Review Article - Preterm rupture of membranes: the Vitamin C factor

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Transabdominal Follicular Aspiration in IVF Treatment Cycle, an Unusual but Necessary Intervention: Experience from a Resource Limited Setting

Controlled ovarian hyperstimulation is one of the major steps in in-vitro fertilization. Inaccessibility or non visualization of developing follicles on transvaginal sonography (preferred method) may be mis-judged for poor response resulting in cycle cancellation. The need for scrupulous appraisal of proxy indicators for ovarian response viz: estradiol levels, endometrial thickness and other individual clinical characteristics are emphasized. This would prompt meticulous and assiduous trans-abdominal ultrasound follicular monitoring and oocyte retrieval as a necessary intervention to avert cycle cancellation and enhance treatment outcome. Keywords: infertility, IVF-ET, ovarian stimulation, ultrasound folliculometry, cycle cancellatio

A Review of the Patterns of Admission and Outcome of Postcaesarian Section Patients in the Intensive Care Unit of a Tertiary Hospital in Nigeria

Despite the increased utilization of invasive monitoring and mechanical ventilation in the care of the obstetric patient, a dedicated intensive care unit (ICU) for this group of patients is almost lacking in the developing world. Critical care for the obstetric patient has been recognized as a useful tool in the reduction of maternal morbidity and mortality. We sought to review the clinical characteristics and outcome of all post-Caesarean section(C/S) patients admitted into a multi-disciplinary ICU over a 10 year period. Parameters evaluated were indications for C/S, duration of stay, mechanical ventilation and ICU outcome. 114 post-C/S patients were admitted into the ICU during the study period, constituting 9.8% of all admission into the ICU. Emergency C/S constituted 92.2% of all C/Ss and eclampsia represented the commonest indication of C/S requiring care in the ICU. Mortality rate was 23.2% and non post-C/S patients were twice more likely to die in the ICU. Majority of these patients had a short ICU stay, 1-2 days and 19.3% required mechanical ventilation. Obstetric critical care is evolving and increasing proportion of obstetric patients utilized ICU care in our environment. A dedicated ICU for the obstetric patients will afford more of this special group intensive care with improved maternal health

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Meconium staining of amniotic fluid in labour: experience from a low resource setting

Objective: To determine the incidence and clinical significance of meconium stained amniotic fluid (MSAF) at onset of labour and to investigate whether MSAF could predict intrapartum and perinatal morbidity. Method: This prospective observational study was conducted over a 5-month period amongst a low risk population with pregnant women admitted for delivery at term. Two groups of 89 patients and 424 patients, were identified according to the presence or absence respectively, of meconium in the amniotic fluid (at admission into labour), and the outcomes of the two groups were compared. Results: Eighty-nine out of the 513 cohort of parturients studiedhad MSAF giving a prevalence of 17.3%. Age and parity did not influence presence of MSAF. The mean gestational age at delivery and birth weight were significantly higher for parturients with MSAF(39.6 weeks vs 38.9; P= 0.0001 and 3.5kg vs 3.2; P=0.0001). There was no difference in labour duration but Caesarean delivery was twice more likely with MSAF (20.2% vs 9.2, P=0.003). Similarly, suspicious/abnormal fetal heart patterns on CTG were observed more in those with MSAF(9/89 vs 15/424) and they also had more need for resuscitation (16.9% vs 8.7, OR 10.75, 95% CI 4.81 – 24.37; P=0.001), especially when it was thick meconium(TMS). However, there was no statistical difference in the Apgar scores at 1 minute and no observed difference with fetal gender, SCBU admission or early neonatal death. Conclusion: MSAF may predict adverse labour outcome. In settings with deficientintrapartum monitoring facilities, the presence of meconium stained liquor, particularly with thick meconium, should attract high level intrapartum vigilance and incisive neonatal resuscitation.Keywords: Meconium-stained amniotic fluid, intrapartum care, perinatal outcom