Orofacial Injuries in Eclamptic Nigerians

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative. (Afr J Reprod Health 2004; 8[3]:147-151

Antepartum Fetal Death in a Nigerian Teaching Hospital: Aetiology and Risk Factors

Context: Antepartum fetal death is a significant contributor to perinatal mortality and challenges the adequacy of antenatal surveillance. Identifying the causes and risk factors for death may aid its prevention. Aim: To determine the causes of antepartum fetal death and identify associated risk factors. Subjects and Methods: All antepartum fetal deaths, with fetuses weighing 1 kg or more, delivered at Wesley Guild Hospital, Ilesa between January 1996 and December 2000 were the subjects. The controls were all live births delivered immediately before and after every index fetal death. Information on maternal demographic details, past obstetric history and antenatal complications were retrieved from the case notes of both the subjects and the controls for analysis. Results: The total number of births during the study period was 5,050 with 266 stillbirths. Of the stillbirths, 111 (41.7%) were antepartum out of which 70 (63.1%) weighed 1 kg and above. The main causes of death were antepartum haemorrhage (20%), maternal disease (14.3%) and pre-eclampsia/eclampsia (11.4%). The cause of death was unknown in 38.8% of cases. The main risk factors identified for antepartum death were lack of antenatal care and low birthweight. Maternal age and parity did not seem to be risk factors for antepartum fetal loss. Conclusion: Maternal disease is still a major cause of antepartum deaths in our society. Improved antenatal care and better surveillance of fetal growth may reduce the current high stillbirth rate in our society. Key Words: Perinatal Mortality, Stillbirth, Intrauterine Death [Trop J Obstet Gynaecol, 2003, 20: 134-136