Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria. Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births. Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ≥40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021. Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility

Predisposing factors and outcome of uterine rupture in Jos, North-central Nigeria

Background: Uterine rupture has continued to be an obstetric catastrophe with tragic maternal and foetal outcomes particularly in Nigeria.Methods: an institutional, cross sectional retrospective study was carried out at Jos University Teaching Hospital, North-Central Nigeria. Case files of mothers with uterine rupture managed at the hospital from 1 January 2011 to 31 December 2019 were retrieved and included in the study. Data extracted from case files included maternal age, parity, gestational age, booking status, presence of uterine scar, obstetric interventions prior to rupture, site of rupture, type of surgery, units of blood transfused, intensive care unit admission and duration of hospital stay and maternal or foetal death.Results: the incidence of uterine rupture was 1 in 497 deliveries (0.2%). The mean age of the patients was 30.1±5.1years. About 75% of the patients were para 1-4. Seventeen (70.8%) patients were unbooked while fourteen (58.3%) had unscarred uterine rupture. Eight out of 14(57.1%) patients with unscarred uterus had uterotonics for induction or augmentation of labour. Fourteen (58.3%) patients had rupture involving anterior lower uterine segment. Over half of the patients had uterine repair only (58.3%), 29.2% had uterine repair with bilateral tubal ligation while 12.5% had subtotal hysterectomy. Twenty-two (91.7%) required blood transfusion, five patients had 5 or more units of blood transfused. The perinatal mortality was 69.6%, there was no maternal death.Conclusions: the major predisposing factors to uterine rupture in our facility were lack of antenatal care, presence of previous caesarean section scar and injudicious use of uterotonics

Comorbidities among infertile women at NKST hospital Mkar-Gboko, North-Central Nigeria

Background:  Infertility, a common, non-fatal ailment, is sometimes associated with substantial comorbidity that can add adverse outcomes during treatment or pregnancy and increase costs of care. This study aims to assess the magnitude and pattern of comorbidities in infertile Nigerian women.Method: This descriptive retrospective study was undertaken at NKST Hospital Mkar-Gboko, Nigeria, from 1st January 2005 to 31st July 2013. Clinic records of patients who attended the gynaecological outreach clinic were retrieved and analyzed using descriptive statistics and test of associations with Microsoft Excel 2013.  Jos University Teaching Hospital gave ethical clearance.Results: 1,926 women seen during the study period, 1030 (53.5%) presented for infertility care. 941 (91.4%) women had complete records, among them, 476 (50.5%) met the inclusion criteria, and their records were analyzed. The mean age of the women was 32.6±6.0 years with a range of 20 to 53 years, see Table1. There were 52 comorbid conditions among the 476 women. The comorbidities included uterine myoma, previous appendectomy/pelvic surgeries, genital tract infections/retroviral disease, hypertension, obesity and diabetes, among others, see Table 4. Table 2 and 3 shows there is a significant statistical association between comorbidity type, age, parity, duration of infertility and symptoms complex between infertile women and comorbidities (p<0.05).Conclusion: Comorbidities that can influence treatment and pregnancy outcomes are common among infertile women in central Nigeria. This finding strongly supports the routine assessment of women for comorbidities during infertility care for appropriate multidisciplinary management and counselling

Secondary prevention of cervical cancer by screen-and-treat approach among HIV negative women in Faith Alive Hospital, Jos Nigeria

Background: Cervical cancer is the second most common cancer among women in Nigeria and the leading cause of cancer-related death in sub-Saharan Africa.  In low-income settings, visual inspections with acetic acid (VIA) and Lugol’s iodine (VILI); and subsequent treatment of cervical precancerous lesions with thermal ablation remains the practical approach for secondary prevention. Objectives were to determine prevalence of pre-cancerous cervical lesions, prevalence of suspected cervical cancer, and associated risk factors. Methods: A retrospective study on sexually active HIV negative women aged 16-55 years screened for cervical cancer using VIA/VILI within 16 months period in Faith Alive Hospital Jos.  Data were analyzed using IBM-SPSS 26. Socio-demographic characteristics and screening results were presented in frequency tables; and logistic regression was performed to determine risk factors for cervical pre-cancerous lesions. Results: 1,073 HIV negative women were screened for cervical cancer using VIA/VILI. 82 (7.6%) tested positive, 30 (2.8%) had suspected cancer with modal age distribution of 36-45 years. Higher positivity yield (58.6%) was found in ages between 36 and ≥55 years while the less positivity yield (41.4%) was found ages ≤35 years. Parity ≥3 had 1.8 fold risk association with precancerous lesion. Conclusions: Our study revealed high prevalence of cervical pre-cancerous lesions among HIV negative women, modal age distribution for suspected cancer and parity ≥3 being significant risk factor. Thus, “screen-and-treat” approach to cervical cancer prevention by VIA/VILI and thermal ablation in resource constraint settings should be undertaken until widespread HPV testing to triage clients is possible

Forgotten sanitary pad following episiotomy repair: A Case Report

Background-Gossypiboma describes an intraoperative mistake discovered postoperatively where surgical sponges, abdominal pack, gauze packs or textile materials are forgotten in the operative field after the patient is closed. This condition is under reported and poses a diagnostic dilemma&nbsp; because it may be silent for varying durations after the surgery. Case Presentation-A 23 -year old Para 1+0 pharmacy assistant presented thirty-one months after childbirth to the gynaecology clinic with&nbsp; complaints of dyspareunia, dysmenorrhoea, offensive menstrual effluent and vaginal discharge since her delivery. She had received an episiotomy,&nbsp; which had been repaired and she had been discharged on antibiotics and analgesia. She passed red lochia for three days followed by brown&nbsp; malodorous fluid per vaginam. She experienced severe abdominal pains, high-grade fever, chills and rigors during the puerperium with dyspareunia&nbsp; and foul smelling vaginal discharge subsequently. She visited several hospitals, and received antibiotics, antimalarials and analgesics,&nbsp; but symptoms persisted. On examination, significant findings were suprapubic tenderness, brown malodorous discharge, adnexal tenderness and a&nbsp; mass plugging the cervical os. It was removed and examination revealed a sanitary pad covered in foul-smelling discharge. Symptoms abated but&nbsp; twelve months after, she presented with inability to conceive and was referred for infertility evaluations. Conclusion- Competent doctors should supervise less experienced colleagues to forestall these gaps which can lead to legal action and maternal&nbsp; morbidity and possibly mortality. Repeat pelvic examinations should be performed after vaginal procedures, and women presenting with abdominal&nbsp; and genital symptoms should receive exhaustive evaluations

Knowledge, attitude and practice of maternity unit staff in Jos Metropolis to universal precautions against HIV

Background: Health care workers in maternity units are exposed to potentially infectious body fluids in the course of their duties. The study assessed the knowledge, attitude and practice of maternity unit staff in Jos Metropolis regarding Universal Precautions (UP) against the background of the high HIV seroprevalence in Plateau state, Nigeria.Methods: A cross sectional descriptive study carried out among maternity unit staff in Jos, Nigeria. A pretested, structured, anonymous questionnaire on knowledge, attitude and practice on universal precautions concerning HIV was administered to a sample of 230.Results: A total of 202 questionnaires were completed and returned giving a response rate was 87.8%, 68.5% of the respondents were female and 31.5% male; 63 of the respondents were physicians while 139 were non physicians. 52 (82.5%) physicians and 113 (81.3%) non physician cadre staff correctly identified UP in the context of labour ward practice to apply to blood, vaginal secretions and liquor. 54 (85.7%) of the physicians and 87 (62.6%) identified that UP involved use of barrier methods. Being a physician conferred knowledge of correct use of barrier methods..Conclusion: A majority of the respondents demonstrated correct knowledge of practice of UP . There was no significant difference in knowledge between physician and non physician cadre of labour ward staff with regard to correctly identifying the fluids that UPs apply to. Physician cadre of labour ward staff in Jos metropolis was associated with the correct identification of barrier methods that UPs apply to.Keywords HIV, Universal precautions, Maternity unit staff, Jos

Gestational age at booking for Antenatal Care and the pregnancy outcome at Faith Alive Hospital, Jos, Nigeria

Background: Early initiation of antenatal care is believed to improve maternal and foetal outcome. We sought to ascertain gestational age at booking and the outcome of these pregnancies at a faith based hospital in northern Nigeria. Methods: A retrospective descriptive study of patients who booked for antenatal care at the Faith Alive Hospital, Jos, st st Nigeria between 1 January, 2010 to 31 December, 2017 was done. Information regarding demographics, gestational age at booking and outcome of these pregnancies were analyzed. Result: During the study period, 3739 women registered for antenatal care. Majority of women were 20-24years (n= 1252 , 33.5 %) while The mean age was 28 ± 4years Of these women, 96.2% were married , 75.2% were Christians, 43.8% had secondary level of education and 41.2% were traders. st Furthermore, 23.2% of the clients booked in the 1 trimester in 2010, decreased to 17.3% in 2012 but progressively increased to 35.2% , 40.2% and 53.4% in 2014, 2015 and 2017 respectively. There was a significant statistical association between parity, marital status and educational status with late booking for antenatal care. Clients who booked late for antenatal care had poorer neonatal outcomes (low birth weight, still births and birth asphyxia) compared to those who booked early. Conclusion: Late initiation of antenatal care is common in our environment and associated with poorer neonatal outcomes.&nbsp; Nonetheless, a progressive improvement in early bookings was noticed with improved pregnancy outcome. Key Words: Gestational age, booking, pregnancy outcome, Faith Alive, Jo

Successful management of severe HELLP syndrome: A case report

Haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a severe pregnancy complication that is life-threatening for both mother and fetus. When HELLP syndrome associates with disseminated intravascular coagulation (DIC) or with other complications, it is necessary to terminate the pregnancy. We present a case of a 26-year-old primigravida with rare combination of HELLP syndrome with coagulopathy and renal complication at 34 weeks of gestation. She had emergency caesarean section followed by haemorrhagic complications, DIC and acute renal failure.&nbsp; During her stay in intensive care unit, she had massive blood transfusion and fresh frozen plasma. She had haemodialysis because of acute renal failure. A gradual improvement of her condition was observed after exploration and drainage of haemoperitoneum. After 13 days she was discharged from the intensive care unit.HELLP syndrome complicated by DIC and Acute kidney injury is a condition that is associated with high maternal and perinatal morbidity and mortality. Prompt recognition, teamwork and treatment with timely administration of blood products along with other supportive care is crucial in the management of this life-threatening and challenging condition. Key words: AKI, Preeclampsia, Disseminated intravascular coagulation, HELLP syndrom