Association between time of delivery and poor perinatal outcomes -An evaluation of deliveries in a tertiary hospital, South-east Nigeria.

OBJECTIVES: Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome. METHODS: This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0. RESULTS: A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652). CONCLUSION: NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health.

Perceptions and practice of epidural analgesia among women attending antenatal clinic in FETHA.

BACKGROUND: The pain of childbirth is arguably the most severe pain that most women will endure in their lifetime. Epidural analgesia is widely used as an effective method of pain relief in labor. It provides almost complete relief of pain if administered timely, and does not affect the progress of the first stage labor. OBJECTIVES: The objective of this study was to determine the awareness and utilization of epidural analgesia in labor in pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki (FETHA). METHODOLOGY: This is a cross-sectional study involving 350 women attending the antenatal clinic between April 2016 and July 2016. A total of 335 questionnaires were correctly completed, and used for analysis. RESULTS: The average age and parity of the respondents were 27.6±8.2 years and 2.4±1.8, respectively. About 58.2% of respondents were civil servants, 98.5% were married, and 74.6% had a tertiary level of education. About 43.3% of the respondents are aware of the use of epidural analgesia in labor, but only 7.5% had used it; 95% of these were satisfied and desired to use it again. The reasons responsible for the poor uptake were desire to experience natural labor, cost, and fear of side effects. However, 70% of those who had not used it expressed the desire to use it. CONCLUSION: Epidural analgesia is one of the most effective methods of pain relief in labor. However, the present study indicates that knowledge and practice of epidural analgesia among parturients are low. Efforts should be made to raise awareness, dispel misconceptions, and subsidize the cost of providing this invaluable care in modern day obstetrics.

Eclampsia in rural Nigeria: The unmitigating catastrophe.

INTRODUCTION: Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work. MATERIALS AND METHODS: This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria. RESULTS: The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9% of the women were delivered by emergency lower segment cesarean section. Fifteen or 17.9% babies were dead giving a perinatal mortality rate of 174 per 1,000After delivery, and 3 (3.8%) of the women had postpartum hemorrhage. Two women (2.6%) died giving a maternal mortality ratio of 2564 per 100,000 deliveries. CONCLUSION: Eclampsia is a dreaded obstetric disease with adverse fetal and maternal consequences that are not mitigating, and no effort should be spared in managing it effectively including public enlightenment.

Evaluation of obstetricians' surgical decision making in the management of uterine rupture.

BACKGROUND: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. METHODS: A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. RESULTS: Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. CONCLUSION: Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.

Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast Nigeria.

INTRODUCTION: Awareness of appropriate waste management procedures and occupational safety measures is fundamental to achieving a safe work environment, and ensuring patient and staff safety. AIM: This study was conducted to assess the attitude of healthcare managers to medical waste management and occupational safety practices. MATERIALS AND METHODS: This was a cross-sectional study conducted among 54 hospital administrators in Ebonyi state. Semi-structured questionnaires were used for qualitative data collection and analyzed with SPSS statistics for windows (2011), version 20.0 statistical software (Armonk, NY: IBM Corp). RESULTS: Two-fifth (40%) of healthcare managers had received training on medical waste management and occupational safety. Standard operating procedure of waste disposal was practiced by only one hospital (1.9%), while 98.1% (53/54) practiced indiscriminate waste disposal. Injection safety boxes were widely available in all health facilities, nevertheless, the use of incinerators and waste treatment was practiced by 1.9% (1/54) facility. However, 40.7% (22/54) and 59.3% (32/54) of respondents trained their staff and organize safety orientation courses respectively. Staff insurance cover was offered by just one hospital (1.9%), while none of the hospitals had compensation package for occupational hazard victims. Over half (55.6%; 30/54) of the respondents provided both personal protective equipment and post exposure prophylaxis for HIV. CONCLUSION: There was high level of non-compliance to standard medical waste management procedures, and lack of training on occupational safety measures. Relevant regulating agencies should step up efforts at monitoring and regulation of healthcare activities and ensure staff training on safe handling and disposal of hospital waste.

Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence.

BACKGROUND: Reproductive health services in the form of adolescent health and contraceptive services are fundamental in the prevention of a high incidence of teenage pregnancy. The purpose of this study was to determine the age at menarche, menstrual pattern, and awareness of and use of modern contraception among secondary school girls in Abakaliki, Nigeria. SUBJECTS AND MATERIALS: This was a cross-sectional study in which self-administered questionnaires were completed by 482 adolescent girls at two girls' secondary schools between August and September 2012. RESULTS: The mean age at menarche was 13.13±1.37 years. The mean menstrual cycle length was 27.8±3.14 days, and the mean duration of menstrual flow was 4.8±1.14 days. Thirty-seven (7.7%) respondents were ignorant of their cycle length, while 29 (6.0%) had irregular cycles. Premenstrual syndrome and dysmenorrhea were major menstrual issues, which resulted in 69 (14.3%) and 59 (12.2%) of respondents resorting to self-medication and absenteeism from school, respectively. Mothers were the main source of their daughters' adolescent education, while friends and mass media were the main source of contraceptive information. Though there was a high level (75.7%) of awareness of contraceptive information among the girls, usage (8.9%) was poor. Only eight (18.6%) of the 43 respondents who had ever used modern contraception were adherent to modern contraceptives. Students who were more than 15 years old, attained menarche at 13 years or less, and whose families were of low socioeconomic classes were more likely to be sexually active. CONCLUSION: The declining age at menarche, menstrual challenges, and poor reproductive health status of adolescent girls in this study have made menstrual issues and contraceptive adherence critical aspects of adolescent health care, especially when appropriate sources of reproductive health information were not fully harnessed. Therefore, there is an urgent need to establish adolescent-friendly clinics and include sexuality education in the curriculum of schools in this environment.