Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of Magnesium sulfate

Background: Magnesium sulfate (MgSO4) is the most effective seizure prophylaxis in the management of severe preeclampsia, and its use is progressively spreading in our environment. It was introduced at the pioneer teaching hospital of southeastern Nigeria in 2007. A study on the outcome of its use is therefore necessary.Objectives: The objective was to determine the effect of introducing MgSO4 on the maternal and perinatal outcomes of severe pre-eclampsia in Enugu, South eastern Nigeria.Materials and Methods: A retrospective study of all cases of severe pre-eclampsia managed at the University of Nigeria Teaching Hospital Enugu (UNTH), Nigeria, from 1 January 2005 to 31 December 2008 - 2 years before, and 2 years after the introduction of MgSO4 – was performed.Result: The prevalence of severe preeclampsia within the study period was 3.3%. The mean age of study participants was 24.5 ± 2.9 years. Thirty women received MgSO4 while 47 women received diazepam. Eclampsia occurred only in a member of the diazepam group but there were no maternal deaths. Babies from the diazepam group were more likely to have low 1 minute Apgar scores but the association was not significant [OR = 3.08 (95% CI 0.78, 13.33)]. Longer hospital stay was significantly lower among women who received MgSO4 [OR = 0.32 (95% CI 0.11, 0.93)]. Perinatal mortality did not differ between the groups.Conclusion: MgSO4 is effective in the management of severe pre-eclamptics at the UNTH, Enugu. Therefore, its accessibility and wider use should be promoted

Impact of Free Maternal and Child Healthcare Programme on Maternal and Neonatal Healthcare Outcome in Enugu State of Nigeria

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Patter of Gynaecological Cancers in University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria

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Trends and Determinants of Episiotomy at The University of Nigeria Teaching Hospital (Unth), Enugu, Nigeria

BACKGROUND: Episiotomy is the most commonly performed obstetric procedure. The indications and efficacy are poorly established and its practice has remained controversial. OBJECTIVE: To determine the rate and the determinants of episiotomy in the parturients at the UNTH, Enugu.METHODS: A five year retrospective review of stepisiotomy at UNTH Enugu between 1 January ,2000 stand 31 December,2004 .RESULTS: Out of 3032 vaginal deliveries, 1201 women had episiotomy during vaginal delivery, giving a rate of 39.6%. The rate fluctuated between 38.7% in 2000 to 32.7% in 2004.The risk of receiving episiotomy is significantly higher among primigravidae than multigravidae [OR=10.92,(95%CI=8.98,13.28]. Similarly, macrosomia(birth weight>4kg) significantly increases the risk of episiotomy[OR=0.096, (95%CI=0.06,0.15]. Women who had instrumental or destructive vaginal delivery are significantly more likely to receive episiotomy than those who had spontaneous vaginal delivery[OR=0.13 (95%CI=0.07,0.26]. The postpartum blood loss is significantly higher among women that received episiotomy than those who did not[t=42.161, P>0.0001]. CONCLUSIONS: The rate of episiotomy in UNTH, Enugu is high. Primigravidity, macrosomia and instrumental deliveries are factors associated with increased risk of episiotomy. Knowledge of these risk factors will guide in predicting episiotomy among paturients in labour ward.KEYWORDS: Episiotomy, Trends, determinants, Enugu-Nigeria

Spontaneous Rupture of Gravid Horn of Bicornuate Uterus at Mid Trimester - A Case Report

Rupture of gravid uterus in a primigravida is rare and is generally associated with Mullerian duct anomalies. A case of rupture of gravid left horn of bicornuate uterus at 20 weeks gestation is reported in a 25-year old unmarried primigravida. The ruptured left horn was excised and defect closed. The need for high index of suspicion, early diagnosis and prompt intervention is highlighted. Keywords: bicornuate uterus, uterine rupture, laparotom

Coinfection with Hepatitis B and C Viruses among HIV Positive Pregnant Women in Enugu South East, Nigeria

Background: Hepatitis B and C viruses coinfection in HIV positive pregnant women is a common public health problem and recognized worldwide. The consequences of this problem in our poor resource setting with the risk of mother to child transmission is obvious with increased morbidity and mortality in our environment. Objective: To determine the prevalence of coinfection patterns of HBV and HCV among HIV positive pregnant women in Enugu Nigeria.Methods: A retrospective survey conducted on 401 Nigeria HIV positive pregnant women seen at Prevention of Mother To Child Transmission (PMTCT) clinic at the UNTH Enugu Nigeria over a 3 year period between 1st January 2007 and 31st December 2009. Results: The prevalence of hepatitis B and C viruses coinfection among HIV positive pregnant women in Enugu is 6.5%. HIV/HBV coinfection was commoner than HIV/HCV coinfection. There was no significant association between hepatitis B and C viruses coinfection and the age, ethnic group, marital or educational status of the women (P>0.05).Conclusion: There is high prevalence of hepatitis B and C coinfection among HIV positive pregnant women in Enugu. This high burden of these hepatotropic virus coinfection calls for continued need to screen for these infections and vaccinate the affected babies for hepatitis B and/or C where appropriate.Keywords: HIV, Hepatitis B, Hepatitis C, PMTCT, pregnant women, Enugu Nigeri