Post-operative morbidity in elective versus emergency caesarean section: a prospective cohort study.

Context: Caesarean delivery is associated with the risks of post-operative morbidities.Objective: To assess post-operative morbidity in clective versus emergcncy caesarean sectionDesign: Prospective cohort studySetting: Department of Obstetrics and Gynaecology University of Abuja Teaching Hospital, Abuja in NigeriaPopulation : Women who underwent either elective or emergency caesarean sections at the hospital during the designated study periodMain Outcome measures: Wound infection. long duration of hospital stay, Postoperative fever. Urinary tract infection and blood transfusion.Results: There were significantly higher morbidities: wound infection (OR 3.4: 95% CI 1.7-7.3: P<0.0001 ) post-operative fever(OR 6.7; 95% 03.6-13.2. P<0.0001 ).longer duration of hospital stay (OR 6.2; 95% CI 3.3-12.6; p<0.0001) and blood transfusion (OR 5.4; 95% Cl 2.7-11.8; P<0.0001) in women who had emergency caesarean delivery compared with elective caesarean delivery. There was no significantbdifference in the frequency of urinary tract infection (OR 3.0; 95% CI 0.8-12.2; P -0.12) in both arns of study. Following logistic regression. only unhooked status retained significant association with wound infection (OR 4.3; 95% CI 2,4-7.9). post-operative fever (OR 3,6; 95% CI 2.3-5.7); longer duration of hospital stay (OR 5,7; 95% CI 3.4- 9.4) and blood transfusion (OR 7.6; 95% CI 4,2- 14.0)Conclusion : This study identified significantly higher post-operative morbidities in emergency than elective caesarean delivery. The most important predictor of post-operativc morbidity was lack of antenatal care

A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients

Background: Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. Objective: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxy- tocin for the prevention of primary post-partum haemorrhage in at risk patients.Materials and methods: A total of 122 patients with risk factors for uterine atony were allocated to receive either 600μg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour.  Post-partum blood loss was measured using differential delivery towel and pad weighing.Results: There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxy- tocin group.Conclusion: Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in prevent- ing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.Keywords: Adjunctive rectal misoprostol, primary post-partum haemorrhage, patients

Practice of healthy timing and spacing of pregnancy (HSTP), experience from a low resource setting

Context: Healthy Timing and Spacing of Pregnancy (HTSP) refers to the optimal time that a woman should conceive for the healthiest outcomes for the mother and the baby.Objective: This study assessed the adherence by Nigerian women of childbearing age to the WHO recommendations of optimal time to be observed by women before embarking on another pregnancy after child birth or a miscarriage.Materials and Methods: This was a cross-sectional descriptive study of 400 consecutive women attending the antenatal clinic of the University of Abuja Teaching Hospital. Interviewer administered questionnaire was used to collect information relating to healthy timing and spacing of pregnancy. The data was analyzed using SPSS windows version 20. Chi square test was used to test for associations between categorical variables with the level of significance set at p<0.05.Results: Two hundred respondents (50%) had birth to pregnancy interval of less than 24 months, while 14(3.5%) had birth to pregnancy interval of greater than 60 months. Overall, 249(62.2%) of women had an unhealthy timing or spacing of their pregnancies. Three hundred and forty (85%) were aware of at least a modern method of contraception but only 42(10.5%) had used contraceptives in the past. Awareness of normal inter-pregnancy interval of at least 24 months was seen in 271 (67.8%) women.Conclusion: Non-adherence to WHO's concept of HTSP is high in Nigeria's Federal Capital Territory. Awareness of the benefits of contraceptive use and HTSP amongst women of child bearing age needs to be stressed.Keywords: Healthy Timing and Spacing of Pregnancy, Antenatal Clinic, Abuja

A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients

Background: Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. Objective: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. Materials and methods: A total of 122 patients with risk factors for uterine atony were allocated to receive either 600\u3bcg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. Results: There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. Conclusion: Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour. DOI: https://dx.doi.org/10.4314/ahs.v19i1.25 Cite as: Muhammad R, Isah A, Agida T, Akaba G. A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients. Afri Health Sci. 2019;19(1). 1517-1524. https://dx.doi.org/10.4314/ahs.v19i1.2

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

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 < 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

Seroprevalence of hepatitis B virus among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria

Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Despite the above, screening of antenatal attendees is not yet done as a routine in many Nigerian Hospitals that offer antenatal services, inclusive of University of Abuja Teaching Hospital.Aim: The aim of the study was to determine the seroprevalence of HBV infection among antenatal attendees at the University of Abuja Teaching Hospital.Materials and Methods: This was a cross‑sectional study of 200 consecutive antenatal attendees at the University of Abuja Teaching Hospital. Rapid Test; Quick profile™; by Lumiquick Diagnostics: Santa Clara, California, USA, was used. All materials and specimen (plasma) were brought to room temperature.Results: The seroprevalence of HBV among antenatal attendee was 7.0%.Conclusion: The prevalence of HBV among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria, is on the high side. It is hereby recommended that routine screening for hepatitis B surface antigen should be offered to all antenatal clinic attendees.Keywords: Abuja, hepatitis B, Nigeria, pregnancy, seroprevalenc