Comparison of Zuspan regimen and its 12-hour modification in women with severe pre-eclampsia and eclampsia in two hospitals in Abeokuta.

BACKGROUND: Hypertensive disorders in pregnancy (HDP) are leading causes of maternal mortality (with severe pre-eclampsia/eclampsia [SPE/EC] being causes of death). Magnesium sulphate (MgSO4) has proven to be the drug of choice for SPE/EC management. However, its availability and cost remain a drawback to its use in developing countries. This study aimed to compare Zuspan regimen with its 12-hour modification for SPE/EC management in two major hospitals in Abeokuta, Ogun state, South Western Nigeria. METHODS: A randomized controlled trial of non-inferior parallel design carried out at Federal Medical Centre and Sacred Heart Hospital, Abeokuta involving 148 consenting women who were randomized into two groups A and B. Both groups had 4 g loading dose of MgSO4, but the duration of maintenance was reduced to 12-hours in Group A (intervention) while Group B received the standard Zuspan regimen (control). Outcome measures were the occurrence/recurrence of convulsions (primary), maternal side effects and perinatal outcomes (secondary). RESULTS: There was no statistically significant difference in the occurrence/recurrence of seizures between the two groups for both SPE/EC. No signs of maternal toxicity were observed in both arm of the study. There were no statistically significant differences in the perinatal/neonatal death and Apgar scores at 1 and 5 min. However, there was a significant increase in the number of days on admission in the control group of those neonates delivered to mothers with eclampsia. CONCLUSION: A 12-hr modification of Zuspan regimen was found to be non-inferior to the standard Zuspan regimen in the management of SPE/EC.

Effect of hyoscine-N-butylbromide on labor duration among nullipara in a southwestern Nigerian teaching hospital: A randomized controlled trial.

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).

Group B streptococcus colonization and HIV in pregnancy: A cohort study in Nigeria.

BACKGROUND: Group B streptococcus (GBS) is a leading cause of maternal and neonatal infectious morbidity. HIV is prevalent among pregnant women in Nigeria. AIM: To determine the rates of anogenital GBS colonization in our institution and compare GBS colonization rates between HIV positive and negative pregnant women. METHODS: A cross-sectional comparative study was conducted over 6 months. Patients were separated according to their HIV status: positive and negative. GBS colonization was assessed by vaginal and anal swabs collected at 35-37 weeks of gestation and cultured in Todd-Hewitt broth, followed by a confirmatory test. Socio-demographic characteristics and CD4 count were extracted from patient medical records. Secondary outcomes were identification of risk factors for GBS colonization, antibiotic sensitivity, and any association between CD4 count and GBS colonization. Appropriate statistical analysis was done. RESULTS: A total of 200 patients attended the clinic; 67 HIV positive and 133 negative. Analyzed samples were 198; the overall prevalence of GBS was 18.2%. No significant difference in GBS colonization was noted between HIV positive (19.4% [13]) and negative patients (17.6% [23/131]). Most GBS isolates were susceptible to ampicillin (87%) and penicillin (81%). A high body mass index (BMI) was independently associated with GBS colonization (OR = 1.25, 95% CI: 1.04-1.51). No association was observed between CD4 counts and GBS colonization. CONCLUSION: A high prevalence of GBS colonization was observed in our institution. Colonization rates were independent of the HIV status but associated with a high BMI in HIV positive women.