Primary post partum haemorhage (PPH) at the university of Maiduguri teaching hospital (UMTH): A ten-year review

Objective: To determine the incidence, risks and aetiological factors for Primary Post-Partum Haemorrhage (PPH) in UMTH. Design Retrospective descriptive study.Setting: University Of Maiduguri Teaching Hospital, Maiduguri, Nigeria.Methods: The case records of all recorded cases of primary PPH between1stJanuary 2000 and 31stDecember 2009 inclusive, who were managed in UMTH were retrieved and relevant data obtained and analyzed.Results: Three hundred and seventy sixwomen had primary postpartum haemorrhage during the period under review with an incidence of 1.9%. However, only three hundred and two were available for analysis.Close to half of the women who had primary postpartum haemorrhage were grandmultiparous136(45%). Uterine atony was the commonest cause of primary PPH which was closely followed by retained placenta 37.7% and 22.5% respectively. This is attributed to mismanagement of labour. Majority of the patients were unbooked (63.6%) and about one third of the women had home delivery. The maternal mortality during the period was 96out of which 4were due to postpartum haemorrhage. The contribution of primary PPH to maternal mortality was 4.2% during the study period.Conclusion: Primary PPH is a largely preventable condition. Uterine atony and retained placenta were major causes of the condition in our center. This is a reflection of mismanagement of third stage of labour. Identification of patients at risk during pregnancy and labour with prompt intervention to prevent blood loss is advocated.Trop J Obstet Gynaecol, 30 (1), April 201

Survey on the use of misoprostol for induction of labour among Obstetricians in the west African sub region

Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complicationsObjective: To determine the use of Misoprostol for induction of labour among the Obstetricians in the West African sub region.Methodology and settings: During the October 2007 pre examination workshop of the West African College of Surgeons (FWACS), Faculty of Obstetrics and Gynaecology 42 examiners responded through structuredquestionnaires on the use of misoprostol for induction of labour (IOL) in their institutions of practice. Results: About 91 % admit using misoprostol for IOL with only half (50%) having written protocols for labour induction with misoprostol. Almost all (93%) prefer the vaginal route for the administration of misoprostol andabout 74% do not use misoprostol for those with Caesarean section scar compared to only 19% who do. Misoprostol is used for cervical ripening and control of post partum haemorrhage among 24.4% and 50% of theObstetricians respectively. The commonest complications encountered were Fetal distress, uterine rupture and uterine hyper tonus among 54.8%, 52.4% and 45.2% of the respondents.Conclusions: Misoprostol use was high with yet serious complication occurring among those using it for IOL. Despite the manufacturers and other regulatory agents warning against its use in pregnancy because of serious maternal and fetal complications, misoprostol use for IOL is widespread. A regulated use of this drug especially in pregnancy is advocated

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Hysterosalpingography versus Laparoscopy in the Evaluation of Female Infertility in Maiduguri, Nigeria.

Objective: To compare the results of hysterosalpingography and laparoscopic methylene blue test for assessment of tubal patency in patients with infertility. Subjects and Methods: The case records of 124 patients who underwent both hysterosalpingography and laparoscopy as part of comprehensive infertility work-ups at the University of Maiduguri Teaching Hospital between January 1996 and December 2000, inclusive, were reviewed. Results: There was a close correlation of both methods in 90.9% of the cases in the diagnosis of tubal patency. There was no statistical difference in the diagnosis of tubal occlusion using both hysterosalpingography and laparoscopy. However, there was a significant difference in the ability to make a diagnosis of peritubal adhesions for which laparoscopy was more useful (p < 0.001). Conclusion: The results suggest that laparoscopy is a superior method in the investigation of tubal patency with a better potential for full appraisal of peritubal adhesions prior to tuboplasty. It is therefore recommended as an essential investigation in patients with infertility. Key Words: Hysterosalpingography, Laparoscopy, Tubal Patency [Trop J Obstet Gynaecol, 2003, 20: 20-23

Survey on the use of misoprostol for induction of labour amon obstetricians in the West African sub-region

No Abstract

Male Contribution to Infertility in Maiduguri, Nigeria

Context: Infertility is a frequent reproductive health problem in this environment. Abnormalities of seminal fluid may be found in up to 60% of infertile couples. Various factors are known to be responsible for seminal fluid abnormalities. Local studies on this very important health problem are few. Objective: The objective of this study was to determine the magnitude of male contribution to infertility in North Eastern Nigeria and the factors responsible. Study Design, Setting and Subjects: A descriptive study of 704 males with abnormal seminal fluid profile who were investigated at a university teaching hospital over a 12-month period. Relevant past medical history, physical examination and investigation results were extracted from the patients' case records. Results: A total of 1201 seminal fluid analyses were conducted during the study period. Abnormalities were detected in the seminal fluid of 704 (58.6%) patients. Male factors were the only identifiable cause of infertility in 70% of the cases. Azoospermia (12.8%) and oligozoospermia (26.8%) were the most frequent semen abnormalities found. Varicocoele (13.9%), previous groin surgery (16.8%) and chronic urethritis and/or male accessory gland infection (5.5%) were the main associated clinical findings in the patients. Conclusion: Male factor contributes significantly to infertility in this environment. The treatment of infertility using conventional methods have very low success rates while recent technologies are expensive and not readily available in this environment. It is therefore necessary for us to understand the various factors that contribute to male infertility in our environment so as to develop preventive strategies. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 87-90

Prolactin Levels Among Infertile Women in Maiduguri, Nigeria

Objective: The objectives of this study were to determine the manner of clinical presentation of women with unexplained infertility in Maiduguri, North-Eastern Nigeria and their plasma levels of prolactin. Materials and Methods:The records of 104 females undergoing infertility investigation at the University of Maiduguri Teaching Hospital and for whom no organic cause had been found were scrutinised to extract the details of their modes of clinical presentation. All had plasma prolactin level assays. Results: The patients were aged between 20 and 40 years (mean: 28.3 years). Thirty-three (31.7%) of them had primary infertility while 71 (68.3%) had secondary infertility. Of the 104 patients, 33 (31.7%) had abnormal plasma prolactin levels. The women with secondary infertility were more likely to have abnormal prolactin levels: 22 (21.1%) compared to only 11(10.6%) among patients with primary infertility. About one-third of the patients presented with amenorrhoea (2% with primary and 34.6% with secondary amenorrhoea). Among patients presenting with amenorrhoea only 13 (12.5%) had elevated prolactin levels. Twenty four (23.1%) of the patients had galactorrhoea, of whom only 10 (9.6%) had hyperprolactinaemia. Patients with secondary infertility were more likely to have galactorrhea (17.3%) compared to patients with primary infertility (5.8%). The association of hirsutism, amenorrhoea and hyperprolactinaemia was not a common finding in our patients. Conclusion: The use of dopaminergic-agonist therapy in women with unexplained infertility requires careful consideration, ensuring that the plasma prolactin levels and the clinical mode of presentation are factored into the decision to prescribe the drugs. Key Words: Infertility, Anovulation, Prolactin, Amenorrhoea [Trop J Obstet Gynaecol, 2003, 20: 97-100