Non‑pregnancy related gynaecological causes of death in a Nigerian Tertiary Hospital

Background: Most gynaecological causes of death are related to pregnancy such as ectopic pregnancy, unsafe abortion, septic incomplete abortion, and gestational trophoblastic diseases. Hence, it was necessary to review the non‑pregnancy related causes of gynaecological deaths in our centre.Aims and Objectives: The aim of this study was to review gynaecological deaths due to non‑pregnancy related causes among women in our centre at the University of Calabar Teaching Hospital (UCTH).Materials and Methods: This was a 5‑year retrospective review of case notes of women who died in the gynaecological ward of UCTH. The demographic profile of the women, the diagnosis and the cause of death were extracted for analysis. All those whose diagnoses were pregnancy related were excluded.Results: There were 38 gynaecological deaths, which were not pregnancy related. Of these, ovarian cancer (19) and cervical cancer (11) constituted 30 cases or 78.9% of causes of death. Endometrial cancer (3), uterovaginal prolapse (3), uterine leiomyosarcoma (1), and vulvovaginal cancer (1) constituted 8 cases or 21.1% of deaths. No deaths were recorded from uterine fibroids, dysfunctional uterine bleeding, pelvic inflammatory disease, etc.,Conclusion: Cancers constitute the majority of causes of gynaecological deaths in women who are not pregnant. This emphasises the need for cancer prevention, early diagnosis and effective treatment.Keywords: Death; gynaecological disease; non‑pregnant women; University of Calabar Teaching Hospita

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Non-pregnancy related gynaecological causes of death in a Nigerian Tertiary Hospital

Background: Most gynaecological causes of death are related to pregnancy such as ectopic pregnancy, unsafe abortion, septic incomplete abortion, and gestational trophoblastic diseases. Hence, it was necessary to review the non-pregnancy related causes of gynaecological deaths in our centre. Aims and Objectives: The aim of this study was to review gynaecological deaths due to non-pregnancy related causes among women in our centre at the University of Calabar Teaching Hospital (UCTH). Materials and Methods: This was a 5-year retrospective review of case notes of women who died in the gynaecological ward of UCTH. The demographic profile of the women, the diagnosis and the cause of death were extracted for analysis. All those whose diagnoses were pregnancy related were excluded. Results: There were 38 gynaecological deaths, which were not pregnancy related. Of these, ovarian cancer (19) and cervical cancer (11) constituted 30 cases or 78.9% of causes of death. Endometrial cancer (3), uterovaginal prolapse (3), uterine leiomyosarcoma (1), and vulvovaginal cancer (1) constituted 8 cases or 21.1% of deaths. No deaths were recorded from uterine fibroids, dysfunctional uterine bleeding, pelvic inflammatory disease, etc., Conclusion: Cancers constitute the majority of causes of gynaecological deaths in women who are not pregnant. This emphasises the need for cancer prevention, early diagnosis and effective treatment

Severe Life-Threatening Pregnancy Complications, “Near Miss” and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study

Background. Investigating severe life-threatening pregnancy complications that women encounter and the maternal morbidities (near miss) may help to evaluate the quality of care in health facility and recommend ways to improve maternal and infant survival especially in low-income countries. The aim of this review was to identify, classify, and determine the frequency and nature of maternal near miss events and the maternal and perinatal outcomes. Methods. A retrospective facility-based review of cases of near miss and maternal mortality occurring between 1st January 2012 and 31st December 2016 at the University of Calabar Teaching Hospital was conducted. Near miss case definition was based on the WHO disease specific criteria. The main outcomes included the maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality index, maternal morbidities, and perinatal outcome. Results. There were 10,111 pregnancy-related admissions, 790 life-threatening pregnancy complications that resulted in 99 maternal deaths, and 691 near miss cases. The maternal mortality ratio was 979 maternal deaths per 100,000 live births, and the maternal near miss ratio was 6,834 per 100,000 maternities. The MMR to MNMR ratio was 1 : 8. Sepsis and severe anaemia had high case-specific mortality indices of 0.4 and 0.53, respectively. The perinatal outcome was poor compared to that of uncomplicated pregnancies: perinatal mortality rate (PMR) 266 per 1000 live births (OR 7.74); neonatal intensive care (NIC) admissions 11.6 percent (OR 1.83); and low birth weight (LBW) (<2.5 kg) 12.19 percent (OR 1.89). Conclusion. Antenatal care and early recognition of danger signs in pregnancy as well as prompt referral and early institution of essential obstetrics care are important for maternal and infant survival

Diabetes knowledge among non-diabetic hypertensive patients in Calabar, Nigeria

Introduction:&nbsp;among hypertensive patients, the comorbidity of diabetes is not uncommon. Yet, little is known about diabetes prevention among non-diabetic hypertensive patients. This study sought to assess such patients' knowledge about diabetes and its risk factors. Methods:&nbsp;a cross-sectional descriptive study design and random sampling were used to recruit non-diabetic hypertensive patients from University of Calabar Teaching Hospital. A pretested 33-item questionnaire was used to assess various aspects of diabetes knowledge. Participants' alcohol consumption, smoking habits, physical activity, and fresh fruit consumption were also assessed. The p-value was set to 0.05. Results:&nbsp;of 212 respondents with a mean age of 45.5 ± 10.8 years, approximately half (49.1%) had inadequate knowledge of diabetes. Most participants demonstrated poor knowledge of diabetes' clinical features (81.1%) and complications (59.4%), while fewer participants showed poor knowledge of causes and risk factors (24.5%) and diabetes management (40.6%). Older subjects, those in the wards, non-drinkers, physically active people, and those who frequently consumed fresh fruit had a significantly greater understanding of diabetes symptoms and complications (p&lt;0.05). Conclusion:&nbsp;hypertensive patients' diabetes knowledge is generally suboptimal, with greater knowledge deficiencies being apparent in specific areas. More strategic health education initiatives are required, about minimizing the risk of developing diabetes comorbidities