Microalbuminuria and its association with adverse pregnancy outcome in a tertiary health centre in Nigeria.

Background: Adverse pregnancy outcomes occur more commonly in developing countries and are still prevalent in our sub-region. Microalbuminuria is a marker of endothelial dysfunction and has been proposed as an aetiological factor in the development of some adverse pregnancy outcomes such as pre-eclampsia, intrauterine growth restriction (IUGR) and pre-term labour. Aim: The aim is to determine the prevalence of microalbuminuria and its association with adverse pregnancy outcomes. Methods: This was a prospective cross-sectional study with follow-up amongst women in early pregnancy presenting at Usmanu Danfodiyo University Teaching Hospital, Sokoto. Three hundred and thirty women with singleton pregnancy at gestational age <20 weeks, blood pressure <140/90 mmHg, normal fasting blood sugar and normal renal function were recruited. Those with a history of hypertension, diabetes mellitus, chronic kidney disease, sickle cell anaemia were excluded, multiple pregnancies, urinary tract infection or positive dipstick proteinuria at first contact were excluded. They were recruited consecutively and a structured interviewer-administered questionnaire was completed. Single-spot urine analysis for albumin was performed. The women were followed up to the time of delivery and the puerperium and any adverse outcome were documented. Results: The prevalence of microalbuminuria was 58.4%. The maternal and foetal adverse outcomes such as hypertensive disorders of pregnancy, pre-mature rupture of membrane, IUGR, preterm birth and stillbirth occurred more amongst the women with microalbuminuria. However, there was no statistically significant association between microalbuminuria and having these adverse outcomes (P > 0.05). Conclusion: There was a high prevalence of microalbuminuria amongst healthy pregnant women and pregnancy complications occurred more frequently in women with microalbuminuria than in those without. However, this association was not sufficient to predict adverse outcomes in pregnancy.

Quality and outcomes of maternal and perinatal care for 76,563 pregnancies reported in a nationwide network of Nigerian referral-level hospitals.

Background: The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods: Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings: Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (n = 187,20·6%), postpartum haemorrhage (PPH) (n = 103,11·4%), and sepsis (n = 99,10·8%). Antepartum hypoxia (n = 1455,31·1%) and acute intrapartum events (n = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention. Interpretation: This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool. Funding: This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).

Low plasma vitamin D as a predictor of uterine fibroids in a nigerian population.

BACKGROUND: Uterine fibroid is the most common benign tumour of the uterus and the exact cause is unknown. Vitamin D has been found to inhibit cell proliferation and enhance apoptosis in vitro. AIM: The aim of this study is to compare the plasma level of Vitamin D among women with uterine fibroids and those without uterine fibroids. MATERIALS AND METHODS: This was an analytical cross-sectional study conducted among women with uterine fibroids and those without uterine fibroids. An interviewer-administered questionnaire was used to obtain relevant information. Five millilitres of venous blood was obtained for plasma Vitamin D assay. Data analysis was performed using the SPSS version 22. Level of significance was set at P < 0.05. RESULTS: There were 100 participants recruited for the study. The mean age of the participants with uterine fibroid was 35.06 ± 6.6 years and that of controls was 33.28 ± 7 years. The mean plasma level of Vitamin D for all the participants was 12.47 ± 7.53 ng/ml. The mean plasma level of Vitamin D in those with uterine fibroids was significantly lower than in those without uterine fibroid (10.16 ± 7.78 vs. 14.35 ± 6.8; t = 2.517, P = 0.014). It also shows that 1 unit increase in Vitamin D level will reduce the risk of developing uterine fibroids by 8% (odds ratio = 0.92, 95% confidence interval = 0.86-0.99). CONCLUSION: The predictors of uterine fibroids were fewer hours spent outdoors, middle social class and low Vitamin D levels.

The efficacy of pentazocine + diclofenac versus paracetamol + diclofenac for post- caesarean section analgesia.

BACKGROUND: The most common major obstetric procedure is caesarean section (CS) and one of the greatest concerns for women after CS is to have optimal pain relief. AIM: This study aims to compare the efficacy of pentazocine + diclofenac and paracetamol + diclofenac on post-operative analgesia after CS. METHODOLOGY: This was a single-blind, randomised trial. Pregnant women that had CS were randomized into two groups. Group A received intramuscular pentazocine + rectal diclofenac postoperatively. Group B received intramuscular paracetamol + rectal diclofenac postoperatively. Post-operative pain was assessed by numeric rating scale at 1 h after the surgery, at 6 h, 12 h and 24 h. The result obtained was analysed using SPSS Version 22 and P < 0.05 was considered statistically significant. RESULTS: The median pain scores in both groups ranged from 2 to 3 across all periods of assessment. The pain relief was slightly better in the pentazocine + diclofenac group with no significant difference in the pain score between the two groups at all periods of assessment. The satisfaction level was good in 66.3% and 69.5% of the participants in the pentazocine + diclofenac and paracetamol + diclofenac group respectively but the difference was not statistically significant (χ2 = 4.14, P = 0. 12). Nausea, vomiting and drowsiness were significantly more in the pentazocine + diclofenac combination (P < 0.001). CONCLUSION: Both combination of analgesics provided adequate analgesia but pentazocine + diclofenac combination had better pain relief but was more associated with side effects.

Adherence to Guidelines in Postpartum Management of Hypertensive Disorders in Pregnancy in Tertiary Health Facilities in Nigeria: A Multi-centre Study.

Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal morbidity and mortality. Available guidelines for their postpartum management are expected to be optimally utilized. This study aimed to determine adherence to guidelines in selected Nigerian tertiary hospitals. It was nested in a cohort of women with HDPs who delivered in eight facilities between October 2017 and June 2018. Nine weeks after delivery, their cases were evaluated on prespecified indicators and supplemented with interviews. The level of adherence to the guidelines was determined using descriptive analyses, including frequencies, percentages, means, and standard deviations, as well as charts. Of the 366 participants, 33 (9%), 75 (20%), 200 (55%), and 58 (16%) had chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, respectively. Only about a third had their blood pressure measured between postpartum days three and five. Similarly, a third of those with persistent hypertension (≥140/90 mmHg) were not on antihypertensive medications within the first week postpartum. In addition, 37% and 42% of participants were not counseled on contraceptives and early subsequent antenatal visits, respectively. Among those with preeclampsia/eclampsia, 93% were not offered postpartum screening for thromboprophylaxis. Although all women with preeclampsia/eclampsia remained hypertensive two weeks after discharge, only 24% had medical reviews. Overall, only 58% and 44% of indicators were adhered to among all HDPs and preeclampsia/eclampsia-specific indicators, respectively. Level of adherence to guidelines on postpartum management of HDPs in Nigerian tertiary hospitals is poor. It is recommended that institutionalization of guidelines be prioritized and linked to the entire continuum from preconception through longer term postpartum care.

Sexual activities of pregnant women attending antenatal clinic of a tertiary hospital in North-West Nigeria.

INTRODUCTION: myths about sex during pregnancy harming fetus and leading to preterm labor or miscarriage are very strong factors releasing fear and leading to avoidance of sexual contact during gestation. We therefore evaluated the attitude, sexual experiences and changes in sexual function during pregnancy. METHODS: a cross-sectional study was conducted among 170 pregnant women who were selected using systematic sampling. Data were collected using an interviewer-administered questionnaire. Data was analysed using IBM SPSS® version 22.0. Descriptive statistics, Chi-square test and Cochran´s Q-test were estimated. RESULTS: the mean age of respondents was 27.2 ± 6.2 years. Most of the respondents, 107 (62.7%) had formal education. One-fifth of the respondents, 34 (20.2%) have been married for over 10 years. More than half of them were multiparous, 112 (68.3%) and in the third trimester of pregnancy, 99 (59.6%). Majority of the respondents, 153 (87.9%) thought coitus was safe in pregnancy. More than half 89 (58.2%) had coitus at least thrice a week before pregnancy and 98.8% have engaged in sexual activities during pregnancy. Most of the respondents, 105 (61.1%) enjoyed coitus during pregnancy. The desire for coitus significantly reduced in the third trimester, p=0.001. CONCLUSION: sexual intercourse during pregnancy was universal and respondents engaged in sexual activities during different stages of pregnancy. Although sexual frequency declined in pregnancy compared to pre-pregnancy period, most of the respondents desired and enjoyed it. We recommend that couples are well educated to understand the normal fluctuations in sexual interest and practices during pregnancy.

Awareness and perception of preconception care among women in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria.

BACKGROUND: Preconception care is an interventions aim to identify and modify biomedical, behavioral and social risks to pregnancy through prevention and management, emphasizing factors that must be acted upon before conception or in early pregnancy to have maximal impact. OBJECTIVE: The aim of the study is to assess awareness and perception of preconception care among women. METHOD: A cross-sectional study conducted at UDUTH Sokoto, Nigeria, from 5 February to 1 March, 2018. A total of 131 women were recruited by simple random sampling technique via the ante-natal care clinic, using semi-structured interviewer questionnaires. Data were analyzed using SPSS version 24 and the results were presented in tables and charts. A P value of <0.05 was considered statistically significant. RESULTS: There ages ranged between 16 years to 46 years and 32.8% (43/131) were within 26-30 years with a mean of 28.10 ± 6.064. Only 20.61% of them were aware of preconception care. There was significant association between awareness and the patient's tribe as well as employment status at P value 0.004 and 0.017 respectively. Among those who were unaware, 88.46% will accept if offered while, about 45.75% of those who declined believed it was not necessary. CONCLUSION: There was poor awareness but good perception and acceptability of preconception care. Therefore, there is a need to create awareness and incorporate it into routine maternal healthcare services to achieve better feto-maternal outcome.

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

INTRODUCTION: Sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. METHODS: It was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients' biodata, and relevant details on the cases were extracted from the patients' case files and analyzed. RESULTS: Out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients' ages ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%). CONCLUSION: Although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children's movement, and stringent laws should be enacted and enforced to curb this heinous act.

Breech Deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto; Northwestern Nigeria: a 10-Year Review

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24;160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto; Sokoto; over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7. Breech deliveries occurred more in the primigravidae. Most babies (69.1) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P 0.05). Similarly; perinatal deaths were more common in unbooked than in booked patients (P 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina

Breech Deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto; Northwestern Nigeria: A 10-Year Review

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24;160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto; Sokoto; over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7. Breech deliveries occurred more in the primigravidae. Most babies (69.1) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P 0.05). Similarly; perinatal deaths were more common in unbooked than in booked patients (P 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina

Place of delivery among women who had antenatal care in a teaching hospital.

BACKGROUND: The utilization of antenatal care services does not necessarily equate to delivery at the health facility. The objectives of this study were to determine the proportion of pregnant women who had antenatal care and delivered in the hospital and the reasons for delivery elsewhere. MATERIALS AND METHODS: Pregnant women of low risk who initiated antenatal care at the University Teaching Hospital were recruited consecutively from January to June 2004 and longitudinally followed up until delivery. A two-part questionnaire was used to obtain information on biosocial data, place of delivery, accoucher, fetomaternal outcome, and reason(s) for delivery elsewhere. RESULTS: Of the 1,080 women studied, 740 (68.5%) delivered in the hospital while 340 (31.5%) delivered elsewhere. The majority (52) of the deliveries elsewhere were at the woman's home. There were more literate women amongst the hospital delivery group, while there were more women of high parity and with a previous home birth in the home delivery group (p<0.05). Fetomaternal outcomes were similar in both groups. Nurses/midwives conducted most (60%) of the home deliveries and the principal reasons for home births were privacy and lack of transport during labor. CONCLUSION: 68.5% of women who had uneventful antenatal care delivered in the hospital. Home delivery was the commonest site for delivery elsewhere and the main reasons were privacy and lack of transportation. Skilled attendants conducted most of the home deliveries with good fetomaternal outcome. There might be a need to encourage women during antenatal care to reach out for skilled attendants when home delivery becomes inevitable.