Emerging statistics on the Epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease

Background: Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to be put in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS- Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations. Main body: Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy. Conclusion: The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes

Hypertensive disorders of pregnancy: A five-year review in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria

Objective: To determine the prevalence and outcome of hypertensive disorder of pregnancy in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State Nigeria Method: This was a retrospective descriptive study of all documented cases of hypertensive disorder of pregnancy between the 1st of June 2012 and 31st May, 2017. Information such as age, parity, booking status, level of education, blood pressure at presentation, urinalysis at presentation, gestational age at presentation, and delivery, mode of delivery, baby’s birth weight was extracted from patients’ case files. Result: There were 1,118 deliveries during the study period out of which 55 (4.9%) patients had hypertensive disorders in pregnancy. The mean age was 31.5years ±48.1 and mean parity, 1.2± 1.1.  The mean systolic and diastolic blood pressures were 180.4 ± 1.88mmHg and 105.1± 1.5mmHg, respectively. Thirty-four (75.5%) of the women had preeclampsia/ eclampsia, while 7 (15.5%) had gestational hypertension. Most women were delivered preterm (22 patients, 48.7%).  The majority of them (33, 73.3%) were delivered by cesarean section, out of which 2 (4.4%) were elective cesarean section and 31 patients (68.8%) were emergency cesarean section. The case fatality rate was 1.8%. Conclusion: Pre-eclampsia was the most prevalent t hypertensive disorder of pregnancy.  It was more prevalent among primigravidae patients and the most common complication was preterm delivery. Strengthening antenatal care services will enable early identification of cases. Prompt referral of cases for specialist care will help in reducing the adverse outcomes associated with the condition

eterminants of seizure occurrence in preeclampsia before commencing and during treatment with magnesium sulphate

Background: Eclampsia is considered as a consequence of severe preeclampsia, with magnesium sulphate regarded as gold standard in seizure treatment and prophylaxis. Convulsions have however been noted when criteria for severe preeclampsia were not met and in patients undergoing treatment with magnesium sulphate.Methods: A secondary analysis of data obtained from a prospective cross sectional study, involving assessment of clinical and biochemical markers of preeclampsia including magnesium in 75 patients with severe preeclampsia who were given magnesium sulphate using the Pritchard regimen.Results: Headache (p = 0.002), vomiting (p = 0.005) and prior occurrence of seizures before presentation (p = 0.001), were significant risk factors for occurrence of convulsions. In addition, serum magnesium levels were significantly lower (1.61±0.32 mg/dL) among patients who had seizures than in those who did not (2.01±0.25 mg/dL), (p<0.001). Systolic blood pressure (p = 0.22), diastolic blood pressure (p = 0.29), mean arterial blood pressure (p = 0.17) and proteinuria (p = 0.18) however did not determine the occurrence of seizures. Only 3/49 (6.1%) of the patients with severe hypertension (MAP≥125 mmHg) fitted, compared to 6/26 (23.1%) with mild hypertension (MAP<125mmHg) who convulsed (p = 0.04). Convulsion during treatment with MgS04 was associated with significantly lower levels of serum magnesium (4.04±0.5 mg/dL), than 4.63±0.5 mg/dL observed among patients with severe preeclampsia who did not convulse (p = 0.04).Conclusions: Headache, vomiting, prior convulsion and low serum magnesium levels preceded the occurrence of fits before treatment while, prior convulsion and low serum magnesium level consistently preceded the occurrence of fits during treatment of preeclampsia with magnesium sulphate

Ectopic breast tissue mimicking Bartholin’s Abscess: a case report

Background: Ectopic breast tissue (EBT) is an uncommon occurrence in which the breast tissue can be found at any point along the milk line. Although it is most commonly found on the axilla, it can also present on the thighs, perineum, vulva, inframammary region, and groin. EBT mimicking a Bartholin’s abscess is extremely rare. Case presentation: Here, we report the case of a 31-year-old nulliparous woman who presented to our gynecology clinic with a complaint of right-sided vulvar swelling. An initial diagnosis of Bartholin’s abscess was made after clinical examination. This was surgically removed using marsupialization. However, following histopathological & immuno-histochemical evaluation, a confirmatory diagnosis of ectopic breast tissue was made.  Conclusion: Indeed, our case re-emphasizes the absolute need for histopathological examination of every tumor notwithstanding the nature of the presentation, site of occurrence, and/or initial diagnosis. Furthermore, although rare, EBT should be considered an important differential in tumors of the vulva

Prevention of unintended pregnancies in Nigeria; the effect of socio-demographic characteristic on the knowledge and use of emergency contraceptives among female university students

Background: The proportion of unintended pregnancy remains high in developing regions due to unmet need for contraception and inconsistent use of modern contraceptives. Practice of emergency contraception is particularly important because of the high rates of unintended pregnancy. The aim was to assess the practice of emergency contraception among female students.Methods: A cross-sectional study was conducted among 5,233 female university students in Nigeria.Results: About 25.4% of the students had ever had sex while 64.3% had heard about emergency contraceptives. About half (49.6%) had good knowledge while 70% thought that emergency contraceptives are effective and easy to access and use. Good knowledge about emergency contraceptives was predicted by dwelling urban or suburban areas (AOR=1.750 and 1.817; P<0.05), being single (AOR=2.597, P=0.001), being in the fourth year (AOR=2.096, P<0.001) and having ever had sex (AOR=1.449, P<0.001). Having ever used emergency contraceptive is predicted by good knowledge (AOR=1.852, P<0.001) and perception that emergency contraceptives are effective (AOR=139.774, P<0.001) and easy to access and use (AOR=8.429, P<0.001).Conclusions: Despite a significant risk of unintended pregnancy among female university students, the usage rate of emergency contraceptive is very low. There is a need to actively promote emergency contraception along with other contraceptive methods with the involvement of health workers and the media.  

Perception and acceptance of Universal Neonatal Hearing Screening among pregnant women attending a Nigerian Teaching Hospital

Background: Nigeria reportedly has one of the highest incidences of congenital hearing loss and the Universal Neonatal Hearing Screening (UNHS) offers a potential for early detection and intervention. Objectives: To determine the awareness and acceptability of newborn hearing screening among the antenatal clinic attendees of a Nigerian Teaching Hospital. Methods: This study was a cross-sectional survey among the pregnant women attending the antenatal clinic. Data were obtained using semi-structured interviewer-administered questionnaire Results: A total of 114 women aged 18 and 45 years participated in the survey; 51/114 (44.7%) were aware of hearing screening with most of them 39/51 (76.5%) having health workers as their first source of knowledge. A high acceptance rate was obtained among 97/114 (85.1%), and this was notably independent (p = 0.399) of awareness; 14/114 (12.2%) rejected UNHS and the commonest reason for rejection was lack of enough information among 10/14 (71.4%) on the existence and use of UNHS. Health care workers were the commonest source of information [39/51(76.5%)]. A majority [51/58 (87.9%)] thought that the best time to initiate treatment is early in life, before speech development, only 4/114 (3.5%) had relatives who had ever undergone UNHS and all were done abroad. Conclusions: Less than half of the participants attending ANC were aware of hearing screening and acceptance was high despite this low awareness rate. Parental awareness appeared to depend on contact with healthcare workers. Community education may increase awareness and demand for UNHS

Assessment of Resident Doctors’ Perception of Postgraduate Medical Education in Nigeria Using the SPEED Tool: A Pilot Study

Background: Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors’ perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool. Methodology: This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants’ sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate. Results: The mean score for the resident doctors’ perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations. Conclusion: Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge

Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial

Objective: Hyoscine butyl bromide (HBB) is known for its antispasmodic action and has been in use for over five decades, there is however no consensus on its effectiveness in the labor process. The aim of this study was to determine the effect of HBB on the duration of the active phase of labor. Materials and methods: A randomized double-blind placebo-controlled clinical trial involving 160 parturient who received either intravenous Hyoscine butyl-bromide (20 mg in 1 ml; n = 80) or intravenous normal saline (1 ml, n = 80). The mean duration of active phase of labor was compared between the two groups. Results: The observed mean duration of the active phase of labor was significantly shorter (P = 0.001) in the Hyoscine butyl-bromide group (365.11 ± 37.32 min, range = 280–490) than in the Placebo group (388.46 ± 51.65 min, range = 280–525). There was no significant difference between the two groups in the mean duration of the second and third stages of labor (20.46 ± 10.46 vs. 23.38 ± 18.95 min, P = 0.43 and 8.96 ± 4.34 vs. 9.23 ± 5.92 min, P = 0.75, respectively). The mean 1-min APGAR scores were also comparable (8.08 ± 1.54 vs. 7.64 ± 1.60, P = 0.08). The mean postpartum blood loss was significantly less in the Hyoscine butyl-bromide group (303 ± 96.52 vs. 368 ± 264.19 ml, P = 0.04). Conclusion: Hyoscine butyl-bromide was effective in shortening the duration of the active phase of labor. It was also associated with significantly less postpartum blood loss

Inflammatory Marker Levels in Preeclampsia versus Normal Pregnancies and Prediction of Preeclampsia Occurrence: A Prospective Mixed Methods Study

Introduction: Preeclampsia is an important cause of adverse maternal and perinatal outcomes. However, this condition remains poorly understood, and since the only cure is delivery, prediction and prevention are crucial to prevent preterm birth or maternal compromise. Aim: To determine the levels of acute phase reactants, namely high-sensitivity C-reactive Protein (hsCRP) and fibrinogen, between preeclamptic and non preeclamptic pregnancies. Additionally, the study aims to determine the predictive value of these acute phase reactants for preeclampsia. Materials and Methods: A prospective mixed methods study was conducted in two tertiary hospitals and two specialist hospitals in the Ijebu/Remo axis of Ogun state, Nigeria. Preeclamptic participants were recruited during pregnancy and postpartum and matched with non preeclamptic controls (case-control arm, n=179, comprised of 87 preeclamptics and 92 controls). Additionally, a cohort of non preeclamptic women (n=71) was recruited and biomarker-assayed before 20 weeks gestation, followed-up for the development of preeclampsia. The biomarker assay was performed using the ELISA technique. The Student's t-test was used to compare the mean levels of markers between the studied groups. Categorical data were compared using the Chi-square test. A p-value <0.05 was considered to be statistically significant Results: The levels of hsCRP were significantly higher in pregnant preeclamptic women (12.71±1.99 mg/L) compared to non preeclamptic women (4.39±3.41 mg/L) (p-value=0.001). Similarly, fibrinogen levels were elevated in preeclamptic women (9.45±1.28 g/L) compared to non preeclamptic women (7.19±1.86 g/L) (p-value =0.001). This trend was also observed among postpartum women, with hsCRP levels of 10.39±2.43 mg/L in preeclamptics compared to 2.53±2.06 mg/L in non preeclamptics (p-value=0.001). The mean fibrinogen level was 8.63±1.91 g/L in preeclamptics compared to 4.09±1.66 g/L in non preeclamptics. Fibrinogen demonstrated a higher specificity (88.9%) and Negative Predictive Value (NPV) of 100% compared to hsCRP (specificity=47.1% and NPV=76.1%). The biomarker levels also correlated significantly with the severity of preeclampsia. For hsCRP, there was a correlation with Systolic Blood Pressure (SBP) (r-value=0.385, p-value=0.001), Diastolic Blood Pressure (DBP) (r-value=0.364, p-value=0.001), and proteinuria (r-value=0.314, p-value=0.001). For fibrinogen, there was a correlation with SBP (r-value=0.252, p-value=0.014), DBP (r-value=0.378, p-value=0.001), and proteinuria (r-value=0.356, p-value=0.001). Conclusion: Although hsCRP and fibrinogen levels were significantly higher and correlated well with the severity of preeclampsia, their use for prediction may be limited. However, fibrinogen appears to have better prospects