Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study.

BACKGROUND: Nigeria has one of the highest burdens of maternal deaths globally, and hypertensive disorders of pregnancy (HDP) are the leading cause of maternal morbidity and mortality in the country. There is a significant implementation gap in utilizing evidence-based practices for the management of HDP in Nigeria. This study evaluated facilitators and barriers to implementing a home blood pressure monitoring program to improve management of HDP. METHODS: From August 2022 to September 2022, we conducted 15 semi-structured, key informant interviews and 4 focus group discussions among patients, health care workers, and administrators at University of Abuja Teaching Hospital (UATH), a tertiary care centre in Nigeria. The study used the Consolidated Framework for Implementation Research to assess five domains: individual characteristics, inner and outer settings, intervention characteristics, and process of implementation. Audio files were transcribed, and data were analysed using a combination of inductive and deductive approaches. We also conducted 32 brief surveys on the participants to assess acceptability, appropriateness, and feasibility of a blood pressure monitoring program. RESULTS: The study sample consisted of healthcare workers (n=22) including specialists in cardiology, obstetrics and gynaecology, maternal-foetal medicine, nurses/midwives and resident doctors as well as patients (n=10). Mean (SD) age was 39.5 (10.9), and 78% were female. Participants identified facilitators including the perceived simplicity of home blood pressure monitoring program, high burden of HDP, and availability of a multi-disciplinary team of healthcare professionals with expertise in HDP management. Barriers identified were cost, limited knowledge of HDP amongst patients, limited transportation networks, inconsistent management protocols, and inadequate manpower and facilities. Survey results indicated that between 81% and 88% of participants reported that a blood pressure monitoring program would be acceptable, 56%-72% reported that it would be appropriate, and 47%-69% reported that it would be feasible. CONCLUSION: This study identified facilitators and barriers while highlighting key implementation strategies to leverage and effectively address these respectively to enable successful implementation of a home blood pressure monitoring program. It also demonstrated that a home blood pressure monitoring program was considered acceptable, appropriate and feasible among respondents interviewed at UATH.

A randomized controlled trial of loading dose alone versus pritchard regimen of magnesium sulphate, for seizure prophylaxis in severe preeclampsia.

Background: Preeclampsia poses a significant risk of maternal and neonatal morbidity and mortality. Magnesium sulfate superiority for seizure prophylaxis in severe preeclampsia has been proven globally. However, the search for the lowest effective dose is an area of continuing research. Aim: The aim of this study was to compare the effectiveness of loading dose with the Pritchard regimen of magnesium sulfate for seizure prophylaxis in severe preeclampsia. Materials and Methods: A total of 138 eligible women after 28-week gestation with severe preeclampsia were randomized to either receiving a single loading dose of MgSO4 (study arm: n = 69) or Pritchard regimen of MgSO4 (control: n = 69). The effectiveness was assessed by the development of seizure. The results obtained were analyzed using SPSS version 21. Categorical variables were analyzed using the Chi-square test and normally distributed continuous variables were analyzed with t-test and Fisher's exact test. P < 0.05 was considered statistical significance. Results: There were no significant differences between those who received only the loading dose when compared with those who had Pritchard regimen other than a single recorded convulsion among the control group (P = 0.316). Similarly, except for the duration of hospital stay which was significantly longer in the Pritchard group (P = 0.019), both the arms of the study shared similar maternal and fetal outcomes. Conclusion: This study suggests the effectiveness of just the loading dose of magnesium sulfate when compared with the standardized Pritchard regimen in the prevention of seizure among women with severe preeclampsia. The study also demonstrated safety and similarity in fetal-maternal outcome. The loading dose only had an added advantage of shorter duration of hospital stay.

Résumé Contexte: La prééclampsie pose un risque important de morbidité et de mortalité maternelle et néonatale. La supériorité du sulfate de magnésium pour 15 prophylaxies épileptiques dans la prééclampsie sévère a été prouvée à l'échelle mondiale. Cependant, la recherche de la dose efficace la plus faible est un domaine de recherche continue. Objectif: L'objectif de cette étude était de comparer l'efficacité de la dose de charge avec le schéma de Pritchard de sulfate de magnésium pour la prophylaxie de 17 épilepsies dans la prééclampsie sévère. Matériels et méthodes: Un total de 138 femmes éligibles après 28 semaines de gestation atteintes de 18 prééclampsie ont été randomisés pour recevoir soit une dose de charge unique de MgSO4 (groupe d'étude : n = 69) soit un régime de Pritchard de MgSO4 (contrôle : n = 69). L'efficacité a été évaluée par le développement de saisie. Les résultats obtenus ont été analysés à l'aide de SPSS version 21. Les 19 variables catégorielles ont été analysées à l'aide du test du chi carré et les variables continues normalement distribuées ont été analysées à l'aide du test t et du test exact de Fisher. 20 P < 0,05 était considéré comme une signification statistique. Résultats: Il n'y avait pas de différences significatives entre ceux qui n'avaient reçu que la dose de charge 21 par rapport à ceux qui avaient reçu le régime de Pritchard autre qu'une seule convulsion enregistrée parmi le groupe témoin (P = 0,316). 22 De même, à l'exception de la durée du séjour à l'hôpital qui était significativement plus longue dans le groupe Pritchard (P = 0,019), les deux bras de l'étude 23 partageaient des résultats maternels et fœtaux similaires. Conclusion: Cette étude suggère l'efficacité de la seule dose de charge de sulfate de magnésium par rapport au régime de Pritchard standardisé dans la prévention des convulsions chez les femmes atteintes de prééclampsie sévère. L'étude a également démontré 24 l'innocuité et la similarité des résultats fœto-maternels. La dose de charge n'avait qu'un avantage supplémentaire de durée d'hospitalisation plus courte. 25. Mots-clés: Éclampsie, dose de charge, sulfate de magnésium, régime de Pritchard, prophylaxie des crises, prééclampsie sévère.

Accuracy of ultrasound estimation of fetal weight at term: A comparison of shepard and hadlock methods.

Background: Ultrasound measurement provides a noninvasive means of obtaining information about fetal weight and may help in necessary preparations at and after delivery. Although some ultrasound methods include only one or two fetal indices, others, to improve accuracy, incorporate either three or all the four fetal indices. The aim of this report is to assess the accuracy of two different methods for fetal weight estimation. Materials and Methods: This was a prospective study of 170 consecutive pregnant women at term. Ultrasound was used to estimate fetal weight by the Shepard and Hadlock methods, and the actual birth weight (ABW) was determined at birth. The ultrasound-estimated fetal weights (EFWs) and ABW were analyzed. Results: The women were aged 21-42 years (mean 31.3 ± 7 years). The EFW using the Shepard method was 1.9 kg-5.0 kg (mean 3.6 ± 0.5 kg) and 1.8 kg-4.4 kg (mean 3.3 ± 0.4 kg) for Hadlock method, and ABW was 2.0 kg-4.5 kg (mean 3.4 ± 0.5 kg). The mean EFW using the Shepard method was significantly higher than that of ABW (P < 0.001). The Shepard method significantly overestimated macrosomia compared to that by the ABW. There was no significant difference in microsomia rate between the two methods and ABW. Conclusion: The Hadlock method was more accurate at estimating fetal weight compared to the Shepard method and is recommended for the ultrasound estimation of fetal weight in our setting and similar settings.

Résumé Contexte: La mesure par ultrasons fournit un moyen non invasif d'obtenir des informations sur le poids du fœtus et peut aider à préparations nécessaires à et après l'accouchement. Bien que certaines méthodes d'échographie n'incluent qu'un ou deux indices fœtaux, d'autres, pour améliorer précision, incorporent trois ou tous les quatre indices fœtaux. Le but de ce rapport est d'évaluer l'exactitude de deux méthodes différentes pour estimation du poids fœtal. Matériels et méthodes: Il s'agissait d'une étude prospective de 170 femmes enceintes consécutives à terme. Ultrason a été utilisé pour estimer le poids fœtal par les méthodes Shepard et Hadlock, et le poids réel à la naissance (ABW) a été déterminé à la naissance. le les poids fœtaux estimés par échographie (EFW) et ABW ont été analysés. Résultats: Les femmes étaient âgées de 21 à 42 ans (moyenne 31,3 ± 7 ans). le EFW utilisant la méthode Shepard était de 1,9 kg à 5,0 kg (moyenne 3,6 ± 0,5 kg) et de 1,8 kg à 4,4 kg (moyenne 3,3 ± 0,4 kg) pour la méthode Hadlock, et ABW était de 2,0 kg à 4,5 kg (moyenne 3,4 ± 0,5 kg). L'EFW moyen en utilisant la méthode Shepard était significativement plus élevé que celui d'ABW (P < 0,001). le La méthode Shepard surestimait significativement la macrosomie par rapport à celle de l'ABW. Il n'y avait pas de différence significative dans la microsomie taux entre les deux méthodes et ABW. Conclusion: La méthode Hadlock était plus précise pour estimer le poids fœtal par rapport à la La méthode de Shepard est recommandée pour l'estimation échographique du poids fœtal dans notre contexte et dans des contextes similaires. Mots-clés: Précision, poids de naissance, poids fœtal, Hadlock, Shepard, échographie.

Ionised serum calcium reference interval among rural women of reproductive age in Abuja, Nigeria.

BACKGROUND: Various medical conditions in pregnancy may be traced to suboptimal levels of serum calcium during pregnancy. Communities' derivation of normal serum calcium reference interval is imperative. OBJECTIVE: The objective was to determine the normal free (ionised) serum calcium reference interval among women of reproductive age in the federal capital territory (FCT) of Nigeria. MATERIALS AND METHODS: This was a cross-sectional study of 240 women from six primary health-care facilities in Abuja, Nigeria. Their blood samples were collected in serum separator bottles. The outcome measure was the determination of the reference interval of free (ionised) serum calcium among the participants. RESULTS: The obtained normal reference interval of ionised serum calcium (iCa) was 0.88-1.4 mmol/L. The accompanying reference intervals for total protein and albumin were 5.7-9.4 mg/dl and 3.3-5.2 mg/dl, respectively. CONCLUSION: The derived reference interval of iCa in this study was 0.88-1.4 mmol/L, while the total calcium range was 2.18-2.82 mmol/L. These intervals are recommended for use in the Nigerian FCT and its environs as it provides lower intervals compared to the operational values. There is a need for a national derived value as this may change the practice.

Short versus Long-Term Antibiotic Prophylaxis in Cesarean Section: A Randomized Clinical Trial.

OBJECTIVE: The objective of the present study was to compare the efficacy of intravenous (IV) 48 h course of cefuroxime/metronidazole with long-term course using 48 h cefuroxime/metronidazole plus 5 days oral regimen of cefuroxime and metronidazole for the prevention of post cesarean section wound infection. METHODS: Two hundred and forty-eight women were randomized into two equal groups. Women in each arm of the study received IV cefuroxime 750 mg twelve hourly and IV metronidazole 400 mg eight hourly for 48 h. Those in the long-term arm received additional tablets of cefuroxime 500 mg twelve hourly and Tabs 400 mg of metronidazole eight hourly for 5 days. After the surgery, surgical site infections were evaluated. Length of hospital stay and the cost of antibiotics were also assessed. RESULTS: The wound infection rate was not statistically significantly different between the 2 groups (1.3% vs. 3.3%, P = 0.136). The incidence of endometritis was 2.1%, with no statistically significant difference seen between the two groups (0.4% vs. 1.6%, P = 0.213). Escherichia coli was the most common isolate seen in 36.4% of infected wounds. The short arm group stayed for significantly shorter days in the hospital (2.9 ± 1.0 vs. 3.8 ± 1.1 days,P < 0.001), and the cost of antibiotics was also significantly less in the short arm group (P < 0.001). Organisms associated with nosocomial infections were seen only in the long arm that stayed in the hospital for longer days. CONCLUSIONS: Short-term prophylactic antibiotics are as effective as long-term prophylaxis and have other benefits such as shorter duration of hospital stay, reduced cost of antibiotics, and reduction of nosocomial infections.

Hypertensive Disorders in Pregnancy: Pattern and Obstetric Outcome in Bida, Nigeria.

CONTEXT: Cases of hypertensive disorders in pregnancy (HDP) are an increase in developing economies. Identifying the pattern of HDP in a particular community and documenting their management outcome may allow for proper planning by all stakeholders. AIMS: The objective was to determine the pattern and management outcome of hypertensive disorders among pregnant women. SETTINGS AND DESIGN: This was a prospective cohort study involving 183 consecutive cases of HDP at Federal Medical Centre, Bida, Niger State, Nigeria, between September 2015 and August 2016. SUBJECTS AND METHODS: Pregnant women with hypertension were recruited and managed according to the departmental protocol. They were followed up till 6 weeks after delivery; fetal and maternal outcomes were documented. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS software version 23. The level of statistical significance was set at P < 0.05. RESULTS: A total of 1956 deliveries occurred during the study with 183 cases of HDP, giving an incidence of 9.4%. Pregnancy-induced hypertension alongside preeclampsia constitutes the majority of HDP during the study and had accounted for over 64%. Women who did not receive antenatal care in our center were at significantly greater risk of eclampsia (P = 0.000), abruption placentae (P = 0.003), maternal death (P = 0.002), very low-birth-weight (LBW) babies (P = 0.002), extremely LBW babies (P = 0.03), and perinatal death (P = 0.000). CONCLUSION: The need for prenatal screening that enables the early identification and prompt management of all expectant mothers with HDP is advised.

Serological survey and risk factors associated with Toxoplasma gondii infection among HIV-infected pregnant women attending Abuja Tertiary Hospital, Nigeria.

Background: Toxoplasmosis in pregnancy could induce miscarriage, congenital anomalies in foetuses and encephalitis in HIV-infected people. Hence, there is a need to determine the prevalence of toxoplasmosis in HIV-infected pregnant women to inform clinicians about the significance of maternal toxoplasmosis in antenatal care. Aim: This study aimed to determine the seroprevalence of Toxoplasma gondii infection, associated CD4+ T-cell profile and sociodemographic risk factors among pregnant women with or without HIV infection attending the University of Abuja Teaching Hospital, Abuja, Nigeria. Methods: This hospital-based cross-sectional study involved blood samples collected from 160 HIV-infected and 160 HIV-seronegative pregnant women. These samples were analysed for anti-T. gondii (IgG and IgM) and CD4+ T-cell count using ELISA and flow cytometry, respectively. Sociodemographic variables of participants were collected using structured questionnaires. Results: The overall seroprevalence of anti-T. gondii IgG and IgM was 28.8% and 3.8%, respectively. The seroprevalence of anti-T. gondii IgG and IgM was 29.4% and 4.4%, respectively, among HIV-seropositive pregnant women and 28.1% and 3.1%, respectively, among HIV-seronegative women. There was no significant association between the seroprevalence of anti-T. gondii-IgG and anti-T. gondii-IgM with age, gestational age, education level, parity or place of residence of HIV-infected pregnant women (P > 0.05). However, there was significant association between the seroprevalence of anti-T. gondii-IgG (P = 0.03) and anti-T. gondii-IgM (P = 0.01) with education level. CD4+ T-cell count varied significantly between HIV-infected and HIV-uninfected pregnant women (P = 0.035). Conclusion: In this study, the seroprevalence of anti-T. gondii IgG and IgM did not differ in HIV-seropositive or HIV-seronegative pregnant women. However, women with primary T. gondii and HIV coinfection had lower CD4+ T-cell count than those with toxoplasmosis monoinfection.

A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients.

BACKGROUND: Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. OBJECTIVE: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. MATERIALS AND METHODS: A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. RESULTS: There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. CONCLUSION: Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.

Knowledge and perception of human papilloma virus vaccine among the antenatal women in a Nigerian tertiary hospital.

BACKGROUND: Cervical cancer is a major health problem globally, especially in sub-Saharan Africa, Nigeria inclusive. One of the preventive measures is the vaccination of teenagers against oncogenic human papilloma virus. The aim of this study was to find out the level of knowledge mothers possess about these vaccines and their willingness to administer vaccination to their teenage girls. MATERIALS AND METHODS: This was a cross-sectional descriptive study of 255 consecutive women attending antenatal clinic at the University of Abuja Teaching Hospital, Abuja. They were given either a self-administered questionnaire or interviewer-administered questionnaire containing both closed and open-ended questions. Information recorded includes socio-demographic variables, knowledge of cervical cancer, knowledge of HPV/HPV vaccines and acceptance of these vaccines for their adolescent girls. The data was analysed using descriptive statistics. RESULTS: The mean age of the respondents was 26.9 years. Over 90% had at least secondary education. A total of 102 (40%) had the knowledge of cancer of the cervix while 153 (60%) had never heard about it. Overall, 236 (92.5%) of them had no idea about the predisposing factors. The study showed that only 23 (9.0%) out of the total respondents had heard about human papilloma virus (HPV) infection. In the same vein, 20 (7.8%) had knowledge about HPV vaccine. Among the respondents, who had the knowledge of HPV and vaccination, 18.2% and 23.4% of them had secondary and tertiary levels of education respectively. Overall, 160 (62.8%) accepted that the vaccines could be administered to their teenage girls. CONCLUSIONS: Awareness of cervical cancer, HPV infections, and HPV vaccines is low among antenatal clinic attendees in Gwagwalada, Abuja. However, majority of them would want their girls vaccinated against HPV infections. There is a need for all stakeholders to step up awareness creation for improved HPV vaccination project in Nigeria.

Prevalence of malaria parasitemia amongst asymptomatic pregnant women attending a Nigerian teaching hospital.

BACKGROUND: Malaria parasitemia among pregnant women is associated with complications to mother and the unborn fetus. There is paucity of data on asymptomatic malaria parasitemia, particularly in the northwest region of Nigeria. The objectives of this study were to determine the prevalence of malaria parasitemia in asymptomatic pregnant women and to estimate the packed cell volume (PCV) of this group of pregnant women. MATERIALS AND METHODS: This was a cross-sectional, descriptive study of only well pregnant women recruited consecutively at the time of booking for antenatal care. Thick film microscopy and qualitative immunoassay test for malaria parasite (MP) were performed for all the women. PCV estimation was also done using the micro-centrifuge method and comparison was made for women with parasitemia with those without MP. Some socio-demographic variables were also analyzed. Chi-square test was used to test for significance and a P-value less than 0.05 was considered statistically significant. RESULTS: Two hundred and twenty-five healthy pregnant women were studied. Seven women (3.1%) had MP by direct microscopy while 11 (4.8%) were MP positive with the qualitative immunoassay test. One hundred and eighty-five (82%) of the women were literate while 128 (57%) used insecticide treated mosquito nets in their homes. The mean PCV of the women with positive MP was 30.57 ± 2.26 as against 32.89 ± 2.45 for those without parasitemia (P < 0.05). CONCLUSION: The prevalence of asymptomatic malaria parasitemia in the study group was low but there was associated anemia in those with parasitemia. The use of intermittent preventive treatment is recommended for all pregnant women including those who are asymptomatic to forestall complications like maternal anemia.