Use of Herbal Medicine by Rural Residents in Lagos, Nigeria.

BACKGROUND: Medicinal plants have been used for years in daily life all over the world. Herbal medicines (HM) may be beneficial but are not completely harmless especially with unregulated use. AIM: To assess the knowledge, preference and use of HM in a rural setting, western Nigeria. METHODOLOGY: This was a cross-sectional study among 417 residents of Epe Local Government Area, Lagos State Nigeria conducted in mid 2016. Respondents were selected using a multi-stage sampling technique. Data were collected using a structured pretested interviewer-administered questionnaire and analyzed using Epi- info version 7.1.5.2. Descriptive and inferential statistics were done. P-value of <0.05 was considered statistically significant.RESULTS: Nearly half (48.7%) of the respondents were between the ages of 18-33 years, over three fourths (78.4%) were married and majority (89.2%) were Yoruba. About half 207(49.6%) of respondents had good knowledge of HM. Over two thirds (67.6%) would use HM as first line treatment and 69.3% perceive it more effective than conventional medicine. Almost all (95.7%) respondents have used HM, majority (87.4%) in the last six months prior to study. Factors significantly associated with knowledge of HM are age (p=0.001) and sex of respondents (p=0.014). Significant factors influencing HM use include level of education (Fisher's exact p=0.017), religion (Fisher's exact p=0.001), and ethnicity (Fisher's exact p<0.001). CONCLUSION: Participants were fairly knowledgeable about herbal medicine but most were oblivious of its potential side effects. Majority were HM users mainly because of its perceived effectiveness. There is need for health education in rural areas on the side effects and safe use of herbal medicines.

CONTEXTE: Les plantes médicinales sont utilisées depuis des années au quotidien la vie partout dans le monde. Les médicaments à base de plantes (HM) peuvent être bénéfiques, mais ne sont pas complètement inoffensifs, surtout avec une utilisation non réglementée. OBJECTIF: Évaluer les connaissances, les préférences et l'utilisation de HM dans un cadre rural, dans l'ouest du Nigéria. MÉTHODOLOGIE: Il s'agissait d'une étude transversale menée auprès de 417résidents de la zone d'administration locale d'Epe, État de Lagos Nigéria menée à la mi-2016. Les répondants ont été sélectionnés à l'aide d'une technique d'échantillonnage en plusieurs étapes. Les données ont été recueillies à l'aide d'un questionnaire prétesté administré par l'intervieweur et analysé à l'aide deEpi- info version 7.1.5.2. Les statistiques descriptives et inférentielles étaient fait. La valeur P de <0,05 a été considérée comme statistiquement significative. RÉSULTATS: Près de la moitié (48,7 %) des répondants avaient entreâgés de 18 à 33 ans, plus des trois quarts (78,4 %) étaient mariés etla majorité (89,2 %) étaient des Yoruba. Environ la moitié 207 (49,6%) des répondants avait une bonne connaissance de HM. Plus des deux tiers (67,6 %) utiliseraient HM comme traitement de première intention et 69,3 % le perçoivent comme plus efficace quemédecine conventionnelle. Presque tous les répondants (95,7 %) ont utilisé HM, majorité (87,4 %) au cours des six derniers mois précédant l'étude. Facteurs significativement associés à la connaissance de HM sont l'âge (p = 0,001)et le sexe des répondants (p = 0,014). Facteurs importants influençant HMl'utilisation comprend le niveau d'éducation (p exact de Fisher = 0,017), la religion(p exact de Fisher = 0,001) et origine ethnique (p exact de Fisher<0,001). CONCLUSION: Les participants connaissaient assez bien les plantes médicinales médecine mais la plupart étaient inconscients de ses effets secondaires potentiels. La majorité étaient des utilisateurs de HMprincipalement en raison de son efficacité perçue. Il y a un besoin de santé l'éducation dans les zones rurales sur les effets secondaires et l'utilisation sûre des plantes médicinales. Mots-clés: Médecine alternative et complémentaire, santé publique,rural, Phytothérapie, Nigéria.

Maternal Outcomes of Eclampsia at the Lagos University Teaching Hospital: A Six-Year Retrospective Review.

BACKGROUND: Eclampsia is one of the leading causes of maternal morbidity and mortality. OBJECTIVES: To determine the incidence as well as the maternal outcomes of eclampsia at the Lagos University Teaching Hospital (LUTH). METHODS: This was a retrospective review. RESULTS: During the six-year review period, 4182 women gave birth at our facility, out of which 67 cases of eclampsia were diagnosed (16 per 1000 deliveries). Four women died constituting a case fatality rate of 5.9%. Fifteen women were admitted to the intensive care unit, 6 women had acute kidney injury while 5 had abruptio placentae. Further comparison of our data with previous studies from our institution decades ago showed a continuous decrease in total number of eclamptic cases presenting to our facility (572 eclamptics in 1977 - 1986, 299 ECLAMPTICS IN 1986 - 1995, 165 IN 1996-2005 AND 67 IN 2015-2020). CONCLUSION: The case fatality rate from eclampsia is still high in our hospital. Increased utilisation of antenatal care may play an important role in improving the maternal outcomes from this life-threatening obstetric condition. There is need for maternal education and increase awareness on the importance of antenatal care and early referral to tertiary level of care in order to reverse this trend.

CONTEXTE: L'éclampsie est l'une des principales causes de morbidité et de mortalité maternelles. OBJECTIFS: Déterminer l'incidence ainsi que les issues maternelles de l'éclampsie à l'hôpital universitaire de Lagos (LUTH). METHODES: Il s'agissait d'une revue rétrospective. RESULTATS: Au cours de la période d'examen de six ans, 4182 femmes ont accouché dans notre établissement, dont 67 cas d'éclampsie ont été diagnostiqués (9,5 pour 1 000 accouchements). Quatre femmes sont décédées, soit un taux de létalité de 5,9 %. Quinze femmes ont été admises à l'unité de soins intensifs, 6 femmes avaient une lésion rénale aiguë tandis que 5 avaient un décollement placentaire. Une comparaison plus poussée de nos données avec des études antérieures de notre institution il y a des décennies a montré une diminution continue du nombre total de cas d'éclampsie se présentant à notre établissement (572 éclamptiques en 1977­1986, 299 éclamptiques en 1986-1995, 165 en 1996-2005 et 67 en 2015­2020). CONCLUSION: Le taux de létalité de l'éclampsie est encore élevé dans notre hôpital. L'utilisation accrue des soins prénatals peut jouer un rôle important dans l'amélioration des résultats maternels de cette affection obstétricale potentiellement mortelle. Il est nécessaire d'éduquer les mères et d'accroître la sensibilisation à l'importance des soins prénatals et de l'orientation précoce vers le niveau de soins tertiaires afin d'inverser cette tendance. MOTS CLÉS: Éclampsie, issues maternelles, Grossesse, hypertension, Lagos.

Paediatric Head Injury and Traumatic Brain Injury.

Aim To determine prevalence of head injury presenting to paediatric emergency departments (PEDs) and characterise by demographics, triage category, disposition neuroimaging or re-attendance. Methods Presentations in 2014 and 2015, with diagnoses of head injury, intracranial bleed, skull fracture including single or re-attendances within 28 days post head injury to all national PEDs, were analysed. Demographics, triage score, imaging rate, admission, mechanisms and representation rate were recorded. Results Head injury was diagnosed in 13,392 of 224,860 (5.9%), median (IQR) age 3.9 (1.4 - 8.3) years. Regionally 3% of children <5 years attend each year. The total admitted/transferred was 10.8% (n=1460). Neuroimaging rate was 4.3% (n= 570). Falls predominated. Sport accounted for 12.2%. Conclusion One in twenty children PED presentations are head injury, over half in preschool children. A sizeable number were symptomatic reflected by admission, transfer, imaging or re-attendance. Observational management was favoured over imaging reflected in the higher admission versus imaging rate.

Trends in Mental Health Presentations to a Paediatric Emergency Department.

Aims This study aimed to analyse trends in mental health presentations to the Emergency Department (ED), which anecdotally had increased over the past decade. Methods The ED's electronic 'Symphony' system was used to identify the annual number of presentations categorised as having a mental health complaint from 2006-2017. A detailed analysis was performed on presentations over a one-year period. Results The number of presentations increased from 69 in 2006 to a peak of 432 in 2016 (526% increase). The overall admission rate was 33.3%(n=99), while 52.5%(n=156) of presentations occurred outside of standard working hours. Similar increases were documented by other ED's worldwide, and the WHO estimate that neuropsychiatric disorders will become one of the top five causes of morbidity, mortality and disability among children by 2020. Conclusion With the number of mental health presentations dramatically increasing, carefully designed and integrated strategies are required to pro-actively tackle this growing epidemic.

Patterns of gestational weight gain and its association with birthweight in Nigeria.

BACKGROUND: Despite the increasing global importance of gestational weight gain (GWG) and its impact on birthweight, little is known about the patterns of GWG in African populations. OBJECTIVES: To determine the pattern of GWG and its association with birthweight in Nigeria. METHODS: It was a longitudinal study of 200 pregnant women receiving antenatal care at two tertiary hospitals in Enugu, south eastern Nigeria. The women were consecutively recruited at <14 weeks gestation and their body mass indexes recorded upon recruitment. Thereafter, weight measurements were taken at each visit until 38-39 weeks. RESULTS: Mean total GWG was 10.7 ± 3.4 kg, while mean birthweight was 3.3 ± 0.6 kg. GWG in second trimester had positive correlation with birthweight (r = 0.164, P = 0.02). Obese women gained above the recommended limits by the "institute of medicine" while underweight women gained below the limits. Excessive total GWG was associated with higher risk of macrosomia [8/21 (38.1%) vs. 7/179; RR: 9.74; 95% CI: 3.9-24.2; P < 0.001] while inadequate total GWG was associated with higher risk of low birth weight [7/72 (9.7%) vs. 3/128 (2.3%; RR: 4.15; 95% CI: 1.1-15.4; P = 0.03]. Maternal age of <35 years, high social class, nulliparity, and regular antenatal care were associated with normal GWG while maternal age <35 years and regular antenatal care were associated with normal birthweight (P < 0.05). CONCLUSIONS: Women should be counseled on the factors that influence GWG and birthweight. Interventions to assist women achieve appropriate GWG may need to include components related to improved dietary intake for the underweight and increased physical activity for the obese.

New hazards in paediatric poisoning presentations.

Accidental ingestion is an important preventable cause of childhood morbidity. All accidental ingestion presentations (n = 478) to a tertiary paediatric ED from January 2010 to December 2011 were analysed. These results were compared with a similar study in the same institution ten years previously in 2001 and showed that while accidental ingestions constituted a higher proportion of presentations (0.5% in this study v 0.45% in 2001), fewer had investigations performed (21% v 35%) and fewer were admitted (7% v 20%). Accidental ingestions account for 0.5% of presentations and are an important focus of home safety information for parents and guardians. Paracetamol (n = 67, 14%) and liquid detergent capsules (n = 44, 9.2%) were the two most common substances implicated in these presentations, and have the potential to cause severe morbidity and mortality.

Visual acuity, safe/unsafe practices and self-reported road traffic crash experiences among commuter bus drivers from two motor parks in Lagos, Nigeria.

BACKGROUND: Road Traffic injuries remain a significant public health problem with serious health and economic implications. This study was conducted to determine visual acuity, safety practices and road traffic crash (RTC) experiences of commercial bus drivers in Lagos, Nigeria. METHODS: This cross-sectional study involved visual acuity screening and interviewer- administered questionnaire survey. Participating motor parks were selected by simple random sampling and all intercity, commercial minibus drivers were included. Data was analyzed with Epi info version 3.5.1. RESULTS: A total of 407 drivers participated with a mean age of 43.4 ± 10.8 years. A total of 68 (16.7%) of the drivers did not meet the minimum VA standard required for driving; 8.6% of them use mobile phones while driving; 97% fasten their seatbelt, out of which almost 98% do so always. Fourteen percent also admitted eating while driving. Sixty two (15.2%) of drivers had been involved in RTC in the past 5 years prior to interview. CONCLUSION: A proportion of commercial minibus drivers did not meet the minimum VA required for driving. Some of them also practiced distracted driving. Free visual acuity screening within the motor park is recommended for commercial drivers at least once a year. There should be awareness campaigns to enlighten commercial drivers on the dangers of distracted driving in addition to strict enforcement of regulations and Highway Code.

Work related stress and coping mechanisms among bankers in Lagos, Nigeria.

BACKGROUND: This study assessed knowledge, prevalence, associated factors and mechanisms of coping with stress among bankers in Lagos State. METHODS: It was a descriptive cross sectional study. A two stage sampling technique was used to select two hundred and twenty seven (227) respondents. Data was collected using a structured self administered questionnaire. The analysis was done using Epi-info version 2002 software and Chi Square was used to determine association between variables at p value 0.05. Fischer's Exact test was used where Chi-square was not valid. RESULTS: The age range of respondents was between 20 and 49 years while the mean age was 31.3 +/- 5.0 years. Only 3.6% had good level of knowledge about stress, 42.2% had fair level while more than half of the respondents had poor level of knowledge about stress (54.3%). Majority (67.0%) of the respondents were moderately stressed while one quarter (24.7%) were highly stressed. Majority (92.4%) of the respondents used good coping mechanisms though 69.5% of the respondents also used bad coping mechanisms. A greater proportion of those who had poor knowledge about stress were stressed or highly stressed (p = 0.002). A statistically significant association was also found between the departments in the bank and level of stress of the respondents (p = 0.002). CONCLUSION AND RECOMMENDATION: The prevalence of stress was high among the bank workers studied. It is recommended that effective stress management programmes are implemented to address the problem of stress among bank workers.

Compliance with driver's license laws and illegal licensing among commercial bus drivers in Lagos, Nigeria: policy implications and evidence for action.

AIMS AND OBJECTIVES: To determine the level of compliance with driver's license laws among commercial bus drivers in Lagos, Nigeria. SUBJECTS, MATERIALS AND METHODS: Two intercity motor parks were selected by simple random sampling and all consenting minibus drivers participated in the study. Key Informant Interviews (KIIs) were also conducted with selected officials in the driver training and licensing authorities. RESULTS: Compliance with the minimum age for driving was high (93.6%), so also was having driving test prior to driver's license procurement (83.3%). Formal driver training and VA testing were very low, (26.1% and 32.9% respectively) Overall, only 9.3% of them were found to have fulfilled all the pre-license obligations before obtaining their first driver's license. The odds of a driver with a secondary education having formal driver training is 3.33 times higher than those with no education (OR 3.33, 95% CI 1.01-11.35). Drivers who were 60 years or older were 3.62 times more likely to be compliant than those who were between 20-29 years (OR 3.62, 95% CI 0.56-29.19). For the 98.3% of them who possessed valid licenses, 52.3% of them obtained them illegally. All the key officials saw RTIs as a serious public health problem but faced several challenges in the course of their work. CONCLUSION: Overall compliance with pre-license regulations was very poor. There is need for a review and strict enforcement of driver's license laws to improve compliance. Also vital are fostering inter-sectoral collaboration and improvement in the operations of all establishments involved in driver training and license procurement in Nigeria.

Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria.

BACKGROUND: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions. AIM: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. RESULTS: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09-0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94-8.42)]. Only 25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61 respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter. CONCLUSION: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.

Post-myomectomy intussusception: report of two cases.

BACKGROUND: Post-myomectomy intussusception is a very rare cause of post-operative intestinal obstruction in adult surgical practice. Preoperative diagnosis is usually missed or delayed because the symptoms are usually subacute and nonspecific. METHOD: The case notes of the patients were retrieved and relevant data extracted and summarized. An extensive literature search was done and results reviewed and compared with the present case. RESULTS: The two patients reported developed features of post operative intestinal obstructions which were thought to be due to adhesive bands and initial conservative managements instituted. Exploratory laparotomies later revealed ileo-ileal and jejuno-ileal intussusceptions which were reduced without resection with good outcome. CONCLUSION: Intussusception is a rare but serious complication of myomectomy. High index of suspicion with prompt intervention and early team management optimize outcomes.

Use of insecticide-treated mosquito nets for children under five years in an urban area of Lagos State, Nigeria.

BACKGROUND: Insecticide-treated nets (ITNs) have proven to be one of the most effective means of reducing malaria morbidity and mortality in children and pregnant women. This study is carried out to determine the practice and determinants of ITN use for children under five years among care givers in an urban area of Lagos State. MATERIALS AND METHODS: A community-based, cross sectional study was carried out in Lagos State in April 2007 among three hundred and forty (340) care givers primarily responsible for child care at home. They were selected by a multi-stage sampling method using a pre-tested, interviewer-administered, structured questionnaire. RESULTS: ITN use rate for under-fives was high (61.8%) and this was significantly determined by care giver's marital status (P < 0.001) and the number of children under five years in the household (P = 0.006). Educational level of care giver and occupation of head of the household were not significant determinants. CONCLUSION: There is need for health campaigns on ITNs targeted at unmarried care givers of young children. In addition, we also recommend social marketing of modern family planning methods to reduce family size, thereby increasing chances of ITN use among children less than five years to reduce malaria burden.

Pregnancy after rupture of the pregnant uterus.

Pregnant women managed by us after suture repairs for rupture of the pregnant uterus between 2006 and 2009 in Enugu, South-east Nigeria were reviewed. Five pregnancies were managed during the study period. Four had normal pregnancies. Three booked early in pregnancy and had repeat caesarean deliveries at 36 weeks' gestation. One booked at another private hospital but had emergency caesarean section at 38 weeks' gestation. The fourth woman had repeat rupture at 28 weeks' gestation, suture repair and bilateral tubal ligation. Four healthy babies were discharged home. There was no maternal death. The outcomes of pregnancies after rupture of the pregnant uterus are good. Suture repairs should be the method of choice whenever preservation of future fertility is necessary. The woman and her family must be counselled on the associated risks and the need for hospital delivery by elective caesarean section in the subsequent pregnancies before discharge.

Impact of Free Maternal and Child Healthcare programme on maternal and neonatal healthcare outcome in Enugu State of Nigeria.

BACKGROUND: Unaffordable medical bills is a major barrier to utilization of maternal and child healthcare services. This is associated with very high maternal and perinatal mortality and the inability to attain the MDG4 and MDG5 in many developing countries. This study examined the uptakes of obstetric services following introduction of Free Maternal and Child Health Care (FMCHC) in Enugu State University Teaching Hospital, Southeast Nigeria and its impact on the maternal and neonatal healthcare outcome. METHODS: A retrospective comparative study of the utilizations of maternal and child healthcare services from June to August in 2008 with that of September to November in 2008 after commencement of the FMCHC. Information on all the pregnant women and neonates in their first week of Life that attended clinic within the period under review was collected from the Medical Records department of the hospital. RESULTS: FMCHC caused tremendous increases in the uptakes of antenatal booking (202.2%), and hospital delivery (151.8%). It also resulted in decreased maternal and perinatal mortality by 16.4% and 34% respectively. CONCLUSION: Implementation of FMCHC can make MDG4 and MDG5 attainable in sub-Saharan Africa.

PERICARDIAL EFFUSION IN A PATIENT WITH HYPERTHYROIDISM: A CASE REPORT.

Pericarditis and pericardial effusion are commonly associated with hypothyroidism. It is an uncommon association with hyperthyroidism. We present a case of pericarditis/pericardial effusion in a 28-year-old Nigerian lady with hyperthyroidism. There was resolution of the pericardial effusion with antithyroid medications and steroid therapy. We recommend a high index of suspicion of this association in patients with hyperthyroidism and/or Graves' disease.

Multiple antenatal bookings among pregnant women in Enugu, Nigeria.

Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women.

Lap belt injuries in children.

The use of adult seat belts without booster seats in young children may lead to severe abdominal, lumbar or cervical spine and head and neck injuries. We describe four characteristic cases of lap belt injuries presenting to a tertiary children's hospital over the past year in addition to a review of the current literature. These four cases of spinal cord injury, resulting in significant long-term morbidity in the two survivors and death in one child, arose as a result of lap belt injury. These complex injuries are caused by rapid deceleration characteristic of high impact crashes, resulting in sudden flexion of the upper body around the fixed lap belt, and consequent compression of the abdominal viscera between the lap belt and spine. This report highlights the dangers of using lap belts only without shoulder straps. Age-appropriate child restraint in cars will prevent these injuries.

Introduction of the low risk ankle rule to a paediatric emergency department.

INTRODUCTION: Ankle injuries are a common presentation to the paediatric emergency department (PED), accounting for approximately 2% of presentations.1 X-rays are ordered for 85-95% of patients but only 12% of x-rays reveal a fracture. Clinical prediction rules, such as The Low Risk Ankle Rule (LRAR) exist to help clinicians safely reduce the frequency of radiography in these injuries. The LRAR has been shown to reduce imaging by up to 60% without missing any clinically significant fractures. We sought to introduce The LRAR into our department and study its outcomes on our practice. AIMS: To introduce the LRAR into our department and study its effects on our radiography rate and length of stay (LOS). METHODS: An audit of x-ray rates in ankle injuries in 2016 was performed to determine our department's baseline rate of radiography and LOS. We then conducted education sessions and created x-ray ordering prompts to encourage clinicians to use the LRAR. We introduced the LRAR, with a pilot period initially, and gathered data prospectively. RESULTS: 969 patients presented in with an ankle injury in 2016, 90.7% of these patients had an x-ray. The median LOS was 109 min. 92 patients presented during  the LRAR implementation period with an ankle injury. Nine patients had exclusion criteria from using the LRAR and the attending physician did not use the LRAR in four patients. Of the remaining 79 patients, 49 had a LRAR positive exam. Only one of these patients went on to have an x-ray, which was normal. The 30 patients with a LRAR negative exam all had an x-ray. Overall, our x-ray rate during the study period was 40/92 (43.4%), a reduction of 47.3%. The average LOS during the study was 101 min. No clinically significant fractures were missed. CONCLUSION: The LRAR can safely and effectively reduce the rate of radiography in ankle injuries, without missing any clinically significant fractures.

Maternal mortality in a transitional hospital in Enugu, south east Nigeria.

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100,000 live births as a specialist hospital, with a decline to 625/100,000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies

Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report.

INTRODUCTION: Placenta percreta is a rare; a life-threatening disorder of placentation and one of the components of the placenta accreta spectrum. It can lead to uterine rupture, an obstetric catastrophe that can be associated with increased maternal and fetal morbidity and mortality. PRESENTATION OF CASE: We present an unusual case of spontaneous uterine rupture due to placenta percreta in an unscarred uterus of a multiparous woman leading to spontaneous intrauterine fetal death. She presented with hypovolaemic shock following spontaneous rupture of the uterus and subsequent intra-peritoneal bleeding. DISCUSSION: Uterine rupture occurs commonly in a scarred uterus from some form of trauma or injudicious use of oxytocics. However, uterine rupture occurring in the absence of prior scar or use of oxytocics is a rarity. Placenta percreta is an unusual cause of uterine rupture and subsequent intra-uterine fetal death. Placenta percreta occurs when the uterine wall is invaded by the placenta up to the level of the serosa. A high index of suspicion and thorough review of the patient is required for making this diagnosis. Misdiagnosis is associated with dare consequences of increased maternal morbidity and mortality. CONCLUSION: Placenta percreta is a rare disorder of placentation that can cause uterine rupture which can easily be misdiagnosed. Prompt diagnosis and institution of the appropriate care can help prevent catastrophic outcomes as demonstrated in the case reported.