Uterine packing in the management of complete placenta praeuvia.

BACKGROUND: Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing is an effective but underutilized life-saving intervention in situation of uncontrolled haemorrahage due to major placenta praevia. OBJECTIVES: To reappraise the effectiveness of uterine packing in the management of complete placenta praevia in order to popularize the practice. METHODS: Seven case series of complete placenta praevia were managed with uterine packing in Enugu, Nigeria between January 2, 2012 and February 28, 2013. RESULTS AND INTERPRETATION: Previous Caesarean delivery (85.71%) was the commonest identified risk factor for complete placenta praevia. Uterine packing was effective in preventing blood transfusion in 57.14% of the cases, and further post-operative intervention in 85.71%.Peripartum hysterectomy and maternal death were 100% avoidable. CONCLUSIONS: Uterine packing is an effective life-saving intervention in management of complete placenta praevia. The technique should be considered whenever there is uncontrollable haemorrage following complete placenta praevia.

Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria.

CONTEXT: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. MATERIALS AND METHODS: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. CONCLUSIONS: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.

Trend in the use of intra-uterine contraceptive device (IUCD ,TCU 380A), in Enugu, Nigeria.

OBJECTIVE: To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enugu, Nigeria PATIENTS AND METHODS: A review of all new acceptors of intrauterine contraceptive device (IUCD) over a nine year period (1999-2007). RESULTS: A total of 133,375 clients were seen at the UNTH family planning clinic between 1999 and 2007. Out of 6,947 users of IUCD, during the period, 1,659 were new acceptors. The IUCD acceptance rate was 5.21%. Majority of the clients (29.7%) were aged 40 years and above. Eight hundred and forty seven (51.4%) had attained post secondary education. Majority of the clients (99.4%) were married . Twenty-six percent (26.0%) had completed their desired family size. Majority 1,359 (82.4%) did not use any method contraception prior to IUCD insertion. The commonest complication was menorrhagia (5.8%) and this was responsible for removal in 3.0% of cases. Eight (0.5%) and nine (0.6%) requested for removal for fear of causing cancer and migration to the brain or heart respectively. Two (0.1%) became pregnant while having the IUCD in-situ. Majority of the clients (50.5%) had the knowledge of lUCD through friends. CONCLUSION: This study has shown that IUCD (TCU 380A) is both safe and effective in Enugu, Nigeria. Its use is for both child spacing and limiting family size.

Pregnancy after rupture of the pregnant uterus.

Pregnant women managed by us after suture repairs for rupture of the pregnant uterus between 2006 and 2009 in Enugu, South-east Nigeria were reviewed. Five pregnancies were managed during the study period. Four had normal pregnancies. Three booked early in pregnancy and had repeat caesarean deliveries at 36 weeks' gestation. One booked at another private hospital but had emergency caesarean section at 38 weeks' gestation. The fourth woman had repeat rupture at 28 weeks' gestation, suture repair and bilateral tubal ligation. Four healthy babies were discharged home. There was no maternal death. The outcomes of pregnancies after rupture of the pregnant uterus are good. Suture repairs should be the method of choice whenever preservation of future fertility is necessary. The woman and her family must be counselled on the associated risks and the need for hospital delivery by elective caesarean section in the subsequent pregnancies before discharge.

Copper and selenium status of healthy pregnant women in Enugu, southeastern Nigeria.

BACKGROUND: Copper and selenium are important trace elements in man. They function as antioxidants and play roles in oxido-reductase reactions. Several imported multivitamin preparations are given to our women during pregnancy and lactation to correct possible deficiencies. OBJECTIVE: The aim of the study is to determine the serum level of these micronutrients (selenium and copper) in a cross section of pregnant women in Enugu, southeastern Nigeria. MATERIALS AND METHODS: A cross section of 130 healthy pregnant women at different trimesters of pregnancy and 30 non-pregnant controls were selected from two health facilities in Enugu, southeastern Nigeria. Serum from the samples collected was assayed for copper and selenium using atomic absorption spectrophotometer. RESULTS: The mean copper level increased (P = 0.018), while the selenium level decreased (P < 0.0001) as pregnancy advanced. CONCLUSION: High copper levels indicate that supplementation should not be undertaken during normal pregnancy. Dietary intake should be modified to ensure optimal selenium levels during pregnancy.

Copper and Selenium Status of Healthy Pregnant Women in Enugu; Southeastern Nigeria

Background: Copper and selenium are important trace elements in man. They function as antioxidants and play roles in oxido-reductase reactions. Several imported multivitamin preparations are given to our women during pregnancy and lactation to correct possible deficiencies. Objective: The aim of the study is to determine the serum level of these micronutrients (selenium and copper) in a cross section of pregnant women in Enugu; southeastern Nigeria. Materials and Methods: A cross section of 130 healthy pregnant women at different trimesters of pregnancy and 30 non-pregnant controls were selected from two health facilities in Enugu; southeastern Nigeria. Serum from the samples collected was assayed for copper and selenium using atomic absorption spectrophotometer. Results: The mean copper level increased (P = 0.018); while the selenium level decreased (P 0.0001) as pregnancy advanced. Conclusion: High copper levels indicate that supplementation should not be undertaken during normal pregnancy. Dietary intake should be modified to ensure optimal selenium levels during pregnancy

Multiple antenatal bookings among pregnant women in Enugu, Nigeria.

Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women.

HIV serostatus disclosure pattern among pregnant women in Enugu, Nigeria.

This study was carried out in two medical facilities in Enugu, Nigeria, from September to November 2007. An interviewer-administered questionnaire was used to collect data from HIV-positive pregnant women accessing PMTCT (prevention of maternal-to-child transmission) services at the two centres. Ninety-two women were interviewed: 89 (96.7%) had disclosed their status, while 3 (3.3%) had not. Of the 89 women who had disclosed, 84 (94.4%) had disclosed to partners, 82 (92.1%) to husbands, 2 (2.2%) to fiancés, 18 (20.2%) to sisters, 13 (14.6%) to mothers, 10 (11.2%) to brothers, 10 (11.2%) to fathers and 10 (11.2%) to priests. Fifty-two (58.4%) gave emotional support as the reason for disclosure and 46 (51.7%) gave economic and financial support as reasons. Fifty-six (62.9%) reported understanding from partner as a positive outcome and 44 (49.4%) reported financial support. Forty-six (51.7%) reported no negative outcome. Serostatus disclosure rate in this study was high with most women disclosing to their partners.

Obstructed labour in Enugu, Nigeria.

All cases of obstructed labour seen and managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1999 and December 2004 were identified from the Accident and Emergency department records, labour ward and obstetric theatre records. There were 4,521 deliveries during the study period and 120 (2.7%) of these were complicated by obstructed labour. Of the 120 women, 68 (56.7%) were nullipara. A total of 41 women (34.2%) were booked, 70 (58.3%) unbooked, and 9 (7.5%) booked elsewhere. Most women were in occupational social class V. The cause of obstruction was cephalopelvic disproportion in 68 women (56.6%). The most common intervention was a lower segment caesarean section. Perinatal mortality was 30%. There were four maternal deaths (3.3%). Obstructed labour remains a major public health problem in Nigeria contributing significantly to perinatal mortality and maternal morbidity and mortality.

Avoidable maternal mortality in Enugu, Nigeria.

OBJECTIVE: The aim of this study was to identify avoidable factors in maternal mortality in Enugu, Nigeria. STUDY DESIGN: A hospital-based descriptive study. METHODS: The case records of maternal deaths in the Obstetric Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between January 2003 and December 2005, were studied to identify maternal characteristics and avoidable factors for maternal mortality. Booked women were those who received formal prenatal care in a medical facility. Abortion-related deaths were not included in the study. RESULTS: There were 49 maternal deaths, 2131 deliveries and 2044 live births during the study period, giving a maternal mortality ratio of 2397.3 maternal deaths per 100,000 live births. The average age of the women was 29.8 years. Twelve women (25.5%) booked in the UNTH, 23 (48.9%) booked elsewhere and 12 (25.5%) were unbooked. Ten women (21.3%) were nulliparous, 15 (31.9%) were Para 1-2, 17 (36.2%) were Para 3-4 and five (10.6%) were Para 5 or above. Twenty-one women (44.7%) first sought medical attention at a private medical clinic, six (12.8%) at the general/mission hospital, five (10.6%) at maternity/health centres, one (2.1%) from a traditional birth attendant and 14 (29.8%) at the UNTH. Fourteen women (39.8%) died within 24h of admission, 12 (25.5%) between 24 and 48h, seven (14.9%) between 48 and 96h and 14 (29.8%) after 96h. Two women (4.3%) delivered at home, eight (17.0%) in private medical clinics, 23 (48.9%) in the UNTH and 14 (29.8%) died undelivered. Major avoidable factors were substandard care (27.7%), delay in seeking care (19.1%), financial constraints (8.4%), delay in recognizing a problem (6.4%), lack of blood (4.3%), lack of drugs (2.1%) and industrial strike action by health workers (2.1%). No major avoidable factor was identified in 14 women (29.8%). CONCLUSION: Avoidable factors are still prevalent in maternal deaths in Nigeria.

Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria.

This study reviewed abortion-related maternal deaths, from January 2000 to December 2005 at the University of Nigeria Teaching Hospital, Enugu, Nigeria, to identify maternal characteristics, abortion types, provider characteristics, complications and causes of death. Abortion was defined as termination of pregnancy before 28 completed weeks of pregnancy. There were 93 pregnancy-related deaths, and 11 were abortion-related. Abortion-related mortality accounted for 11.8% of all maternal deaths. Nine (81.8%) had induced abortions; three (27.3%) were teenagers; five (45.5%) were married; and six (54.5%) were unmarried. Five (45.5%) of the women were nulliparous. Six (54.5%) of the procedures were in private medical clinics. The cause of death was sepsis and haemorrhage in eight (72.7%) and three (27.3%) of the women, respectively. Abortion-related mortality is a major contributor to maternal mortality in our institution, with induced unsafe abortion constituting the bulk of the burden. Improved access to family planning and reproductive health services may reduce abortion-related maternal deaths.

Juxtacervical vesicovaginal fistulae: outcome by route of repair.

Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psychological and social consequences for the patient. This study compared the outcome of vaginal vs abdominal repair of juxtacervical vesicovaginal fistulae. It was a retrospective review undertaken at the University of Nigeria Teaching Hospital, Aghaeze Hospital and Mbanefo Hospital, all in Enugu, Nigeria, from 1 January 1992 to 31 December 2004. The outcome measures were primary repair success rate, blood transfusion, postoperative urinary tract infection rate and duration of hospital stay. Abdominal repair of juxtacervical vesicovaginal fistula was associated with a significantly higher need for blood transfusion when compared with vaginal repair. Both routes of repair had similar primary repair success rates, postoperative urinary tract infection rates and duration of hospital stay. It was concluded that the route of repair of juxtacervical vesicovaginal fistula should be determined by accessibility of the fistula and whenever possible, the vaginal route should be preferred.

Vesico-vaginal fistula in Eastern Nigeria.

Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Eastern Nigeria, and maternal characteristics and sociocultural factors predisposing to vesico-vaginal fistula. The case-records of 74 patients with vesico-vaginal fistula were reviewed. The mean age of the patients was 34.1 years and the mean age at occurrence of fistula was 30.1 years. A total of 24 women (32.4%) presented within 6 months of fistula formation. They were mainly multipara, housewives, subsistence farmers and still living with their husbands. A total of 68 (91.9%) developed a fistula following prolonged obstructed labour. Juxta-cervical fistula was the most common, 33 (44.6%) followed by juxta-urethral 11 (14.9%). The other associated morbidity included chronic vulval excoriation, cervical damage and amenorrhoea. Fetal wastage was high with 53 (77.9%) stillbirths and four (5.9%) early neonatal deaths. Vesico-vaginal fistula is still a major problem in the developing countries and a reflection of standard of obstetric care currently available to our women.

Trends in uterine rupture in Enugu, Nigeria.

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.