Hypoxaemia During Gynaecological Laparoscopy Under Local Anaesthesia and Sedation

Context: Laparoscopy is a procedure with significant potential for hypoxaemia due to the respiratory changes accompanying pneumoperitoneum and the Trendelenberg position used. Hypoxaemia may be critical when the procedure is conducted under local anaesthesia and conscious sedation. Objective: The aim of this study was to determine the extent to which hypoxaemic episodes occurred during gynaecological laparoscopy performed under conscious sedation. Study Design, Setting and Subjects: This was a cross-sectional study of consecutive patients undergoing investigative laparoscopy at the University College Hospital, Ibadan. Informed consent was obtained from patients and they were prepared for the procedure on a day-care basis. The demographic data and vital signs were recorded. Pentazocine (60 mg) and diazepam (10 mg) were administered intravenously. Main Outcome Measures: The respiratory rate, pulse rate, blood pressure and oxygen saturation were measured pre-, intra-, and post-operatively. Results: Thirty-two patients were recruited into the study. They had no intercurrent medical diseases. Mean age was 33 years (SD 4.2) and mean Body Mass Index (BMI) was 24.49 (SD 2.87). Oxygen saturation was normal in every patient pre-sedation. Post sedation, 19 (54%) of the patients desaturated in the period before surgical stimulation. Oxygen saturation remained between 90% and 95% in 6 (19 %) patients intraoperatively. There were no postoperative episodes of desaturation. There was no correlation between the BMI and the degree of desaturation. Conclusion: A significant degree of desaturation occurs during gynaecologic laparoscopy under pentazocine and diazepam sedation. It is recommended that oxygen should be administered to all patients during the procedure. Key Words: Gynaecological Laparoscopy, Sedation, Hypoxaemia. [Trop J Obstet Gynaecol, 2002, 19: 4-7]

Intensive care unit admissions during the puerperium in Ibadan

Context: Intensive care unit (ICU) admissions of parturients are rare and is about 0.2% of total number of maternities per year in the United Kingdom (UK) compared to 1.1% reported from a teaching hospital in Benin, Nigeria. Objective: This study sought the indications and outcome of critically ill obstetric patients admitted into the intensive care unit (ICU) of the University College Hospital (UCH), Ibadan, Nigeria in the year 2001. Study Design, setting and subjects: Descriptive study involving 21patients admitted into the ICU, University st st College Hospital, Ibadan, between 1 January to 31 December 2001. Data was prospectively collected from each obstetric patient admitted. Results: The total number of deliveries during the year was 1,132 and 21 patients required admission into the ICU (1.86%). The median age was 26 years with a range of 20 35years. Eighteen patients (81%) were admitted postemergency caesarean section or exploratory laparatomy. Eclampsia accounted for 47.6% (10/21) of the admissions, followed by severe haemorrhage from ruptured uterus 33.3% (7/21). Ten patients died giving a mortality rate of 47.6% in this series of obstetric patients admitted into the ICU. Conclusion: The admission rate of obstetrics patient into the ICU in Ibadan is 1.86%, this may be reduced by an improvement in the management of hypertensive disease of pregnancy and reducing the incidence of ruptured uterus through health education of parturient with high risk pregnancies on the need to have monitored ante-natal care and delivery. Keywords: obstetric, ICU admissions, indications, outcome Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 56-5

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study

CITATION: Bishop, D. et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. The Lancet Global Health, 7(2):e513-e522. doi:10.1016/S2214-109X(19)30036-1The original publication is available at https://www.thelancet.com/journals/langlo/issue/vol7no2/PIIS2214-109X(19)X0002-9Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30036-1/fulltextPublisher’s versio

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran