Hepatitis B surface antigenaemia among pregnant women in a tertiary health institution in Ekiti State, Nigeria

Background: It has been recognized that Hepatitis B virus infection is endemic in Nigeria. Despite this, routine screening in pregnancy and treatment are not widely practiced in the country.Objective: To identify the prevalence and pattern of the disease among the obstetric population in Ekiti State.Materials and Methods: A review of the records of 505 consecutively booked and consenting pregnant women at the antenatal clinics of the Ekiti State University Teaching Hospital, Ado - Ekiti. The duration of the study was from April 2011 to November 2011. All the patients were screened for Hepatitis B surface antigen (HBsAg). Using a questionnaire, information retrieved included their socio-demographic characteristics, possible risk factors (blood transfusion and surgery) and HBsAg screening result.Results: 20 of the 505 pregnant women were seropositive for HBsAg giving prevalence of 4.0%. Multiparous women aged between 30 - 34 years and with secondary education had the highest proportion of infected people although these associations did not reach significant levels. More women in the latter half of pregnancy were HBsAg seropositive (p < 0.05).Conclusion: It is recommended that all pregnant women be routinely screened for HBV, and preventive measures emphasized to reduce the burden of HBV infection.Keywords: Hepatitis B surface antigen, pregnancy, seroprevalence, Ekit

Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population.

PURPOSE: Morbidity and mortality from ruptured tubal pregnancies (RTPs) have been linked with delays in seeking and receiving care. Evaluation of the reasons for these delays and their contributions to maternal deaths is rarely done for women with RTPs in resource-constrained settings. PATIENTS AND METHODS: This was a 3-year retrospective review of the case records of women with tubal pregnancies managed at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Clinical and sociodemographic parameters were obtained, including information on onset of symptoms and intervals between the symptoms and when help was sought and obtained at the hospital. RESULTS: There were 92 cases of tubal pregnancies, giving an incidence of 18 per 1,000 births. Most of the patients were married (74.7%), parous (64.9%), and urban dwellers (76.9%), and 11% were severely anemic on arrival. The case-fatality rate was 1.1% and 74.7% had delay in seeking care, while 82.4% of the women spent more than 2 hours after admission before surgical intervention. Rural dwellers (adjusted odds ratio 2.96, 95% confidence interval 1.08-8.36) and those without formal education (adjusted odds ratio 6.39, 95% confidence interval 1.06-67.30) had delays in seeking help, while problems with funds (χ (2)=7.354, P=0.005) and initial misdiagnosis (χ (2)=5.824, P=0.018) predicted delay in obtaining help at the hospital. CONCLUSION: RTPs are common gynecological emergencies in our environment that are often associated with delayed decisions to seek help and obtain care. Efforts should be geared toward women's education and financial independence, improved hospital accessibility, and better diagnostic skills

Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital.

PURPOSE: This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. METHOD: A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. RESULTS: The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (p = 0.016), delays in seeking medical care and/or in receiving treatment (p = 0.001), wrong initial diagnosis (p = 0.001), inadequate intrapartum monitoring (p = 0.001), and inappropriate clinical management (p = 0.001). CONCLUSION: Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence

Preterm births in a resource constrained setting: sociobiologic risk factors and perinatal outcomes

Background: To determine maternal risk factors and perinatal outcomes of preterm births in south-western Nigeria.Methods: A retrospective study of preterm and term deliveries in a tertiary hospital in Nigeria. The delivery records were reviewed and case files of preterm births were identified and retrieved. Perinatal outcomes were determined by review of the postnatal and special care baby unit records. Multivariate logistic regression was carried out to determine factors independently associated with preterm births. Adjusted odds ratios and confidence intervals were determined.Results: The preterm birth rate was 5.7%. Prelabour rupture of membranes was the leading cause of preterm birth, while a third of them were unexplainable. Age >35yrs (AOR 2.16(1.36-3.42)), the unbooked status (AOR 2.52(1.76-3.61)), Previous history of preterm delivery (AOR 6.41(2.48-16.60)), pre-labour rupture of membranes (AOR 11.08(6.01-18.56)), antepartum haemorrhage (AOR 10.91(4.94-24.09)), multiple gestations (AOR 32.23(13.07-79.50)) and hypertension in pregnancy(AOR6.42(3.79-10.88)) were independently associated with preterm delivery. Low birthweight, asphyxia, neonatal intensive care unit admission and perinatal mortality were common among preterm births. The perinatal mortality rate among the preterm neonates was 14.5%.Conclusion: Preterm birth remains a significant cause of perinatal deaths. Strategies addressing potentially modifiable risk factors will reduce the incidence and improve the perinatal outcomes associated with preterm births.Keywords: preterm delivery, prematurity, perinatal mortality, Nigeria

Caesarean myomectomy – An option in fibroid-endemic, low-resource settings?

Context: Widespread use of myomectomy during caesarean delivery could potentially eliminate multiple surgeries for both indications. However, many surgeons have been reluctant to adopt this policy without conclusive evidence demonstrating its safety.Objective: To evaluate the safety of myomectomy during caesarean delivery.Study Design: A review of the publications on caesarean myomectomy especially from the African continent.Main outcome measures: Duration of surgery, blood loss, length of hospital stay and blood transfusions.Results: Judging from the lack of large studies on caesarean myomectomy, the proportion of surgeons who attempt the procedure is low largely because of concerns about its safety. However, most of the authors suggested that the complications and morbidity following caesarean myomectomy do not significantly differ from those occurring during caesarean section alone, while fertility is apparently not compromised by this treatment. With careful patient selection, adequate experience and efficient haemostatic measures, the procedure does not appear as hazardous as was once thought. This information is relevant for counseling women who request for the simultaneous removal of previously diagnosed fibroids during caesarean section.Conclusion: Although complications could occur, caesarean myomectomy appears safe. Staff and facilities for safe management of haemorrhage are a requisite for the procedure. Large randomized trials are needed to guide decisions as to the best clinical practice regarding myomectomy during caesarean delivery.Key words: Caesarean section, myomectomy, fibroids, complications, Africa