Vaginal Candida infection in pregnancy and its implications for fetal well-being

Vaginal Candida infection is one of the most common genital tract infections reported in pregnant women. This study was designed to determine the prevalence of vaginal Candida infection and pattern of Candida species isolates in the genital tract of pregnant women during antenatal period and in early labour; and the associated fetal outcome. The study was conducted at the antenatal clinic and labor ward of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria. High vaginal swabs were collected from 408 pregnant women at the antenatal clinic and repeated in early labour. The samples were processed to isolate Candida species. Data were analysed using Statistical Package for Social Science (SPSS) windows version 21.0 (IBM Corp., Armonk, NY, USA). Prevalence of Candida infection was significantly higher in early labour (46%) than during antenatal period (38%) (P=0.02). Candida albicans was the predominant isolate, followed by Candida glabrata and Candida tropicalis. Candida infection was associated with increased likelihood of low birth weight babies (AOR 2.8, CI: 1.1-6.8; P= 0.03). However there was no statistically significant effect of Candida infection on the likelihood of preterm delivery (AOR 1.4, CI: 0.7-2.6; P= 0.35). Routine screening and prompt treatment of women at risk of delivering low birth weight babies is advocated. Keywords: Candida; Pregnancy; Preterm birth; Prevalence   L'infection vaginale à Candida est l'une des infections des voies génitales les plus courantes signalées chez les femmes enceintes. Cette étude a été conçue pour déterminer la prévalence de l'infection vaginale à Candida et le profil des isolats d'espèces de Candida dans le tractus génital des femmes enceintes pendant la période prénatale et au début du travail; et l'issue foetale associée. L'étude a été menée à la clinique prénatale et au service d'accouchement de l'hôpital universitaire Olabisi Onabanjo de Sagamu, dans l'État d'Ogun, au Nigéria. Des écouvillons vaginaux élevés ont été prélevés sur 408 femmes enceintes à la clinique prénatale et répétés au début du travail. Les échantillons ont été traités pour isoler les espèces de Candida. Les données ont été analysées à l'aide de la version 21.0 de Windows Package for Social Science (SPSS) (IBM Corp., Armonk, NY, USA). La prévalence de l'infection à Candida était significativement plus élevée au début du travail (46%) qu'au cours de la période prénatale (38%) (P = 0,02). Candida albicans était l'isolat prédominant, suivi de Candida glabrata et Candida tropicalis. L'infection à Candida était associée à une probabilité accrue de bébés de faible poids à la naissance (AOR 2,8, IC: 1,1-6,8; P = 0,03). Cependant, il n'y avait aucun effet statistiquement significatif de l'infection à Candida sur la probabilité d'accouchement prématuré (AOR 1,4, IC: 0,7-2,6; P = 0,35). Le dépistage systématique et le traitement rapide des femmes à risque d'accoucher de bébés de faible poids à la naissance sont recommandés. Mots-clés: Candidose; Grossesse; Naissance prématurée; Prévalenc

Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome

Background: To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design: A prospective longitudinal study. Setting and Population: Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods: Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures: Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results: Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis.At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period(P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions: Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Keywords: Bacterial vaginosis, foetal outcome, Lactobacillus, pregnancy, vaginal microflora. Funding: This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with referencenumber OOU/IBR/010

"Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study

AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. METHODS: Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care. RESULTS: There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5%) and maternal death (88.6%) were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100,000 deliveries. The overall maternal death to near-miss ratio was 1: 4.8 and this remained relatively constant over the 3-year period. CONCLUSION: The quality of care received by critically ill obstetric patients in this centre is suboptimal with no evident changes between 2002 and 2004. Reduction of the present maternal mortality ratio may best be achieved by developing evidence-based protocols and improving the resources for managing severe morbidities due to hypertension and haemorrhage especially in critically ill unbooked patients. Tertiary care hospitals in Nigeria could also benefit from evaluation of their standard of obstetric care by including near-miss investigations in their maternal death enquiries

Outcome of Pregnancy and Labour in the Nullipara

Context: Nulliparous women are reportedly at a higher risk of developing complications of pregnancy and delivery than multipara. There is a need to document the outcome of their pregnancy in order to improve the quality of care they receive. Objectives: To find out problems associated with pregnancy and labour in the nullipara compared to their multiparous counterparts. Subjects and Methods: The delivery records of 528 nulliparous women and 2980 multipara delivering singleton babies at Ogun State University Teaching Hospital, Sagamu from January 1988 to December, 1990 were retrieved and data about the socio-demographic and clinical characteristics of the patients were extracted for analysis. Results: The mean age of the nullipara and the multipara were 21.2 (SD 3.5) years and 27.4 (SD 5.7) years respectively, a statistically significant difference (p < 0.001). The multiparae had a mean parity of 3.3 (SD 2.0). The nulliparae were significantly shorter (159.0cm; SD 6.1) than the multipara (160.7 cm; SD 1.3). The nullipara were more likely to have anaemia, preeclampsia, preterm births, prolonged second stage of labour, vacuum extraction and to give birth to lighter babies than the multipara (2.9 kg; SD 0.5) vs (3.1kg; SD 0.5). The multipara were at a higher risk of developing urinary tract infection in pregnancy, ante- and post- partum haemorrhage, fetal distress, retained placenta and perinatal mortality. Conclusion: Both the nullipara and multipara are exposed to a variety of complications in pregnancy, which require prompt and adequate attention in order to forestall perinatal and maternal morbidity and mortality. Key Words: Pregnancy, Parturient, Parity, Outcome. [Trop J Obstet Gynaecol, 2003, 20: 56-58

Qualité de services prénatals de soin principal au Sud-ouest du Nigeria

A survey of 452 pregnant women accessing care at first level public health facilities in a local government area in southwest Nigeria was conducted to assess their perspectives on the quality of antenatal care received. Majority of the women expressed satisfaction with the level of expertise and basic technical competence of their careproviders. Less than 30% were pleased with the existing patients’ referral mechanisms. At least two-thirds received as much information as desired in salient aspects of antenatal health information needs. Frequency of antenatal visits was “about the same as expected” for 93.6% of the women. The mean reported waiting time before antenatal consultation was 131.1 minutes although 106 (43.3 %) women expected to be attended within 30 minutes of arrival. Approximately two-thirds of women were unhappy about their involvement in decision-making with respect to birth planning and postpartum contraception. Compared to other elements of quality, women were least pleased with constellation of services especially sanitary facilities and number of skilled healthcare providers. On the whole, respondents expressed a high level of overall satisfaction (81.4%) with the care received. The survey indicates that antenatal women may generally express satisfaction with the quality of services despite some inconsistencies between received care and their expectations of the facilities (Afr J Reprod Health 2008; 12[3]:71-92).Une étude de 452 femmes enceintes ayant accès au soin de premier niveau de santé publique dans une région publique du Sud-ouest du Nigeria a été faite afin de déterminer leurs vues sur la qualité de soin prénatal reçu. La majorité des femmes étaient satisfaites avec le niveau du savoir-faire et la compétence technique de base des dispensateurs de soins. Moins de 30% étaient contentes avec les mécanismes existant des recommandations des patients. Au moins deux tiers ont reçu autant de renseignements désirés dans des aspects marquants des renseignements des soins sanitaires prénatals. La fréquence des consultations prénatales étaient ‘presque la même exigée’ pour 93,6% des femmes. Le moyen du temps d’attente reporté avant la consultation prénatale étaient 131.1 minutes, pourtant, 106 (43,3%) des femmes qu’on devrait assister en moins de 30 minutes de leur arrivée. Approximativement deux tiers des femmes n’étaient pas heureuses concernant leur participation de prendre la décision en ce qui concerne le projet d’accouchement et le contraceptif postpartum. Par rapport aux autres éléments de qualité, les femmes sont moins heureuses avec la constellation de service surtout l’équipement sanitaire et le nombre de dispensateurs sanitaires qualifiées. Dans l’ensemble, des femmes interrogées ont exprimé une satisfaction complètement supérieure (81,4%) des soins reçus. L’étude indique que des futures mamans peuvent en général exprimer une satisfaction avec la qualité de service malgré les contradictions entre les soins reçus et leur espérance des installations (Afr J Reprod Health 2008; 12[3]:71-92)

Maternal Deaths from Induced Abortions

Context: Unsafe abortion has grave implications for the life of a woman and her future reproductive career. Efforts to find the reasons underlying how a woman gets to the point of having an unsafe abortion, and means of preventing and minimising complications arising thereby are highly desirable. Objective: To find the extent to which unsafe abortion contributes to maternal mortality in our environment. Study Design, Setting and Subjects: A descriptive study of patients who were admitted for complications arising from induced abortions between January 1988 and December 2000 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with the data being obtained from case records. Results: A total of 103 patients presented with complications arising from induced abortions. Twenty-one (20.4%) of these patients died as a result of complications arising thereby. During the same period, there were 71 deaths in the gynaecological ward. Thus, deaths from induced abortion accounted for 29.6% of all gynaecological deaths. There were 105 maternal deaths in the hospital during the period. Hence, induced abortions were responsible for 20% of all maternal deaths. The patients had various complications including 15 (71.4%) with septicaemia, 10 (47.6%) with anaemia, 7 (33.3%) each with jaundice and peritonitis. Conclusion: Abortion-related maternal death is still a major contributor to maternal mortality in this environment. Women empowerment, easy access to good quality and cheap family planning methods and post abortion care and rationalisation of abortion law may help to halt this stream of deaths from unsafe abortions. Key Words: Pregnancy, Unsafe Abortion, Maternal Mortality [Trop J Obstet Gynaecol, 2003, 20: 101-104

Effects of Nutritional Status and Supplementation on Resumption of Menstruation Amongst Parturient Nigerian Women

Context: Breastfeeding patterns, ethnic variation and nutrition have been shown to influence the return of menstruation after childbirth, but the role played by nutritional status requires further elucidation, particularly in a place like Nigeria where undernutrition is common. Objectives: To determine the effects of nutrition and breastfeeding pattern on the duration of lactational amenorrhoea in Nigerian women. Subjects and Methods: Marginally malnourished mothers (162) were randomised into two groups [A & B] for comparison with a third group [C] of well-nourished mothers. Mothers in Group A (83 subjects) received supplements in the form of specially formulated biscuits while those in Group B (79 women) & Group C (85 women) received none. The subjects were visited 3 times a week to ensure compliance with the supplements and to collect information on breastfeeding pattern and duration of lactational amenorrhoea. Results: There were no significant differences in the duration of postpartum amenorrhoea in the three groups of mothers, being 270, 220 and 234 days for Groups A, B and C respectively. Wide individual variations were observed in the duration of amenorrhoea in each group of mothers despite the fact that they generally had similar patterns of breastfeeding. The energy expenditure patterns in the supplemented and unsupplemented mothers were similar. Conclusion: Nutritional status and supplementation do not seem to influence the duration of lactational amenorrhoea in this group of Nigerian women. Subtle physiological differences between individual women may account for the wide individual variations observed in the time of resumption of menstruation after childbirth in the subjects. Key Words: Breastfeeding, Lactational Amenorrhoea, Nutritional Status, Menstruation. [Trop J Obstet Gynaecol, 2002, 19: 39-43]