Incidence, Determinants, and Outcomes of Spontaneous Preterm Birth at Tertiary Hospitals in Enugu, Southeast, Nigeria: A Cross-Sectional Study.

BACKGROUND: In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment. AIM: This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria. METHODS: This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp. RESULTS: The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each. CONCLUSIONS: The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage.

Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria.

Background: Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by significant intraoperative bleeding. Aim: To determine whether misoprostol and tourniquet compared with tourniquet alone would significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu. Materials and Methods: This study is an open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 µg) and B (no misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A P- value of < 0.05 was considered statistically significant. Results: An intention-to-treat analysis was carried out. All 63 participants (100%) and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not significantly different in both groups. The mean intraoperative blood loss in the "misoprostol group" (522.6 ± 127.91 ml) was significantly lower than in the "no-misoprostol group" (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the "misoprostol group" than in the "no-misoprostol group" (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001. Conclusion: Among women receiving tourniquet during myomectomy in Enugu, the additional use of vaginal misoprostol 400 µg significantly reduced intraoperative blood loss.

Low-dose lisinopril in normotensive men with idiopathic oligospermia and infertility: a 5-year randomized, controlled, crossover pilot study.

The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n = 17) or daily oral placebo (n = 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P ≥ 0.093), the total sperm cell count and the percentage of motile sperm cells increased (P ≤ 0.03 and P < 0.001, respectively), whereas the percentage of sperm cells with abnormal morphology decreased (P ≤ 0.04). The pregnancy rate was 48.5%, and there was no serious adverse drug event. It is concluded, albeit cautiously, that prolonged treatment with 2.5 mg/day of oral lisinopril may be well tolerated in normotensive men with idiopathic oligospermia, may improve sperm quantity and quality, and may enhance fertility in approximately half of those treated.

Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.

Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital(UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.