Evaluation of Obstetricians' Opinion of Thrombocytopenia in Pregnancy: A Cross-Sectional Study.

BACKGROUND: Thrombocytopenia occurs in about 8-10% of pregnancies. Thrombocytopenia may be incidental in pregnancy and could point to medical or gestational conditions that may pose a morbidity and mortality risk to both mother and foetus. AIM: To determine Obstetricians' view/opinion about thrombocytopenia in pregnancy. METHODS: A pre-tested structured questionnaire was distributed amongst consultant and resident obstetricians during their antenatal clinics in 3 tertiary hospitals over a period of one month. Analysis was descriptive and results were expressed as frequencies in words, tables and charts. RESULTS: A total of 91 responders were studied of which 24 were consultants (26.4%), 57 (62.6%) senior registrars and 10 (11%) were registrars. There were 20 (22.7%) responders who were unaware of incidental thrombocytopenia in pregnancy. Most obstetricians (n=83, 91.2%) requested for only packed cell volume (PCV) at antenatal booking, only 2 (2.9%) routinely requested for full blood count (FBC). At booking; only 10 (11.1%) obstetricians asked for a history of thrombocytopenia. Majority (n=87, 98.9%) never requested for platelet counts. If they encountered thrombocytopenia, up to 89 (97.8%) would investigate further with a repeat FBC (n=77, 86.5%), coagulation screen (n=54, 61.4%) or bone marrow aspiration (n=20, 24.7%). Most of the obstetricians (n=82, 96.5%) would transfuse patients with thrombocytopenia and 34 (43.6%) of them would do so when the count is <50 X 109/L. CONCLUSION: Obstetricians have the capacity to investigate symptomatic thrombocytopenia in pregnancy but do not routinely screen for asymptomatic thrombocytopenia. Routine FBC if done at booking may identify missed cases of asymptomatic thrombo-cytopenia for adequate management.

CONTEXTE: La thrombocytopénie survient dans environ 8 à 10 % des grossesses. La thrombocytopénie peut être fortuite pendant la grossesse et peut indiquer une condition médicale ou gestationnelle qui peuvent poser un risque de morbidité et de mortalité pour la mère et le fœtus. OBJECTIF: Déterminer le point de vue/opinion des obstétriciens concernant la thrombocytopénie pendant la grossesse. MÉTHODES: Un questionnaire structuré et pré-testé a été distribué parmi les obstétriciens consultants et résidents lors de leurs consultations prénatales dans trois hôpitaux tertiaires sur une période d'un mois. L'analyse descriptive et les résultats ont été exprimés sous forme de fréquences en mots, tableaux et graphiques. RÉSULTATS: Au total, 91 répondants ont été étudiés, dont 24 étaient Les conseillers(26,4 %), 57 (62,6 %) des chefs de clinique et 10 (11 %) des titulaires. Il y' avait Vingt (22,7 %) des répondants n'étaient pas au courant de la présence de thrombocytopénie fortuite pendant la grossesse. La plupart des obstétriciens (n=83, 91,2 %) demandaient uniquement un volume globulaire (VGP) lors de la consultation anténatale, seuls 2 (2,9 %) demandaient systématiquement une formule sanguine complète (FBC). Lors de la réservation, seuls 10 obstétriciens (11,1 %) ont demandé des antécédents de thrombocytopénie. La majorité (n=87, 98,9 %) n'a jamais demandé de numération plaquettaire. S'ils rencontraient une thrombocytopénie, jusqu'à 89 (97,8 %) poursuivaient les investigations en répétant la numération formule sanguine (n=77, 86,5%), un test de coagulation (n=54, 61,4%) ou une ponction de moelle osseuse (n=20, 24.7%). La plupart des obstétriciens (n=82, 96,5 %) transfuseraient des patients atteints de thrombocytopénie et 34 (43,6%) d'entre eux le feraient lorsque la numération est <50 X 109/L. CONCLUSION: Les obstétriciens ont la capacité d'investiguer la thrombopénie symptomatique pendant la grossesse, mais ne procèdent pas systématiquement au dépistage systématique de la thrombocytopénie asymptomatique. La FBC de routine, si elle est effectuée peut identifier les cas manqués de thrombocytopénie asymptomatique pour une prise en charge adéquate. Mots clés: Thrombocytopénie, grossesse, obstétriciens.

Resumption of vaginal intercourse in the early postpartum period: determinants and considerations for child spacing in a Nigerian population.

A total of 860 mothers were interviewed during their first postnatal clinic visit to determine the factors that influenced their resumption of sexual intercourse as well as their family planning practices in the early postpartum period. Some 255 (29.7%) women had resumed sexual intercourse with a mean delivery - resumption interval of 5.4 ± 2.6 weeks. Resumption of menses and HIV-negative status were the factors most significantly associated with resumption of sexual intercourse. Other significant determinants were urban residence and vaginal delivery without tears. Only 21.5% of the sexually active mothers used a modern contraceptive in the form of a male condom, while 56.9% did not consider contraception at all. The major reason for prolonged abstinence was fear of another pregnancy. In this group of women, child spacing appears to be the major consideration for resumption of coitus, even over the fear of painful discomfort.

Emergency peripartum hysterectomy in Nnewi, Nigeria: a 10-year review.

BACKGROUND: Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging. AIMS: This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south-east Nigeria. MATERIALS AND METHODS: A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1. RESULTS: During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days. CONCLUSION: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial.