Primary Caeserean Section In Grandmultiparae At Mater Misericordiae Hosptial Afikpo: A 5 Year Retrospective Study

To identify the common indications and the outcome of primary caesarian section in grandmultiparae at Mater Misericordiae Hospital Afikpo. The case notes of 69 grandmultiparae who had primary caesarean section at Mater MisericordiaeHospitalAfikpo between January 1999 toDecember 2003 inclusively.The information obtained included age, parity, occupation, height, educational status, booking status, indication for caesarean section, operative and post-operative complications, types of anaesthesia, types of uterine incision, mean blood loss, associated pelvic findings and foetal outcome. Eighty nine percent (89%) of 69 primary caesarean sections were done emergency procedure. The commonest indications for a caesarean section were dystocia (76.8%), antepartum haemorrhage (17.4%), essential hypertension (10.1%) Puerperal pyrexia (24.6%), haemorrhage (7.2%)wound dehiscence (4.3%) and anaemia (2.9%), were the commonest intra- and post operative complications encountered. The perinatal mortality ratewas 153/1000.Therewere twomaternal deaths (29 per 1000). Health education of the population coupled with better utilization of comprehensive maternity care and family planning facilities are advocated. Keywords: Caesarean Section, Grand multiparae. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 368-37

Antenatal Care Booking Pattern at a Tertiary Hospital in South- Eastern Nigeria

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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

Human Immuno-Defiency Virus Antibody Seroprevalence among Pregnant Women at Booking at a Univesity Teaching Hospital in South-Eastern Nigeria

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Wound Infection following Caesarean Section in a University Teaching Hospital in South-East Nigeria

Background: Caesarean section is a common operation in obstetric practice, but there is a general aversion to caesarean section amongst Nigerian women due to a myriad of reasons amongst which are its associated morbidity and mortality. Surgical site infection following caesarean section is both a major cause of prolonged hospital stay and the wide spread aversion to caesarean delivery in our environment.Objective: To determine the risk factors for surgical site infection following caesarean section as well as the relative contribution of each of the risk factors at the Anambra State University Teaching Hospital, (ANSUTH) Awka.Methodology: A retrospective case controlled study of patients delivered by caesarean section in Amaku General Hospital now ANSUTH from January 1st, 2000 to December 31st, 2011. The cases were the patients whose caesarean sections were complicated by surgical site infections, while those without surgical site wound infection served as controls. The hospital records were compared.Results: Five hundred and nine patients with complete records were analyzed. Fifty-six (56) patients (11%) had complicating wound infection. Statistically significant risk factors for infection were: body mass index >25 (p=0.003), prolonged rupture of membranes (p=0.0003), prolonged operation time (p=0.0011), anaemia (p=0.0009) and blood transfusion (p<0.0001), multiple vaginal examinations during labour (p<0.0001) and long duration of labour prior to caesarean section (p<0.0001).Conclusion: To make caesarean section more acceptable to women in our environment, efforts should be concentrated on strategies to prevent the risk factors.Keywords: Awka, caesarean section, infectio

Preliminary outcome of the management of eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia.Aim: This study aims at determining the prevalence and management outcome of  eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7% of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p<0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p<0.05). Twenty-eight (93.3%) of the eclampsia occurred antepartum. Twenty-eight (93.3%) had severe hypertension on presentation. Twenty nine (95.8%) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital.  Twenty-six (86.7%) of the patients had emergency Caesarean section was carried out, mostly for unfavourable cervix. The perinatal mortality was 6.7% while maternal mortality was 3.3%. Complications included acute renal failure, aspiration pneumonitis and abruptio placentae.Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking, antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment. Keywords: Eclampsia, Prevalence, Morbidity, Mortality, Orl

Prevalence of Anaemia Among Human Immunodeficiency Virus (HIV) Positive Pregnant Women at Booking in Orlu, South-Eastern Nigeria

Background: Anaemia is the most commonly encountered haematological abnormality in human immunodeficiency virus (HIV) positive patients with estimates climbing as high as 95% depending on clinical settings. The twin effects of HIV infection and anaemia in pregnancy is associated with adverse maternal and perinatal outcomes.Objective: To determine the prevalence of anaemia among HIV positive pregnant women at booking at Orlu, South-East Nigeria.Methods: A retrospective analysis of the case records of women who were screened for Human Immunedeficiency Virus and anaemia at the Imo State University Teaching Hospital from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, marital status, haemoglobin concentration and retroviral status were collected and analyzed using SPSS version 13.Results: Nine hundred and twenty one pregnant women were screened at booking within the study period. The age range of the women was  8-39years with a mean age of 28.22 ± 5.04years. One hundred and six (11.5%) of the women tested and were confirmed positive to HIV 1 & 2 antibodies. Anaemia was significantly higher among HIV positive pregnant women than in HIV negative pregnant women (75.5% vs 57.9%; P=0.001). Seventy seven point three percent (75/97) of women ≤ 20 years were anaemic. This was shown to be significant (P=0. 000). Three hundred and thirty three (69.2%) of the women that had only secondary education were significantly (P=0.000} more anaemic than those that had postsecondary education.Conclusion: There was a high prevalence of anaemia among HIV positive pregnant women at booking at the Imo State University Teaching Hospital (IMSUTH, Orlu. Anaemia was also more significant in younger age (≤20years} and lesser educated women (only secondary.school}Key Words: Anaemia, HIV, Pregnancy, Booking, Orl

Uterovaginal prolapse at a University Teaching Hospital in South-East Nigeria

Background: Uterovaginal Prolapse is a common gynaecological problem particularly in the grandmultipara. It is of considerable importance to the practising gynaecologist in the tropics because of its strong association with repeated child birth and poor conduct of labour.Objective: To determine the hospitalprevalence and management pattern of this condition in Imo State University Teaching Hospital, Orlu and the attendant problems associated with the management.Methodology: This was a retrospective study of all patients presenting with uterovaginal prolapse between 1st January, 2004 and 31st December, 2007. There were 1,075 gynaecological admissions during the period and 43 patients had genital prolapse out of which 42 (97.7%) case notes were retrieved from the medical records department. Relevant data were obtained from the case notes, which included age, parity, presenting symptoms, number of living children, types of delivery, types of surgical management and associated operative morbidity and mortality. The data were presented as simple percentages.Results: The prevalence of uterovaginal prolapse in this study was 39.1 per 1000 gynaecological admissions making it 3.9% of total gynaecological admissions. The mean age of presentation was 51.4± 3.3 years. The mean parity was 4.2± 1.6. Grandmultiparity accounted for 81% of the cases. The most common symptom at presentation was the sensation of a protrusion down the vagina in 32 (76.2%) of the patients. Difficult labour was found to be the most common associated factor in 32 (76.2%) of the patients. The most common form of treatment offered was vaginal hysterectomy with pelvic floor repair, 37 (88.1%).Conclusion: There is need to educate women on the importance of accessing skilled antenatal, delivery and postnatal services as these might reduce the prevalence of uterovaginal prolapse in our environment.Keywords: Difficult labour, genital, hysterectomy, multiparit