Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

OBJECTIVE: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. METHODS: A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. RESULTS: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). CONCLUSION: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids at a University Teaching Hospital in Southwest Nigeria: A Comparative Cross-Sectional Study.

Background: Studies have suggested the potential roles of serum trace elements such as calcium and magnesium in the development of uterine fibroids. Aims: This study compared magnesium and calcium serum levels in reproductive-age women with and without uterine fibroids in Lagos, Southwest Nigeria. Methods: A comparative cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. Results: This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio= 0.06; 95% CI: 0.004, 0.958; p=0.047), uterine size (p=0.004), and the number of fibroid nodules (p=0.030). However, no significant association was observed between serum magnesium levels and uterine fibroids (p=0.341). Conclusion: The findings of this study suggest the promising role of calcium-rich diets and supplements in the prevention of uterine fibroids among Nigerian women. However, future longitudinal studies are required to further evaluate the potential role of these trace mineral elements in the development of uterine fibroids.

Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study.

Background: An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. Aim: This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. Methods: We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. Results: Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. Conclusion: The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.

Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014.

BACKGROUND: There is uncertainty in the trend of ectopic pregnancy incidence in the Southwest region, though the region has a lower fertility rate and a higher contraceptive use than some other regions of Nigeria. The study objective was to determine the temporal trends, presentation and management outcome of ectopic pregnancy at the Lagos University Teaching Hospital (LUTH), Lagos, South-Western Nigeria over a decade. SUBJECTS AND METHODS: This is a retrospective study of ectopic pregnancies at LUTH, Lagos, Nigeria, from January 2005 to December 2014. Participants' medical records were used to extract socio-demographic, clinical characteristics, management and outcome data. Joinpoint regression modelling (version 4.7.1) was used to evaluate the trends while descriptive statistics were conducted using Stata version 14 software. RESULTS: There were 434 cases of ectopic pregnancies giving an overall incidence of 2.2/100 deliveries and 3.50/100 gynaecological admissions. Overall, there was a 59.7% increase in the ectopic pregnancy rate from 1.81/100 deliveries in 2005 to 2.89/100 deliveries in 2014. Join point regression revealed two trends. There was an initial non-significant decrease in incidence of ectopic pregnancy from 2005 to 2010 (annual percent change [APC] = -1.5%, 95% confidence interval [CI]: -8.1% to 5.6%, P = 0.6). However, there was a statistically significant increase in incidence of ectopic pregnancy at an average of 11.6% per annum from 8.6/100 deliveries in 2011 to 25.4/100 deliveries in 2014 (APC = 11.6%, 95% CI: 1.2% to 23.1% P < 0.001). About one-third (33.9%) of the patients with ectopic pregnancy were within the age range 25-29 years while the majority (68.0%) presented at 9-10 weeks of gestational age. The most common identifiable risk factor was previous pelvic infection (35.71%). Majority (96.5%) had tubal pregnancy and all the cases had laparotomy. There were six maternal deaths giving a case fatality rate of 1.4%. CONCLUSION: The hospital had an increased trend in the incidence of ectopic pregnancy from 2005 to 2014. Frontline health workers need high index of suspicion in the prompt diagnosis and intervention of ectopic pregnancy among women in the reproductive age.

Asymptomatic bacteriuria among antenatal women in Lagos.

This cross-sectional study was undertaken to determine the prevalence of asymptomatic bacteriuria (ASB), the commonest bacterial isolates and the antibiotic sensitivity pattern among 556 pregnant women in Lagos University Teaching Hospital (LUTH), Nigeria. Women with a bacterial count over 100,000 colony-forming units per millilitre of the same organisms in paired urine samples were considered to have ASB. The prevalence of ASB was 14.6%. Klebsiella was the commonest micro-organism (39.2%) isolated. ASB was significantly associated with marital status, body mass index and parity. There was a significant relationship between urinary nitrites and ASB. The isolated organisms showed remarkable resistance to commonly prescribed antibiotics such as amoxicillin, cloxacillin and trimethoprim but good sensitivity to ofloxacin, gentamycin and ceftazidime. These facts have implications for the management of ASB in pregnancy.

Pregnancy complicated by a severe form of foetal osteogenesis imperfecta in a 17-year-old primigravida: case report and overview of literature.

Abstract Osteogenesis imperfecta (OI) is an important inheritable thanetrophic disorder with wide ranging variable implications and prognosis for babies in utero and those who survive the perinatal period. The diagnosis of the severe forms can be readily made but some forms of the disease are known to go unrecognised until childhood.

Trends in maternal mortality at the Lagos University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Recent reports suggest that the burden of maternal mortality remains heavy in Sub-Saharan Africa; and that the fifth millennium development goal might not be achieved. As the target date 2015 draws near, we carried out a review of maternal mortality in a Teaching Hospital unitto assess the current situation. OBJECTIVES: To determine the Maternal Mortality Ratio (MMR), the clinical causes of maternal deaths and the numerical and etiological trends in maternal mortality at the Lagos University Teaching Hospital (LUTH). METHOD: The records of births and maternal deaths at LUTH over a five year period were reviewed. The data collected was analyzed to determine the maternal mortality ratio, the socio-biological factors associated with maternal death and the clinical causes. Comparisons are made with findings from previous studies done in LUTH and elsewhere. RESULTS: The maternal mortality ratio was 2096 per 100000 live births. The mortality ratio has more than doubled over a period of 3 decades. Unbooked patients accounted for 7.1% of deliveries but contributed 88.1% of the maternal deaths.Majority (59.0%) of the deaths occurred within 24 hours of admission. The main clinical causes of death included sepsis (17.9%), hypertensive diseases (17.9%), abortion (11.2%), HIV/AIDS infection (11.2%)), haemorrhage (9.0%) and medical disorders (18.7%). CONCLUSION: The maternal mortality ratio remains high in our unit in line with some other reports from Nigeria but in contrast to the trends in other developed and developing countries. Unless urgent action is taken, the 5th millennium development goal may not be achieved.

Perinatal mortality in Lagos University Teaching Hospital: a five year review.

BACKGROUND: An overwhelming proportion of the annual global perinatal deaths occur in developing countries. However few data on perinatal mortality are available from these countries. Reducing perinatal deaths requires adequate data that can be used to develop appropriate strategies. OBJECTIVES: To determine the perinatal mortality rate at the Lagos University Teaching Hospital (LUTH), the associated risk factors and the causes of perinatal deaths; and make recommendations to help reduce perinatal mortality. METHODS: A retrospective study of all deliveries in LUTH in the period between January 2002 and December 2006 was done. Data were collected on all stillbirths and early neonatal deaths. Analysis included such variables as booking status, maternal age, parity, gestational age, fetal weight and cause of perinatal death. RESULTS: The perinatal mortality rate was 70.6/1000 total births. The rate was higher among unbooked patients and those with multiple pregnancies. It increased with parity after the 2nd delivery and was highest at the extremes of reproductive age groups. The commonest causes of death were antepartum haemorrhage, pre-eclampsia/eclampsia, mechanical causes, intrapartum asphyxia and prematurity. CONCLUSIONS: The perinatal mortality rate in our institution is high. The causes of perinatal death are largely preventable. Urgent clinical and political actions are required to make any progress towards attaining the fourth millennium development goal (MDG4).