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

Have you seen a rape kit? A snapshot at the quality of care of rape survivors in Nigerian tertiary hospitals

Context: The rape kit has become a fundamental tool in the evaluation of the rape survivor in many countries. Itsavailability and use in Nigeria has however not been documented.Objective: To assess the current availability and usage of the rape kit in Nigerian tertiary hospitals, and evaluate the management of rape survivors.Methodology: Resident Doctors attending the Obstetrics and Gynaecology update course, held in Abuja in March,2009 were interviewed using a self-administered questionnaire assessing experience in rape management, knowledge about the rape kit and its availability, as well as current management of rape survivors.Results: There were 138 respondents from 25 tertiary hospitals, with a male-to-female ratio of 2.8:1 and a meanduration of 3.3 (SD 1.4) years in training. 120 (87%) had personally managed one or more rape survivor(s), but none of the respondents had ever seen a rape kit, and only 29% were aware of it. Although all the respondents indicated availability of emergency contraception, antibiotics and tetanus prophylaxis in their centres, only 32.4% had access to HBV vaccine, and about 8% indicated lack of HIV prophylaxis. Only 28.7% and 45.6% indicated access to clinical psychologists and medical social workers respectively.Conclusion: The rape kit is not available in Nigerian tertiary hospitals. We recommend its provision, and regulartraining of doctors, especially Obstetrics and Gynaecology Residents on rape management, to improve the care ofrape survivors in Nigeria.Key Words: Rape, Rape kit, Rape survivor, Nigeria

Contraceptive uptake among women attending family planning clinic in a Nigerian tertiary health facility: a 6 year review

Background: Contraceptive uptake is one of the most important determinants of pregnancy rates and birth rates in the world. Aim: To determine the principal trends in contraceptive use from 2004-2009 in the family planning unit of a tertiary health centre in South-Western Nigeria, and to identify the effect of age, marital status and parity on the choice of contraceptive method.Methods: The record of 1,862 clients attending the Family Planning unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun-State, Nigeria for the period between 2004-2009 were reviewed. Information related to the age, marital status, parity and the choice of contraception were obtained using a structured proforma and the data analyzed with SPSS version 16. Pearson chi-square test was used as test of significance where applicable.Results: Within the study period, the contraceptive uptake was 13.2%. Copper-T IUCD was the most commonly used method of contraception (77.9%), followed by the progestogen only injectable contraceptives (12.6%), then oral pills (4.1%) and progestin implants (2.3%). Single women and women of low parity are more likely to use pills than IUCD (69% vs. 38.3%) while long acting reversible contraception (injectables and IUCD) are preferred by women with higher parity (P=0.000).Conclusions: IUCD is the most popular method of contraception in Ife-Ijesha area of Nigeria. Contraceptive uptake is relatively low among the women. Age and parity are key influences on the uptake and choice of contraception practiced by the women, while the influence of marital status is not statistically significant

Premature rupture of membranes at term: immediate induction of labor versus expectant management

Objective: To compare the maternal outcomes of immediate induction of labor with expectant management in women presenting with premature rupture of membranes (PROM) at term.Methods: One hundred and fifty two women with PROM at term were randomized into either immediate induction of labor with oxytocin or expectant management for a period of 12 hours. The primary outcome measure was the incidence of clinical endometritis in each group. Secondary outcomes were the mode of delivery, the neonatal outcome and the proportion of women in the expectant management group that progressed to spontaneous labor.Results: The immediate induction arm had a lower caesarean section rate, (7.9% vs 28.9%, P=0.001), higher spontaneous vaginal delivery rate (92.1% vs 71.1%; P=0.001) and lower incidence of clinical endometritis (0% vs 5.3%, P=0.006), when compared with the expectant management arm. The estimated duration of labor was shorter in the expectant management arm (8.9±2.17hours vs 10.6±2.35hours; P=<0.001). Neonatal morbidity rates were comparable in both groups.Conclusion: Immediate induction of labor in women with PROM at term resulted in significantly lower rate of infectious morbidity without increasing the risk of operative delivery. It is therefore recommended as the management option of choice.Keywords: Premature rupture of membranes, induction of labor, endometriti

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

Is menarche really occurring earlier? A study of secondary school girls in Ile-Ife, Nigeria

Context: A secular trend of progressively earlier attainment of menarche has been described in various populations. The existence of this trend in Ile-Ife, Nigeria, has not been documented. Aim: To determine the current age of menarche and its trend in comparison with previous studies among secondary school girls in Ile-Ife, Nigeria. Settings and Design: School-based cross-sectional analytical study. Materials and Methods: Three-hundred secondary school girls in the lower four classes (JSS 1--SSS 1) were studied. Sociodemographic and menstrual data such as cycle length, duration of menstrual flow, and presence of dysmenorrhoea were obtained using a structured self-administered questionnaire. The mean age at menarche was compared with figures from previous local studies to determine the trend in Ile-Ife. Menstrual characteristics were also analyzed. Statistical Analysis: Data was analyzed with SPSS version 20. Means and standard deviations were generated for continuous variables, while frequencies and proportions were determined for categorical variables. Results: Out of the 300 subjects studied, a total of 198 (66%) had attained menarche at the time of this study. Their reported ages at menarche ranged from 11 to 17 years with a mean of 13.08 ± 1.61 years. This was lower than the 13.98 ± 1.30 and 13.94 ± 1.31 years reported in Ile-Ife in 1992 and 1997, respectively. These three figures show a trend of progressive decline in the mean age at menarche. The subjects' mean duration of menstrual flow was 4.26 ± 0.87 days, with 97.5% of them reporting flow of ≤5 days. Only 22 (11.1%) of the respondents had a cycle length of 28 days. Dysmenorrhoea was reported by 75% of the respondents and 24% reported loss of concentration during periods. Conclusion: Similar to the widely reported secular trend, menarche indeed appears to be occurring progressively earlier in Ile-Ife, Nigeria

Cholestatic Diseases of Pregnancy

Cholestatic diseases of pregnancy (CDP) are also referred to as intrahepatic cholestasis of pregnancy, recurrent cholestatic jaundice of pregnancy, icterus gravidarum and cholestatic hepatosis. It is a form of intrahepatic cholestasis characterized by pruritus and mild jaundice that usually occurs in the third trimester of pregnancy, though occurrence in earlier gestations is encountered occasionally. It is the second most common cause of jaundice occurring in pregnancy, ranking next to viral hepatitis1. IFEMED Journal Vol. 14 (1) 2008: pp. 23-2

A randomized controlled trial of the impact of dopamine on outcome of asphyxiated neonates

Background: Vasoactive drugs such as low dosage dopamine are often used in the intensive care of asphyxiated term neonates but there is insufficient evidence to support the practice.Aims: To evaluate the impact of low dose dopamine on the clinical course and outcome of newborns with severe perinatal asphyxia and to determine factors that predict survival.Methods: This was a randomized controlled trial. Term asphyxiated newborns were alternately recruited into ‘dopamine’ and ‘nodopamine’ sub groups. Asphyxia was defined as Apgar score ≤3 at one minute or ≤5 at five minutes, and/or clinical evidence of hypoxic ischemic encephalopathy (HIE). The intervention comprised dopamine infusion at 3.0mcg/kg/minute. Primary outcome was death or survival till discharge while secondary measures were apnoea, oliguria, seizures and other clinical morbidities. The Student t-test was used to compare outcomes between the subgroups.Results: A total of fifty five asphyxiated infants took part in the study: 27 in the intervention group while 28 were in the control group. The subgroups were similar in mean gestational age, Apgar scores, age at admission and modes of delivery (p>0.05). HIE occurred in over a half of the subjects. The frequency of apnoea, oxygen requirement, duration of anticonvulsant treatment and urine outputs were similar between the subgroups(p > 0.05).The mean durations of admission (days) were 5.13±3.0 and 5.3±3.0 for the intervention and non-intervention subgroupsrespectively (t=0.183, p=0.856). Likewise,survival rates were similar (x2 = 1.261, p = 0.948). Selected perinatal eventsdid not influence outcome (p>0.05).Conclusion: Low-dosedopamine has no impact on the short term outcome of asphyxiated infants.Key words: hypoxic ischemic encephalopathy, clinical course, outcome, dopamin

Obstetric outcome of teenage pregnancy and labour in Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife: A ten year review

Background: Teenage or adolescent pregnancy is a recognized problem of public health significance. Every year, in excess of 14 million teenage girls give birth to a child; most of these young mothers are living in non-industrialized countries. In view of the high prevalence, there is a need to audit such cases regularly to identify areas of possible improvement in its management. Results obtained from the audit can help in policy formulation and strengthen advocacy on issues ranging from abortion complications to early marriage. Objectives: The objectives of this 10-year retrospective study are to document the pattern of prevalence, presentation, obstetric outcome of teenage pregnancy, and labor at the Ife Hospital unit of obafemi awolowo university teaching hospitals complex (OAUTHC), Ile-Ife. Materials and Methods: The study involved a 10-year retrospective analysis of the data collected from the records of all cases of teenage pregnancies during the period from January 1999 to December 2008. Results: During the period studied there were 6,250 deliveries of which teenage pregnancies accounted for 255 giving an incidence of 4.08% of the total deliveries. Majority (51.76%) of the pregnant teenagers were unbooked for antenatal care and 92.12% of them were nulliparous. Antepartum hemorrhage, abnormal presentations, obstructed labor, and anemia were the commonest complications seen occurring in 54.5, 36.5, 14.1, and 11.4 per cent of the teenagers respectively which was significantly higher when compared to the adult pregnant women (P = 0.000). Delivery was by caesarean section in 32.2% of the teenagers compared to 22.6% in the other women (P = 0.000). The overall perinatal mortality rate was 68.8/1000 births while teenagers had a perinatal mortality rate of 106/1000 births (P = 0.013). Conclusion: Teenage pregnancy still remains a major recognized problem of public health significance. Most of these patients are from low socio-economic class and their obstetric performance is relatively poor compared to the adult group. The concept of women's sexual and reproductive health rights needs to be reinforced in most developing countries. Improving access to contraception and discouragement of early marriage will help to reduce teenage pregnancy and the overall burden of maternal mortality. Optimal care should be given to teenage mothers not only to improve the pregnancy outcome but also to enhance their social, educational, and emotional adjustment