The Challenges Of Managing Quintuplets In A Developing Country (Nigeria)

High order multiple deliveries have been reported from a number of developed countries previously but not from a developing country. This report highlights the challenges posed by the management of the second surviving quintuplet delivery in Nigeria at the University of Benin Teaching Hospital Benin, and the subsequent management of the babies. The first was at UNTH in 1988 but the mother took fertility drugs. The challenges encountered during the antenatal care of the mother included the long stay in the hospital of the mother for bed rest, accurate diagnosis of the number of the babies prenatally, management of the weight of the mother and acceleration of the maturation of the babies' lungs. During delivery, resuscitation of the babies with the available health professionals, materials and equipment also posed some problems. Continuous ambubagging with oxygen was performed when some of them went apnoeic. Continuous positive airway pressure (CPAP) ventilation with a respirator (i.e. Mechanical ventilation), which was not available during resuscitation or early in their lives, could not be offered. Management consisted of using hot water bottles; perplex glass shied to maintain body temperature instead of incubators and respirators; which also were not available. It is recommended that adequate manpower, equipment and diagnostic procedures be made readily available to cope with such circumstances. This case is highlighted because this is the first known surviving quintuplet delivery in Nigeria by a mother without having taken fertility drugs and to evaluate the management of these babies and their mother in difficult circumstances. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 71-7

Equal Access Is Quality: an Update on the State of Disparities Research in Trauma

Purpose of Review: Over the past 5 years, disparities in the access to and quality of trauma care have expanded on the relatively nascent body of literature. Recent Findings: This review summarizes the newest findings in trauma disparities research, identifying 47 original research articles that either illuminate disparities that had not been previously described or augment our understanding of a known disparity. Furthermore, the current literature on trauma disparities establishes the importance of investigating disparities in pre and post-hospital quality metrics and refining the approach to quality measurement for trauma care in pediatric and geriatric populations in particular. A new development on the study of trauma disparities is the effort to establish the mechanisms by which racial/ethnic and socioeconomic disparities occur. Summary: The authors conclude from this evidence-based review that, as new disparities in trauma care continue to emerge, novel approaches to measuring and eliminating these disparities are needed