Cesarean Delivery for a Life‑threatening Preterm Placental Abruption

Placental abruption is one of the major life‑threatening obstetric conditions. The fetomaternal outcome of a severe placental abruption depends largely on prompt maternal resuscitation and delivery. A case of severe preterm placental abruption with intrauterine fetal death. Following a failed induction of labor with a deteriorating maternal condition despite resuscitation, emergency cesarean delivery was offered with good maternal outcome. Cesarean delivery could avert further disease progression and possible maternal death in cases of severe preterm placental abruption where vaginal delivery is not imminent. However, further studies are necessary before this could be recommended for routine clinical practice.Keywords: Cesarean delivery, Intrauterine fetal death, Preterm placental abruptio

Maternal mortality in a Transitional Hospital in Enugu, South East Nigeria

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100 000 live births as a specialist hospital, with a decline to 625/100 000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies (Afr J Reprod Health 2009; 13[4]:67-72)

Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria

Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating  adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions.Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria.Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant.Results: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09–0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94–8.42)]. Only25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter.Conclusion: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.Key words: Acceptability, health workers, HPV vaccine, Nigeri

Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop.Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria.Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level.Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavourable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively.Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re‑training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high‑risk patients for prompt referral to hospitals before complications develop. Keywords: Childbirth emergencies, Delay, Outcomes, Referrals, Trained traditional birth attendant

The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria

BACKGROUND:Hypertension is a common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications associated with the condition.OBJECTIVES: To determine the pattern, risk factors, maternal and fetal outcomes in women with hypertensive disorders of pregnancy.METHODOLOGY:This was a descriptive retrospective study of the pattern and obstetrics outcome of hypertensive disorders in Nnewi.. The Obstetric variables from 148 women with hypertensive disorders of pregnancy at the Nnamdi Azikiwe University Teaching Hospital Nnewi, from the 1st January 2004 to 31st December 2008 were analyzed. Stastical analysis was done using Epi Info version 3.3.2. The level of statistical significance was set at P<0.05.RESULTS: of the 4021 deliveries in the hospital during the period under review, 148(3.7%) were managed for hypertensive disorders of pregnancy. Only 138 folders were used for analysis. The mean age of the women was 31.3±5.7years. Majority of the women were unbooked (57.2%). Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (46.4%) with the majority presenting with severe disease. The level of proteinuria was significant in 74.6% of cases of preeclampsia. The mean gestational age at delivery was 35.3±1.5weeks. The mean birth weight was 1.6±0.3kg. Twenty-four intra uterine deaths were recorded giving a stillbirth rate of 17.4%. The perinatal mortality rate was 20.9%.  Diagnosis was made in the ante-partum period in 92.0% of the cases while 55.2% of the women delivered through Caesarean section. Eight maternal deaths were recorded, giving a case fatality rate of 5.8%. CONCLUSION: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality in Nnewi, Nigeria. Antenatal care will help in early diagnosis and timely intervention of the cases. There is need for strengthening of communication and referral systems in the healthcare.KEY WORDS: Hypertensive disorders, pattern, obstetrics outcome.Erratum Note: Mbachu 1, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU on the article “The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria” on Page Nig. J. Med 2013. 117-122. Should read: Mbachu II, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU

Women’s experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria

Background Disrespect and abuse (D&A) of women in health facilities continues to be a prevailing public health issue in many countries. Studies have reported significantly high prevalence of D&A among women during pregnancy and childbirth in Nigeria, but little is known about women’s perceptions and experiences of D&A during maternity care in the country. The aim of this study was to explore: 1) how women perceived their experiences of D&A during pregnancy, childbirth, and in the postnatal period in Benue State, Nigeria; and 2) how women viewed the impact of D&A on the future use of health facilities for maternity care. Method Five focus group discussions with a sample of 32 women were conducted as part of a qualitative phenomenological study. All the women received maternity care in health facilities in Benue State, Nigeria and had experienced at least one incident of disrespect and abuse. Audio-recorded discussions were transcribed and analysed using a six-stage thematic analysis using NVivo11. Results The participants perceived incidents such as being shouted at and the use of abusive language as a common practice. Women described these incidents as devaluing and dehumanising to their sense of dignity. Some women perceived that professionals did not intend to cause harm by such behaviours. Emerged themes included: (1) ‘normative’ practice; (2) dehumanisation of women; (3) 'no harm intended' and (4) intentions about the use of maternity services in future. The women highlighted the importance of accessing health facilities for safe childbirth and expressed that the experiences of D&A may not impact their intended use of health facilities. However, the accounts reflected their perceptions about the inherent lack of choice and an underlying sense of helplessness. Conclusion Incidents of D&A that were perceived as commonplace carry substantial implications for the provision of respectful maternity care in Nigeria and other similar settings. As a country with one of the highest rates of maternal deaths, the findings point to the need for policy and practice to address the issue urgently through implementing preventive measures, including empowering women to reinforce their right to be treated with dignity and respect, and sensitising health care professionals

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence