Thyroid function determinants in cord blood of Nigerian neonates

Background: Congenital hypothyroidism is one of the most prevalent endocrine disorders in the newborn; early diagnosis and treatment have resulted in normal growth and development in nearly all cases. Data on congenital hypothyroidism in Nigeria is limited, hence, this study aims at establishing the baseline values and prevalence of congenital hypothyroidism as a prelude to a screening centre in our locality.Methods: Cord blood samples were consecutively obtained from two hundred and eighty nine neonates born in the Delivery ward of the University of Maiduguri Teaching Hospital (UMTH). 152 (52.8%) of the neonates were males and 137 (47.2%) were females. Nineteen were preterm and 270 were full term. Triiodothyronine (T3), Thyroxine (T4) and Thyroid-stimulating hormone (TSH) were analyzed using ELISA kits. Data was analyzed using student “t” test and Pearson correlation coefficient. The difference was considered statistically significant at p 0.05). Triiodothyronine (T3) was undetectable in 75.8% of the neonates and very low in 24.2%. Twelve (4.2%) of the neonates had TSH levels >40µIU/ml with a mean TSH of 61.7±14.7 µIU/ml and a mean T4 of 7.7±3.7µg/dl.Conclusions: About 4.2% of neonates are at risk of congenital hypothyroidism with High TSH and low T4 values, T3 values are undetectable or very low in late prenatal life

Seroprevalence and associated risk factors of hepatitis E virus infection among pregnant women attending Maiduguri teaching hospital, Nigeria

Background: Hepatitis E Virus (HEV) is a major public health problem in developing countries and often fatal among pregnant women in the third trimester. Objectives: The study investigated the sero-prevalence and risk factors of HEV infection among pregnant women attendee of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methods: The cross-sectional study was carried out between 4th January 2016 to 30th May, 2016. One hundred and eighty blood samples from pregnant women who consented and enrolled for the study were analyzed for anti – HEV IgM using a quality assured commercial Enzyme Linked Immunosorbent Assay (ELISA) kit. Structured questionnaires were used to collate the sociodemographic characteristics and risk factor of study subjects. Results: Out of the 180 pregnant women sampled, the anti-HEV IgM seroprevalence of 13.3% was recorded.  The seroprevalence was significantly higher in the age range of 31 – 35 years (26.5%) and least in age range ≤ 20 years (4.9%) (p=0.009).  The highest seroprevalence was recorded in the third trimester 14.1% followed by second (p>0.05). After logistic regression, nature of toilet system, and source of water consumption were significant risk factors for active HEV infection (p˂0.05). Conclusion: Based on the 10.8 % pooled national prevalence of HEV infection in Nigeria, this study recorded a significantly high level of anti – HEV IgM seropositivity, an indication of recent and active HEV infection among pregnant women at the study area. Also, these infections are most among the pregnant women in their third trimester. HEV infection was related to personal, water and environmental hygiene

The Natural History of Placenta Praevia in a Nigerian Population

Context: Placenta praevia is a major cause of antepartum haemorrhage. The introduction of real time ultrasound scan has made early detection of placenta praevia possible. However, the determination of which placenta will consistently remain praevia throughout pregnancy is uncertain. Objective: To determine the natural history of placenta praevia detected by transabdominal ultrasound scan at 12-14 weeks gestation till delivery. Study Design: A prospective longitudinal study of antenatal women with placenta praevia detected by transabdominal ultrasound scan at 12-14 weeks gestation at the antenatal clinic of the University of Maiduguri Teaching Hospital. The subjects were followed up by serial ultrasound scan until delivery. Result: Out of 895 consecutive pregnant women scanned in early pregnancy, 14.6% had placenta praevia at 12-14 weeks gestation. Longitudinal follow-up of those with placenta praevia showed that 85% had normally situated placenta at term. Among those with partial or total placenta praevia at 30 weeks gestation, 60% and 75% respectively persisted as major placenta praevia at term. A total of 45% of those with placenta praevia at recruitment had threatened abortion while 15.7% of them had anepartum haemorrhage. Caesarean section rate was as high as 25% among the study population when compared with 8.4% among the general population (p< 0.005). Conclusion: Placenta praevia in the first trimester becomes normally situated at term in about 85% of cases. However, partial and total placenta praevia at 30 weeks gestation are likely to persist to term in 60% and 75% of cases respectively; these categories of patients should be closely followed-up to term. Key Words: Placenta Praevia,Ultrasonography, Antepartum Haemorrhage [Trop J Obstet Gynaecol, 2004;21:128-130

The Pattern and Spectrum of Severe Maternal Morbidities in Nigerian tertiary Hospitals

Maternal morbidities are precursors to maternal mortality as well as potential causes of life time disability and poor quality of life. This study aimed to determine the pattern and spectrum of life-threatening maternal morbidities seen in tertiary reproductive health facilities in Nigeria. All cases of severe maternal outcome (SMO), maternal near-misses (MNM), or maternal death (MD), attending 42 tertiary hospitals across all geopolitical zones of Nigeria were prospectively identified using the WHO criteria over a period of 14 months. The main outcome measures were the incidence and outcome of severe maternal outcome by geopolitical regions of Nigeria. The participating hospitals recorded a total of 4383 severe maternal outcomes out of which were 3285 maternal near-misses and 998 maternal deaths. The proportion of maternal near-miss was similar across all the geopolitical zones but the maternal mortality ratio was highest in the southwestern zone (1,552) and least in the northcentral zone (750) of the country. Haemorrhage was the leading cause of severe maternal morbidities followed by hypertensive disorders of pregnancy. The mortality index of about 41% using the organ dysfunction criterion was triple the figures from other parts of the world. The findings reflect poor obstetric care in the tertiary hospitals in Nigeria. The health facilities in the country urgently need to be revamped. Keywords: Pattern and spectrum, severe maternal outcome, maternal near-miss, maternal death, WHO near-miss criteriaLes morbidités maternelles sont des précurseurs de la mortalité maternelle ainsi que des causes potentielles d'invalidité à vie et d'une mauvaise qualité de vie. Cette étude visait à déterminer le modèle et le spectre des morbidités maternelles potentiellement mortelles observées dans les établissements de santé de la reproduction tertiaire au Nigéria. Tous les cas de résultats maternels graves (SMO), de quasi-accidents maternels (MNM) ou de décès maternels (MD), fréquentant 42 hôpitaux tertiaires dans toutes les zones géopolitiques du Nigéria ont été prospectivement identifiés en utilisant les critères de l'OMS sur une période de 14 mois. Les principales mesures de résultats étaient l'incidence et l'issue des issues maternelles graves dans les régions géopolitiques du Nigéria. Les hôpitaux participants ont enregistré un total de 4383 issues maternelles graves, dont 3285 quasiaccidents maternels et 998 décès maternels. La proportion de quasi-accidents maternels était similaire dans toutes les zones géopolitiques mais le taux de mortalité maternelle était le plus élevé dans la zone sud-ouest (1 552) et le moins dans la zone centre-nord (750) du pays. L'hémorragie était la principale cause de morbidités maternelles sévères, suivie de troubles hypertensifs de la grossesse. L'indice de mortalité d'environ 41% en utilisant les critères de dysfonctionnement des organes était le triple des chiffres des autres parties du monde. Les résultats reflètent la médiocrité des soins obstétricaux dans les hôpitaux tertiaires au Nigéria. Il est urgent de réorganiser les établissements de santé du pays. Mots-clés: Schéma et spectre, issue maternelle grave, quasi-accident maternel, décès maternel, critères WHO de quasi-acciden

A Shortened versus Standard Matched Postpartum Magnesium Sulphate Regimen in the Treatment of Eclampsia: a Randomised Controlled trial.

Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia. Between January and June 2011, 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart. The maternal and fetal outcomes were compared. The primary outcome measure was recurrence of fits. The recurrence of fits and other maternal complications were similar in the two groups. The total dosage of magnesium sulphate in the shortened group was reduced by 40% in 66% of patients. The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia.Le sulfate de magnésium est actuellement le médicament le plus idéal pour le traitement de l&apos;éclampsie, mais son utilisation au Nigeria est encore limitée en raison de son coût et des cliniciens inexpérience avec la drogue. Le but de cette étude était de déterminer si un cours du post-partum raccourcie de sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans le contrôle unique de l&apos;éclampsie. Entre janvier et juin 2011 98 mères éclampsie qui se présentent à la salle de travail du Centre Hospitalier de l’Université de Maiduguri ont été randomisés pour recevoir soit le traitement de Pritchard standard de sulfate de magnésium ou d&apos;un cours du post-partum raccourci dans lequel seulement deux doses de sulfate de magnésium par voie intramusculaire sont données quatre heures d&apos;intervalle. Les résultats maternels et foetaux ont été comparés. Le critère de jugement principal était la récurrence de crises. La récurrence des crises et autres complications maternelles étaient similaires dans les deux groupes. La dose totale de sulfate de magnésium dans le groupe raccourci a été réduite de 40% à 66% des patients. Le cours du post-partum abrégée du sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans la gestion de l&apos;éclampsie

Ectopic pregnancy at a tertiary hospital in North Eastern Nigeria: a 2 year review of the clinical presentations and management

Background: Ectopic pregnancy is a life threatening gynaecological condition associated with adverse reproductive health consequences. It commonly implants in the fallopian tube and most patients in the developing world present &nbsp;late when it has ruptured leading to maternal morbidity and mortality if intervention is delayed. Method: This was a descriptive cross-sectional retrospective study of patients with ectopic pregnancy managed at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, North east Nigeria between 1st January, 2013 and 31st December, 2014. Data on the age, parity, clinical symptoms and signs and the types of surgical treatment offered was extracted and computed using excel spreadsheet and statistical analysis was done using SPSS (version 23) and results presented as frequency tables, percentages, and mean (± SD). Results: There were 1,577 gynaecological admissions during the period of study and 98 of them (6.2%) were ectopic pregnancies. The total number of deliveries during the same period was 6,738, putting the incidence of ectopic pregnancy to be 1.45% of all deliveries. Majority of the affected patients (39.2%) were between 25- 29 years with a mean and SD of 26.5 ± 4.9 years. Majority of the patients who had ectopic pregnancy 26 (35.1%) were nulliparous women. Of these patients, 97.3% presented with symptoms of abdominal pain, amenorrhoea (83.8%) and vaginal bleeding (68.9%). 97.3% of them had salpingectomy of the affected side. Conclusion: Ectopic pregnancy is a common life-threatening emergency in early pregnancy. Efforts made to improve early diagnosis prior to tubal rupture, would help reduce the associated maternal morbidity and eliminate mortality from this condition

Implementation and Evaluation of Obstetric Early Warning Systems in Tertiary care Hospitals in Nigeria

Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to explore the experience of health workers about the implementation of an obstetric EWS and assess its effectiveness as an alternative clinical monitoring method compared to standard practice. This mixed-method study included obstetric admissions (n=2400) to inpatient wards between 01/08/2018 and 31/03/2019 at three Nigerian tertiary hospitals (1 intervention and two control). Outcomes assessed were the efficiency of monitoring and recording vital signs using the patient monitoring index and speed of post-EWS trigger specialist review. These were evaluated through a review of case notes before and four months after EWS was introduced. Qualitative data was collected to explore healthcare workers’ views on EWS’ acceptability and usability. EWS was correctly used in 51% (n=307) of the women in the intervention site. Of these women, 58.6% (n=180) were predicted to have an increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. Health workers reported that the EWS helped them cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use and that scores consistently correlated with the clinical picture of patients. Identified challenges included rotation of clinical staff, low staffing numbers and reduced availability of monitoring equipment. The implementation of EWS improved the frequency of patient monitoring, but a larger study will be required to explore the effect on health outcomes. The EWS is a feasible and acceptable tool in low-resource settings with implementation modifications

Thyroid function determinants in cord blood of Nigerian neonates

Background: Congenital hypothyroidism is one of the most prevalent endocrine disorders in the newborn; early diagnosis and treatment have resulted in normal growth and development in nearly all cases. Data on congenital hypothyroidism in Nigeria is limited, hence, this study aims at establishing the baseline values and prevalence of congenital hypothyroidism as a prelude to a screening centre in our locality.Methods: Cord blood samples were consecutively obtained from two hundred and eighty nine neonates born in the Delivery ward of the University of Maiduguri Teaching Hospital (UMTH). 152 (52.8%) of the neonates were males and 137 (47.2%) were females. Nineteen were preterm and 270 were full term. Triiodothyronine (T3), Thyroxine (T4) and Thyroid-stimulating hormone (TSH) were analyzed using ELISA kits. Data was analyzed using student “t” test and Pearson correlation coefficient. The difference was considered statistically significant at p &lt; 0.05.Results: The mean T3, T4 and TSH, in preterm compared with full term neonates were similar (p&gt;0.05). Triiodothyronine (T3) was undetectable in 75.8% of the neonates and very low in 24.2%. Twelve (4.2%) of the neonates had TSH levels &gt;40µIU/ml with a mean TSH of 61.7±14.7 µIU/ml and a mean T4 of 7.7±3.7µg/dl.Conclusions: About 4.2% of neonates are at risk of congenital hypothyroidism with High TSH and low T4 values, T3 values are undetectable or very low in late prenatal life

Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria

ObjectiveTo estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.DesignRetrospective observational study.SettingA total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.PopulationPregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.MethodsSecondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.Main outcome measuresRisk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.ResultsObstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.ConclusionsModifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions