Effect of upgraded emergency services on obstetric case fatality at a Tertiary Hospital in Cross River state, Nigeria

No Abstract

The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003

Objective: To determine the factors contributing to unexplained antepartum stillbirth in Scotland. Study Design: A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above. Result: Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures. Conclusion: Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value

Review of Policies and Programs for Reducing Maternal Mortality and Promoting Maternal Health in Cross River State, Nigeria

The study was designed to determine the status of maternal health in Cross River State, a state in the Niger-Delta region of Nigeria with high rate of maternal mortality. The study consisted of analysis of clinical data, desk reviews of published and unpublished materials and interviews with policymakers and service providers. The results show that although 75.6% of pregnant women in the state attend at least one antenatal visit, only 34.8% are attended to by skilled birth attendants when in labour. Hospital based maternal mortality rate in the state over 11 years (1999-2009) averaged 1,513.4 per 100,000 live births. Human resources for health are 12 Doctors and 47.4 Nurse/midwives per 100,000 of the population. Obstetrics hemorrhage remains the most common cause of maternal mortality, while type III delay is the leading social cause of death. The state has relevant policies that address maternal health such as Free Maternal and Child Health and the national Midwives Service Scheme. However, budgetary allocation for maternal health is small. Deliberate efforts must be made to increase allocation and improve political commitment to reduce the high rate of maternal mortality in Cross River State (Afr. J. Reprod. Health 2010; 14[3]: 37-42).Key words: Maternal Mortality, Cross River State, Nigeria, Policies, Programs, Free Maternal Health Services

Pregnancy outcome in women aged 40 years and above in Calabar, Nigeria

One hundred and ten women who were 40 years old and above and 109 women of between 20 and 30 years that delivered in University of Calabar Teaching Hospital, Calabar were studied to assess the maternal and perinatal outcome of such pregnancies. Relevant information was obtained from the case files. The incidence of 1 in 98 or 1% of total deliveries was established in the older age group. Most of the pregnancies occurred before the age 43 years (85.5%) and among the illiterates with only 16.4% educated to primary school level. Married women were 50.9% and 65.5% were grand multiparous. The complications identified included anemia (45.5%) preterm labour (45.9%), obstetric haemorrhage (12.5%) with uterine fibroid and diabetes mellitus seen only in women of advanced age. Labour was less likely to be induced (7.3% vs 12.8%) or augmented (10.9% vs 19.3%) in the older women compared to the young ones. The older women were delivered more by caesarean section (28.2% vs 9.1%) while the young people had more of instrumental vaginal deliveries. Prematurity and birth asphyxia were the most common perinatal complications. Pregnancy at advanced maternal age, which is not rare in Calabar is high risk whose problems are compounded by illiteracy, high parity and low contraceptive usage. Effective and affordable contraceptive methods will reduce the incidence and proper utilization of available obstetric facilities by the old pregnant women will reduce the complications. Keywords: pregnancy, maternal age 40 years and above, outcome Mary Slessor Journal of Medicine Vol. 5(1), 2005: 28-3

Unattended Deliveries and Perinatal Outcome: A Tertiary Hospital Experience

Objective: To determine the neonatal morbidity and mortality pattern in a cohort of infants born outside hospital but admitted in Abha Maternity Hospital, Saudi Arabia. Patients and Methods: The charts of 151 women and their infants born at home or en route to the hospital were reviewed and the findings were compared with those of 300 in-hospital (in-born) deliveries from January 1990 to December 1996. Results: Of the 151 unattended deliveries, 36 percent occurred at home and 64 percent in motor vehicles. Eighty-three percent of the out-born and 63 percent of the controls had no antenatal care. The incidence of respiratory distress syndrome (RDS) was significantly higher (p=0.002) among the out-born cases. Perinatal mortality among the out-born deliveries was 6.7 percent, in contrast to the 1.0 percent in the in-born group. Conclusion: Despite adequate health facilities and governmental financial support, lack of health education and initiative on the part of the patients might be a major contributing factor to the high level of unattended deliveries with the associated adverse outcome. Intensive health education with emphasis on the need for antenatal care and on the dangers of delivering infants outside health facilities is advocated. Keywords: Unattended delivery, perinatal outcome, Saudi Arabia Nigerian Journal of Paediatrics 2002; 29: 66-70

A Prospective Comparative Study of the Bacterial Flora of the Vagina and Cervix in Non-Pregnant Women of Childbearing Age in Calabar, Nigeria.

A qualitative comparative study of the bacterial flora of the vagina and cervix of 90 non-pregnant women of childbearing age (18-35 years) in Calabar was undertaken. The study revealed that both aerobic and microaerophilic organisms as well as the strictly anaerobic bacteria constituted the microflora of the lower genital of this group of women. Of the 90 women sampled, Lactobacilli were the most frequently isolated organism in both the cervix and vagina, occurring in 62.2% and 75.6% and the samples respectively. Proteus species were the least in incidence, occurring in only 4% of either the cervical or vaginal specimens. The following pathogenic organisms were isolated in both the vagina and cervix: Escherichia coli, Staphylococcus aureus, Candida albicans, Clostridium species and Beta-haemolytic Streptococci. In general, the same types of organisms were isolated in both the cervical and vaginal samples, although the incidence in the two sources varied. Mary Slessor Journal of Medicine Vol.3(2) 2003: 1-

The Profile of Norplant Acceptors in Calabar

This study was based on a review of client record notes of 1048 Norplant acceptors at the Family Planning Unit, University of Calabar Teaching Hospital (UCTH), who presented between January 1989 and December, 1995. There were 5340 new contraceptive acceptors during the study period, with a Norplant acceptance rate of 19.6%. The modal age range in the study was 20-29 years (60.0%). Educational level of clients showed that 143 (13.6%) did not have any formal education, while 486 (46.4%) had secondary education. Norplant acceptors were engaged in nine different types of occupation, with the most predominant being petty traders (19.2%), seamstresses (14.3%) and hairdressers (14.0%). Six hundred and seventy-six (64.5%) clients were married, while, 472 (45.0%) had three to five children. Clients became aware of Norplant through friends and relatives in 398 (38.0%) cases and through referrals from other clinics in 203 (19.4%) cases. These results suggest that Norplant is readily acceptable to married clients of low and middle – income levels desirous of regulating their family size. Adolescents and other women in unstable relationships should also be targeted. Key Words: Norplant Use, Profile of Acceptors, Source of Information. Mary Slessor Journal of Medicine Vol.4(1) 2004: 45-4