Early onset pregnancy induced hypertension/eclampsia in Benin City, Nigeria

Pregnancy induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focussed on early onset pregnancy induced hypertension/eclampsia in Nigerian women To determine the incidence, clinical features and outcome of cases of early onset pregnancyinduced hypertension /eclampsia in a Nigerian tertiary hospital, and compare maternofetal outcome in early and late onset disease.: A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital.: Severity of disease, rates of induction of labour, caesarean section rate, maternal mortality, abruptio placenta, still births, severe birth asphyxia and early neonatal deaths. : Early onset pregnancy induced hypertension/eclampsia contributed 6.3% of all cases of hypertensivedisorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate was 34.0%. Early onset pregnancy induced hypertension was associated withsignificantly higher risk of presenting with eclampsia, having induction of labour and worse perinatal outcome than late onset disease.: Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease

Active phase slow labour management: a review of the evolutionary history of the 2 hours and 4 hours oxytocin augmentation treatment

Context: Currently, slow labour is treated with oxytocin augmentation after delay of either 4 hours or 2 hours but there is debate as to whether the 2 hours or 4 hours delay is better to adopt especially for tertiary centre labour ward. Randomized controlled studies which have been conducted to resolve this issue have yielded conflicting reports because the studies used as primary outcome measures caesarean section rate or mode of delivery and perinatal outcome which are also affected by other confounding variables not related to the oxytocin augmentation. The debate as to which is better between the 4 hours and 2 hours delay before augmentation is still on.Objective: In order to identify the appropriate primary outcome measure to assess the 4 hours and 2 hours delay before augmentation, a historical review has been undertaken of the evolution of the 4 hours and 2 hours delay in order to identify the aim of treatment of the slow labour progress in active phase. This is to reveal what dependable primary outcome measure that can be used to assess which of 4 hours or 2 hours can better prevent prolonged labour which is the original aim of treating the slow labour with oxytocin augmentation. This is the way to end the debate.Sources of materials used: Information was obtained from Journals, medline, W.H.O. publications, Cochrane database systematic reviews and reputable textbooks using publications from 1969 to 2009.Materials: In active management of labour, it is the aim to prevent prolonged labour through a strategy to identify slow labour progress and institute immediate oxytocin augmentation hence the need for hourly vagina examination in the original concept by O'Driscoll and associates. Because this regimen required a large compliment of persons with good obstetric knowledge and materials, implementation was difficult hence there were modifications. This was first by Phillpott who designed oxytocin augmentation after 4 hours delay and later 2 hours and 3 hours by otherworkers before oxytocin augmentation when slow labour occurred. In spite of these delay the results were comparable to what O'Driscoll obtained with immediate augmentation and hourly vagina examinations. Presently,oxytocin augmentation is often after 4 hours or 2 hours delay after slow labour occurs. In a bide to know the better option, between 4 hours and 2 hours of delay, there have been randomized controlled studies in which the primary outcome measures assessed, were caesarean section rate or mode of delivery and perinatal outcome with conflicting results. The conflicting report is because mode of delivery and perinatal outcome following treatment of slow labour with oxytocin augmentation, is dependent more on the cause of the slow labour and state of the feto-placenta function before the augmentation. Hence, mode of delivery and perinatal outcome are not dependable outcome measures to assess which is the better option of 4 hours and 2 hours delay before augmentation. Since the aim of treating slow labour progress, is to restore progress to the normal 1cm per hours, cervical dilation rate, the appropriate outcome measure to assess in any comparative studies of the 4 hours and 2 hours are cervical dilation rate, duration of labour and reduction of prolonged labour rate.Conclusion: It is concluded that the appropriate outcome measure to assess randomized comparative studies of 4 hours and 2 hours delay before oxytocin augmentation, is cervical dilation rate, duration of labour and reduction of prolonged labour rate. This will produce reproducible results and help identify whether 4 hours or 2 hours delay before augmentation contribute more to preventing prolonged labour

Spontaneous latent phase labour: A review of issues in definition, classification and management options

Latent phase labour has been a subject of controversy since the time of the original concept over 5 decades ago by Friedman and this controversy is still persisting till date. There is presently so much of new knowledge of labour which when applied to latent phase may clear several of the grey areas particularly in the definition and diagnosis. However, there is still substantial debate and heat in the areas of classification and the management of latent phase where for now there is still no consensus. This review has attempted to throw more light on the grey areas in thedefinition and diagnosis by reviewing the original studies by Friedman, Hendricks and O'Driscoll who are the lead scholars in the evolutionary history of latent phase labour. The studies of several other workers in the debate on classification and management were critically review with a view to evolve a consensus. It is finally concluded that nowadays latent phase labour is a clinically recognizable entity with clear cut features and parameters for a prospective diagnosis. Also in spite of the current debate, it is suggested that latent phase which is only the earlier aspect of 1st stage labour, be classified as a continuum consisting of normal latent phase, prolonged latent phase and false labour. By this type of classification, false labour is not a differential diagnosis but a continuum of prolonged latent phase. Based on the knowledge that latent phase of whatever classification is merely yet the earlier aspect of first stage labour, the management should be passive observation until transformation into active phase labour in the absence of any associated complication either before or during the observation. This is the best option to avoiding orevoking further problem from what is a normal occurrence

Partograph as a tool for team work management of spontaneous labor

It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non‑obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4‑h action line, but other workers have attempted with 2‑ and 3‑h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.Nigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Safety and efficacy of Bolus administration of magnesium sulphate for preeclampsia

Context: Magnesium sulphate is currently the drug of choice in the prevention and treatment of eclampsia. On-going research is addressing its administration in terms of dosage, duration and safety.Objective: We evaluated a modified method of magnesium sulphate administration with respect to safety, efficacy and maternofetal outcome.Design, Setting And Subjects: This was a prospective cohort study conducted at the UBTH, Benin City with patients managed for severe preeclampsia between June and December, 2011. The Zuspan regimen was compared with a modified intravenous regimen in which magnesium maintenance therapy was given as 1g hourly bolus injection administered over 10 minutes. Both methods were evaluated for safety, efficacy and materno-fetal outcome.Result: The mean age, parity, gestational age and body mass index were 28.09±5.5 years, 2.72±1.98, 36.67±3.54 weeks and 26.51±5.60 respectively. Both methods achieved therapeutic levels, but blood pressure control was better in the continuous group than the bolus group (27% vs 100%, P=0.000). Birth asphyxia occurred in 14.8% of the babies and was 3 times more in the continuous group (22% vs 7.5%; p=0.062). More babies in the bolus group were admitted to SCBU (54.1% vs 7.9%; p=0.000). There was no early neonatal death, and no maternal death in the first week of puerperium.Conclusion: This study showed that hourly bolus intravenous administration of magnesium sulphate is comparable to continuous intravenous therapy in terms of safety and efficacy in the treatment of severe preeclampsia. A larger scale study is recommended to further confirm our findings.Keywords: safety, efficacy, bolus magnesium sulphate, preeclampsia, University of Benin Teaching HospitalTrop J Obstet Gynaecol, 30 (1), April 201

Barriers to the universal application of the portograph for labour managent: A review of the issues and proposed solution

The Partograph is a simple clinical tool for recording observation in first stage active phase labour aiming to alert staff who provide care in labour to deviation in labour progress as well as in the wellbeing of mother and baby. Due to the devise of the alert and action line and the protocol for the use of the Partograph, there is early alert to complications (alert line) and the eventual treatment (action line), is by the staff with the requisite skill in order to ensure good feto-maternal outcome. This principle of the Partograph has not been clearly understood. The main reason for this misunderstanding is poor knowledge of why and how the Partograph was created. This is why there are the debate and consequent lack of a consensus over several issues like the number of hours of separationbetween the alert and action lines; use of the alert and action line in a tertiary centre; the time for artificial rupture of fetal membrane and the time for commencement of oxytocin augmentation to correct slow labour. These debates which constitute the barriers are all unnecessary because the facts which should guide opinion are revealed by a revisit to the history of the Partograph which will help to establish the reasons for each actions and procedure for the use of the Partograph. Finally, poor knowledge of how to use the Partograph to conduct labour is the greatest barrier for now. It is concluded that removing the barrier is best by concerted training on how to use the Partograph to all staff cadre involved in labour management.Keywords: Reducing Barriers to the use of Partograph for labour care

Pelvic abscess complicating transvaginal oocyte retrieval: A case report from a public in vitro fertilization centre in Southern Nigeria

Pelvic abscess complicating transvaginal oocyte retrieval for in vitro fertilization is uncommon. Difficulties and/or delays in diagnosis,  attributable to the rarity of the pathology, are associated with  complications that lead to severe maternal and perinatality morbidity and mortality. In this report, we present a 37 year old nulliparous woman who underwent in vitro fertilization and embryo transfer for infertility treatment. She presented with non-specific symptoms of pelvic pain nine weeks after transvaginal oocyte retrieval for in vitro fertilization and embryo transfer. Despite antibiotic therapy, she developed acute abdomen that resulted in pregnancy loss and necessitated two laparotomies to save her life.There is need for high index of suspicion and early diagnoses of this rare complication of transvaginal oocyte retrieval particularly now that uptake of assisted reproduction technique in the treatment of infertility is likelyto increase in sub-Saharan Africa with the advent of public hospital involvement.Keywords: Pelvic abscess, transvaginal oocyte retrieval, in vitro fertilization

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones

Maternal Malaria Induces a Procoagulant and Antifibrinolytic State That Is Embryotoxic but Responsive to Anticoagulant Therapy

Low birth weight and fetal loss are commonly attributed to malaria in endemic areas, but the cellular and molecular mechanisms that underlie these poor birth outcomes are incompletely understood. Increasing evidence suggests that dysregulated hemostasis is important in malaria pathogenesis, but its role in placental malaria (PM), characterized by intervillous sequestration of Plasmodium falciparum, proinflammatory responses, and excessive fibrin deposition is not known. To address this question, markers of coagulation and fibrinolysis were assessed in placentae from malaria-exposed primigravid women. PM was associated with significantly elevated placental monocyte and proinflammatory marker levels, enhanced perivillous fibrin deposition, and increased markers of activated coagulation and suppressed fibrinolysis in placental plasma. Submicroscopic PM was not proinflammatory but tended to be procoagulant and antifibrinolytic. Birth weight trended downward in association with placental parasitemia and high fibrin score. To directly assess the importance of coagulation in malaria-induced compromise of pregnancy, Plasmodium chabaudi AS-infected pregnant C57BL/6 mice were treated with the anticoagulant, low molecular weight heparin. Treatment rescued pregnancy at midgestation, with substantially decreased rates of active abortion and reduced placental and embryonic hemorrhage and necrosis relative to untreated animals. Together, the results suggest that dysregulated hemostasis may represent a novel therapeutic target in malaria-compromised pregnancies

Resident Doctors Perceptions Of The Postgraduate Examinations In Obstetrics And Gynaecology

The National Postgraduate Medical College was established by Decree 67 in September 1979 with the main objective of conducting professional postgraduate examinations for candidates in specialized branches of Medicine and Dentistry and to make awards thereto. A total of 46 specialists graduated from the Faculty of Obstetrics and Gynaecology over a period of 5years (1999 and 2004), which is a grossly inadequate number when one considers the high maternal mortality rate and shortage of specialists. The aim of this study was to ascertain the perception of resident doctors of the examination and make suggestions as to how their training and performance at the examinations can be enhanced. A total of 159 residents in Obstetrics and Gynaecology who attended the September 2006 update course organized by the College were interviewed with a structured questionnaire. Majority of the residents 84(53%) were between the ages of 31 and 35years with 79% being males. Seventy percent (70%) were married and 54% were 6-10 years post MBBS Seventy percent felt poor preparation of candidates was responsible for examination failure while 21% blamed this on biased examiners, 53% wanted the format for the examination to be changed with 24% of these opting for objective structured clinical examination method (OSCE). In conclusion, the study established that poor preparation, examiners bias and inadequate consultant involvement in residency training were significant causes of poor performance. Keywords: Perception, resident doctors, postgraduate examsAnnals of Biomedical Sciences Vol. 6 (2) 2007: pp. 22-2