Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014–2018

Background Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. Objectives The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. Methods This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). Results The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25–34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. Conclusion Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria

Is serum magnesium estimate necessary in patients with eclampsia on magnesium sulphate?

The therapeutic index of magnesium is said to be low, hence, there are fears of toxicity when used as anticonvulsant in eclamptic patients. The objective of this study was to determine the serum levels of magnesium in eclamptic patients treated with magnesium sulphate and relate the levels with clinical indicators. It was a prospective study involving consecutive eclamptic patients that were managed between January and December 2002, with magnesium sulphate as the sole anticonvulsant agent, using a modified Pritchard regimen. Blood samples were taken before the administration of the loading and maintenance doses of magnesium sulphate and serum levels of magnesium were estimated using the Jenway 605 colorimeter. There were 19 patients and 72 blood samples. The mean baseline serum magnesium was 0.72 ± 0.10mmol/L while serum magnesium levels when the patients were on treatment ranged from 1.95 to 2.82mmol/L. No serum magnesium level was greater than 3.0mmol/L and none of the patients had clinical evidence of magnesium toxicity. We conclude that serum magnesium levels in these patients were within the therapeutic range, therefore, routine estimation of this cation is not necessary. Even where the laboratory facility is available, it is suggested that serum estimation be limited to cases where clinical monitors suggest toxicity. (Afr J Reprod Health 2005; 9[1]: 128-132

Prevalence and Outcome of Increased Nuchal Translucency in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria: A Cohort Study

Background: An important component of the first‑trimester scan is nuchal translucency thickness at 11 weeks to 13 weeks 6 days of gestation. A nuchal translucency ≥3.3 mm is a significant early pregnancy scan finding associated with Trisomies 13, 18, and 21 and congenital heart diseases. Aims: To determine the prevalence and outcome of increased fetal nuchal translucency among pregnant women. Subjects and Methods: A prospective cohort study at the Obstetrics and Gynaecology Department of Usmanu Danfodiyo University Teaching Hospital Sokoto. This was a prospective study of 265 consecutively recruited women in the first trimester of pregnancy who presented to antenatal clinics over a 20‑week period. An NT scan was conducted at 11 weeks to 13 weeks 6 days followed by an anomaly scan at 18–22 weeks. Patients were followed up to delivery and 6‑week post‑partum. The neonates were examined at delivery and at 6‑week postnatal life. Data entry and analysis was done with IBM SPSS version 20. The level of significance was set at less than 0.05. Frequency distribution; student t‑test and Chi‑squared test. Results: The 95th percentile NT was 3.3 mm and the prevalence of increased  NT above 3.3 mm was 3%. The mean maternal age of the participants was28.1 ± 5.1 years and the modal parity was Para 0. The most common anomalies associated with increased NT were ventricular septal defect and spina bifida. A congenital anomaly was significantly associated with increased NT (P <0.001). Conclusions: The prevalence of increased fetal nuchal translucency is relatively high in our environment and is associated with congenital fetal defects. Routine screening with first‑trimester ultrasound will help detect congenital anomalies early