Preconception Care and Sickle Cell Anemia in Pregnancy

Background: Pregnancy in women with sickle cell anemia is associated with adverse outcome for mother and child, but with improvements in medical care, the outcome has greatly improved in developed countries. Despite being the most prevalent genetic disease in Africa, sickle‑cell disease, along with its serious health problems in pregnancy, is largely neglected.Objective: To determine the effects of preconceptual care on pregnancy outcome among booked patients with homozygous sickle cell disease at Aminu Kano Teaching Hospital, Kano, Nigeria.Materials and Methods: A cohort study of the pregnancy outcome, among booked 39 pregnant women with homozygous sickle cell disease (Hbss), who had preconception care, and an equal number of booked pregnant women with homozygous sickle cell disease (Hbss), who did not have preconception care (controls), at Aminu Kano Teaching Hospital, between January 2000 and December 2006.Results: There was no statistically significant difference in the occurrence of complications between the two groups, but complications occurred with less frequency among the cases compared to the controls.Conclusion: This study suggest that preconception care and effective prenatal care by a multidisciplinary team, and delivery in a hospital which is accustomed to management of sickle cell disease and its complications, is associated with good pregnancy outcome in women with sickle cell anemia in pregnancy. Keywords: Multidisciplinary team management, preconception care, pregnancy outcome, sickle cell anemi

Caesarean Section in Kano, North-West Nigeria

A prospective study of all Caesarean sections (C/S) that were performed at Aminu Kano Teaching Hospital, Kano, Nigeria, between January 2001 and December 2006 was carried out to determine the incidence, age, parity, indications, types and feto-maternal outcome. The caesarean section rate in this review was 13.7%. Emergency C/S accounted for 87.9%, while12.1% were done electively. Among them 52.4% were booked while 47.6% were unbooked, giving a C/S rate of 9.2% for booked and 29.2% for unbooked patients. The leading indications for emergency C/S were cephalo-pelvic disproportion (CPD)/obstructed labour and preeclampsia/eclampsia, while for elective C/S it was two or more previous C/S and breech presentation. Feto-maternal morbidity and mortality were significantly higher among unbooked patients because of late presentation in the hospital. We recommend that Traditional Birth Attendants should be trained to refer patients early. Antenatal care should be free or subsidizedand made more accessible. In a predominantly Islamic society like ours where early marriage and teenage pregnancies are common, campaign for antenatal care and hospital delivery, should include education of the husbands and community about the importance of antenatal care. Involvement of religious and community leaders will go a long way to achieve this goal, as well as the aims of Millennium Development Goals- 4 and 5.Key Words: Caesarean section, booking status, feto-maternal outcom

Ruptured uterus in Kano, Nigeria - study of risk factors

This is a comparative prospective study of the risk factors for ruptured uterus in Aminu Kano Teaching Hospital, Kano, Nigeria, between 1st January 2000 and 31st December 2005. Forty six women with ruptured uterus (cases) were compared with two hundred and thirty women who delivered without ruptured uterus (control). Chi-square (x2) test was used for comparison of the data for statistical significance. The incidence of ruptured uterus was 1 in 278 deliveries (0.36%). The significant risk factors found were unbooked status (OR = 36.70, CI = 12.85 – 112.94), low socioeconomic status (OR = 11.51, CI = 5.34 – 25.10), 30-39 years of age (OR = 2.23, CI = 1.10 – 4.50), grandmultiparity (OR = 8.25, CI = 3.88 – 17.64). Prolonged obstructed labour (OR = 5.92, CI = 2.57 – 13.66).Poor supervision in labour (unbooked status) was found to be the commonest cause of ruptured uterus. In a predominantly Islamic community like ours where early marriage is common, female western education and employment, as well as education of their husbands, community and religious leaders on the importance of antenatal care and hospital delivery, will go a long way to improve its utilization and reduce the prevalence of ruptured uterus in our community. Keywords: Ruptured uterus, risk factors, KanoNigerian Hospital Practice Vol. 2 (3) 2008: pp. 65-6