Case Report; Heterotopic Pregnancy Following Induction of Ovulation

Heterotopic pregnancies are occurring more commonly with the increasing use of assisted reproductive methods. No single investigation can predict the presence of heterotopic pregnancy. Heterotopic pregnancy should be suspected in any patient who presents with lower abdominal pain in the early phase of an obvious intrauterine pregnancy following fertility treatment. Transvaginal ultrasonography is a useful diagnostic adjunct. Early intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality. Key Words: Pregnancy, Ectopic, Heterotopic, Ovulation Induction .[Trop J Obstet Gynaecol, 2002, 19: 115-116

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

Community perception of the causes of maternal mortality among the Annang of Nigeria's South-East coast

Context: Nigeria still has one of the highest maternal mortality rates in the world despite several intervention programmes aimed at its reduction. In Akwa Ibom state, Nigeria, maternal mortality has been found to be highest among the Annang speaking people of the state.Objective: The aim of this study was to ascertain the perception of the causes of maternal mortality among the Annang speaking people of Akwa Ibom State, Nigeria. Method: Focus group discussions were carried out in 2 local government areas of Akwa Ibom State, Nigeria between 1st February 2002 and 30th April 2002.Results: Majority of the participants (60%) were between 26 and 35 years. Most of the participants felt hospitals generally connote sickness and were places reserved for only sick people. The most common causes of maternal death highlighted by the participants were spiritual attack from enemies and punishment by the Gods for infidelity. Suggestions made by the participants to reduce maternal death included, education of women on the need to be faithful to their husbands, acceptance of Christianity by all women and total surrender to God during pregnancy. Conclusion: There must be intensive grassroots enlightenment and health education in our communities on the causes and prevention of maternal mortality. The advantages of antenatal care and hospital delivery should be included as part of the health education curriculum in our primary and secondary schools. There is need for provision of accessible comprehensive health centres with facilities for emergency obstetric care in our communities by the government. Keywords: community perception, maternal mortality, Annang, NigeriaTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 189-19

Fertility Profile Following Induced Abortion in Calabar, Nigeria

Context: The incidence of induced abortion in Nigeria is high. Pelvic infection as a complication of this abortion is also common and with the rising prevalence of infertility in the population, there is a need to assess the impact of induced abortions on fertility in our women. Objective: To establish the impact of induced abortion on the fertility rate of women in Calabar. Design and Setting: Cross sectional descriptive study in Calabar, an urban community on the eastern flank of Nigeria's Atlantic coast. Subjects and Methods: Women seeking gynaecological, antenatal and family planning services who gave their informed consent were recruited. Those of them who gave a history of induced abortion were interviewed in-depth. Their demographic characteristics and detailed information about their abortion history such as number of abortions, sites where the abortions were performed, the personnel providing the abortion services and complications arising from the abortions were obtained. Results: Some 242 (40.3%) of the study subjects had undergone at least one induced abortion. The commonest late complications of induced abortion were secondary infertility (42.1%) and chronic pelvic infection (36.0%). Only 48.3% of the women who had induced abortions maintained their fertility while the remainder suffered secondary infertility ranging from three to eighteen years in duration. The fertility rate decreased with increasing number of abortions. Conclusion: Induced abortion is a major factor in the high prevalence of secondary infertility in Calabar. Training of medical practitioners on post-abortion care may help to ameliorate the burden of secondary infertility in Nigeria. Key Words: Abortion, Pregnancy Termination, Fertility, Infertility [Trop J Obstet Gynaecol, 2003, 20: 89-92

The impact of motorcycle accidents on the obstetric population in Calabar, Nigeria

Contexts: Motorcycle accidents are very common in most cities in Nigeria since the introduction of motorcycle for public commercial transportation in the early 1980s and because most pregnant women use this popular means of transport it may contribute to non-obstetric causes of maternal and perinatal morbidity and mortality. The impact of this on our obstetric population is yet to be studied in Calabar. Objectives: is to assess the influence of motorcycle accidents on maternal and perinatal performance in patients manage in the University of Calabar Teaching Hospital, Calabar. Study Design, Setting and Subjects: This was a retrospective descriptive study carried out in the maternity Annex of the University of Calabar Teaching Hospital (UCTH), Calabar. One hundred and four patients managed as a result of motorcycle accidents in the index pregnancy over two years were studied. Results: Motorcycle accounted for 7.1% of all obstetric emergencies during the period. The victims were mostly married (43.3%); multiparous (23.1%) and 34.6% were civil servants. Twenty (19.2%)of patients were ridding the motorcycles themselves. Of the 64 victims who were passengers, 68.8% sat sideways. Most of the victims (40.4%) were in the third trimester of gestation while 23.0% were actually in labor. The maternal complications included premature labour and deliveries (7.6%), abruptio placentae (3.8%) and ruptured uterus (1.9%). Complications occurred in 33.0% of the babies, which included birth asphyxia and prematurity with perinatal death of 5.5%. Conclusion: Motorcycle accidents are common among the Obstetric population in Calabar. There is high rate of life threatening maternal complications and perinatal morbidity. Relevant authority should ensure that only those duly licensed are allowed to ride the motorcycle when carrying pregnant women who should be the only passenger and sit astride.Keywords: motorcycles accidents, obstetric populationTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 164-16

What proportion of abortion seekers in Calabar are really pregnant?

Context: The incidence of induced abortion and the associated health risks are high in Calabar, Nigeria. There is need to confirm whether all the women subjected to these procedures are really pregnant. Objective: To determine what proportion of women seeking abortion services in Calabar were really pregnant. Design and Setting: Cross sectional study on women in Calabar who seek and obtain abortion services. Calabar is the capital of Cross River State in South-Eastern part of Nigeria. Subjects and Methods: Women who sought and obtained induced abortions in Calabar during the period of study were recruited into the study. The products of conception from the induced abortions were sent for histopathological examinations to confirm whether they were really pregnant. Results: One Hundred and Fifty claimed to be pregnant and procured induced abortions but 17 (11.3%) women were not pregnant from the histological reports of the products of conception. Conclusion: A significant proportion of women seeking abortion services in Calabar Nigeria are not pregnant. The routine use of pregnancy tests and/or ultrasonography could prevent a substantial proportion of unnecessary procedures. This will result in reduced health risks and substantial cost saving for women. Keywords: pregnancy test, ultrasonography, induced abortion Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 12-1

Extrauterine Decidual Reaction in Pregnancy Presenting as an Acute Abdomen: A Case Report

Ectopic decidua is usually an incidental finding at caesarean section and is not usually associated with symptoms. A 37-year-old multiparous patient presented with features of acute abdomen in the third trimester of pregnancy. Laparotomy revealed haemoperitoneum of about 2 litres, multiple pelvic adhesions and nodular lesions (measuring 2-4mm across) on the serosa of the uterus. Histology of biopsy specimens from the lesions showed them to be decidual in nature. Postnatal examination at 6 weeks revealed a healthy looking lady with complete involution of pelvic organs. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 91-92

Plasma Fibronectin Concentration in Obese/Overweight Pregnant Women: A Possible Risk Factor for Preeclampsia

Plasma fibronectin (FN) levels in obese/overweight and non-obese pregnant women were evaluated as a possible risk factor for preeclampsia. A total of one hundred and sixty three pregnant women attending antenatal clinic at University of Calabar Teaching Hospital participated in the study and sixty non-pregnant women served as control. About 77 (47.24%) of the pregnant women were followed up for any subsequent development of preeclampsia during the pregnancy. Fibronectin levels in plasma were measured by ELISA assay and serum total protein, urea and creatinine were determined spectrophotometrically. The mean plasma FN concentration of non-obese pregnant women in first trimester was lower than those of the non-pregnant women by 24%, but however, increased to the non-pregnant level in second and third trimesters. Obese/overweight pregnant women had significantly (P < 0.05) higher values than non-obese pregnant women in second and third trimesters. FN in obese/overweight pregnant women correlated positively with mean arterial blood pressure (MAP: r = 0.414, P = 0.04). About 28.57% of the pregnant women with FN above cut off point of 330 μg/ml at 18–24 weeks of gestation developed preeclampsia. This value increased to 40.0% when only the obese/overweight women were considered. On analysis of both fibronectin >330 μg/ml and MAP > 90, the predictive value increased to 66.7%. We therefore conclude that elevated FN may be regarded as a risk factor of preeclampsia especially among the obese women

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

Background: The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. Objective: To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. Study Design: In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. Results: A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. Conclusion: In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.</p