Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014–2018

Background Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. Objectives The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. Methods This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). Results The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25–34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. Conclusion Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria

Bone tumour diagnosis in resource poor settings: the role of fine needle aspiration cytology

Background: Bone tumours are rare with limited diagnostic options in resource- poor settings. Open biopsies have several complications hence the need for an alternative, cheaper, effective diagnostic method. Aim: To compare fine needle aspiration cytology (FNAC) in the diagnosis of bone tumours with histology of open surgical biopsy and to ascertain whether FNAC can be substituted for open surgical biopsy. Methodology: This prospective study was carried out at the National Orthopaedic Hospital, Lagos between August 2005 and July 2006. We compared the diagnostic accuracy of bone tumour specimens obtained by FNAC with the follow -up open surgical biopsy. We determined whether FNAC could be used to delineate bone tumours into benign, malignant,or metastatic tumours. Results: 22 patients were studied, age range 11-57 years. FNAC had sensitivity of 100%, false positive of 16.7%(1), and overall diagnostic accuracy of 95.2% which was higher for conclusive smears. FNAC was non- diagnostic in one case but diagnostic accuracy for giant cell tumours and osteosarcomas was 100%.  The average time interval for FNAC result was 5.1 days + SD 2 days (1-9 days) compared  to 25.4 + 20.5 SD (9-91 days) for the histology surgical biopsy (P. value 0.001). No significant complications were noted with FNAC. Conclusion:  Where clinicoradiological evaluations have provided a focused differential, FNAC can confidently be used in the diagnosis of bone tumours and is a cheaper and quicker alternative to open surgical biopsy with little or no significant complication in resource poor settings. Keywords: Fine needle aspiration cytology, open biopsy, histopatholog