(APD) and postpartum depression(PPD) and predictors of postpartum depression among an obstetric population in South-western Nigeria. METHODS: This was a prospective longitudinal cohort study involving272 pregnant women recruited between 34 and 36 weeks of pregnancy and followed up to till 6 weeks after delivery. Edinburgh Postnatal Depression Scale (EPDS) questionnaires were administered to collect data. Data were analysed with SPSS version 23.A p-value < 0.05 was taken as statistically significant. RESULTS: The prevalences of antepartum and postpartum depression were 6.3%, (95% CI 3.4%-9.2%) and 8.8% (95% CI 5.4%-12.1%) respectively. The Spearman correlation coefficient for antepartum EPDS and postpartum EPDS scores was 0.52, p < 0.001.The predictors of postpartum depression were antepartum depression (adjusted OR 10.6, 95% CI 8.33-48.60, p < 0.001), puerperal sepsis (adjusted OR 4.33, 95% CI 3.89-8.69, p = 0.03), domestic violence (adjusted OR 3.40, 95% CI 1.94-15.67, p = 0.01) and age group 25-34 years (adjusted OR 0.11, 95% CI 0.02-0.75, p = 0.02), and household income $1671-$3330 (adjusted OR 0.10, 95% CI 0.02-0.56, p = 0.01). CONCLUSION: There was a positive association between the antenatal EPDS and postnatal EPDS scores. Screening for maternal depression should be considered in prenatal period. Further studies are necessary to explore the novel finding of predictive role of puerperal sepsis in PPD.

Predictors of Maternal Preference for Sex-Selective Pregnancy Termination in a Developing Nation with Restrictive Abortion Laws.

INTRODUCTION: The rapid and unexpected increase in the sex ratio at birth in Nigeria between 1996 and 2014 is yet to be fully explained. The contribution of sex-selective abortion has not been explored. METHODS: A cross-sectional survey of pregnant women was employed to address this need. RESULTS: Preference for sex-selective abortion was noted in 8.6% of the respondents. The association between parity ≥ 4 and preference for sex-selective abortion was statistically significant. Women who were child gender-biased were significantly more likely to prefer sex-selective abortion. Experiencing intimate partner violence, and having problems with in-laws for inability to give birth to their desired gender, were predictors of maternal preference for sex-selective abortion. Women who preferred sex-selective abortion, however, felt it was necessary to campaign against gender preference. CONCLUSION: Preference for sex-selective abortion exists in Nigeria, despite our restrictive abortion laws. However, the women's underlying reasons may include gender balancing in the family and an escape from discrimination. Improving contraceptive uptake, restriction of disclosure of fetal sex for non-medical indications, and sanctions against violent partners/oppressive in-laws are advocated. Rapid progress towards achieving a world free of the offensive gender inequalities that force women to opt for sex-selective abortion ab initio is desirable.

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria.

BACKGROUND: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. RESULTS: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. CONCLUSION: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required.

Obstetric Correlates of Maternal Falls in Southern Nigeria.

Falls during pregnancy can be associated with serious obstetric complications. Apart from sparse data highlighting traumatic outcomes, there are no studies identifying the obstetric correlates of maternal falls in Nigeria. A cross-sectional cohort survey of 1,175 women in five public health facilities in Ado-Ekiti was conducted to address this need. Fall rate was 25%; mothers who fell during pregnancy were significantly older, of higher parity, and with unintended/unwanted pregnancies than those who did not fall. Most of the reported falls occurred in the third trimester, with about 10% of the women falling at least thrice during the course of the pregnancy. More than half of the reported falls occurred while engaging in household chores and carrying child/object with compromised visibility of the feet and floor. Uterine contractions/abdominal pain was the commonest; 29 (76.3%), obstetric event attributed to the falls. Antepartum haemorrhage, 4 (10.5%), and ruptured membranes, 2 (5.3%), also occurred after falls, although it was rare and occurred with the same frequency as in the general population. Maternal age ≥ 30 years (odds ratio: 1.36; 95% C.I. 1.03 - 1.80, p = 0.031), multiparity (odds ratio: 1.54; 95% C.I. 1.15 - 2.07, p = 0.004), unintended pregnancy (odds ratio: 1.48; 95% C.I. 1.02 - 2.15, p = 0.037), and delivery age ≤ 40 weeks (odds ratio: 1.71; 95% C.I. 1.07 - 2.75, p = 0.026) were found to be independent risk factors for falls during pregnancy. Fall awareness campaigns and fall-preventing safety tips are advocated in women's clinics. Improving contraceptive uptake will reduce unintended pregnancies and the risk of pregnancy-related fall/injuries.

Cesarean section on maternal request: the viewpoint of expectant women.

PURPOSE: To determine the women's perception and factors influencing willingness to have cesarean section on maternal request (CSMR) in the absence of medical or obstetric indication. METHODS: A cross-sectional questionnaire-based survey of 752 antenatal clinic attendees at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti. Pre-tested questionnaires were used to elicit information on socio-demographic and obstetric variables, awareness and perspective of CSMR and the willingness to request CS without physician's recommendation. Frequency tables were generated and univariate and multivariate logistic regression were used to determine factors that influenced CSMR using SPSS software version 16.0. RESULTS: Forty-eight (6.4 %) of the respondents reported willingness to request CS. The most common motivations for the request were fear of losing the baby during labor, delay in conception and fear of labor pains. Analysis by simple logistic regression and multiple regression showed age, parity and educational status were not significantly related to the decision for CSMR. CONCLUSION: CSMR is an evolving entity in obstetrics practice in the developing countries. Delay in conception, fear of labor pain and loss of baby during labor appear to be strong motivations.

Synergistic action of carvedilol and clomiphene in mitigating the behavioral phenotypes of letrozole-model of PCOS rats by modulating the NRF2/NFKB pathway.

INTRODUCTION: Psychiatric and cognitive impairment has been observed in premenopausal women with a hormonal disorder called polycystic ovary syndrome (PCOS). This study aimed to explore the possibility of combining pharmacological agents: Carvedilol and Clomiphene citrate, with antiestrogenic, antioxidant and anti-inflammatory properties in letrozole-induced PCOS rats. METHODS: PCOS was induced in rats by the administration of letrozole (1 mg/kg) daily for 21 days. They were subsequently divided into four groups, each receiving either the vehicle or Clomiphene citrate (1 mg/kg) or Carvedilol or a combination of Clomiphene citrate and Carvedilol, respectively from days 22-36. Neurobehavioral studies were conducted on day 35 (Elevated plus maze and Y maze) and day 36 (Novel object recognition). The serum levels of the antioxidants Superoxide dismutase, Catalase, Interleukin 1B (IL-1B), and the gene expression of nuclear factor-erythroid factor 2-related factor 2 (Nrf2), Nuclear Factor k-Beta (NFKB), and acetylcholine esterase in the frontal brain homogenate was determined. RESULT: Both Carvedilol and the combination therapy reversed the anxiety-like behavior, while Clomiphene citrate and the combination therapy ameliorated the spatial and non-spatial memory impairment observed in PCOS rats. Carvedilol, Clomiphene citrate, and the combination therapy increased the serum concentration of SOD and Catalase and decreased the serum concentration of IL-1B. The combination therapy up-regulated the NRF-2, NFKB, and acetylcholine esterase gene expression. CONCLUSION: Study showed that the combination of carvedilol and clomiphene citrate has anxiolytic potential and improved cognitive functions in PCOS rats. This might have been achieved by carvedilol and clomiphene citrate's ability to modulate the cholinergic system and the Nrf2 pathway while downregulating the NFκB signaling pathway.

Synergistic Action of Virgin Coconut Oil and Clomiphene in Reversing Endocrine Dysregulation in Letrozole-Model of Polycystic Ovarian Syndrome in Rats: Role of Nrf2/HMOX-1 Pathway.

Polycystic ovarian syndrome (PCOS) is an endocrine disorder in women's reproductive age. Currently, the pathophysiology of PCOS is unclear, and the limited treatment options are unsatisfactory. Virgin coconut oil (VCO) is functional food oil associated with pharmacological effects in reproductive disorders. Therefore, we aimed to evaluate whether VCO could enhance clomiphene (CLO) therapy against PCOS in female rats. Rats were randomly divided: (1) Control, (2) PCOS model, (3) PCOS + CLO, (4) PCOS + VCO, and (5) PCOS + CLO + VCO. The PCOS was induced via daily letrozole (1 mg/kg, orally) administration for 21 days. After the PCOS induction, CLO, VCO, and CLO + VCO were administered from days 22 to 36. Serum levels of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estrogen, progesterone, and prolactin were estimated. Polymerase chain reaction gene expression for nuclear factor-erythroid-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), catalase (CAT), glutathione reductase (GSR), LH receptor (LHr), androgen receptor (AR), tumor necrosis factor-alpha (TNF-α), interleukin-1ß (IL-1ß), and caspase-3 were analyzed. The letrozole-induced PCOS caused considerable increases in GnRH, LH, prolactin, estrogen, and testosterone, whereas FSH decreased significantly compared to the control. The gene expression of Nrf2, HO-1, CAT, and GSR were markedly diminished, while IL-1ß, TNF-α, caspase-3, AR, and LHr prominently increased compared to control. Interestingly, the CLO and VCO separately exerted anti-inflammatory and endocrine balance effects. However, VCO-enhanced CLO effect in LH, prolactin and testosterone, Nrf2, HO-1, CAT, GSR, and AR. VCO may synergize with CLO to depress hyperandrogenism and oxidative inflammation in PCOS.

How Do Private Providers Unaffiliated With the Nigeria National TB Program Diagnose and Treat Drug-Susceptible TB Patients? A Cross-Sectional Study.

INTRODUCTION: TB diagnosis and treatment practices among private providers not affiliated with the Nigeria National TB Program (NTP) have implications for TB control efforts. Studies evaluating these practices among non-NTP providers are scarce. We aimed to investigate TB diagnosis and treatment practices among non-NTP private providers in urban Lagos State, Nigeria. METHODS: We conducted a cross-sectional study among doctors and nurses operating private facilities not formally affiliated with the NTP for TB case notification. Between May 2018 and January 2019, we implemented a survey using a pretested questionnaire among 152 doctors and nurses attending TB sensitization seminars in Lagos, Nigeria. We used descriptive statistics to summarize the sociodemographic information and proportion of non-NTP providers with different self-reported TB diagnostic, prescription, and monitoring practices. RESULTS: Private non-NTP doctors and nurses self-reported diagnosing TB using 8 different types of tests. Acid-fast bacilli was the most common (39.8%) means of diagnosing TB. Private non-NTP providers also self-reported prescribing 23 different TB regimens, including streptomycin, to treat TB. Only 32.4% of providers self-reported using the correct combinations of anti-TB drugs to treat TB. Additionally, 58.3% of providers prescribed the standard 6-month treatment duration for pulmonary TB patients, and the remaining 41.7% either undertreated or overtreated TB. CONCLUSION: A large proportion of private doctors and nurses not formally affiliated with the NTP in Nigeria were not following the NTP guidelines in the diagnosis and treatment of TB. Overtreatment and undertreatment were common. Engagement of these practitioners by the NTP in the form of supervision, on-the-job mentorship, and other strategies can mitigate the negative effects of their current practices on TB case notification and the spread of drug-resistant strains in Nigeria.

Preliminary report of sexual assaults at Ekiti Sexual Assault Referral Centre, Ado-Ekiti, Southwest, Nigeria (Moremi Clinic).

There has been a surge in the incidence and severity of sexual assaults globally with the insurgence of COVID-19 owing to lockdown restrictions. Ekiti Sexual Assault Referral Centre, Ado-Ekiti also known as Moremi Clinic was established in June 2020 as a multisectoral response centre to this surge. Seventy-four survivors accessed medical services from June 2020 to May 2021. Adolescents made up 54.1% while the median age was 14.5 years. Only seven survivors were seen within 24 h of the event and around a quarter had follow-up visits. A quarter of survivors reported repeat episodes of sexual assault. Complications documented were sexually transmitted infections (13.5%), depression (4.1%) and posttraumatic stress disorder (5.4%). There was a failure of contraception in 4.5% of survivors who had taken emergency contraceptive pills. For improvements in quality of care, strategies to ensure early presentation and encourage follow-up visits must be introduced.

Adverse birth outcomes among women exposed to intimate partner violence in pregnancy in Ikere-Ekiti, South-west Nigeria: A prospective cohort study.

OBJECTIVE: Studies on birth outcomes associated with intimate partner violence in pregnancy in Nigeria are scarce. We aimed to evaluate adverse birth outcomes among women exposed to intimate partner violence in pregnancy in a Nigerian population. STUDY DESIGN: We performed a prospective cohort study involving 363 women with singleton pregnancies presenting for antenatal care between March 2019 and September 2019. Intimate partner violence was assessed with a validated self-administered questionnaire- ongoing abuse screen. We compared adverse birth outcomes between women that experienced intimate partner violence in pregnancy and those that did not. Multivariate logistic regression was used to adjust for confounders. RESULTS: Of the 363 pregnant women that completed the study, 56(15.4%) experienced intimate partner violence in pregnancy. Women who experienced intimate partner violence in pregnancy were significantly more likely to experience composite adverse birth outcome (53.6% compared with 20.2%,adjusted OR 4.72, 95% CI: 2.43-9.19, p < 0.001) preterm delivery (26.8% compared with 13.4%,adjusted OR 2.96, 95% CI: 1.34-6.50, p = 0.007), stillbirths(17.9% compared with 3.3%,adjusted OR 9.52, 95% CI: 3.96-22.90, p < 0.001) and neonatal intensive care unit admission (32.1% compared with 19.9%, adjusted OR 1.93, 95% CI: 1.19-10.60, p = 0.03). Mode of delivery and low birth weight did not differ significantly between the two groups. CONCLUSION: Intimate partner violence is associated with increased risk of preterm delivery, stillbirth and neonatal intensive care unit admission. There is a need to evaluate the effect of interventions on these adverse birth outcomes.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria.

INTRODUCTION: Poor prenatal service utilization is common in developing countries. However, the predictors and pregnancy outcomes of poor utilizers have not been fully examined in our setting. METHODS: Poor and good prenatal service utilizers were compared with respect to demographic characteristics and pregnancy outcomes in Ado-Ekiti, Nigeria. RESULTS: Poor utilizers were significantly more likely to be single mothers, with unemployed husbands/partners, but less likely to have labour induction compared with good utilizers. Also, the women with fewer than four antenatal visits had significantly more babies with low birth weight (18% versus 9.8%, p = 0.003), and 5-minute Apgar scores less than 7 (17.9% versus 10.1%, p = 0.023). Multivariate regression analysis revealed that having an unemployed husband/partner (adjusted odds ratio (AOR): 2.33; 95% Confidence Interval (C.I.): 1.24 - 4.38; p = 0.009), with low birth weight babies (AOR: 1.66; 95% C.I.: 1.01 - 2.73; p = 0.045), and delivering without induction of labour (AOR: 4.27; 95% C.I.: 2.38 - 7.64; p < 0.001) were independently associated with poor prenatal service utilization. CONCLUSION: Efforts devoted to identifying women who are likely to be non- and poor-utilizers of prenatal care are recommended. Scaling up awareness campaigns on maximizing the benefits of prenatal care, increasing the content quality of antenatal visits to give women a positive pregnancy experience and implementing a National Health Insurance package that strategically targets the most socially underprivileged classes are advocated to promote safe motherhood and the objectives of antenatal care.

Randomised Controlled Trial of Sublingual and Rectal Misoprostol in the Prevention of Primary Postpartum Haemorrhage in a Resource-Limited Community.

BACKGROUND/PURPOSE: Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH. METHODS: In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24 h postpartum. Primary outcomes were blood loss of 500 ml or greater and at least 10% change in peripartum haematocrit levels. RESULTS: Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route. CONCLUSION: At the recommended dose, sublingually administered misoprostol ('the sweet of life') is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol.ClinicalTrials.gov identifier PACTR201911500348367.

COVID-19 and obstetric practice: A critical review of the Nigerian situation.

OBJECTIVE: To review what is known about COVID-19 and highlight gaps in the context of Nigerian obstetric practice. Research data on COVID-19 are understandably sparse in Africa. Nigeria, like most African countries, is battling a disease she is poorly equipped to fight. METHODS: The current available literature on COVID-19 was reviewed in relation to obstetric practice in the Nigerian context, gaps were identified, and recommendations were made to improve the handling of the COVID-19 pandemic in Nigerian obstetric practice. RESULTS: In and out of hospital, both the obstetrician and the obstetric patient are constantly being put at risk of exposure to the coronavirus because testing and preventive measures are either ineffective or non-existent. CONCLUSION: The pandemic has exposed the gross inadequacies in Nigeria's healthcare system and is therefore a wake-up call to the need for a complete overhaul of infrastructure and services. The government will do well to increase the budget allocation for health from the current paltry 4.14% to the recommended 15% of the total budget. The Nigerian obstetrician stands a high risk of exposure due to inadequate preventive measures, and testing and diagnostic challenges.

Human immunodeficiency virus awareness and condom use among female adolescent prostitutes in Lagos, Nigeria.

INTRODUCTION: The cornerstone of HIV prevention among female adolescent prostitutes is awareness promotion complemented with advocacy on consistent and correct use of condom. The study aimed at reviewing HIV awareness and condom use among female adolescent prostitutes in Lagos communities, Nigeria. METHODS: It was a mixed-method study realized through a questionnaire-based survey and in-depth interviews of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria; conducted between 1st of April, 2014 and 30th of September, 2014. SPSS version 17.0 and content analysis were used in analyzing quantitative and qualitative data respectively. RESULTS: 97.3% had heard about HIV/AIDS; with 86.9% being tested for HIV in the preceding 6 months. While there was consistent use of male condom in 99.7% of the respondents, 90% had experience with the use of female condom, however, 95.5% would allow non- use of condom for higher financial reward. CONCLUSION: Although the level of awareness of HIV/AIDS was high among the respondents, there is need to improve on the level of awareness and preventive strategies for HIV/AIDS, with more emphasis laid on the consistent and correct use of condom in this highly vulnerable class of people.

Spinal anaesthesia in a restless eclamptic with undiagnosed second twin: case report.

The use of sub-arachnoid block in a restless eclamptic is not very common. Studies have demonstrated some benefits of sub-arachnoid block over general anaesthesia in stable eclamptic but its role in the management of unstable eclampsia has not been established. Reported below is an eclamptic parturient who was restless despite magnesium sulphate regimen and possesed features suggestive of difficult airway who had uneventful subarachnoid- block for caesarean section.

Routine Iron Supplementation and Anaemia by Third Trimester in a Nigerian Hospital.

BACKGROUND: Anaemia in pregnancy is associated with adverse maternal and fetal outcome. Unfortunately, in developing countries its prevalence has continued to rise. To improve the situation, iron supplement is routinely prescribed during pregnancy. We therefore examine the impact of the intervention as being currently practised in our clinical setting. METHODS: In total, 255 prenatal clinic attendees who had more than 8 weeks of prescribed iron supplements were sampled. Data was obtained on their socio-demographic features, haemoglobin concentration at booking, compliance with iron supplements and third trimester haemoglobin value. RESULTS: Observed iron supplementation compliance rate was 184(72.2%). There was a significant drop in mean haemoglobin (Hb) concentration between the two time points (booking Hb: 32.56±2.99; third trimester Hb: 31.67±3.01; mean diff: 0.89±3.04; t = 4.673; 95% CI= 0.52-1.27; p= <0.001). Anaemia increased from 132(51.8%) to 150(58.8%) by the third trimester. Increase in anaemia occurred in both iron-compliant and non-compliant groups. Non-compliance however had higher odds of predicting anaemia by the third trimester (OR: 1.83; 95% CI: 1.03-3.26; p: 0.04). CONCLUSION: Although iron supplementation is still a good intervention in developing countries, it is not sufficient to reduce overall prevalence of anaemia by the third trimester. There is a need to look beyond the approach and reinforce the importance of better feeding practices, food fortification and reduced frequency of pregnancies.

Maternal perspectives on gestational weight gain: Critical information on developing weight control interventions.

BACKGROUND: Our aim was to demonstrate what women reported being counselled about weight gain in pregnancy, their perceptions of inappropriate gestational weight gain (GWG), and plans for weight gain in pregnancy. MATERIALS AND METHODS: A cross-sectional survey of perceptions of prenatal attendees about inappropriate GWG was conducted at the prenatal clinic of a referral tertiary health facility in south western, Nigeria, between January 1, 2013 and June 30, 2013. Primary outcomes were the perceptions of women about risks involved with inappropriate weight gain and the proportion of women who self-reported being counselled at all on GWG, and had the right knowledge of risk(s) involved with inappropriate weight gain during pregnancy. RESULTS: Of the 348 women who completed the survey, approximately four-fifths (82.8%) reported GWG being discussed at all by health care provider. Fewer women (29.3%) believed there were maternal risks with excess weight gain compared to inadequate weight gain (34.8%). With respect to perception of risks of inappropriate weight gain to infants, 23.65 and 18.4%, respectively, believed there were infant risks with excess and inadequate GWG. Overweight women [OR 0.39 (95% CI 0.16-0.98)] and those who received GWG information from more than one type of health care provider [OR 4.71 (95% CI 1.64-13.78)] had significant increased rate of correct knowledge of risks involved with inappropriate GWG. CONCLUSION: The lack of awareness of risks involved with inappropriate GWG by over half of respondents underscores the need for improvement in educational intervention on GWG in our environment.

Obstetric outcome of twin gestations in a tertiary hospital South-western Nigeria.

BACKGROUND: Twin pregnancy is considered a high risk pregnancy due to associated adverse obstetric outcomes. The objective was to determine the prevalence, complications and the obstetric outcomes of twin deliveries in EKSUTH. MATERIAL AND METHODS: A retrospective analysis of twin gestations managed at the Ekiti State University Teaching Hospital, Ado-Ekiti between January 2009 and December 2012 was done. RESULTS: The prevalence of twin deliveries was 1 in 23 deliveries (4.3%). Increasing age and parity and Yoruba ethnicity were associated with higher twinning rate. The mean gestational age at delivery was 36.6 ± 2.9 weeks and the mean birth weight was 2.47 ± 0.49 kg with first twins having higher birth weight. Spontaneous vaginal delivery was the most common mode of delivery accounting for 52.6% and 49.3% in twin 1 and twin 2, respectively, and majority (39.5%) of the twins were in cephalic-cephalic presentation. The most common indication for caesarean delivery was breech presentation in the first twin. Preterm labour was the commonest maternal complications occurring in 25.7% of cases. The perinatal mortality rate was 105 per 1000 deliveries and this was significantly associated with unbooked patients, p = 0.001. There were no maternal deaths. CONCLUSION: Preterm labour remains the commonest complication with associated high perinatal mortality.