Comparison of maternal and fetal outcomes of elective and emergency caesarean deliveries

Background: Caesarean delivery (CD) is a procedure which poses a major public health concern to Obstetricians. The outcome of emergency and elective caesarean delivery largely depend on the maternal and or fetal conditions. The study compared maternal and fetal outcomes in both elective and emergency caesarean delivery at the University College Hospital, Ibadan, Nigeria. Methods: This was a six-year retrospective study of pregnant women who underwent caesarean delivery at the University College Hospital. Information was extracted from their medical records using a proforma. Comparison of maternal and fetal outcomes of elective and emergency caesarean deliveries was done. Data were analyzed using SPSS version 20. Results: A total of 6,854 women had caesarean delivery (CD), mean age was 28.85 ± 5.62 years and ranged from 15-48 years. A higher proportion (85.5%) had emergency CD in which majority were unbooked (80.4%) with the commonest indication as prolong obstructed labour while repeat caesarean delivery (57.6%) was the commonest indication for elective CD. Haemorrhage, puerperal sepsis, wound infection, anaemia, blood transfusion, urinary tract infection, and admission into intensive care unit were more among those with emergency CD and all were statistically significant (p<0.05). Low birth weight stillbirths and admission into special care baby unit were also higher among the fetus of those who had emergency CD, and these were statistically significant (p< 0.05). Women with postdated pregnancy had twice the chance of having emergency CD (OR= 2.15, 95% CI= 1.71-2.72). Conclusion: Maternal and fetal complications were more among women with emergency caesarean delivery and prolong obstructed labour was the main indication thus it is expedient to educate pregnant women and the community on complications of pregnancy and labour to prevent or  promptly intervene when necessary to reduce adverse maternal and fetal outcomes

Maternal side effects of efavirenz‑containing highly active antiretroviral therapy (HAART): A comparative study of HIV‑positive pregnant and nonpregnant women in a tertiary hospital

Background: Efavirenz is now a first‑line non‑nucleoside reverse transcriptase inhibitor used as highly active antiretroviral therapy (HAART) though its use is fraught with maternal side effects, usually of the central nervous system (CNS) and fetal complications.Objective: The study aims to comparatively document the maternal side‑effect profile of an efavirenz‑containing fixed‑dosage HAART and compliance with its use in HIV‑positive pregnant and nonpregnant women at the Lagos University Teaching Hospital (LUTH), Idi‑Araba.Methodology: A prospective study among HIV‑positive pregnant (40) and nonpregnant women (40) on efavirenz‑containing fixed‑dose HAART (Atripla®) who were recruited purposively at the antenatal clinic and AIDS Prevention Initiative Nigeria (APIN) clinics of LUTH. Data analysis was done with EPI Info 2014, and the results are presented in frequencies.Results: The mean age of respondents was 31 ± 5.7 years. Atripla® was the only fixed‑dose combination used. Fifty‑three percent and 62.5% of pregnant and nonpregnant HIV‑positive women, respectively, reported CNS side effects of Atripla® [odds ratio: 0.66, 95% confidence interval 0.27–1.62]. Adherence to the use of Atripla® was 100% among HIV‑positive pregnant women. Women with baseline viral load values greater than 400 copies/mL reported more side effects to Atripla®.Conclusion: There are similar side‑effect profiles of Atripla® in HIV‑positive women irrespective of pregnancy. Education and counselling can help foster adherence, resulting in improved immunological and virological outcome.Keywords: Efavirenz; HAART; maternal; side-effect

Trends, pattern and outcome of caesarean section at Lagos University Teaching Hospital, Lagos, Nigeria: A ten-year review

Background: Caesarean section (C/S) rate and pattern of indications can be a reflection of maternal health status and quality of medical practice. This study aimed at determining current C/S rate at Lagos University Teaching Hospital (LUTH) and to assess trend, pattern and outcome of C/S in the last ten years. Study design: A cross sectional study of all cases of C/S ≥28 weeks gestational age performed at LUTH from January 1, 2008 to December 31, 2017. Information which included maternal age, parity, gestational age at delivery, booking status, type of C/S and indications was retrieved from Labour Ward register using an electronic database. Data analysis was done with IBM SPSS version 23. Results: A total of 12,811 deliveries that met the inclusion criteria during the study period were reviewed. Overall C/S rate was found to be 51.3% and there has been an increase over the years (p = 0.000). Commonest indications were previous C/S, HIV infection, hypertensive disorders, fetal distress and antepartum haemorrhage. HIV infection ranked topmost in the list of indications in 2008 and 2009, with a change in trend to previous C/S in subsequent years. Maternal death was significantly lower in women who had C/S (0.1%) compared to those who delivered vaginally (0.4%), p = 0.000. Perinatal death rate was also lower in those who had C/S (4.8%) compared to women delivered vaginally (8.5%), p = 0.000. Conclusion: Decision to perform primary C/S should be based on clear cut indications as repeat C/S was found to be a major contributor to rising C/S rate in this study. There is thus a need to conduct regular audits on C/S performed in every health institution using the World Health Organization Robson classification and review policies regarding delivery based on the findings