Prevalence, Risk Factors, Maternal and Perinatal Outcome of Patients with Eclampsia in University of Maiduguri Teaching Hospital, Maiduguri, Nigeria: A 15-Year Retrospective Review.

BACKGROUND: Eclampsia, defined as the occurrence of generalised, tonic-clonic convulsions or coma that is unrelated to other medical conditions in a woman with hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality. METHODS: Retrospective review of cases of eclampsia managed over 15 years (2006 to 2020) at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. Factors associated with adverse maternal and perinatal outcomes were determined using appropriate bivariate analysis. Statistical significance was set at P < 0.05. RESULTS: The prevalence of eclampsia was 2.96%. Most of the patients, 55.2% (420/761) were >35 years, 76% (579/761) were primigravidae and 80.4% (612/761) were unbooked. In 59.1% (450/761) of the cases, the eclampsia was antepartum and 40.3% (301/761) were delivered through a caesarean section. The commonest risk factor was previous eclampsia. There were 58(7.6%) maternal deaths, and the perinatal mortality was 18.1% (138/761). There was a statistically significant association between adverse maternal outcomes and having no formal education (P<0.001), being unemployed (P<0.001), being in coma for >10 hours(P=0.029), caesarean delivery (P<0.001), SBP >160mmHg (P<0.001) and DBP >110mmHg (P<0.001). Adverse perinatal outcome was significantly associated with having no formal education (P<0.001), being unemployed (P=0.004), unbooked status (P=0.015), multiple pregnancy (P=0.021), preterm delivery(P<0.001), caesarean delivery (P=0.012) and Systolic BP >160mmHg (P<0.001). CONCLUSION: The prevalence of eclampsia is high. Having no formal education, unemployment, coma of 10 hours or more, vaginal delivery and severe hypertension, unbooked status, and multiple gestation are significantly associated with poor maternal or fetal outcomes.

CONTEXTE: L'éclampsie, définie comme la survenue de convulsions tonico-cloniques généralisées ou d'un coma sans rapport avec d'autres conditions médicales chez une femme atteinte d'un trouble hypertensif de la grossesse, est une cause majeure de morbidité et de mortalité maternelles et périnatales. METHODES: Examen rétrospectif des cas d'éclampsie pris en charge sur 15 ans (2006 à 2020) à l'hôpital universitaire de Maiduguri, État de Borno, Nigéria. Les facteurs associés aux issues maternelles et périnatales indésirables ont été déterminés à l'aide d'une analyse bivariée appropriée. La signification statistique a été fixée à P < 0,05. RESULTATS: La prévalence de l'éclampsie était de 2,96 %. La plupart des patients, 55,2 % (420/761) >35 ans, 76 % (579/761) étaient Primigravidés et 80,4 % (612/761) non réservés. Dans 59,1 % (450/761) des cas, l'éclampsie était antepartum et 40,3 % (301/761) ont été accouchés par césarienne. Le facteur de risque le plus courant était une éclampsie antérieure. Il y avait 58 (7,6%) décès maternels et la mortalité périnatale était de 18,1% (138/761). Il y avait une association statistiquement significative entre les issues maternelles défavorables et l'absence d'éducation formelle (P<0,001), le chômage (P<0,001), le coma pendant >10 heures (P=0,029), l'accouchement par césarienne (P<0,001), PAS > 160 mmHg (P<0,001) et PAD ed110 mmHg (P<0, 001). Les résul t at s péri nataux i ndési rabl es ét ai ent significativement associés à l'absence d'éducation formelle (P<0,001), au chômage (P=0,004), au statut non réservé (P=0,015), à la grossesse multiple (P=0,021), à l'accouchement prématuré (P<0,001), à la césarienne accouchement (P=0,012) et TA systolique >160mmHg (P<0,001). CONCLUSION: La prévalence de l'éclampsie est élevée. L'absence d'éducation formelle, le chômage, le coma de 10 heures ou plus, l'accouchement vaginal et l'hypertension sévère, le statut non réservé et la grossesse multiple sont significativement associés à de mauvais résultats maternels ou fœtaux. Mots clés: Eclampsie, Issue maternelle, Issue périnatale, Prévalence, Facteurs de risque.

Postpartum hypocalcaemia in Maiduguri, North-eastern Nigeria: a 10-year review.

The aim of maternal calcium homeostasis is to provide adequate calcium flux across the placenta during pregnancy and into breast milk during lactation, to ensure normal fetal and neonatal skeletal mineralisation. The objective of this study was to document the characteristics and outcome of patients who had postpartum hypocalcaemia. Cases of symptomatic postpartum hypocalcaemia managed over a 10-year period (1 January 1998 to 31 December 2007) at the University of Maiduguri Teaching Hospital, were retrospectively reviewed. A total of 34 cases were identified. The sociodemographic characteristics, corrected calcium level, duration of treatment, mode of delivery and the packed cell volume (PCV) were analysed using the EPI-INFO Version 3.4.3 statistical package. The mean age and parity were 24.29 ± 5.88 and 3.39 ± 2.32, respectively. All the patients presented with carpopedal spasm with or without associated symptoms. There was a direct relationship (R² linear = 0.292, p = 0.001) between PCV and serum calcium. Multiparous women were significantly more affected than primiparae (χ² = 15.08; p = 0.0005). Half of the patients presented within 1 week of onset of symptoms. In conclusion, the association between anaemia and postpartum hypocalcaemia needs further study to determine the cause and effect relationship.

A review of preterm admissions into special care baby unit, in University of Maiduguri Teaching Hospital: a four year experience.

There is little or no report of preterm (babies born less than 37 completed weeks of gestation) admission from this part of Sahel Savannah of Nigeria. This study of four-year period is presented to identify areas that require improvement, such as in the Labour ward and neonatal care. The case files of the 428 preterm newborns admitted into Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital were reviewed. Preterms constituted 54.9% of the overall admissions, 53.4% being Low birth weight newborns (=2500 gm). Premature rupture of membrane, previous preterm deliveries, twin gestation and pregnancy induced hypertension were some of the common maternal factors that were associated with preterm deliveries. Birth asphyxia, Apnoea, Small for gestation age 9weight less than 10th centile), respiratatory distress were the main problem observed among the preterm newborns. Neonatal mortality rate was 349/1000 live birth; 62.1% of the death were preterm infants. Mortalities were common among babies weighing 1000 gm or less and also of babies of lower gestational age. We can improve on this, by implementing simple common measures such as educating our mothers on the need for good antenatal care and hospital deliveries, so that those with pregnancy induced hypertension, premature rupture of membrane, previous preterm delivery can be detected early and institute proper management.

Pregnancy in hemoglobin sickle cell patients at the University College Hospital, Ibadan.

A retrospective review of pregnancy outcome in hemoglobin (Hbsc) patients managed at the University College Hospital, Ibadan over a 5-year period (1984-1988) was carried out. The main antenatal complications included anemia (51.2%), bacterial infection (22.0%), bone pain crisis (7.3%) and preeclampsia (2.4%). Intrapartum complications included anemia (29.2%), bone pain crisis (12.2%) and pseudotoxemia (4.9%). The maternal and perinatal mortality rate were 48 and 195 per 1000, respectively. The duration of labor and operative delivery rate were not different from the general population.

Calcium and vitamin D status of pregnant teenagers in Maiduguri, Nigeria.

This study investigates parameters related to calcium and bone metabolism by determining the concentrations of total calcium, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, and phosphorous in young pregnant women. The patient population was 30 pregnant Nigerian teenage women grouped by trimester (10 per group), 10 women immediately following delivery, and 21 healthy age-matched controls. On the basis of serum prealbumin levels, the general nutrition of the pregnant women was found to be significantly below that of the more privileged and better-educated nonpregnant controls. The mean total calcium concentration in sera of the third-trimester women was 8.83 mg/dL, which was significantly below that of the controls (9.77 mg/dL) and the first-trimester group (9.30 mg/dL). Despite the 10% to 15% decline in the serum level of total calcium during pregnancy, the parathyroid hormone level decreased markedly from 0.60 to 0.61 ng/mL in the first and second trimesters to 0.41 ng/mL in the third trimester. Serum vitamin D and 1,25-dihydroxyvitamin D levels in the second and third trimesters were within the normal range. These data indicate that toward the end of gestation, pregnant teenagers in northern Nigeria appear to become calcium deficient and do not exhibit the expected increase in serum parathyroid hormone levels normally seen in pregnant women.

Endometrial sampling at a teaching hospital in northern Nigeria.

The objective of the current study is to assess the value of endometrial sampling as a diagnostic tool at the University of Maiduguri Teaching Hospital (UMTH). A histopathological study of the endometrium in 255 patients seen at the Gynaecological clinic of UMTH from January 1988 to October 1998 formed the study group. The patients' age, parity, contraceptive and menstrual history were reviewed from case records. The mean age of the study group was 28 years. A normal secretory endometrium was observed in 47.1% of the 255 patients analysed while 8.6% showed a proliferative pattern. 43.1% (110/255) showed some endometrial abnormalities. The findings revealed that endometrial sampling is an indispensible diagnostic tool especially in the investigation of infertile couple. It is concluded that sensitive immunohistochemical technique is needed to improve the sensitivity of endometrial sampling as a diagnostic tool.

Hormonal profile of men investigated for infertility at the University of Maiduguri in northern Nigeria.

INTRODUCTION: This study aims to determine the prevalence and pattern of endocrinological abnormalities in patients investigated for male infertility in our environment. METHODS: An observational, retrospective study was conducted on men investigated for infertility at the University of Maiduguri Teaching Hospital over a two-year period, from April 2004 to March 2006. Hormonal assessments were done on those with abnormalities of their sperm count. RESULTS: A total of 1,201 men were evaluated for infertility during the study period, out of which 96 underwent hormonal assessment because of abnormalities of their sperm counts. 88 had abnormal hormonal assays, giving a prevalence of endocrine abnormality of 7.3 percent. The mean age of the patients was 35.7 years. 68 (70.8 percent) patients had primary infertility and 72 (75 percent) had azoospermia. 64 (66.7 percent) patients had elevated follicle-stimulating hormone levels, while 48 (50 percent) had decreased testosterone levels. 12 (12.5 percent) patients had elevation of serum prolactin. 40 (41.7 percent) patients had hormonal profile in keeping with hypergonadotropic hypogonadism, while the endocrinological diagnosis in four (4.2 percent) patients was hypogonadotropic hypogonadism. Patients with primary infertility were found to be more likely to have partial androgen resistance (odds-ratio 2.241, 95 percent confidence interval 0.458-10.955). CONCLUSION: Endocrinopathy, which can be successfully treated, is not an uncommon cause of male infertility in our environment. Therefore, hormonal assessments should be performed in the evaluation of male infertility as appropriate.

Caesarean morbidity and mortality at Maiduguri, Nigeria.

A total of 2456 deliveries took place at the University of Maiduguri Teaching Hospital, Maiduguri, between January 1995 and December 1996 inclusive. Two hundred and five women were delivered by caesarean giving a caesarean section rate of 8.3%. One hundred and ninety-eight (96.6%) case records were retrieved for analysis. Eighty-eight patients (44.4%) had one or more intra- and/or postoperative complications. Sepsis was the commonest complication involving 62 (70.4%) women. All were cases of emergency caesarean section. The incidence of other complications were anaemia, 59 (67%); hemorrhage, 38 (43.2%); and wound dehiscence, 11 (12.5%). There were two maternal deaths (2.3%) due to an anaesthetic accident and septicaemia respectively. The factors resulting in complications of the caesarean deliveries were prolonged obstructed labour, prolonged rupture of fetal membranes, previous caesarean sections, antepartum haemorrhage and severe pre-eclampsia and eclampsia. A review of the use of prophylactic antibiotics in selected cases, early recourse to operation in cases with cephalo-pelvic disproportion, and the acquisition of trained anaesthetists are advocated.

Maternal plasma glycaemia and fetal outcome in north-eastern Nigeria.

This paper aims to assess the influence of maternal glycaemia and other clinical indices on the birthweight of babies born to Nigerian women resident in Maiduguri. Eighty-four pregnant women (aged, 25.7 0.5 years, mean SE) in the third trimester of pregnancy were recruited for the studies. Blood pressure, weight and height were measured while other social variables were obtained by questionnaire. Fasting and 2-hour blood samples, after 75 g oral glucose load, were collected for plasma glucose measurements. None of the women was a known diabetic while 3.6% were known hypertensives. The mean SE fasting (4.2 0.11 mmol/l) and 2-hour (5.8 0.19 mmol/l) plasma glucose concentrations and the systolic (111 1.20 mmHg) and diastolic (72 0.96 mmHg) blood pressures were normal by WHO criteria. Incidence of macrosomic babies was nil. The birthweight of the babies was not significantly related to either the fasting plasma glucose (r=-0.11, P 0.05) or 2-hour postprandial glucose concentrations (r=-0.09, P 0.05), but was significantly related to the maternal pre-pregnancy bodyweight (r=0.30, P 0.05) and body mass index (BMI) (r=0.31, P 0.05). It is concluded that Nigerian women resident in Maiduguri maintain a normal glucose tolerance during the third trimester of pregnancy. Pre-pregnancy body weight and BMI, and not plasma glycaemia, would seem more important factors associated with the birthweight of babies born in this Nigerian population.

HIV infection among pregnant women. A worsening situation in Maiduguri, Nigeria.

A serosurvey of 1,233 pregnant women aged 15-41 years, and attending antenatal clinics in Maiduguri, Nigeria from July 1991 to February 1993 showed that 28 (2.3%) of the women were positive for HIV antibodies. Twenty-four (1.9%) were positive for HIV-1 only, 1 (0.08%) was positive for HIV-2 only and 3 (0.24%) were reactive for both HIV-1 and HIV-2. The overall seroprevalence rose gradually from 2.1% in 1991 to 2.3% in 1992, and to 2.6% so far in 1993. From July 1992 to February 1993 6 children aged 24 hours to 8 months were found HIV-positive in the same hospital where this survey was carried out. The only known risk factor for HIV infection applicable to the pregnant women studied was heterosexual intercourse.

PIP: In northeastern Nigeria between July, 1991, and February, 1993, health workers took blood samples from 1233 15-41 year old pregnant women attending the prenatal clinic at the University of Maiduguri Teaching Hospital to compare HIV prevalence with rates from the same hospital during September, 1988-April, 1990. Researchers did not test any of the partners for HIV infection. Overall HIV prevalence was 2.3%. This was 4.83 times higher than that of the earlier period. Yaounde, Cameroon, has experienced a similar increase in HIV infection among pregnant women (0.9-2.2%, in 1989-1991). In 1989-1990, HIV infection among pregnant women in Abidjan, Ivory Coast, was 8%. The significant increase in HIV prevalence in Maiduguri was comparable with the HIV prevalence of infants less than 24 hours to 8 months old in the same hospital between July, 1992, and February, 1993. 4, 1, and 1 of the 280 pregnant women who were tested in 1991 were positive for HIV-1, HIV-2, and both HIV-1 and HIV-2, respectively. These figures for 1992 (838 women) were 17, 0 and 2. They were 32, 0, and 0 in 1993 (115 women).

Serum vitamin A, vitamin E, and beta-carotene levels in preeclamptic women in northern nigeria.

We compared the serum levels of beta-carotene, vitamin A (retinol), and vitamin E (alpha-tocopherol) in healthy pregnant women and their counterparts who exhibited the signs and symptoms of preeclampsia or eclampsia, including: systolic blood pressure greater than 160 mm Hg, edema, and proteinuria. The study was conducted in the cities of Maiduguri and Bauchi, which are located in the semi-arid northeastern region of Nigeria. Most of the pregnant subjects: (1) were teenagers, though they ranged in age from 14 to 25 years; (2) had 2 or fewer prior pregnancies; and (3) were predominantly of the Muslim faith and members of the Hausa, Fulani, or Kanuri ethnic groups. Few of the women had received prenatal care. Serum levels of vitamins A and E and betacarotene were quantified using high pressure liquid chromatography. The serum vitamin A levels of the 9 preeclamptic women (15.3 mg/dL) and the 7 eclamptic women (8.3 mg/dL) were significantly reduced (p < 0.01) relative to the serum vitamin A levels of healthy women in the third trimester (24.2 mg/dL). For the healthy pregnant controls, the levels of vitamins A and E and beta-carotene were relatively constant throughout pregnancy. The mean serum beta-carotene levels for both the preeclamptic and eclamptic groups of subjects were half as high as those of healthy control women in the third trimester (p = 0.004). The serum vitamin E levels of the preeclamptic and eclamptic women were 15% and 30% lower, respectively, than those of the corresponding controls (p < 0.01). The serum levels of these three lipids in the healthy pregnant and non-pregnant women we studied are similar to values reported by others for North American and European women of childbearing age. These results support the hypothesis that preeclampsia-eclampsia deplete natural lipid antioxidants and suggest that the reduced levels of vitamin A in such women experiencing hypertension of pregnancy, if they happen to be infected with the HIV-1 virus, may place them at increased risk for mother-child transmission of the virus.

Lysosomal enzymuria in preeclampsia.

We hypothesize that the preeclamptic patient has proximal tubule epithelial injury, which leads to the release of lysosomal enzymes, and that the excretion of these enzymes might serve as a diagnostic or predictive marker in preeclamptic women. The study group consisted of 14 women with preeclampsia (10 severe and 4 mild, as defined by The American College of Obstetricians and Gynecologists criteria) and 28 normotensive controls with singleton pregnancies at 27 to 41 weeks. There were no significant differences between the two groups for gestational age, maternal age, or race. Maternal serum and urine specimens were prospectively obtained and analyzed for beta-glucuronidase, beta-hexosaminidase, alpha-galactosidase, beta-galactosidase, and alpha-mannosidase using fluorometric assays. Median serum and urine activities and fractional excretions of each of the five hydrolases were compared between the two study groups using the Mann-Whitney two-sample rank test. The serum enzyme activities of beta-hexosaminidase (P = 0.002), alpha-galactosidase (P = 0.0001), and alpha-mannosidase (P = 0.02) were significantly lower in preeclamptic patients than in controls. The urine enzyme activities of beta-glucuronidase (P = 0.001), alpha-galactosidase (P = 0.002), beta-galactosidase (P 0.0003), and alpha-mannosidase (P = 0.003) were significantly higher in the preeclamptic patients. The fractional enzyme excretions of all five lysosomal hydrolases were higher in preeclamptic patients than in controls with P < or = 0.0003 for each enzyme. Preeclampsia is associated with a significant decrease in serum activities of three of the five hydrolases studied, a significant increase in urine enzyme activities in four of the five hydrolases studied, and a significant increase in the fractional excretion of all five lysosomal hydrolases.