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

The use of plasma lipid and lipoprotein ratios in interpreting the hyperlipidaemia of pregnancy.

The aim of this study was to determine the lipid and lipoproteins ratio in pregnant mothers and to evaluate their role in the interpretation of hyperlipidaemias. A total of 222 pregnant women who registered for ANC and 222 non-pregnant healthy women of the sameage and parity as control were recruited for the study. A sample of venous blood after an overnight fast was collected for analysis and interpretation. The mean ± SD age (years) of pregnant women, 27.317 ± 7.283 years and that of the non-pregnant women, 26.234 ± 6.234 years are not significantly different, p = 0.429. Total cholesterol, HDL-c and TGs were significantly higher in pregnant women (5.29 ± 1.04 mmol/l, 1.64 ± 0.42 mmol/l and 1.74 ± 0.42 mmol/l) compared with that of non-pregnant women (4.64 ± 0.92 mmol/l, 1.25 ± 0.35 mmol/l and 1.37 ± 0.45 mmol/l, respectively) All showed p < 0.000. The frequencies of hypercholesterolaemia, 96(43.2%) and hypertriglyceridaemia, 82 (36.9%), are significantly higher in the pregnant women than in the non-pregnant women, 58 (26.1%) and 26 (11.7%), respectively. TC/HDL-C ratio, 3.33 ± 1.01 and LDL/HDL-C ratio, 1.91 ± 0.85 are significantly lower in pregnant women compared with non-pregnant women counterparts, 3.89 ± 0.97 and 2.35 ± 0.84, respectively. Similarly the frequencies of increased TC/HDL-C ratio, 22 (9.9%) and LDL/HDL-C ratio, 16 (7.2%) are significantly less in the pregnant compared with the non-pregnant women, 54 (24.3%) and 28 (12.6%), respectively.

A 5-Year Review of Maternal Mortality Associated with Eclampsia in a Tertiary Institution in Northern Nigeria

Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed; retrospectively. Their social demography; mode and place of delivery; time of eclampsia; and fetal outcome were extracted for analysis. Results : Eclampsia accounted for 52 (46.4) of the 112 total maternal deaths recorded within the 5-year period; with case fatality of 22.33. Age group 20; 20-29 and above 30 all had similar case fatality rate of 22.1; 23.8and 26.7; respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5of the case fatality in that category. As expected; unbooked had higher case fatality of 24.0compared to 15among booked cases; while those with no formal education also had more death (22.3case fatality) as compared to 3.3among those who had some form of formal education. Antepartum eclampsia was the cause in 50of the death; 11(21.2) of the pregnancies were not delivered before their death; while 18 (34.6) were stillbirth. Conclusion : Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery

Effectiveness of Manual Vacuum Aspiration (MVA) in the Management of First Trimester Miscarriage: Experience in a Specialist Centre in North-Eastern Nigeria

Background: Safe management of abortion with an easy; simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity; gestational age at presentation; indication for MVA use; duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period; out of which 251 were MVA procedures performed for various first trimester miscarriages; accounting for 13.2of the total gynaecological admissions. Sixty one (24.3) of the patients who benefited from MVA were in the 25-29 years age group; while those in the age 20-24 and 30-34 years group constituted 21.5and 20.7respectively. Grandmultiparas (53.7) constituted the majority. The procedure was performed for 50.2of the patients at 9-11 wks of gestation. Most (88.0) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0were for check MVA after complete abortion and missed abortion. Most (67) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre

Anaemia in pregnancy: a cross-sectional study of pregnant women in a Sahelian tertiary hospital in Northeastern Nigeria.

This prospective study was carried out between June 2005 and June 2006, to determine the prevalence and determinants of anaemia among pregnant women attending a tertiary Sahelian Hospital in Northeastern Nigeria. A total of 1,040 pregnant women enrolled at their first antenatal visit were monitored through pregnancy for anaemia. The overall prevalence of anaemia, malaria parasitaemia and schistosomiasis was 72.0%, 22.1% and 3.8%, respectively. Mild, moderate and severe anaemia constituted 31.8%, 39.4% and 0.9%, respectively. Anaemia was most common among the multipara and women presenting in late stages of pregnancy. More multipara and primigravidae had malaria parasitaemia than grandmultipara. Schistosomiasis, malaria infestation and a short birth interval as well as illiteracy are additional risk factors for anaemia in pregnancy. This study confirms the high prevalence of anaemia in pregnancy in this area. Appropriate intervention strategies are necessary to reduce the prevalence of anaemia.

Community perspective of maternal mortality: experience from Konduga Local Government Area, Borno State, Nigeria.

BACKGROUND/OBJECTIVE: High maternal mortality in Nigeria in particular and Sub-Saharan Africa in general has remained one of the key indicators of our poor health care services, infrastructural facilities and negative socio-cultural attitudes to healthy living. The objective is to identify barriers to prompt and effective treatment of obstetric complications leading to maternal mortality in order to develop appropriate strategies to address them at the community level. METHOD: The study took place between 10th October and 10th December 2003. An in-depth interview guide developed by the network for the prevention of maternal mortality (NPMM), which contains mainly open ended questions, modified to suit our socio-cultural setting was used. RESULTS: There was a good understanding among the people of the area that women are dying during pregnancy, labour and puerperium. 28(93.3%) of the respondents recognized some obstetric complications. The main obstacles to accessing the hospital for emergency obstetric care were lack of money and transportation difficulties. Equipping the health facilities, employment of qualified staff, community supported emergency funds for obstetric emergency and the provision of reliable, effective and affordable transport are identified as necessary measures to prevent maternal mortality. The Local Government Areas and community leaders are to champion the cause for the provision of these facilities in their localities. CONCLUSION: There is a good understanding of obstetric complications in the community leading to maternal death. The main reasons for delay in seeking care are ignorance, poverty, lack of transportation and distance. Community enlightenment, health education, training of TBAs, poverty reduction and effective, affordable and reliable transportation are means of obviating delays in the decision and transportation leading to maternal mortality. Upgrading and re-equipping of health facilities to provide emergency obstetric care services are mandatory. Community participation in the safe motherhood drive can be ensured using the traditional rulers, religious leaders and the Local Government Authority.