Intrauterine adhesions at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria: A 3 year review

Context; Menstrual abnormalities and infertility are leading gynaecological complaints which can be caused by intrauterine adhesion, a preventable condition. Hence, the need to know the common aetiological factors in ourenvironment.Objective; To determine the mode of presentation, aetiological factors and outcome of treatment of intrauterine adhesions in our institutionStudy design, setting; A retrospective analysis of all cases of intrauterine adhesions at the university of Maiduguri teaching hospital from 1st January 2008 to 31st December 2010. The case records of 22 patients wereanalysed.Main outcome measure; Aetiological factors and outcome of treatment in regard to restoration of normal menses and conception.Results; Menstrual disorder was the most common complaint (90.9%) followed by infertility (86.4%). The most common aetiologic factor was C-section (10; 45.5) followed by abortion (8; 36.3). All patients were treated by adhesiolysis, Foleys catheter insertion and hormonal therapy for three cycles. Restoration of normal menstruation was achieved in 45.5% of cases and 27.3% conceived during the follow up period. No change in menstrual pattern was recorded in 36.4% of cases.Conclusion; C-section as a cause of intrauterine adhesion may be on the increase and subclinical infection is an important inciting factor.Keywords; Intrauterine adhesions, aetiological factors, reproductive outcome, Maiduguri

Survey on the use of misoprostol for induction of labour among Obstetricians in the west African sub region

Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complicationsObjective: To determine the use of Misoprostol for induction of labour among the Obstetricians in the West African sub region.Methodology and settings: During the October 2007 pre examination workshop of the West African College of Surgeons (FWACS), Faculty of Obstetrics and Gynaecology 42 examiners responded through structuredquestionnaires on the use of misoprostol for induction of labour (IOL) in their institutions of practice. Results: About 91 % admit using misoprostol for IOL with only half (50%) having written protocols for labour induction with misoprostol. Almost all (93%) prefer the vaginal route for the administration of misoprostol andabout 74% do not use misoprostol for those with Caesarean section scar compared to only 19% who do. Misoprostol is used for cervical ripening and control of post partum haemorrhage among 24.4% and 50% of theObstetricians respectively. The commonest complications encountered were Fetal distress, uterine rupture and uterine hyper tonus among 54.8%, 52.4% and 45.2% of the respondents.Conclusions: Misoprostol use was high with yet serious complication occurring among those using it for IOL. Despite the manufacturers and other regulatory agents warning against its use in pregnancy because of serious maternal and fetal complications, misoprostol use for IOL is widespread. A regulated use of this drug especially in pregnancy is advocated

Risk factors of prelabor rupture of membranes at University of Maiduguri Teaching Hospital, Maiduguri: A cross‑sectional study

Background: Prelabor rupture of membranes (PROM) is a common obstetrics problem associated with maternal and perinatal morbidity and mortality.Patients and Methods: This was a hospital-based cross-sectional study to determine the risk factors for PROM among women presenting to the Department of Obstetrics and Gynecology of the University of Maiduguri Teaching Hospital, Maiduguri. It was conducted between 1st May 2016 and 28th February 2017. Sociodemographic and obstetrics variables were obtained from the patients, and risk factors such as previous preterm delivery, previous PROM, miscarriages, fever, abnormal vaginal discharge, urinary tract infection, abdominal distension, trauma, and coitus were sought. For each patient, an endocervical swab, high vaginal swab, and urine samples were taken for microbacteriologic studies. The next patient without PROM is used as control. Data were analyzed using SPSS 20. A total of 258 (129 with PROM and another 129 without PROM) were analyzed.Results: The mean age, gestational age, and parity were 27 ± 6 years, 33 ± 0.3 weeks, and 1 ± 0.92, respectively. A majority of the women (55%) had parity between 1 and 4. Term PROM recorded the highest frequency [49 (37.9%)]. Previous history of PROM [odds ratio (OR) 5.18, 95% confidence interval (CI): 2.31–11.62], history of Preterm Delivery (OR 3.26, 95% CI: 1.16– 9.19), low socioeconomic status (OR 1.95 95%, CI: 1.15–3.31), and genitourinary infection are highly predictive of PROM.Conclusion: The modifiable or treatable risk factors should be addressed during the antenatal care to reduce the risk of PROM. High-risk patients should be counseled and monitored closely to optimize pregnancy outcomes.Keywords: Maiduguri; morbidity; mortality; prelabor rupture of membranes; risk factor

Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs

Primary post partum haemorhage(PPH) at the University of Maiduguri Teaching Hospital (UMTH): A ten –year review

Objective: To determine the incidence, risks and aetiological factors for Primary Post-Partum Haemorrhage (PPH) in UMTH.Design Retrospective descriptive study.Setting: University Of Maiduguri Teaching Hospital, Maiduguri, Nigeria.Methods: The case records of all recorded cases of primary PPH between1stJanuary 2000 and 31stDecember 2009 inclusive, who were managed in UMTH were retrieved and relevant data obtained and analyzed.Results: Three hundred and seventy sixwomen had primary postpartum haemorrhage during the period under review with an incidence of 1.9%. However, only three hundred and two were available for analysis.Close to half of the women who had primary postpartum haemorrhage were grandmultiparous136(45%). Uterine atony was the commonest cause of primary PPH which was closely followed by retained placenta 37.7% and 22.5% respectively. This is attributed to mismanagement of labour. Majority of the patients were unbooked (63.6%) and about one third ofthe women had home delivery. The maternal mortality during the period was 96out of which 4were due to postpartum haemorrhage. The contribution of primary PPH to maternal mortality was 4.2% during the study period.Conclusion: Primary PPH is a largely preventable condition. Uterine atony and retained placenta were major causes of the condition in our center. This is a reflection of mismanagement of third stage of labour.  Identification of patients at risk during pregnancy and labour with prompt intervention to prevent blood loss is advocated

Pregnancy complications and outcome following cervical cerclage operations at the University of Maiduguri Teaching Hospital,

Objective: To determine the Pregnancy Complications and Outcome following Cervical Cerclage Operations. Subject: The case records of 76 patients who underwent Cervical Cerclage Operation for Cervical incompetent at the University of Maiduguri Teaching Hospital between January, 1983 and December 1999 inclusive were reviewed. In all the patients the diagnosis of Cervical incompetence was made based on the history of two or more midtrimester abortions or preterm deliveries and ultra-sound finding of internal OS diameter of 16mm or more in the second trimester of Pregnancy. Result: The MacDonald (81%) and shirodkar (19%) techniques were the two forms of Cerclage employed. Preterm rupture of membranes vulvovaginitis and Urinary tract infection were the Common Post-insertion Complications encountered while antepartum haemorrhage, Perineal/Cervical tear and mal-presentations were the common associated labour complications. 65.3% of the deliveries were term births while preterm deliveries made up 23.1% of the births. The overall foetal salvage rate was 85.3%. There was no maternal death. The Peritanal mortality was 84 per 1000. Conclusion: The overall foetal salvage rate of 88.3% observed in this study is high and in a developing Country like Nigeria with inadequate neonatal facilities and a slim foetal survival between 24-28 weeks, any procedure like cervical cerclage that will prolong pregnancy until foetal maturity is still relevant and beneficial. KEY WORDS: Cervical incompetence, Cervical Cerclage, Pregnancy outcome, Maiduguri, Nigeria. [Nig J Clinical Practice Vol.5(1) 2002: 25-28

Survey on the use of misoprostol for induction of labour amon obstetricians in the West African sub-region

No Abstract

Maternal and neonatal outcomes in premature rupture of membranes at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria

Background: Premature rupture of membrane (PROM) is linked to significant adverse events in the prenatal, peripartum and neonatal period. Both, PROM and PPROM are associated with maternal and neonatal morbidities and mortalities. Severe oligohydramnios after PROM is associated with foetal abnormalities, pulmonary hypoplasia, respiratory distress syndromes, intrauterine growth restriction, intrauterine foetal death, foetal/neonatal sepsis, presence of meconium and an Apgar score lower than seven at five minutes. Objective: To determine the factors that influenced maternal and neonatal outcomes following a premature rupture of membranes. Subjects and Methods: This retrospective cross-sectional study was conducted over five years between 1st January 2012 and 31st December 2016 on mother neonate pair delivered at the University of Maiduguri Teaching Hospital Maiduguri. Results: During the period of the study there were 7200 deliveries at the labour ward of (UMTH), out of which 91 (1.3%) had PROM. Seventy three ( 80.2%) of the case files were retrieved and analysed. Thirty six women (49.3%) were delivered by emergency caesarean section (EMCS), while 37 (50.7%) were delivered vaginally (SVD). In the bivariate (crude) analysis, Apgar score < 7 at 5 minutes (P = 0.008, OR 95 % CL: 0.092 (0.011, 0.742), birth weight ≥ 2500g (P = 0.006, 8.944 (1.892, 42.284), and absence of APH (P = 0.007, 4.83 (1.440, 16.196) were factors modifying neonatal outcome. When adjusted regression with only factors with P value < 0.2 in crude analysis were done, only birth weight ≥ 2500 g (P = 0.024, 6.677 [1.286, 34.664]) and absence of APH (P = 0.038, 4.406 [1.085, 17.883]) were independent predictors of neonatal outcome. Thus, neonates with birth weight ≥ 2500 g were about 6.7 times more like to show favourable outcome than those with birth weight < 2500g while those without APH showed 4.4 times more likelihood for a favourable neonatal outcome. Antenatal corticosteroids use also was associated with favourable outcome as it had significantly improved preterm neonatal survival. Conclusion: Intervention with steroids, antibiotics in labour and delivery within 24 hours of PROM will greatly reduce maternal complications and enhances favourable neonatal outcome

A Review Of Preterm Admissions Into Special Care Baby Unit, In University Of Maiduguri Teaching Hospital: A Four Year Experience

There is little or no report of preterm (babies born less than 37 completed weeks of gestation) admission from this part of Sahel Savannah of Nigeria. This study of four-year period is presented to identify areas that require improvement, such as in the Labour ward and neonatal care. The case files of the 428 preterm newborns admitted into Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital were reviewed. Preterms constituted 54.9% of the overall admissions, 53.4% being Low birth weight newborns (=2500 gm). Premature rupture of membrane, previous preterm deliveries, twin gestation and pregnancy induced hypertension were some of the common maternal factors that were associated with preterm deliveries. Birth asphyxia, Apnoea, Small for gestation age 9weight less than 10th centile), respiratatory distress were the main problem observed among the preterm newborns. Neonatal mortality rate was 349/1000 live birth; 62.1% of the death were preterm infants. Mortalities were common among babies weighing 1000 gm or less and also of babies of lower gestational age. We can improve on this, by implementing simple common measures such as educating our mothers on the need for good antenatal care and hospital deliveries, so that those with pregnancy induced hypertension, premature rupture of membrane, previous preterm delivery can be detected early and institute proper management. Nigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp. 229-23