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

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

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  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

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.Results: The mean T3, T4 and TSH, in preterm compared with full term neonates were similar (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