Effects of Birth Preparedness and Complication Readiness on Pregnancy Outcome in Nigeria

Background: Birth preparedness and complication readiness (BPCR), a component of focused antenatal care, has a great potential to reducing maternal and newborn deaths in low‑income countries. However, the success of this strategy is not well known in most of sub‑Saharan Africa, and the effectiveness of the strategy has not been widely studied. Aims: This study aimed at evaluating the effects of BPCR on pregnancy outcome. Materials and Methods: This was an observational cohort study of eligible consecutive pregnant women presenting in labour at a tertiary hospital in Abakaliki, Nigeria. Maternal and neonatal outcomes of labour were compared between women who had a birth plan (n = 115) and a control group without a birth plan (n = 115). Results: The mean age of the parturients was 27.87 ± 5.20 years. Women who had a birth plan were less likely to have postpartum anaemia (P < 0.001), receive blood transfusion (P < 0.001), and have prolonged hospital stay (P = 0.03). Their neonates were at less risk of low birth weight (P = 0.02) and admission into newborn special care unit (P = 0.003). There was no association between BPCR and incidence of Caesarean section (P = 0.65) and maternal satisfaction (P = 0.20). Conclusion: The practice of BPCR in Abakaliki, Nigeria, is associated with some favourable maternal and neonatal outcomes. The study findings indicate the need for more advocacies for adequate implementation of BPCR during pregnancy in Nigeria.&nbsp

Anti‑malaria prescription in pregnancy among general practitioners in Enugu state, south east Nigeria

Background: The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT‑SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin‑based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs). Objective: To determine the pattern of anti‑malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control. Materials and Methods: Questionnaires were administered to a cross‑section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election. Results: The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti‑malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy‑six (51.7%) practitioners prescribed IPT‑SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05). Conclusion: The pattern of anti‑malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence‑based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.Keywords: Anti‑malaria prescription, Enugu state, general practitioners, pregnancyNigerian Medical Journal | Vol. 54 | Issue 2 | March-April | 201

Serum selenium levels of pre-eclamptic and normal pregnant women in Nigeria: A comparative study.

IntroductionTrace element selenium, an antioxidant, and peroxynitrite scavenger when incorporated into selenoproteins and enzymes reduce oxidative stress which is implicated in the aetiopathogenesis of pre-eclampsia. A paucity of information exists on the serum selenium levels among pre-eclamptic pregnant women in Nigeria, hence the need for this study.ObjectiveTo compare mean serum selenium levels and prevalence of selenium deficiency in preeclamptic pregnant women and their normotensive pregnant controls.Materials and methodsA comparative case-control study was carried out at the Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri, Imo state. Fifty-eight preeclamptic and equal normotensive pregnant controls were matched for age groups, gestational age groups, parity groups, and socio-economic status had their serum samples analyzed for selenium level using atomic absorption spectrophotometer (ASS). Data analysis was done using the statistical package for social sciences (SPSS) version 20.0. P-value of ResultMean serum selenium levels of the preeclamptic women(0.67±0.27μmol/l) was significantly (pConclusionSerum selenium levels of pre-eclamptic women were significantly lower compared to that of normotensive pregnant controls and selenium deficiency occurred significantly more among the preeclamptic pregnant women compared to the normotensive controls. Selenium level dynamics in pregnancy possibly could play a role in the incidence of pre-eclampsia among pregnant women

Predictors of puerperal menstruation.

BackgroundPuerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation.ObjectiveTo determine frequency and predictors of puerperal menstruation.MethodsThis was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P- value is ResultsA total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p0.05, for all).ConclusionOne in 3 women resumes menstruation within 6 weeks of childbirth. The major predictor was early initiation of family planning, and exclusive breastfeeding with manual removal of placenta a major protective factor. These interesting issues require further investigation to better understand the mechanism of puerperal menstruation

Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial

Objectives: To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. Methods: A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous ( n  = 115) and intramuscular ( n  = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby’s delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. Results: The baseline socio-demographic and clinical characteristics were similar between the two groups ( p  > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p  = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p  = 0.412) or adverse effects ( p  > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p  = 0.032). Conclusion: Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles

Maternal and umbilical cord blood levels of leptin in pre-eclamptic and healthy pregnant women: A comparative cross-sectional study

Background: Pre-eclampsia is a multi-systemic disease with its attendant increased maternal and perinatal morbidities and mortality. It has been hypothesized that leptin contributes immensely to the natural history of pre-eclampsia. However, there is considerable disagreement in the reports of existing research work on the link between fetomaternal serum leptin levels and pre-eclampsia. Objective: To determine and compare the maternal and umbilical cord sera levels of leptin in women with pre-eclampsia and healthy pregnant women. Study design: This is an analytical cross-sectional study. Methods: The study involved consenting 120 pregnant participants (60 on each arm). Pregnant women diagnosed with pre-eclampsia constituted the investigation group, while the controls were normotensive pregnant women. They were matched for maternal age and body mass index. Venous blood specimens were obtained from the participants for assessment of the serum leptin concentration while umbilical cord blood samples were obtained following delivery of the neonate in advance of the removal of the placenta. The collected blood samples were analysed for the levels of leptin in a blinded pattern. The primary outcome measures were maternal serum leptin levels and umbilical cord serum leptin levels. Results: Mean maternal serum leptin concentration in the pre-eclampsia group was significantly higher than that in the control group (24.88 ± 3.92 vs. 15.03 ± 2.98ng/mL, p  < 0.001). Similarly, maternal serum leptin concentration was significantly higher in participants with severe pre-eclampsia compared with those with mild pre-eclampsia (25.91 ± 3.5 vs. 22.83 ± 4.02ng/mL, p  = 0.003). However, the mean umbilical cord serum leptin level in the pre-eclampsia group was significantly lower than in the control group (6.43 ± 2.08 vs. 7.27 ± 2.24; p  = 0.034). There was a weak positive correlation between maternal serum leptin level and neonatal umbilical serum leptin level in the pre-eclamptic group ( r  = 0.21, p  = 0.04). Conclusion: Maternal serum leptin concentration is significantly increased in women with pre-eclampsia, compared with their normotensive counterparts. This increase becomes even more pronounced as the severity of the disease progresses. Maternal serum leptin assessment has the potential to become a veritable tool in the diagnosis and monitoring of pregnancies complicated by pre-eclampsia