Near Miss and Maternal Mortality at the Jos University Teaching Hospital.

BACKGROUND: Some women who enter pregnancy in a healthy state may survive with serious complications while others may die. This study sets out to determine the frequency of maternal near-miss (MNM) and maternal death. It also intended to identify common causes and determinants. MATERIALS AND METHODS: This was a cross-sectional study from June 2012 to May 2013 that involved women who were admitted for delivery, within 42 days of delivery or termination of pregnancy and those who died from pregnancy, childbirth, or puerperal complications. Data obtained were analyzed using Epi info 2002. RESULTS: There were 105 maternal near misses and deaths. Nineteen of them were mortalities, whereas 86 were MNMs. The maternal mortality ratio over the period was 806/100,000 live births and near miss was 3649/100,000 live birth. Hypertensive disorders in pregnancy were the leading cause of maternal deaths (47.36%) and MNMs (47.7%). Maternal deaths (57.9%) and near misses (43%) were the highest among those that treatment was instituted after 60 min and within 30-60 min of diagnosis, respectively. The consultants were the highest level of expertise involved in the management of 73.3% and this group recorded the least maternal death and highest MNM. CONCLUSION: Hypertensive disorder was the leading cause of MNM and mortality. Involving the highest level of expertise in patient management and reducing the time interval between diagnoses and instituting definitive treatment is essential for a better outcome. Health institutions will benefit from the evaluation of their quality of obstetric care by including near miss investigations in their maternal death enquiries.

Prevalence of hepatitis B virus infection among pregnant women in Jos, Nigeria.

Objectives: The study sought to determine the prevalence and risk factors associated with Hepatitis B surface antigenemia (HBsAg) positivity among pregnant women in Jos, Nigeria. Methodology: This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version 15. Results: Of the 3,238 women enrolled, 7.4% (241/3238) (95% confidence interval [CI] = 6.6% to 8.4%) were HBsAg positive. The absence of HBV vaccination (adjusted odds ratio [AOR] = 2.49; 95% CI = 1.49-4.09; P < 0.001), co-infection with HIV (AOR = 1.90; 95% CI = 1.18-3.08; P = 0.009), and higher parity (AOR = 1.37; 95% CI = 1.04-1.79; P = 0.024) were independently associated with HBV infection in pregnancy. Conclusions: The prevalence of HBV infection among pregnant women was high, especially among those without prior vaccination for HBV, those with HIV co-infection and higher parity.

RésuméObjectifs: L'étude visait à déterminer la prévalence et les facteurs de risque associés à la positivité à l'antigénémie de surface de l'hépatite B (AgHBs) chez les femmes enceintes à Jos, Nigéria. Méthodologie: Il s'agit d'une étude transversale réalisée auprès de la population enceinte dans cinq dans les établissements de santé de Jos, entre le 1er novembre 2017 et le 30 avril 2018. Un consentement éclairé a été obtenu et des données sociodémographiques et des facteurs de risque d'infection par le virus de l'hépatite B (VHB) ont été collectés. L'infection virale de l'hépatite B a été évaluée à l'aide du diagnostic in vitro de l'HBsAg kit rapide (Acon Laboratories, USA). Des statistiques descriptives, un test du chi carré et une régression logistique ont été effectués pour identifier les prédicteurs de Infection par le VHB dans la population étudiée. Toutes les analyses statistiques ont été effectuées sur STATA version 15. Résultats: Sur les 3 238 femmes inscrites, 7,4% (241/3238) (intervalle de confiance à 95% [IC] = 6,6% à 8,4%) étaient positifs pour l'AgHBs. L'absence de vaccination contre le VHB (cotes ajustées rapport [AOR] = 2,49; IC à 95% = 1,49­4,09; P <0,001), co-infection par le VIH (AOR = 1,90; IC à 95% = 1,18­3,08; P = 0,009) et plus la parité (AOR = 1,37; IC à 95% = 1,04-1,79; P = 0,024) était indépendamment associée à l'infection par le VHB pendant la grossesse. Conclusions: le la prévalence de l'infection par le VHB était élevée chez les femmes enceintes, en particulier chez celles qui n'avaient pas été vaccinées contre le VHB, celles avec le VIH co-infection et parité plus élevée.

Labial adhesion in children at the Jos University Teaching Hospital.

BACKGROUND: Labial adhesion is one of the most common reasons for gynaecologic consultations in children. We sought to determine the prevalence of labial adhesions, mode of presentation and treatment in children at the Jos University Teaching Hospital. MATERIALS AND METHODS: A retrospective study of labial adhesions in children from January 2004 to December 2013. Data on paediatric gynaecological consultations, and labial adhesions were retrieved from the gynaecological clinic and the theatre records. The case notes of those with labial adhesions were retrieved and the relevant data extracted. RESULTS: The total number of paediatric patients seen at the gynaecology clinic over the study period was 379 and 25 had labial adhesion (6.6%). The majority (88%) presented in the first 2 years of life, all the patients were asymptomatic, and 2 (8%) had surgical separation of the adhesions while the rest were managed conservatively. A total of 5 (20%) came for follow-up. While 2 (8%) came a week later following surgical management, 3 (12%) came back more than 6 months later due to recurrence following conservative management. CONCLUSION: Labial adhesions account for significant proportion of paediatric gynaecologic consultations. They are usually asymptomatic, occur in the first 2 years of life and frequently managed conservatively.

Correlation between maternal weight and insulin resistance in second half of pregnancy.

BACKGROUND: In pregnancy, routine measurement of maternal weight gives a crude assessment of maternal and foetal well-being. Excess weight gain in pregnancy is related to increased risk for gestational diabetes mellitus (GDM), hypertension in pregnancy and foetal macrosomia. In the Nigerian context, lack of knowledge of pre-pregnancy weight coupled with late booking of women in pregnancy hinders accurate assessment of weight gain in pregnancy. The absolute maternal weight is often used as surrogate. This study evaluates the relationship between absolute weight in the second half of pregnancy and insulin resistance. PATIENTS AND METHODS: The weight of hundred pregnant women was measured between 24 to 32 weeks of pregnancy and their insulin resistance was measured using Homeostatic Model Assessment (HOMA-IR) from fasting serum glucose and fasting serum insulin. RESULTS: Twenty-six women had weight ≥95 kg and 74 women had weight of <95 kg. There was a significant positive correlation between weight and HOMA-IR (r = 0.248), fasting glucose (r = 0.198), and fasting insulin (r = 0.228), (P < 0.05). The mean weight, HOMA-IR, fasting glucose and fasting insulin were higher in women with weight ≥95 kg compared to those with less weight. Also maternal weight ≥ 95 kg was associated with severe insulin resistance, (Odds Ratio = 3.1). CONCLUSION: Absolute weight in pregnancy correlates well with insulin resistance. Women having weight ≥95 kg between 24-32 weeks of gestation were more likely to have severe insulin resistance with implications for increased risk of GDM and other complications.