Eclampsia at the university of Abuja teaching hospital: a ten-year review

Background: Worldwide, eclampsia remains one of the major causes of maternal and perinatal morbidity and mortality. Pre-eclampsia/eclampsia is a multisystem disease and despite extensive research, no definitive etiology has been identified. This disease therefore continues to pose a challenge in obstetric practice, especially in developing countries like ours. We therefore set out to determine the prevalence, associated factors, and outcome of eclampsia at the University of Abuja Teaching Hospital, Abuja, Nigeria.Methods: A descriptive retrospective review of cases of eclampsia managed at the University of Abuja Teaching Hospital, Abuja over a 10-year period. The case notes of these women were retrieved, and relevant data obtained included age, parity, booking status, type of eclampsia, gestational age at presentation, mode of delivery, maternal and perinatal outcome variables. Data was analysed using the statistical package for social sciences (SPSS Inc, Chicago) version 20 and outcome variables represented in simple percentages.Results: Of the 22,945 deliveries conducted during that period, 257 cases of eclampsia were managed, putting the prevalence of eclampsia at 1.12%. Of these, 90.5% were unbooked, 67.6% were primigravidae and 88.2% were below 30years of age. Antepartum eclampsia was the commonest form, occurring in 67.6% of the patients. Caesarean section was the mode of delivery in 82.2% of cases. Maternal and perinatal mortality were 4.6% and 11.1% respectively.Conclusions: Eclampsia is still a major cause of maternal and perinatal morbidity and mortality in our environment. One intervention to reduce its impact is education on the importance of antenatal care attendance. It’s also pertinent that this basic form of care be made more affordable and more easily accessible to those women who are socially disadvantaged

Incidence, characteristics, pattern and management of ovarian cancer in Abuja, Nigeria

Background: The prevalence of ovarian cancer is thought to be increasing with huge burden of the disease with no comprehensive cancer center that can offer appropriate care in developing countries. However, little is known about the incidence, pattern and outcome of this disease in Abuja, Nigeria. Therefore, the aim of this study was to review the pattern of care offered to patients with ovarian cancer in our center and to evaluate patients’ outcome.Methods: This was a retrospective review of all the patients with histologically confirmed ovarian cancers admitted to the gynecological ward of the hospital over a period of 5 years. Relevant information was extracted from the ward register and patients medical case records. Data were analyzed using statistical package for social science version 23 and results were then presented in tables and chart.Results: Ovarian cancers constituted 19.6% and 5.6% of all gynecological cancers and all gynecological admissions respectively. The mean age at presentation was 50.2±8.5 years and premenopausal 32 (55%) constituting the majority. A large proportion 43 (74.1%) of the patients were parous. The commonest symptoms at presentation were abdominal swelling (86.2%), and abdominal pain (53.4%) with the majority 38 (65.5%) presenting in an advanced stage. The commonest histological type of ovarian cancers was epithelial accounting for 30 (51.7%) of all ovarian cancers. Common treatment modality was surgery and chemotherapy and majority 32 (55.3%) of the patients had cytoreductive surgery with 19 of them having optimum cytoreduction and 33 (57%) benefitted from chemotherapy. Lost to follow- up was significantly high (55%) and mortality rate was 15.5%.Conclusion: Cases of ovarian cancers are on the increase. Women presented at an advanced stage of the disease, which resulted in short survival times. Failure of optimal management was also worsened by poor compliance to treatment with high patients' default rate

Risk factors for hypertensive disorders of pregnancy in Abuja, Nigeria: A prospective case‑control study

Background: Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries like Nigeria. The study determined the risk factors for the development of HDP among women who booked early for antenatal care. Materials and Methods: This was a prospective case‑control study conducted from March 2015 to March 2016 involving pregnant women with gestational age less than 20 weeks at booking and were followed up until delivery and 6 weeks postpartum. Information on gestational age at recruitment, at diagnosis of HDP, mode of delivery, and fetal outcome were recorded. Risk factors for HDP were compared between women who developed HDP (cases) and those who did not develop HDP (controls) by Fisher’s exact test, Chi‑square, and student’s t‑tests. Univariate and multivariate logistic regression analysis was used to test the relationship between certain risk factors and the development of HDP. A P value of less than 0.05 was considered statistically significant. Results: The prevalence of HDP in the study was 19.4%. Family history of preeclampsia (OR: 5.339, 95% CI: 1.149–24.818, P = 0.033); previous history of preeclampsia (OR: 10.819, 95% CI: 3.570–32.792, P < 0.001); multifetal gestation (OR: 13.275, 95% CI: 2.899–38.127, P = 0.010); chronic hypertension (OR: 3.431, 95% CI: 1.778–8.710, P < 0.001) and diabetes; (OR: 2.846 95% CI: 0.460–17.584, P < 0.251) were the risk factors associated with the development of HDP among the study population while nulliparity (OR: 0.726, 95% CI 0.366–1.440, P = 0.395); body mass index (BMI) (mean ± SD), (OR: 0.405, 95% CI: 0.173–0.945, P < 0.037);and low educational level (OR: 0.582, 95% CI: 0.070–4.857, P = 0.613) were not. Conclusion: The prevalence of HDP in the study group was high. Risk factors for HDP included family history of hypertension, previous history of preeclampsia, multifetal gestation, and chronic hypertension. Key words: Abuja; hypertensive disorders of pregnancy; Nigeria

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Analysis of burden of sexual assaults at Abuja: a 4-year retrospective study

Background: Sexual assault is a worldwide crime associated with traumatic experience and largely affects women and girls. It is greatly underreported, more especially in the low income countries due to our peculiar culture.Methods: A retrospective study of sexual assault victims managed at the Hospital from January 1, 2015 to December 31, 2018. Case notes were retrieved and relevant data extracted and analyzed.Results: A total of 58 cases were seen and mostly involving pupils/students 44 (75.9%) and singles 52 (89.7%). The ages ranged from 3 to 37 years with a mean of 14.1±7.8. The assailants were known to the victims in 63.8% of cases. Sexual assault through vaginal route was the commonest type 57 (98.3%) and perpetrated by one person in majority of cases (79.0%). Physical force (43.1%) was major method used to subdue victims. About 60.3% of assaults occurred during the daytime and mainly occurred (60.4%) at home/office. The time interval between assault and presentation in the hospital ranged from 6 hours to 96 hours; majority presented within 24 hours (59.6%). Only 35 (60.3%) reported to the police. About 48.3% received post exposure prophylaxis. About 37.7% eligible for emergency contraception received it. Only 32.8% of the victims completed 3- month follow-up.Conclusions: Sexual assault is common in our environment with most victims being less than 14 years of age and assailants were mostly persons known to them. Some victims presented late