Obstetric and gynaecological admissions in an intensive care unit of a Nigerian teaching hospital: a 5-year review

Background: Management of critically ill women in intensive care units (ICU) is crucial in reducing maternal mortality. This study sought to determine the ICU obstetric and gynaecology utilization rate, indications for admissions, assess the outcome and risk factors associated with mortality.Design/ settings: A retrospective descriptive study of admissions in a multidisciplinary ICU setting in a University Teaching Hospital in Nigeria.Methods: Records of obstetric and gynaecological patients admitted to the ICU over a 5-year period were entered into a computer. Data included demographic and clinical characteristics of the patients, interventions performed and outcomes of patients' ICU care. Data was analysed using SPSS version 20 for windows.Results: The MMR was 870 per 100,000 live births. The incidence of obstetric and gynaecological admissions to the ICU was 5.2% (37/706) of all admissions. 20 (58%) were obstetric cases, mostly severe PET/eclampsia15 (40.5%), 42% of the women were admitted for complications of gynaecological procedures. Commonest complication was adult respiratory distress syndrome (ARDS). The mortality was 16 (43%) overall, 10 (62.5%) were obstetric cases mainly PET/eclmpsia (56%). The likelihood of Obstetric mortality was twice that of gynaecological mortality (OR 2.5, 95% CI 0.99 – 6.16, P<0.026). Factors related to poor outcomes were 2 or more interventions (P=0.001).Conclusion: Obstetric and gynaecology ICU utilization was low considering the high MMR. The major indication for admission was severe PET/eclampsia. The need for ventilatory support may predict poor outcome. There is need for dedicated obstetrics and gynaecology ICU to make access easier for Near Miss cases.Keywords: Obstetrics; Critical care; Gynaecology; Intensive care uni

Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria

ObjectiveTo estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.DesignRetrospective observational study.SettingA total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.PopulationPregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.MethodsSecondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.Main outcome measuresRisk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.ResultsObstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.ConclusionsModifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions

Ethanol Extract of Carica papaya Seeds Induces Reversible Contraception in Adult Male Wistar Rats

Abstract: The quest for the development of an ideal male contraceptive has led to the discovery of the antifertility property of some species of C. papaya seed extracts. This study investigates the antifertility activity and reversibility of ethanol extract of C. papaya seeds in sexually matured male Wistar rats. 30 adult males and 60 female Wistar rats weighing between 180 and 220 g were used for the study. The male rats were randomly divided into 3 groups of 10 each. Group I which served as control were orally administered distilled water while groups II and III received 100 and 250 mg/kg/day of ethanol extract of C. papaya seeds respectively for a period of 90 days. 5 males from each group were subjected to fertility test before they were sacrificed to harvest the testes for histopathological analysis. The administration of the extract was discontinued for another 90 days period and the remaining 5 males in each group were subjected to fertility test before they were sacrificed to obtain the testes for histopathological analysis. The results showed normal pregnancy outcome in the females paired with the control group, reduced and zero pregnancy outcome in the females paired with the 100 and 250 mg/kg groups respectively after 90-day administration of the extract. After 90 days of discontinued administration of extract, normal pregnancy outcome were recorded in both the control and treated groups. The result of the histopathological analysis showed a moderate and highly depleted germinal epithelium in the 100 and 250 mg/kg groups respectively after 90 day administration of the extract. The germinal epithelium seen in both the control and the experimental groups were normal after 90 days discontinued extract administration. The study concludes that ethanol extract of C. papaya seeds induces reversible male contraception in Wistar rats