RESUMO
OBJECTIVE: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. DESIGN: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. SETTING: Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. POPULATION: A total of 69 698 births. METHODS: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. OUTCOME MEASURES: Preterm birth and preterm perinatal mortality. RESULTS: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality. CONCLUSIONS: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.
Assuntos
Mortalidade Perinatal , Nascimento Prematuro , Centros de Atenção Terciária , Humanos , Feminino , Gravidez , Nigéria/epidemiologia , Nascimento Prematuro/epidemiologia , Recém-Nascido , Adulto , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem , Lactente , Fatores de Risco , Cuidado Pré-Natal/estatística & dados numéricos , Idade Materna , Incidência , Recém-Nascido PrematuroRESUMO
OBJECTIVE: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. DESIGN: A secondary data analysis using a cross-sectional design. SETTING: Referral-level hospitals (48 public and six private facilities). POPULATION: Women admitted for birth between 1 September 2019 and 31 August 2020. METHODS: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. MAIN OUTCOME MEASURES: Prevalence of PPH and maternal and neonatal outcomes. RESULTS: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. CONCLUSIONS: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
Assuntos
Hemorragia Pós-Parto , Humanos , Feminino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Nigéria/epidemiologia , Gravidez , Adulto , Estudos Transversais , Prevalência , Fatores de Risco , Parto Obstétrico/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto Jovem , Recém-Nascido , Mortalidade Materna , Cesárea/estatística & dados numéricos , Resultado da Gravidez/epidemiologiaRESUMO
Most children acquire human immunodeficiency virus (HIV) infection through mother-to-child transmission (MTCT). The risk of MTCT of HIV is generally 15%-40% without prophylaxis. MTCT has been responsible for approximately 370,000 infant HIV infections worldwide, with Nigeria accounting for 30% of cases. The study evaluated the effectiveness of a prevention program for MTCT of HIV infection by determining the rate of MTCT of HIV in infants who underwent the program by reviewing health records of mother-infant pairs at the Olabisi Onabanjo University Teaching Hospital. This cross-sectional study conducted over 12 years used medical records of 545 mother-infant pairs. The rate of MTCT of HIV infection was 2.9% in this study compared to 7.1% reported by the center earlier. The rate of MTCT of HIV infection was the lowest among mother-infant pairs who received prophylaxis. Ages at recruitment are a strong determinant of the risk of infection. Late usage of the MTCT prevention service is a risk for HIV infection in exposed infants.
Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Lactente , Humanos , Feminino , Gravidez , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Nigéria/epidemiologia , Estudos Transversais , Atenção Terciária à Saúde , Complicações Infecciosas na Gravidez/prevenção & controleRESUMO
Background: Overt thyroid dysfunction is an accepted cause of female infertility. Its milder form, subclinical hypothyroidism have also been implicated as a contributing factor to disturbed reproductive function. Objective: To determine the contribution of subclinical hypothyroidism (SCH) to the burden of infertility. Methodology: This is a cross sectional, comparative study of One hundred and twenty women with primary or secondaryinfertility who presented for evaluation at gynaecological clinic and controls which are clients that came to access Family planning services. Results: The prevalence of infertility among gynaecological patients seen in the clinic was 38.8% (192/495). The prevalence of SCH among the studied infertile women was 11.7% (7/60) compared with 3.3% (2/60) of the control group (p=0.222). The commonest type of infertility was secondary, 76.7% (46/60). All thestudied infertile women with SCH presented with secondary infertility. There was an observed statistically significant difference in the mean serum TSH (3.19±4.38mIU /L vs 1.60±1.22mIU /L) and FT3, FT4 (0.29±0.074ng/dl vs 0.95±0.16ng/dl and 0.33±0.071ng/dl vs 1.09±0.19ng/dl respectively). Conclusion: Subclinical hypothyroidism was found to be higher among infertile women but this finding was not statistically significant, therefore, the routine screening for SCH among infertile women might be unnecessary.
Assuntos
Hipotireoidismo , Infertilidade Feminina , Humanos , Feminino , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Tireotropina , Estudos Transversais , Centros de Atenção Terciária , Nigéria/epidemiologia , Hipotireoidismo/epidemiologiaRESUMO
OBJECTIVE: To assess the effectiveness of hyoscine-N-butylbromide on the duration of the first stage of labor among nulliparous women. METHODS: A randomized double-blind placebo-controlled study among 126 nulliparous women admitted in the active phase of labor to a teaching hospital in Sagamu, Nigeria, from January to August 2018. Based on the inclusion criteria, women were recruited and randomized to the study or control group, and given intravenous hyoscine-N-butylbromide 20 mg (1 mL) or sterile water (1 mL), respectively, during the active phase. Labor progress and outcomes were compared between the groups. RESULTS: The mean ± SD duration of active phase of first stage of labor was significantly shorter in the hyoscine-N-butylbromide group (324.9 ± 134.6 min) than in the control group (392.7 ± 119.6 min) (P = 0.004). The rate of cervical dilatation was 1.4 ± 0.8 cm/h in the hyoscine-N-butylbromide group and 1.0 ± 0.5 cm/h in the control group (P = 0.004). There were no significant differences in fetal heart rate, maternal vital signs, or Apgar scores between the two groups. CONCLUSION: Hyoscine-N-butylbromide was found to be effective in shortening the duration of the first stage of labor without adverse outcomes for mother or neonate. The trial was registered with the Pan African Clinical trials Registry (PACTR), protocol number: PACTR201808146688942 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3532).
Assuntos
Brometo de Butilescopolamônio/administração & dosagem , Primeira Fase do Trabalho de Parto/efeitos dos fármacos , Trabalho de Parto/efeitos dos fármacos , Administração Intravenosa , Adulto , Índice de Apgar , Brometo de Butilescopolamônio/efeitos adversos , Método Duplo-Cego , Feminino , Hospitais de Ensino , Humanos , Recém-Nascido , Nigéria , Parassimpatolíticos/administração & dosagem , Gravidez , Adulto JovemRESUMO
A case of thanatophoric dysplasia with sudden death at term is hereby presented. Thanatophoric dysplasia is an uncommon, lethal skeletal dysplasia which is associated with mutation in the extracellular region of fibroblast growth factor receptor 3 (FGFR3). It is an autosommal dominant condition that has sporadic occurrence and early ultrasound scan has not been of great benefit in its detection. Diagnosis is mostly made in the third trimester. The fetal death is usually due to severe respiratory insufficiency from a reduced thoracic capacity and hypoplastic lungs and/or respiratory failure due to brainstem compression. In view of the autosomal dominance of TD, it will be advisable for a woman with previous history to have prenatal screening to relieve parental anxiety and prevent late detection.
Assuntos
Receptor Tipo 3 de Fator de Crescimento de Fibroblastos/genética , Displasia Tanatofórica/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Displasia Tanatofórica/genéticaRESUMO
Background:Extirpativeuterinesurgeries for near-miss events are usually thelast resort when other conservative measures fail.Emergency obstetric hysterectomy(EOH)may still have a significant role where there are limited options.Objectives:To determine the prevalenceof EOH, theassociatedfactorsandthe foeto-maternal outcomeat the Olabisi Onabanjo University Teaching Hospital, Nigeria.Methods:This was a retrospective observational study covering sevenyears (January 2010 to December 2016). The case records of patients who hadEOH during this period were retrieved for data extraction. Results:There were 5,608 deliveries and 31 cases requiringEOH giving aprevalence rateof31/5,608(0.55%). The mean age of the patients was 30.3±4.2years, whilethe mean gestational age at delivery was 36.3±5.1 weeks. Most of thepatients16/25(64.0%) were of higher parity (>3), and12/25(48%)of the patients were within the age bracket of 25-34 years. Subtotal hysterectomywas the most common procedure(18; 72.0%), andruptured uterus wasthe main indication for EOH (40.0%). The twomost common interventions that were critical to survival includedmassive blood transfusion (24.0%)andIntensive Care Unit admission (20%).Two (8%)maternal deathsand 58.3% perinatal mortality wererecorded.Conclusion:EOH is still relatively frequently performedat this centredue tothehigh incidence of a ruptured uterus. Effortsshould be made to increase the proportion of deliveries attended by skilled personnel and improvethe capacity of lower levelhospitals for comprehensive emergency obstetric care