Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria. Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births. Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ≥40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021. Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility

Predisposing factors and outcome of uterine rupture in Jos, North-central Nigeria

Background: Uterine rupture has continued to be an obstetric catastrophe with tragic maternal and foetal outcomes particularly in Nigeria.Methods: an institutional, cross sectional retrospective study was carried out at Jos University Teaching Hospital, North-Central Nigeria. Case files of mothers with uterine rupture managed at the hospital from 1 January 2011 to 31 December 2019 were retrieved and included in the study. Data extracted from case files included maternal age, parity, gestational age, booking status, presence of uterine scar, obstetric interventions prior to rupture, site of rupture, type of surgery, units of blood transfused, intensive care unit admission and duration of hospital stay and maternal or foetal death.Results: the incidence of uterine rupture was 1 in 497 deliveries (0.2%). The mean age of the patients was 30.1±5.1years. About 75% of the patients were para 1-4. Seventeen (70.8%) patients were unbooked while fourteen (58.3%) had unscarred uterine rupture. Eight out of 14(57.1%) patients with unscarred uterus had uterotonics for induction or augmentation of labour. Fourteen (58.3%) patients had rupture involving anterior lower uterine segment. Over half of the patients had uterine repair only (58.3%), 29.2% had uterine repair with bilateral tubal ligation while 12.5% had subtotal hysterectomy. Twenty-two (91.7%) required blood transfusion, five patients had 5 or more units of blood transfused. The perinatal mortality was 69.6%, there was no maternal death.Conclusions: the major predisposing factors to uterine rupture in our facility were lack of antenatal care, presence of previous caesarean section scar and injudicious use of uterotonics

Maternal satisfaction with intrapartum care at the Jos University Teaching Hospital

Background: A woman's satisfaction with the delivery service may have immediate and long term effects on her health and subsequent utilization of the services. Maternal satisfaction is an essential indicator of the quality and efficiency of health care systems. Providing skilled and satisfying care during pregnancy, intrapartum and postpartum period saves lives of both mother and neonates and so increases service utilization. Women play a principal role in the upbringing of children and the management of family affairs, and their loss from pregnancy related causes is a significant social and personal tragedy. Hence we sought to assess maternal satisfaction with the delivery service in Jos University Teaching Hospital and to determine satisfaction in relation to three dimensions; interpersonal care, information and involvement in decision making and physical birth environment Methods: A cross sectional study of postnatal women that attended the family health clinic between January to March 2015. A simple random sampling was used on eligible participants. An interviewer administered questionnaire that included respondents sociodemographic characteristics and validated 14 items maternal satisfaction with intrapartum care scale was used. Data was analysed using SPSS version 23. Results: A total of 173 mothers were interviewed, of which 64.6% of the respondents were between the ages of 20-34 years. All the respondents were married and had a mean age of 27.3±3.2 years. Greater than half of the participants (50.9%) had secondary level of education, 67.1% were multiparous while 32.9% were primiparous. Overall maternal satisfaction level with the delivery services rendered at the hospital was 86.7%. Conclusion: Although the majority of the participants were satisfied with the services given to them during delivery, lack of satisfaction by the minority group will limit their ability to engage in health facility delivery which will further contribute to maternal mortality. Thus, mechanisms should be devised to increase maternal satisfaction in this health institution

Accidental discovery of Unicornuate uterus during laparotomy for ruptured uterus: A case report

Background: Unicornuate uterus is one of the congenital anomalies that results from hypoplasia or agenesis of the Mullerian ducts. Its incidence is not well established due to varied classification systems. It is commonly diagnosed during evaluation for recurrent pregnancy losses and dysmenorrhoea. Some are diagnosed accidentally during Caesarean sections and laparotomies. This case is unique as she had previous recurrent pregnancy losses and a failed cervical cerclage in her th 4 pregnancy. She also had a Caesarean section in this facility in the past but proper diagnosis of her condition had not been made prior to the index pregnancy. Case  presentation We report a unicornuate uterus accidentally diagnosed during laparotomy for a ruptured unicornuate +3 uterus in a 29 year ol3d G7P3 2A at a gestational age of 35weeks and 2days. She had laparotomy with delivery of a fresh still born. There was an oblique rupture in the lower segment of the unicornuate uterus involving part of the previous incision. She had repair of the  unicornuate uterus because she insisted on her desire for future reproduction.Conclusion: Clinicians should always consider congenital uterine anomalies as one of the causes of recurrent pregnancy losses especially where cervical cerclage fails. Exhaustive evaluation of patients like this with 3D-ultrasonography and hysterosapingography in the preconception period will help to identify this anomaly. There is need for meticulous intraoperative examination of the pelvic and abdominal organs to forestall missing anomalies such as this. Key words- Accidental discovery, Unicornuate uterus, Laparotomy, ruptured uteru

Risky sexual behaviour and associated factors among female students of a Tertiary institution in North-Central Nigeria

Background: Human sexual behaviour is the way in which humans experience and express their sexuality. It could be risky and non-risky. Risky  sexual behaviours including early sexual debut, unprotected sexual intercourse, multiple sexual partners and having sex under the influence of  alcohol or drugs. Objective: This study assessed the sexual practices and factors associated with risky-sexual behaviour of the female students. Methodology: This was a cross-sectional study involving 400 female students of the Plateau State Polytechnic. The subjects were selected from all  the departments using a two-stage sampling technique. A pretested semi-structured selfadministered questionnaire was used to obtain relevant  information from the subject. Analysis was done using IBMSPSS 22.0. Statistical significance was set at p < 0.05. Results: Sixty-four percent of the respondents had sexual debut at age 19-23 years. Fifty-two percent had sex with only one partner within the last  six months while respondent's sexual partners were mostly male. About 92% practiced vaginal sex, 6.2% oral sex and 2.3% anal sex. Less than one-quarter and 19.2% of the study participants used condom always and did negotiate for safer sex respectively. There was a significant association  between substance use and risky-sexual behaviour. Conclusion: There is a high prevalence of risky-sexual behaviours among the study cohort.  These were seen from the high percentage of the female students who had sexual debut before the age of 18 years, unprotected sexual intercourse  as well as multiple sexual partners. Substance use, desire for pleasure, expression of love, and quest for money were the factors  associated with sexual behaviour of the cohort

Knowledge, attitude and practice of maternity unit staff in Jos Metropolis to universal precautions against HIV

Background: Health care workers in maternity units are exposed to potentially infectious body fluids in the course of their duties. The study assessed the knowledge, attitude and practice of maternity unit staff in Jos Metropolis regarding Universal Precautions (UP) against the background of the high HIV seroprevalence in Plateau state, Nigeria.Methods: A cross sectional descriptive study carried out among maternity unit staff in Jos, Nigeria. A pretested, structured, anonymous questionnaire on knowledge, attitude and practice on universal precautions concerning HIV was administered to a sample of 230.Results: A total of 202 questionnaires were completed and returned giving a response rate was 87.8%, 68.5% of the respondents were female and 31.5% male; 63 of the respondents were physicians while 139 were non physicians. 52 (82.5%) physicians and 113 (81.3%) non physician cadre staff correctly identified UP in the context of labour ward practice to apply to blood, vaginal secretions and liquor. 54 (85.7%) of the physicians and 87 (62.6%) identified that UP involved use of barrier methods. Being a physician conferred knowledge of correct use of barrier methods..Conclusion: A majority of the respondents demonstrated correct knowledge of practice of UP . There was no significant difference in knowledge between physician and non physician cadre of labour ward staff with regard to correctly identifying the fluids that UPs apply to. Physician cadre of labour ward staff in Jos metropolis was associated with the correct identification of barrier methods that UPs apply to.Keywords HIV, Universal precautions, Maternity unit staff, Jos