Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

Effects of Nutritional Status and Supplementation on Resumption of Menstruation Amongst Parturient Nigerian Women

Context: Breastfeeding patterns, ethnic variation and nutrition have been shown to influence the return of menstruation after childbirth, but the role played by nutritional status requires further elucidation, particularly in a place like Nigeria where undernutrition is common. Objectives: To determine the effects of nutrition and breastfeeding pattern on the duration of lactational amenorrhoea in Nigerian women. Subjects and Methods: Marginally malnourished mothers (162) were randomised into two groups [A & B] for comparison with a third group [C] of well-nourished mothers. Mothers in Group A (83 subjects) received supplements in the form of specially formulated biscuits while those in Group B (79 women) & Group C (85 women) received none. The subjects were visited 3 times a week to ensure compliance with the supplements and to collect information on breastfeeding pattern and duration of lactational amenorrhoea. Results: There were no significant differences in the duration of postpartum amenorrhoea in the three groups of mothers, being 270, 220 and 234 days for Groups A, B and C respectively. Wide individual variations were observed in the duration of amenorrhoea in each group of mothers despite the fact that they generally had similar patterns of breastfeeding. The energy expenditure patterns in the supplemented and unsupplemented mothers were similar. Conclusion: Nutritional status and supplementation do not seem to influence the duration of lactational amenorrhoea in this group of Nigerian women. Subtle physiological differences between individual women may account for the wide individual variations observed in the time of resumption of menstruation after childbirth in the subjects. Key Words: Breastfeeding, Lactational Amenorrhoea, Nutritional Status, Menstruation. [Trop J Obstet Gynaecol, 2002, 19: 39-43]

Uterine Rupture: a Major Contributor to Obstetric Morbidity in Sagamu

Background: The incidence of uterine rupture is high in most developing countries and it is a leading cause of maternal mortality and morbidity. Objectives:To determine the incidence, aetiology and the associated morbidity and mortality in cases of ruptured uterus presenting at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Materials and Methods: A review of all the case notes of patients that were managed for uterine rupture over a 7-year period was conducted. The records were analysed for the patients' mode of presentation, possible predisposing factors, type of uterine rupture, and the associated morbidity and mortality. Results: The incidence of rupture during the period was 1 in 67 deliveries or 14.9 per 1000 deliveries. The mean age [SD] was 30.1 [1.8] and the mean parity was 3.3 [0.93]. Majority (88.5%) of the patients were unbooked. Oxytocin administration was the identified aetiological factor in 41 (67.2%) of the patients. Majority (73.8%) presented with clinical signs of shock. At operation, 56 (91.8%) were found to have complete uterine rupture, with a predominance of anterior wall rupture (83.6%). Uterine repair with or without bilateral tubal ligation was the usual surgical treatment offered while wound sepsis, with or without generalized septicaemia, was the commonest morbidity found. Maternal mortality was 14.8%. Conclusion: Uterine rupture continues to be a major cause of maternal morbidity and mortality in Sagamu and efforts should be geared towards reducing the number of women affected by this problem. Key Words: Uterus Rupture, Genital Injury, Haemorrhage, Shock [Trop J Obstet Gynaecol, 2003, 20: 137-140