Comparing neonatal outcomes in women with preeclampsia and those with normal pregnancy

Background: Preeclampsia has remained an important public health problem in the developing world where it is associated with a five-fold increase in perinatal morbidity and mortality. Objective: We set out to compare neonatal outcomes between women with preeclampsia and those with normal pregnancy. We also sought to evaluate factors associated with poor outcome in the neonates. Materials and Methods: This was a prospective cohort study that enrolled 90 women (45 with preeclampsia and 45 with normal pregnancy) after 20 weeks gestation. Maternal socio-demographic and clinical information was obtained at enrolment and delivery using questionnaire. Neonatalanthropometric and physiologic data was obtained at delivery and used for classifying the birth weight according to the WHO classification. APGAR score was used to evaluate the presence of birth asphyxia. We defined poor outcome as the presence of at least one of low birth weight,  prematurity, birth asphyxia and need for admission. SPSS version 25 was used in all analysis. Significance testing was set at p=0.05. Results: The women with preeclampsia were significantly heavier at booking (BMI 29.0±6.9 Kg/ m2 vs 25.0±5.2. p=0.005), have higher mean booking systolic blood pressure (122.±22.6 mmHg vs 111.5±12.7mmHg, p=0.003) and diastolic blood pressure ( 7 9 . 8 ± 1 4 . 3mm Hgvs 68.8±9.0mmHg, p<0.001). Neonates of women with preeclampsia were significantly more premature ( meangestational age = 36 . 8 ± 3 . 2 week svs 38.7±2.0weeks, p=0.001) and lighter (mean birth weight =2,529±817.5g vs 3,079.2±527.4g, p<0.001). Overall, 22 (49.4%) of the neonates of women with preeclampsiahad significantly poor outcome compared with 12(27.4%) of the neonates of women with normal pregnancy (p=0.01). Univariate logistic analysis showed only being a male neonate, maternal preeclampsia and admission in index pregnancy were significantly associated with poor outcome.  Multivariable logistic regression showed only being a male neonate to be 3 times more likely to have a poor outcome (Wald=5.34. OR=3.2, p=0.02) Conclusions: Intrauterine exposure to preeclampsia is associated with poor neonatal outcomes especially in males Key words: infant outcome, preeclampsia, Nigeri

The burden of diabetes mellitus during pregnancy in low- and middle-income countries : a systematic review

Peer reviewedPublisher PD

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

Case Report - Persistent Haematuria and Chronic Pelvic Pain Due to a Way-Ward Intra-Uterine Contraceptive Device

Background: The bladder is one of the organs that an intra-uterine contraceptive device can migrate into because of its close proximity to the uterus. Its complication of bladder perforation is seldom diagnosed prior to intervention probably as a result of its rarity.Method: A case report of a Nigerian female who presented with persistent filling-phase lower urinarytract symptoms, haematuria and chronic pelvic pain as a result of a migrated IUCD into the bladder. The device was inserted after uterine evacuation of retained products of conception following an incomplete spontaneous miscarriage with the consent of the husband. It was discovered at cystoscopy, retrieved and she was followed up.Result: The patient was a 29-year old woman who presented with a 2-yearhistoryof persistent haematuria, dysuria, and chronic pelvic pain despite several episodes of antibiotic treatment for suspected urinary tract infection. Intra-uterine contraceptive device was discovered in the urinary bladderat a diagnostic cystoscopy and was retrieved. Further history revealed that an IUCD was inserted without her knowledge by health personnel immediately after evacuation of the uterus of retained products of conception following an incomplete miscarriage. She recovered without complication within 2 weeks of its removal.Conclusion: This report highlights the need to discourage the insertion of IUCD by untrained health workers and to consider intra-vesical migration of IUCD in women of reproductive age with recurrent or persistent urinary tract symptoms recalcitrant to antibiotic treatment

Prevalence and determinants of lower urinary tract symptoms before and during pregnancy in a cohort of Nigerian women

Background: Pregnancy and childbirth are thought to be associated with development of lower urinary tract symptoms (LUTS). The study aimed at ascertaining prevalence rates of LUTS before and during pregnancy, the determinants and perceived effects of these symptoms on the life of the women. Materials and Methods: Questionnaires in which LUTS were defined according to recommendations of International Continence Society was administered on consecutive women who delivered at ≥37 weeks′ gestation to ascertain the presence or absence of LUTS before and during pregnancy and perceived effects on their life. Data was also collected on their socio-demographic and obstetric features. Descriptive statistics and relationship between LUTS and other variables were analyzed using SPSS version 16. Results: Prevalence rates of LUTS before and during pregnancy were 52.9% and 89.2%, respectively, and mostly included nocturia and stress urinary incontinence. Women were more likely to develop LUTS during pregnancy (P = 0.002, OR 4.99, 95% CI 1.793 - 13.906). Only 14.4% and 41.7% reported any burden on their daily life before and during pregnancy, respectively. Previous vaginal delivery (P = 0.01, OR 3.12, 95% CI 2.91-5.62), grand-multiparity (P = 0.04, OR 4.15, 95% CI 3.82-7.24) were associated with LUTS prior to pregnancy while presence of LUTS before pregnancy (P = 0.001, OR 10.80, 95% CI 4.24-27.52), previous vaginal delivery (P = 0.002, OR 6.38, 95% CI 4.25-12.43) and moderate maternal obesity (P = 0.03, OR 2.56, 95% CI 1.82-3.47) were predictive of LUTS during pregnancy. Conclusion: LUTS are common among women both before and during pregnancy but most of them were not bothered by the LUTS. Those with previous vaginal delivery and are grand-multiparous are more likely to develop LUTS prior to pregnancy while the presence of LUTS before pregnancy, vaginal delivery and maternal obesity are determinants of LUTS during pregnancy

Vesico-vaginal fistula repair: experience with first twenty-three patients seen at a tertiary hospital in north-central Nigeria

Background: Vesico-vaginal fistula (VVF) has been a recurrent challenge to Obstetricians and Gynaecologists in many hospitals in Nigeria. The objective of this study was to determine the causes of VVF, site and size and the success of surgery in VVF patients.Methods: This was a prospective descriptive study of the first 23 cases of VVF repair at the Federal Medical Centre, Makurdi, from January, 2012 to December, 2014. The clinical records of all patients who had VVF repair were reviewed and analysed.Results: The main cause of VVF in this study was prolonged obstructed labour accounting for 52.1% followed by iatrogenic causes such as gynaecological procedures (30.4%). Anterior vaginal wall fistula was the commonest defect accounting for 91.3%. Most of the fistulas were less than 5cm and surgery was successful in 80.9% of the cases. Most of the cases (76.2%) were done under regional anaesthesia. Majority (94.1%) of the successful repairs were done under spinal anaesthesia. Most of the patients were discharged after three weeks.Conclusion: Prolonged obstructed labour was still the leading cause of VVF, though the percentage is lower compared to most reviews across the country. Majority of the cases had successful surgery because of the sizes and the uncomplicated nature of the fistulae. Iatrogenic causes account for about a third of the cases of VVF indicating the need for extra vigilance on the part of the practitioners. Spinal anaesthesia can be used beneficially for VVF repair.Keywords: Vesico-vaginal fistula, repair, iatrogenic, outcomes