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INTRODUCTION: The objective of this study was to evaluate the effect of preoperative administration of sublingual misoprostol and intravenous tranexamic acid (TXA) on intraoperative blood loss during elective caesarean sections. METHODS: This was a double-blinded, randomised, placebo-controlled study involving 116 women scheduled for elective caesarean sections. The treatment arm, group 1 (n=58), received 1000 mg of intravenous tranexamic acid 10-15 minutes before skin incision and 600 mcg of sublingual misoprostol after sub-arachnoid anaesthesia and before skin incision. Group 2 (n=58) received placebos; both groups had oxytocin injections at the delivery of the placenta. The data were analyzed using IBM® Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY). RESULTS: The primary outcome was the intraoperative blood loss and the difference between preoperative and postoperative hematocrit values in both groups. The mean intraoperative blood loss was significantly lower in the study group than in the control group (308.552 ± 42.991 mL versus 736.414 ± 171.889 mL, p<0.001). The differences between the preoperative and post-operative hematocrit values were also significantly lower in the study group than in the control group (2.212% ± 0.805% versus 5.660% ± 2.496%, p<0.001). CONCLUSION: Preoperative administration of 1000 mg of intravenous tranexamic acid and 600 mcg of sublingual misoprostol significantly reduced blood loss related to elective caesarean delivery.
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Background and objective A facemask is often indicated for the control of the spread of airborne pathogens. At the peak of the COVID-19 pandemic, there was mass enforcement of mask use across the globe. Pregnant women were not excluded. While several studies have been conducted to evaluate and compare the efficacy of various mask types, data on their effects on pregnant women during exercise are scarce. The objective of this study was to evaluate and compare the effects of N95 and surgical facemasks on the cardiopulmonary functions of pregnant women during moderate-intensity exercise. Methods A prospective randomized study was conducted among 104 healthy women with advanced singleton pregnancies performing moderate-intensity exercise wearing either surgical or N95 masks during routine antenatal care. Their respiratory rates were counted, and arterial oxygen saturation (SPO2) and radial pulses (heart rates) were recorded with a mobile digital pulse oximeter at baseline and after 30 minutes of exercise. The mean values were calculated. Data analysis was done using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY). An independent t-test was used to compare the mean SPO2 and radial pulse between the two groups. Chi-square was used to examine differences in categorical variables. The level of significance was set at 0.05. Results Their demographic profiles and measured baseline parameters were comparable. Following a 30-minute exercise, the N95 mask group had lower mean SPO2 compared to the surgical mask group (95.5% versus 97.0%; P=0.028, 95%CI; -2.607 to 0.15). Further, the N95 group recorded a higher mean heart rate than the surgical mask group ((97.23 b/m versus 95.02b/m, respectively, mean difference (MD)=2.212, P=0.021, 95%Cl: 1.249-3.672). The mean respiratory rates were also higher among women in the N95 mask group (32.1 c/m versus 29.08 c/m, MD=3.018, 95%CI: 1.392-4.662, P=0.001). Conclusion The study, comparing the relative effects of the surgical and N95 facemask on the cardiorespiratory functions of exercising pregnant women, findings suggest that surgical facemasks may be better tolerated in advanced pregnancy when performing routine antenatal aerobic exercise in comparison with N95 masks.
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BACKGROUND: Pregnancies complicated by threatened miscarriage (TM) may be associated with adverse pregnancy outcomes. The objective of this study was to compare the differences in pregnancy outcomes between the women who experienced TM and asymptomatic controls. METHODS: This was a 10-year retrospective review. Case records of 117 women who were managed for TM from January 1, 2010, to December 31, 2019, were retrieved and studied. The control group was developed from an equal number of asymptomatic clients matched for age, parity, and BMI who were receiving antenatal care (ANC) during the same period. Data on demography, clinical and ultrasound findings, treatment, and pregnancy outcomes were retrieved and analyzed. RESULTS: Spontaneous abortion rate of 13.7% was recorded among the study group compared with 3.4% in the control (P-value [p] = 0.005, odds ratio [OR]: 4.475; 95% confidence interval [CI]: 1.445 - 13.827). Women with TM had higher odds for placenta previa (p = 0.049, OR: 4.77, 95% CI: 2.19 - 23.04), premature rupture of membranes (PROM) (p = 0.028, OR: 1.918, 95% CI: 1.419 - 2.592), postpartum hemorrhage (PPH) (p = 0.001, OR: 2.66, 95% CI: 20.8 - 8.94), and preterm birth (OR: 2.5, 95% CI: 1.75 - 3.65). They were also more likely to undergo cesarean section (p = 0.020, OR: 1.70, 95% CI: 1.053 - 2.964). There was no statistically significant difference in their infants' mean birth weight (3.113 ± 0.585kg for the TM group and 3.285± 0.536kg for the control, P=0.074). Other maternal and perinatal complications were similar. Admission for bed rest significantly improved fetal survival. Women who were not admitted for bed rest had higher odds of pregnancy loss (OR: 3.443, 95% CI: 1.701-7.99). Other treatment plans did not significantly contribute to a positive outcome. CONCLUSION: Threatened miscarriage is a significant threat to fetal survival and may increase the risk for operative delivery. Bed rest improves the live birth rate.
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BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility. AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures. METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the "Woman Intervention Trial" was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition. RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission. CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.