The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria

BACKGROUND:Hypertension is a common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications associated with the condition.OBJECTIVES: To determine the pattern, risk factors, maternal and fetal outcomes in women with hypertensive disorders of pregnancy.METHODOLOGY:This was a descriptive retrospective study of the pattern and obstetrics outcome of hypertensive disorders in Nnewi.. The Obstetric variables from 148 women with hypertensive disorders of pregnancy at the Nnamdi Azikiwe University Teaching Hospital Nnewi, from the 1st January 2004 to 31st December 2008 were analyzed. Stastical analysis was done using Epi Info version 3.3.2. The level of statistical significance was set at P<0.05.RESULTS: of the 4021 deliveries in the hospital during the period under review, 148(3.7%) were managed for hypertensive disorders of pregnancy. Only 138 folders were used for analysis. The mean age of the women was 31.3±5.7years. Majority of the women were unbooked (57.2%). Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (46.4%) with the majority presenting with severe disease. The level of proteinuria was significant in 74.6% of cases of preeclampsia. The mean gestational age at delivery was 35.3±1.5weeks. The mean birth weight was 1.6±0.3kg. Twenty-four intra uterine deaths were recorded giving a stillbirth rate of 17.4%. The perinatal mortality rate was 20.9%.  Diagnosis was made in the ante-partum period in 92.0% of the cases while 55.2% of the women delivered through Caesarean section. Eight maternal deaths were recorded, giving a case fatality rate of 5.8%. CONCLUSION: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality in Nnewi, Nigeria. Antenatal care will help in early diagnosis and timely intervention of the cases. There is need for strengthening of communication and referral systems in the healthcare.KEY WORDS: Hypertensive disorders, pattern, obstetrics outcome.Erratum Note: Mbachu 1, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU on the article “The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria” on Page Nig. J. Med 2013. 117-122. Should read: Mbachu II, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU

Physical domestic violence against married women by their intimate partners in Nnewi South East Nigeria

Background: Gender based violence is very common in our environment supported by religious and cultural considerations and often justifiedby women.Objective: This study was carried out to determine the pattern of physical violence in the home among intimate partners with a view toascertain the magnitude of the problem and possible intervention strategies.Method: Women attending the child welfare clinic of the hospital were interviewed with structured questionnaires. Focus group discussionswere also held.Results: The peak age incidence of the 164 women studied was 25- 29 years (40.2%), 93.5% had secondary education or more while 80.0%were employed in one form or the other. Many (42.1%) had witnessed physical violence against a female member of the household while 25.6%have been physically abused by their husbands. Cane/belt/stick were used in 40.6%, hands and legs in 29.0% while 16.6% were sexuallyassaulted. One-third (33.0%) were beaten at least once a month, 12.8% were beaten during pregnancy while 8.5% of victims required hospitaladmission for injuries sustained from spousal abuse.Conclusion: Intimate partner violence is common in our environment. There is need to reach out to men while women should be empowered todevelop coping strategies to navigate through this phenomenon

A Clinico-pathological Study Of Cervical Carcinoma In South Eastern Nigeria; A Five-year Retrospective Study

Objective : To determine the pattern of clinical presentation of carcinoma of the cervix in Nnewi Southeast Nigeria with a view to determining strategies for intervention. Method : This is a retrospective descriptive study involving all cases of clinically diagnosed carcinoma of the cervix seen over a five year period. Results : Forty three case notes were available for study. The age range was 38 to 87 years with a peak age incidence of 51 to 60 years. The commonest symptom at presentation were postmenopausal bleeding (51.2%), vaginal discharge (32.6%), postcoital bleeding (9.3%) and irregular vaginal bleeding (7%). Nearly 80% presented with the advanced form of the disease with 20 (46.5%) and 14 (32.6%) presenting in stage III and IV respectively. 27( 62.8% ) were lost to follow up at various stages of management. Conclusion : The pattern of presentation follow known trends. Lack of facilities for radiotherapy and loss to follow up are major obstacles in the management of carcinoma of the cervix. Keywords: Cervical carcinoma, pattern of presentation. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 202-20

Knowledge, Attitude and practice of cervical cancer screening (Pap smear) among female nurses in Nnewi South Eastern Nigeria

No Abstract. Nigrian Journal of Clinical Practice Vol.9 (1) 2006: pp.40-4

Awareness of Human Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria

Objective: To determine the level of awareness of Human  Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria.Subjects and Methods: A cross sectional descriptive study of six hundred consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private specialist hospitals (run by Consultant Obstetricians) in Nnewi was conducted over a six-month period (1st September 2008 -28th February 2009). Anonymous, structured, pretested questionnaire designed to assess the awareness of HIV infection was used.Results: The mean age of all the 600 clients was 31.4 (SD 2.8) years, majority were married (94%) and in the third trimester of pregnancy (69%). Most (58%) attended secondary school while 0.83% had no formal education. Only 2% had complete knowledge of the modes of HIV  transmission while majority (96.5%) had partial knowledge. There was a statistically significant relationship between level of education and  knowledge of HIV (p<0.00001). HIV test was done on 419(69.84%); 37 tested positive giving a seroprevalence rate of 8.83%. Among those tested, only 51.55% had counseling before testing.Conclusion: This study showed that the knowledge of HIV among women of child bearing age and the practice of voluntary counseling and testing are still poor in our environment. Improved public enlightenment and training of health workers are urgently needed.Key words: Antenatal, HIV, awareness, Counseling and Testing

A review of the prevalence and pattern of presentation of gynaecological cancers in a tertiary hospital in Nnewi, South-East Nigeria

Background: Although the battle against infections and communicable diseases is still ongoing, malignancies are increasingly becoming a health burden especially in gynaecological practice due to the late presentation of cancer patients. When these patients present with advanced forms of disease, medical personnel are often handicapped as they can only offer palliative treatment.Aim / Objective: To conduct a preliminary review (pilot study) of gynaecological cancers in our centre preparatory to the establishment of a Gynaecological Oncology unit.Method: This is a retrospective review of gynaecological cancers in our centre over a three-year period using information from patients’ folders, and theatre and admission registers.Results: Out of a total of 1849 new gynaecological patients, 57(3.1%) were malignancies, representing 10.8% of all gynaecological admissions. Cervical cancer (61.4%) remains the most common cancer, while cancers of the fallopian tube and vulva (1.8%) are the least common. About 80% of the patients either had only primary or no formal education. The mean onset-to-presentation interval for symptoms ranged from 130days for cervical cancer to 336days for endometrial cancer.Conclusion: Cervical cancer, though largely preventable, remains the most common gynaecological cancer in our environment with a strong linkage to illiteracy.Keywords: Cancers, gynaecological, Nnewi, patter

Molar pregnancy: a ten year review at Onitsha, Nigeria

A retrospective analysis of all cases of molar pregnancies managed at St. Charles Borromeo Hospital, Onitsha, from 1991 to 2000 was done. Fifty-nine patients were treated, but fifty-three case-notes were retrieved. The ages parity, clinical presentation, pregnancy outcome and complications following treatment, extracted the age range was 17-43 years, mean 20.9 + 7.7 years. The incidence of molar pregnancy was 1:332 deliveries or 1.416 pregnancies. There was no definite age pattern in the distribution of molar pregnancy. The commonest clinical presentation was recurrent vaginal bleeding 90.6% while the least was uterine size less than date in 3.8% of the cases. Syntocinon induction with evacuation of the uterus was the commonest form of treatment. Total abdominal hysterectomy with the mole insitu was performed only in 5.7% of the patients. The commonest complication was haemorrhage 26.4%, while persistent gestational trophoblastic tumour occurred in 9.4% of cases. There was no maternal death. Proper treatment of this condition is emphasized, molar gestation carries the risk of malignant trophoblastic tumour. There is need for adequate follow-up of these patients in subsequent pregnancies. Jnl Med. Investigation & Practice Vol.3 2001: 26-3

Pattern of Eclampsia in Onitsha, Nigeria

Objective: To ascertain the incidence, pattern and outcome of eclampsia in mothers attending and using the obstetric services of the St. Charles Borromeo Hospital, Onitsha. Methods: A retrospective study of 102 patients that had eclampsia between January 1991 and December 2000, a ten-year period was done. Information extracted from the case-notes included maternal age, parity, booking status, maternal morbidity and mortality. Statistical analysis was with the Chi-square distribution. Results: The study revealed a hospital incidence of eclampsia was 0.65% of all deliveries. The incidence for the unbooked (1.31%) patients was higher than for the booked (0.54%) patients (X2=16.67,

A study of risk factors for anaemia in pregnancy at the first antenatal clinic visit at Nnamdi Azikiwe university teaching hospital, Nnewi.

Background: This study is justified because anaemia in pregnancy is very common in this country and it is a major cause of maternal and perinatal morbidity and mortality among our populace.Aim: To identify the risk factors for anaemia in pregnancy and evaluate the effects of these risk factors of anaemia in pregnancy among pregnant women attending their first (booking) antenatal clinic visit at NAUTH, Nnewi Anamabra State.Methodology: This case control study involved seven hundred and fifty pregnant women at their first antenatal visit with three hundred and seventy-five as cases with anaemia compared to a matched three hundred and seventy-five controls without anaemia. The socio demographic, medical and obstetric information data were obtained including laboratory data. The data was analysed using univariate analysis and logistic regression.Result: Univariate analysis revealed some potential risk factors, but after adjustment using logistic regression only six factors remained associated with increased risk of anaemia in pregnancy. These were low socioeconomic status ( OR = 2.3), primigravidity ( OR = 3.2 ), inter-delivery interval of 2 years or less ( OR = 35.2 ), twin pregnancy (OR = 3.2), HIV infection ( OR = 1.5 ), and malaria parasitaemia (OR=2.2).Conclusion: The application of risk modifying practices and the institution of programmes that would enhance the economic status of women would help reduce the incidence of anaemia and improve nutrition. Improvement in the quality and availability of family planning would increase inter delivery interval while early and appropriate use of antenatal care would provide focus on primigravidae and women with multiple pregnancy and also help in identification of patients HIV sero- status for effective management. Moreover, early institution of intermittent preventive therapy for malaria especially in primigravidae, sustained rollback malaria programme including use of insecticide treated nets would all contribute significantly to the reduction of pregnancy anaemia and indirectly maternal mortality.Keywords: Anaemia, pregnancy, antenatal care, risk factors

Prevalence and pattern of stillbirths in a tertiary institution in South-East Nigeria

Background: Death of a foetus in-utero is devastating both to the parents and the attending obstetrician. Knowledge of the relative importance of the different causes will help in the prevention or reduction of its occurrence.Aim: This study evaluated the prevalence and pattern of stillbirths at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, South-East Nigeria.Methodology: This was a retrospective study of 297 stillbirths at the Nnamdi Azikiwe University Teaching Hospital, Nnewi from 1st January, 2007 to 31st December, 2011.Results: The stillbirth rate was 56.9/1000 deliveries. Majority of the cases 238 (80.1%) were unbooked. One hundred and twenty-nine (43.4%) were nulliparous. There were 180 (60.6%) male stillbirths while 117 (39.4%) were females. The major causes were abruptio placentae 40 (13.5%), prolonged pregnancy 38 (12.8%), uterine rupture 37 (12.5%) and pre-eclampsia 31 (10.4%). Seventy (23.6%) cases were unexplained.Conclusion: The stillbirth rate is high in our centre. There is need for quality, accessible and affordable antenatal care and delivery services to reduce the rate of stillbirth. Establishment of a subspecialty of prenatal diagnosis and foetal medicine will help in reducing the rate of stillbirths in our environment.Keywords: Foetal death, nulliparous, obstetric care, risk factors, unbooke