Role of national blood transfusion service (NBTS) in promoting emergency obstetrics care (EMOC)

Background: Obstetrics haemorrhage is one of the leading cause of maternal mortality in our settings, this was compounded by the non availability to safe blood in situation of need. Hence the prompt access and availability of blood can avert this preventable cause of maternal death. Objectives: to highlight the benefits of effective collaboration with NBTS in ensuring prompt availability of blood for emergency obstetric services requiring blood for transfusion. Material And Method: All obstetrics cases requiring blood transfusion in FMC Nguru from 1st stJanuary 2006 ­ 31 December 2011 were retrospectively reviewed. Trends and pattern of the st strequest and source of blood were looked at within the two periods (from 1 January 2006 ­ 31 st stDecember 2008 and 1 January 2009 ­ 31 December 2011). Records of 1634 obstetric patients requiring blood transfusion or received blood transfusion in the maternity units were retrieved from the medical records, maternity ward record and blood bank. Information pertaining to their age, parity, indication for the transfusion or requests and source of blood was obtained for analysis. Data was analysed using simple percentage. st st Results: Between 1 January 2006 and 31 December 2008 only 513 (56%) of the units requested st st907 units of blood were supplied, while between 1 January 2009 and 1 December 2011 1367 ( 87%) of the 1567 units of blood requested were supplied. Within the earlier study period the only available source were from willing relatives and commercial blood donors, however between 2009 and 2011 more than 2/3 (64.2%) were supplied from the north east zonal NBTS office in Maiduguri. In 2006 through 2008, donation from relatives and commercial donors accounted for 53.22% and 46.78% respectively, but in 2009 and 2011 donation from relatives and commercial donors were recorded as 23.9% and 11.6% respectively. The commonest indication for the requests were anaemia, obstetrics haemorrhage (PPH, APH) and emergency C/S. Conclusion: Ready available source of blood will significantly improve timely availability of blood in our setting. There is the need to encourage this collaboration in other regions to ensure prompt availability of blood to attend to emergencies requiring blood transfusion

Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year.

BACKGROUND: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. MATERIALS AND METHODS: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. RESULTS: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30-49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of <30% (P=0.081). CONCLUSION: Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.

Prevalence, risk factors and effects of placental malaria in the UMTH, Maiduguri, North-eastern, Nigeria: a cross-sectional study.

SUMMARY: Most of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period.

Attitude of Nigerian women to contraceptive use by men.

This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms.

Methods of induction of labour at the University of Maiduguri Teaching Hospital, Maiduguri: a 4-year review.

BACKGROUND: Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol. METHOD: This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50 microg of misoprostol, 57 women had 100 microg of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion. RESULT: Induction of labour constituted 6.6% (468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8%, followed by pregnancy induced hypertension in 33.5%. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (chi2 = 1.13, p = 0.57). The mean induction delivery time was shortest for those induced with 100 microg of misoprostol (6.38 +/- 2.25 hours), followed by 8.16 +/- 3.58 hours in those induced with 50 ug of misoprostol and 9.73 +/- 4.32. 43 hours in those induced with Foleys catheter/oxytocin (p < 0.001). The babies delivered to women induced with 100 microg of misoprostol were more asphyxiated 12.3% (7/57) compared to 9.2% (21/228) and 6.6% (12/183) in the 50 ug misoprostol and Foleys catheter/oxytocin respectively and was statistically significant (chi2 = 23.08, p = 0.01). The short induction delivery time in the group with 100 microg of misoprostol was advantageous but there was an associated higher risk of birth asphyxia, stillbirth, uterine hyperstimulation, perineal tear and uterine rupture. The normal delivery outcome was not significantly different from those induced with 50 microg of misoprostol and those induced with Foleys catheter/oxytocin (chi2 = 1.24, p = 0.94). Normal delivery rate was significantly higher in those induced with 50 microg of misoprostol compared with those induced with 100 microg of misoprostol (chi2 = 14.38, p = 0.01). CONCLUSION: Misoprostol appears to be safe and may be a suitable alternative for induction of labour by the traditional Foleys catheter/oxytocin protocol. The 50 microg dosing of misoprostol is safer than the 100 microg.

Methods of Induction of Labour at the University of Maiduguri Teaching Hospital, Maiduguri: A 4-Year Review

Background: Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol. Method: This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50?g of misoprostol; 57 women had 100?g of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion. Result: Induction of labour constituted 6.6(468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8; followed by pregnancy induced hypertension in 33.5. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (x2=1.13; p=0.57). The mean induction delivery time was shortest for those induced with 100?g of misoprostol (6.38+2.25 hours); followed by 8.16+3.58 hours in those induced with 50ug of misoprostol and 9.73+4.32.43 hours in those induced with Foleys catheter/oxytocin (p