Risk factors for hypertensive disorders of pregnancy in Abuja, Nigeria: A prospective case‑control study

Background: Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries like Nigeria. The study determined the risk factors for the development of HDP among women who booked early for antenatal care. Materials and Methods: This was a prospective case‑control study conducted from March 2015 to March 2016 involving pregnant women with gestational age less than 20 weeks at booking and were followed up until delivery and 6 weeks postpartum. Information on gestational age at recruitment, at diagnosis of HDP, mode of delivery, and fetal outcome were recorded. Risk factors for HDP were compared between women who developed HDP (cases) and those who did not develop HDP (controls) by Fisher’s exact test, Chi‑square, and student’s t‑tests. Univariate and multivariate logistic regression analysis was used to test the relationship between certain risk factors and the development of HDP. A P value of less than 0.05 was considered statistically significant. Results: The prevalence of HDP in the study was 19.4%. Family history of preeclampsia (OR: 5.339, 95% CI: 1.149–24.818, P = 0.033); previous history of preeclampsia (OR: 10.819, 95% CI: 3.570–32.792, P < 0.001); multifetal gestation (OR: 13.275, 95% CI: 2.899–38.127, P = 0.010); chronic hypertension (OR: 3.431, 95% CI: 1.778–8.710, P < 0.001) and diabetes; (OR: 2.846 95% CI: 0.460–17.584, P < 0.251) were the risk factors associated with the development of HDP among the study population while nulliparity (OR: 0.726, 95% CI 0.366–1.440, P = 0.395); body mass index (BMI) (mean ± SD), (OR: 0.405, 95% CI: 0.173–0.945, P < 0.037);and low educational level (OR: 0.582, 95% CI: 0.070–4.857, P = 0.613) were not. Conclusion: The prevalence of HDP in the study group was high. Risk factors for HDP included family history of hypertension, previous history of preeclampsia, multifetal gestation, and chronic hypertension. Key words: Abuja; hypertensive disorders of pregnancy; Nigeria

Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria

Background: Anaemia in pregnancy and HIV infection are two common public health issues in sub-Saharan African with Nigeria bearing the greatest burden. The duo occurring together poses a higher risk of morbidity and mortality for both the foetus and the mother. We therefore conducted this study to determine the burden of anaemia and other haematological abnormalities among HIV positive pregnant mothers on antiretroviral therapy who attended antenatal clinical services in our health institution.Methods: A 10-year retrospective review from January 2010 to December 2019 of medical records of HIV positive mothers on highly anti-retroviral therapy in attendance for antenatal clinical services in our health institution was carried out for the above objectives. Information extracted were, age, HIV status, gestational age at delivery, type of antiretroviral drugs used, duration of use, haemoglobin level, platelet, and complete blood count at booking of the positive mothers.Results: Of a total of 330 HIV positive mothers seen during the review period, 82.7% were from rural communities, 88.8% were from middle socio-economic class, 80.0% were Christians, and 80.3% started their highly active antiretroviral therapy before their index pregnancy. Most, 51.5% and 42.7% were on zidovudine, lamivudine and nevirapine, and tenofovir with lamivudine and lopinavir boasted ritonavir combinations, while 94.2% were on 1st line antiretroviral medication. Their mean age, gestational age at delivery, and parity were 31.11±4.7 years, 38.57±3.1 weeks, and 2.0±1.6 respectively. The prevalence of anaemia, thrombocytopenia and leucopoenia were 36.1%, 4.8%, and 6.7% respectively while their mean CD4 cell count and viral loads at the point of booking were 543.63±283.7 cells/μl, and 2953.02±1619.9 copies/ml. The two maternal variables that showed significant relationship with haemoglobin concentration of <10 gm/dl was mother’s level of education x2=6.29, p=0.043, and her socio=economic class, x2=10.162, p=0.006.Conclusions: There is high burden of anaemia among HIV positive mothers on antiretroviral therapy in our environment. The prevalence of thrombocytopenia and leucopoenia was much lower. The burden of maternal anaemia was associated with maternal level of education and her socio-economic class

Trends in female sterilization in north central Nigeria

Background: Contraception is key to the reduction of maternal mortality. Tubal ligation is a good option for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. The objective of this study was to determine the trends, uptake, socio-demographic characteristics of acceptors, indications and complications of bilateral tubal ligation (BTL) in our environment.Methods: A retrospective study of BTL at UATH was conducted over a five year period, from 1 January 2015 to 31 December 2019. The records of women who had BTL were retrieved from the medical records department, family planning clinic, and the theatre. The data was analyzed using SPSS 21.Results: The mean age and parity were 36.0±4.0 and 5.0±2.0 respectively. The incidence of BTL was 1.3%. Majority of those that had BTL had at least secondary level of education 100 (83.4%) and 58 (48.3%) were grand multiparous. Majority of cases 87 (72.5%) were done during caesarean section/laparotomy. Postpartum BTL accounted for 15.0%, while interval BTL accounted for 12.5%. Completed family size was the commonest indication 48.3%. No client came back with regrets. There was one case of failed BTL.Conclusions: BTL is a safe and effective method of sterilization. There is an increasing trend in utilization of BTL however the rate is still low

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

Background: Long-acting reversible contraceptives (LARC) are methods used in the prevention of pregnancy that are long lasting. They are effective and efficacious methods of contraception and return to fertility after removal is prompt. Objectives was to determine the uptake of long-acting reversible contraception and assess the characteristics of acceptors of these methods in the area.Methods: This was a retrospective study of clients’ who visited the family planning unit of the University of Abuja teaching hospital over a 5-year period, from 01 January 2015 to 31 December 2019. Information on socio-demographic characteristics and specific methods selected were extracted from their records and represented on simple tables, graphs, and charts.Results: A total of one thousand eight hundred and ninety-one (1,891) clients accepted available methods of contraceptives during the five-year study period. One thousand seven hundred and twenty-four (1,724) accepted LARC (91.1%) while only one hundred and sixty-seven (167) accepted non-LARC (8.9%). Majority 946 (54.9%) of the clients that accepted LARC were aged between 30-39 years and clients less than 20 years were 22 (1.3%). Clients with parity 3 and above were 1162 (67.7%), and majority of LARC acceptors wanted more children 1145 (66.4%). Amongst the LARC acceptors, most of the clients opted for subdermal implant either Jadelle or Implanon 940(49.7%). Three hundred and ninety-eight (23.1%) discontinued a form of LARC during the study period while 1127 (65.4%) continued with one form of LARC or another.Conclusions: The uptake of LARC in this region is very high. Teenagers and low parity rarely attended the family planning clinic

Umbilical and middle cerebral arteries Doppler velocimetry in early and late onset pre-eclampsia

Background: Pre-eclampsia (PE) is a multisytemic disorder originating from the placenta with a high prevalence in sub-Saharan Africa. Early (34 weeks) – onset PE have different maternal and perinatal outcomes with overlapping clinical features. Differences in Doppler velocimetry pattern in these subgroups appears unsettled.Methods: In a prospective cohort study, 110 pregnant women with singleton pregnancy diagnosed with PE were recruited and had umbilical and middle cerebral arteries (MCA) Doppler velocimetry done. The pregnancies were followed up to delivery and outcome recorded and analysed using Microsoft excel 2013. Student t-test and Chi-squared test were used for continuous and categorical variables respectively. Level of significance was set at less than 0.05.Results: There were 53 (49.1%) women with early – onset preeclampsia and 55 (50.9%) with late-onset PE. The mean age of women was 30.30±5.2 years. The mean umbilical artery, middle cerebral artery pulsatility indices (PI) and cerebroplacental ratio (CPR) were 1.3±0.5, 1.1±0.5 and 1.1±1.2 respectively. There was statistical significant difference between the umbilical artery PI (p˂0.001), middle cerebral artery PI (p˂0.05) and CPR (p˂0.001) between early onset and late onset preeclamptic women. The resistance index and systolic diastolic ratio of both the umbilical and middle cerebral arteries were similar between the two groups (p>0.05).Conclusions: This study showed that umbilical and middle cerebral artery PI and CPR may be the most important Doppler parameters to watch-out for in monitoring women with PE

Review of Twin Pregnancies in a Tertiary Hospital in Abuja, Nigeria

Studies on twin pregnancy are uniquely important to Africa and particularly Nigeria where the highest incidence in the world exists. This study was designed to determine the trend, rate, and obstetric outcomes of twin deliveries in the University of Abuja Teaching Hospital, Gwagwalada. This was a retrospective study of twin deliveries in the hospital over a period of 10 years. During the study period, there were 349 twin births out of 10,739 deliveries, giving an overall twining rate of 32.5 per 1,000 deliveries. Preterm delivery occurred in 39.7% cases and was, therefore, the most common complication. Mode of delivery was vaginal in 72.7% while 27.3% were delivered by caesarean section. Emergency caesarean section for delivery of both the babies was carried out in 22.3% while elective caesarean section for both the babies accounted for 1.0 %. Combined vaginal and abdominal delivery occurred in 4.0% of deliveries. The stillbirth rate was 102 per 1,000 births. There were 24 (8.0%) and 37 (12.3%) stillbirths among the first and the second baby respectively. The mean foetal weight was 2.395\ub10.63 kg while the female-to-male ratio was 1:1.1. The rate of twin deliveries in our centre is high. Successful vaginal delivery of twins is high when the mothers are booked and the presentations of the twins are favourable. The use of antenatal care services and good intrapartum management will help improve outcome in twin pregnancies

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Analysis of burden of sexual assaults at Abuja: a 4-year retrospective study

Background: Sexual assault is a worldwide crime associated with traumatic experience and largely affects women and girls. It is greatly underreported, more especially in the low income countries due to our peculiar culture.Methods: A retrospective study of sexual assault victims managed at the Hospital from January 1, 2015 to December 31, 2018. Case notes were retrieved and relevant data extracted and analyzed.Results: A total of 58 cases were seen and mostly involving pupils/students 44 (75.9%) and singles 52 (89.7%). The ages ranged from 3 to 37 years with a mean of 14.1±7.8. The assailants were known to the victims in 63.8% of cases. Sexual assault through vaginal route was the commonest type 57 (98.3%) and perpetrated by one person in majority of cases (79.0%). Physical force (43.1%) was major method used to subdue victims. About 60.3% of assaults occurred during the daytime and mainly occurred (60.4%) at home/office. The time interval between assault and presentation in the hospital ranged from 6 hours to 96 hours; majority presented within 24 hours (59.6%). Only 35 (60.3%) reported to the police. About 48.3% received post exposure prophylaxis. About 37.7% eligible for emergency contraception received it. Only 32.8% of the victims completed 3- month follow-up.Conclusions: Sexual assault is common in our environment with most victims being less than 14 years of age and assailants were mostly persons known to them. Some victims presented late

Analysis of burden of sexual assaults at Abuja: a 4-year retrospective study

Background: Sexual assault is a worldwide crime associated with traumatic experience and largely affects women and girls. It is greatly underreported, more especially in the low income countries due to our peculiar culture.Methods: A retrospective study of sexual assault victims managed at the Hospital from January 1, 2015 to December 31, 2018. Case notes were retrieved and relevant data extracted and analyzed.Results: A total of 58 cases were seen and mostly involving pupils/students 44 (75.9%) and singles 52 (89.7%). The ages ranged from 3 to 37 years with a mean of 14.1±7.8. The assailants were known to the victims in 63.8% of cases. Sexual assault through vaginal route was the commonest type 57 (98.3%) and perpetrated by one person in majority of cases (79.0%). Physical force (43.1%) was major method used to subdue victims. About 60.3% of assaults occurred during the daytime and mainly occurred (60.4%) at home/office. The time interval between assault and presentation in the hospital ranged from 6 hours to 96 hours; majority presented within 24 hours (59.6%). Only 35 (60.3%) reported to the police. About 48.3% received post exposure prophylaxis. About 37.7% eligible for emergency contraception received it. Only 32.8% of the victims completed 3- month follow-up.Conclusions: Sexual assault is common in our environment with most victims being less than 14 years of age and assailants were mostly persons known to them. Some victims presented late.</jats:p