Obstetric admissions in a general intensive care unit in north-central Nigeria

Context: Maternal mortality remains unacceptably high in many developing countries and many pregnant women in these countries will require critical care during pregnancy and will be managed in general intensive care units.Objective: To determine the indications for admission of obstetric patients into the general intensive care unit of Jos University Teaching Hospital over a 14 years period and the outcome of their management.Study Design: The study is a retrospective descriptive study. All obstetric admissions into the intensive care unit of Jos University Teaching Hospital from January 1994 to December 2007 were reviewed.Results: There were 231 obstetric admissions which was 17.29% of total ICU admissions and 2.05% of all deliveries in the hospital during the period of review. The mean age of the patients was 25±7.1 years. Pregnancy induced hypertension made up 80.52% of the admissions, while haemorrhage was 12.56% and non-obstetric admission was 6.93%. The most common non-obstetric admission was sepsis (43.70%). Of all admissions 90.91% were in the postpartum period and 9.09% during the antepartum period. The medium length of was two days. The mortality rate was 15.15% with significantly higher ratio of deaths in patients with non-obstetric indications for admission and in patients older than 35 years.Conclusion: There is a high rate of ICU admission of obstetric patients in our hospital. This increases the burden of care in the ICU and contributes to poor outcome. Establishment of obstetric high dependency units will reduce the burden on general ICUs

Predisposing factors and outcome of uterine rupture in Jos, North-central Nigeria

Background: Uterine rupture has continued to be an obstetric catastrophe with tragic maternal and foetal outcomes particularly in Nigeria.Methods: an institutional, cross sectional retrospective study was carried out at Jos University Teaching Hospital, North-Central Nigeria. Case files of mothers with uterine rupture managed at the hospital from 1 January 2011 to 31 December 2019 were retrieved and included in the study. Data extracted from case files included maternal age, parity, gestational age, booking status, presence of uterine scar, obstetric interventions prior to rupture, site of rupture, type of surgery, units of blood transfused, intensive care unit admission and duration of hospital stay and maternal or foetal death.Results: the incidence of uterine rupture was 1 in 497 deliveries (0.2%). The mean age of the patients was 30.1±5.1years. About 75% of the patients were para 1-4. Seventeen (70.8%) patients were unbooked while fourteen (58.3%) had unscarred uterine rupture. Eight out of 14(57.1%) patients with unscarred uterus had uterotonics for induction or augmentation of labour. Fourteen (58.3%) patients had rupture involving anterior lower uterine segment. Over half of the patients had uterine repair only (58.3%), 29.2% had uterine repair with bilateral tubal ligation while 12.5% had subtotal hysterectomy. Twenty-two (91.7%) required blood transfusion, five patients had 5 or more units of blood transfused. The perinatal mortality was 69.6%, there was no maternal death.Conclusions: the major predisposing factors to uterine rupture in our facility were lack of antenatal care, presence of previous caesarean section scar and injudicious use of uterotonics

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care

Forgotten sanitary pad following episiotomy repair: A Case Report

Background-Gossypiboma describes an intraoperative mistake discovered postoperatively where surgical sponges, abdominal pack, gauze packs or textile materials are forgotten in the operative field after the patient is closed. This condition is under reported and poses a diagnostic dilemma&nbsp; because it may be silent for varying durations after the surgery. Case Presentation-A 23 -year old Para 1+0 pharmacy assistant presented thirty-one months after childbirth to the gynaecology clinic with&nbsp; complaints of dyspareunia, dysmenorrhoea, offensive menstrual effluent and vaginal discharge since her delivery. She had received an episiotomy,&nbsp; which had been repaired and she had been discharged on antibiotics and analgesia. She passed red lochia for three days followed by brown&nbsp; malodorous fluid per vaginam. She experienced severe abdominal pains, high-grade fever, chills and rigors during the puerperium with dyspareunia&nbsp; and foul smelling vaginal discharge subsequently. She visited several hospitals, and received antibiotics, antimalarials and analgesics,&nbsp; but symptoms persisted. On examination, significant findings were suprapubic tenderness, brown malodorous discharge, adnexal tenderness and a&nbsp; mass plugging the cervical os. It was removed and examination revealed a sanitary pad covered in foul-smelling discharge. Symptoms abated but&nbsp; twelve months after, she presented with inability to conceive and was referred for infertility evaluations. Conclusion- Competent doctors should supervise less experienced colleagues to forestall these gaps which can lead to legal action and maternal&nbsp; morbidity and possibly mortality. Repeat pelvic examinations should be performed after vaginal procedures, and women presenting with abdominal&nbsp; and genital symptoms should receive exhaustive evaluations

Pattern of gynaecological malignancies in Jos

Context: Female cancer is a public health problem the world over. The malignancies of the female genital organs are major causes of morbidity and mortality which necessitates data for policy formulation and health planning.Objective: To document the relative frequency, age distribution and histological patterns of gynaecological malignancies seen at the Jos University Teaching Hospital (JUTH).Methodology: A retrospective 5 year review of all gynaecological malignancies seen at the JUTH. Main outcome measures: frequency, age distribution and histological patterns of gynaecological malignanciesResult: Female genital tract cancers account for 5.4% of gynaecological disorders in JUTH. The complete records of 203 out of 250 patients with gynaecological malignancies were retrieved giving a retrieval rate of 81.2%. Of these 203 case records, 152(74.9%) cases were from the uterine cervix while 31(15.3%) and 13(6.5%) cases were from the ovary and uterine corpus respectively. The vagina and vulva accounted for 3(1.4%) and 4(1.9%) cases respectively. Squamous cell carcinoma accounted for 93.4% of cervical cancers and 100% of vaginal and vulval cancers. Epithelial tumours accounted for 61% of ovarian tumours while choriocarcinoma accounted for 53.8% of cancers of the corpus uteri.Conclusion: Squamous cell cervical cancer is still the most common gynaecological malignancy in Jos. The challenges of HIV/AIDS and cervical screening need to be addressed to reduce its incidence.Keywords: Gynaecological cancers, pattern, frequency, histology, JosTrop J Obstet Gynaecol, 30 (1), April 201

Induction of labour at Jos University teaching, hospital, Jos, Nigeria: a four year review

Background: Induction of labour (IOL) is a common procedure that remains a relevant Obstetric procedure. The maternal and perinatal outcomes are paramount hence the need to review the intervention in order to implement needed change.Objectives: To determine incidence, indications, outcome and complications of induction of labour at the Jos University Teaching Hospital (JUTH), Jos, Nigeria.Methods: This was a retrospective study reviewing 584 women who had IOL in JUTH from January 2004 to December 2007. Parameters selected for review include parity, gestation age, outcome and cervical state prior to IOL.Results: Four hundred and eighty women had vaginal deliveries (82.2%). There were fifty two induced on account of antepartum Intra Uterine Foetal Deaths (IUFD), while 1.5% of the deliveries ended up as still births, 10.5% had birth asphyxia and neonatology review and care. Thirty two patients had various complications after IOL. There were no maternal mortalities.Conclusion: Parity and presence of IUFD were found to influence the outcome of IOL

Knowledge, attitude and practice of maternity unit staff in Jos Metropolis to universal precautions against HIV

Background: Health care workers in maternity units are exposed to potentially infectious body fluids in the course of their duties. The study assessed the knowledge, attitude and practice of maternity unit staff in Jos Metropolis regarding Universal Precautions (UP) against the background of the high HIV seroprevalence in Plateau state, Nigeria.Methods: A cross sectional descriptive study carried out among maternity unit staff in Jos, Nigeria. A pretested, structured, anonymous questionnaire on knowledge, attitude and practice on universal precautions concerning HIV was administered to a sample of 230.Results: A total of 202 questionnaires were completed and returned giving a response rate was 87.8%, 68.5% of the respondents were female and 31.5% male; 63 of the respondents were physicians while 139 were non physicians. 52 (82.5%) physicians and 113 (81.3%) non physician cadre staff correctly identified UP in the context of labour ward practice to apply to blood, vaginal secretions and liquor. 54 (85.7%) of the physicians and 87 (62.6%) identified that UP involved use of barrier methods. Being a physician conferred knowledge of correct use of barrier methods..Conclusion: A majority of the respondents demonstrated correct knowledge of practice of UP . There was no significant difference in knowledge between physician and non physician cadre of labour ward staff with regard to correctly identifying the fluids that UPs apply to. Physician cadre of labour ward staff in Jos metropolis was associated with the correct identification of barrier methods that UPs apply to.Keywords HIV, Universal precautions, Maternity unit staff, Jos

Gestational age at booking for Antenatal Care and the pregnancy outcome at Faith Alive Hospital, Jos, Nigeria

Background: Early initiation of antenatal care is believed to improve maternal and foetal outcome. We sought to ascertain gestational age at booking and the outcome of these pregnancies at a faith based hospital in northern Nigeria. Methods: A retrospective descriptive study of patients who booked for antenatal care at the Faith Alive Hospital, Jos, st st Nigeria between 1 January, 2010 to 31 December, 2017 was done. Information regarding demographics, gestational age at booking and outcome of these pregnancies were analyzed. Result: During the study period, 3739 women registered for antenatal care. Majority of women were 20-24years (n= 1252 , 33.5 %) while The mean age was 28 ± 4years Of these women, 96.2% were married , 75.2% were Christians, 43.8% had secondary level of education and 41.2% were traders. st Furthermore, 23.2% of the clients booked in the 1 trimester in 2010, decreased to 17.3% in 2012 but progressively increased to 35.2% , 40.2% and 53.4% in 2014, 2015 and 2017 respectively. There was a significant statistical association between parity, marital status and educational status with late booking for antenatal care. Clients who booked late for antenatal care had poorer neonatal outcomes (low birth weight, still births and birth asphyxia) compared to those who booked early. Conclusion: Late initiation of antenatal care is common in our environment and associated with poorer neonatal outcomes.&nbsp; Nonetheless, a progressive improvement in early bookings was noticed with improved pregnancy outcome. Key Words: Gestational age, booking, pregnancy outcome, Faith Alive, Jo

Successful management of severe HELLP syndrome: A case report

Haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a severe pregnancy complication that is life-threatening for both mother and fetus. When HELLP syndrome associates with disseminated intravascular coagulation (DIC) or with other complications, it is necessary to terminate the pregnancy. We present a case of a 26-year-old primigravida with rare combination of HELLP syndrome with coagulopathy and renal complication at 34 weeks of gestation. She had emergency caesarean section followed by haemorrhagic complications, DIC and acute renal failure.&nbsp; During her stay in intensive care unit, she had massive blood transfusion and fresh frozen plasma. She had haemodialysis because of acute renal failure. A gradual improvement of her condition was observed after exploration and drainage of haemoperitoneum. After 13 days she was discharged from the intensive care unit.HELLP syndrome complicated by DIC and Acute kidney injury is a condition that is associated with high maternal and perinatal morbidity and mortality. Prompt recognition, teamwork and treatment with timely administration of blood products along with other supportive care is crucial in the management of this life-threatening and challenging condition. Key words: AKI, Preeclampsia, Disseminated intravascular coagulation, HELLP syndrom

Predictors of Mortality in a Clinic Cohort of HIV-1 Infected Children Initiated on Antiretroviral Therapy in Jos, Nigeria

Background: Mortality among Human Immunodeficiency Virus-1 (HIV-1) infected children initiated on Antiretroviral Therapy (ART) though on a decline still remains high in resource-limited countries. Identifying baseline factors that predict mortality could allow their possible modification in order to improve pediatric HIV care and reduce mortality. Methods: We conducted a retrospective cohort study analyzing data on 691 children, aged 2 months-15 years, diagnosed with HIV-1 infection and initiated on ART between July 2005 and March 2013 at the pediatric HIV clinic of Jos University Teaching Hospital. Lost to follow-up children were excluded from the analyses. A multivariate Cox proportional hazards model was fitted to identify predictors of mortality. Results: Median follow-up time for the 691 children initiated on ART was 4.4 years (interquartile range (IQR), 1.8-5.9) and at the end of 2752 person-years of follow-up, 32 (4.6%) had died and 659 (95.4%) survived. The mortality rate was 1.0 per 100 child-years of follow-up period. The median age of those who died was about two times lower than that of survivors [1.7 years (IQR, 0.6-3.6) versus 3.9 years (IQR, 3.9 - 10.3), p5 years (p=0.02) Multivariate modeling identified age as the main predictor of death with mortality decreasing by 24% for every 1 year increase in age (Adjusted Hazard Ratio (AHR)=0.76 [0.62-0.94], p=0.013. Conclusion: The lower mortality rate for our study suggests that even in RLCs, mortality rates could be reduced given a good standard of care. Early initiation of ART in younger children with close monitoring during follow-up could further reduce mortality