Basic indices for labour and delivery management in Nigeria

Background: One of the key challenges of labour management is the delayed involvement of senior medical personnel due to weak knowledge of basic labour and delivery indices in the health facilities in this environment.Objectives: To determine the mean cervical dilatation at presentation, the mean presentation-delivery interval and the mean cervical dilatation rate of women who presented in active labour at the health facilities.Materials and Methods: This was a 6 year prospective cross-sectional study of deliveries in 60 secondary health facilities in Nigeria from 1st July, 2003- 31st July, 2008 using the Emergency Obstetric care Register.Results: Out of the 1,176 deliveries, 909 (77.3%), 120 (10.2%) and 147 (12.5%) were spontaneous vaginal deliveries, dystocic vaginal deliveries and Caesarean sections respectively. The mean cervical dilatation, presentation-delivery interval and the cervical dilatation rate were 7.05cm, 3 hours 29 minutes and 1.36cm/hr respectively. The mean cervical dilatation rate for spontaneous deliveries, assisted deliveries, and caesarean sections were 1.6, 0.7 and 0.5 cm/h respectively.Conclusion: Adequate labour monitoring by the junior obstetric team for early detection/management of slow progress and review of all women that have not delivered within 6 hours of labour by the experienced obstetric staff will prevent prolonged labour.Keywords: Labour, Basic delivery indices, NigeriaTrop J Obstet Gynaecol, 30 (1), April 201

Determinants of adverse perinatal outcome in preeclampsia at the federal medical centre, Makurdi: a cross-sectional study

Background: Preeclampsia currently accounts for the high burden of adverse perinatal morbidity and mortality in Nigeria. Aim of study was to determine the prevalence of preeclampsia and factors associated with adverse perinatal outcome at the Federal Medical Centre Makurdi. Methods: This was an analytical cross-sectional study in which 170 consecutively consenting women with preeclampsia were recruited. The perinatal outcomes were identified in the antenatal period, at delivery and early puerperium. The data was analyzed using SPSS version 20.0 for windows (IBM SPSS Inc, Chicago, IL, USA). Categorical variables were analyzed using Chi-Square ( 2) test and Fisher's exact test. Bivariate analysis was used to test for association between basic characteristics of participants and adverse perinatal outcomes, while logistic regression analysis was used to determine the strength of these association. P < 0.05 and if CI does not include value 1, it was considered statistically significant. Results: This study shows that the prevalence of preeclampsia and adverse perinatal outcome was 2.4% and 63.5% respectively. The adverse perinatal outcomes were more with the severe disease than with mild preeclampsia. The estimated gestational age at presentation (EGAP), severity of the disease and mode of delivery were the risk factors strongly associated with adverse perinatal outcomes. Conclusions: This study had shown the high burden of preeclampsia in Makurdi, North Central Nigeria and recommends quality improvements in maternal and child care to reduce perinatal adverse outcomes

Assessment of the Quality of Emergency Obstetric Care at the Federal Medical Centre, Makurdi, Nigeria

Context: This audit was conducted with the goal of reducing maternal mortality by finding out the quality of obstetric services rendered, because of the frequent maternal deaths in the centre, with the aim of upgrading the standard of care. Objective: To assess the quality of emergency obstetric care using the maternal mortality ratio, case fatality rate, the caesarean section rate and management problems (Drugs, Equipment and Staff). Subjects and Methods: A four year descriptive study of obstetric service data from 1 January 2000 to 31 December, 2003 in Federal Medical Centre, Makurdi. Results: During the study period, there were a total of 3,551 deliveries and 83 maternal deaths giving amaternal mortality ratio of 2,337/100,000 deliveries. Of the 83 maternal deaths, adequate data for analysisof the Case Fatality Ratio was available in 73 (88%). Out of these 73 deaths, there were 66 direct maternal deaths. Total recorded direct obstetric complications for the period were 459 giving the overall case fatality rate of 14%. The caesarean section Rate was 10%. Parenteral antibiotics and anticonvulsants and blood were not immediately available in the maternity during the period. The readiness and responsiveness of the staff to obstetric emergencies during the period was slow. Conclusion: The results suggest that the quality of Emergency Obstetric Care (EmOC) in the centre is poor and this is a call to action. Key Words: Quality Assessment, Emergency Obstetric Care (EmOC) [Trop J Obstet Gynaecol, 2004;21:160-163

Contribution of direct obstetric complications to maternal deaths in Makurdi, North-Central Nigeria

Context: The Federal Medical Centre Makurdi is the only tertiary health institution in Benue State. Maternal deaths are a frequent occurrence in the centre thereby necessitating this study. Objective: To determine the maternal mortality ratio, the case fatality rate and the contribution of direct obstetric complications to these deaths. Subjects and Methods: A four month descriptive study of obstetric service data from 1 January to 30 April 2004.Results: During the study period, there were a total of 363 deliveries (52% unbooked, 48% booked, 20% DOC.) and 16 maternal deaths (94% were direct) giving a maternal mortality ratio of 4 408 / 100 000 deliveries.14 (87.5%) of the deaths were unbooked obstetric emergencies. The overall case fatality rate (CFR) was 21%. The contribution of each direct obstetric complication to the direct maternal deaths was as follows: obstructed labour/ ruptured uterus (53.3 %), postpartum haemorrhage (13.35%), puerperal sepsis (13.35 %), Eclampsia (6. 68 %), induced Abortion (6.68 %). The cause- specific CFR was in this order. Ruptured uterus 100%, Puerperal sepsis 100%, Abortion 25%, severe Preeclampsia/Eclampsia 20%, Obstetric haemorrhage 12.5%, obstructed labour 11.4%. The caesarean section rate was 15 %. Facilities to provide life saving functions were lacking and staff commitment was low. Conclusion: Urgent emergency obstetric care training of residents and provision of parenteral antibiotics, anticonvulsants, oxytocics and safe blood for transfusion is recommended. Keywords: maternal mortality, direct obstetric complications, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 22: 37-3