Antenatal Care Booking Pattern at a Tertiary Hospital in South- Eastern Nigeria

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Outcome of Teenage Pregnancy at a Tertiary Hospital in Abakaliki Southeast Nigeria

Background: Teenage pregnancy is a high risk pregnancy associated with obstetric, fetal, neonatal and psycho‑social complications. These complications are worsened by poverty, ignorance and lack of special care during pregnancy.Aim: The objective of the following study is to determine the obstetric and neonatal outcome of teenage pregnancy.Materials and Methods: A retrospective case control study was carried out over a 6 years period, 2006‑2011. All teenage pregnancies (aged 13‑19 years) at Federal Medical Center Abakaliki, Ebonyi were taken as cases. Pregnancy deliveries from mothers aged 20 to 29 that met the inclusion criteria were selected as controls. A total of 137 teenage pregnancies were analyzed and compared with 948 controls. Statistical analysis was performed using 2008 Epi‑info statistical software version 3.5.1 (Atlanta, Georgia, USA). Results: The incidence of teenage deliveries over the period of the study was (137/8020) 2.25%. Single mothers were commoner (40.9% [56/137] vs. 3.1% [29/948], P < 0.01) among the teenagers. Low educational status was more common among teenage mothers (P < 0.01). Unbooked pregnancies were significantly common among teenage mothers (23.4% [32/137] vs. 12.3% [117/948], P < 0.01). Anemia in pregnancy (18.1% [41/226] vs. 11.2% [65/579], P = 0.01), human immunodeficiency virus (HIV) in pregnancy (4.9% [11/226] vs. 1.7% [10/579], P = 0.01) and malaria in pregnancy (26.1% [59/226] vs. 12.4% [72/579], P < 0.01) were significantly common in teenage pregnancies than the control. Teenage mother had significantly increased cesarean deliveries (23% [31/137] vs. 14.8% [140/948], P < 0.02), male deliveries (64.3% [90/140] vs. 52.1% [502/963], P < 0.03) and low birth weight (19.3% [27/140] vs. 12.7% [122/963], P < 0.03). Fetal loss (22.1% [31/140] vs. 3.3% [32/963] P < 0.01) and birth asphyxia (19.3% [27/140] vs. 6.8% [65/963], P < 0.01) were significantly common among teen mothers in the 1st min American Pediatric Gross Assessment Records score. Conclusion: Teenage pregnancies were associated with a significantly higher risk of anemia in pregnancy, HIV in pregnancy, malaria in pregnancy, cesarean deliveries and poor fetal outcome. Health education, women enlightenment and empowerment will be essential in reducing the problems of teenage pregnancy.Keywords: Abakaliki, outcome, teenage pregnancy, tertiary hospita

Antibiotic sensitivity pattern of uropathogens from pregnant women with urinary tract infection in Abakaliki, Nigeria

RC Onoh,1 OUJ Umeora,1 VE Egwuatu,2 PO Ezeonu,1 TJP Onoh31Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu State, Nigeria; 3Department of Pathology, Federal Teaching Hospital Abakaliki, Ebonyi State, NigeriaBackground: Urinary tract infection (UTI) is a common bacterial infection during pregnancy and a significant cause of perinatal and maternal morbidity and mortality. The causative bacteria have remained virtually the same although with variations in individual prevalence. There has been an increasing resistance by these bacteria to the commonly available antibiotics.Objectives: To determine the prevalence of UTI, the common causative bacteria, and their antibiotic sensitivity pattern among pregnant women with UTI.Methodology: This is a descriptive study that was carried out at the Obstetrics Department of two tertiary institutions in Abakaliki, Ebonyi State, Nigeria (Federal Medical Center and Ebonyi State University Teaching Hospital) over a period of 12 months. Midstream urine specimens from selected pregnant women with clinical features of UTI were collected for microscopy, culture, and sensitivity. The results were analyzed with the 2008 Epi Info™ software.Results: A total of 542 pregnant women presented with symptoms of UTI and were recruited for the study over the study period. Of the 542 pregnant women, 252 (46.5%) had significant bacteriuria with positive urine culture and varying antibiotic sensitivity pattern. The prevalence of symptomatic UTI was 3%. Escherichia coli was the most common bacteria isolated with a percentage of 50.8%. Other isolated micro organisms included Stapylococcus aereus (52 cultures, 20.6%), Proteus mirabilis (24 cultures, 9.5%), S. saprophyticus (18 cultures, 7.1%), Streptococcus spp. (14 cultures, 5.6%), Citrobacter spp. (5 cultures, 2.0%), Klebsiella spp. (4 cultures, 1.6%), Enterobacter spp. (4 cultures, 1.6%), and Pseudomonas spp. (3 cultures, 1.2%). Levofloxacin had the highest overall antibiotic sensitivity of 92.5%. Others with overall antibiotic sensitivity pattern greater than 50% included cefpodoxime (87.3%), ofloxacin (77.4%), ciprofloxacin (66.7%), ceftriaxone (66.7%), and gentamicin (50.8%).Conclusion: E. coli was the most common etiological agent of UTI in pregnancy with Enterococcus (Staphylococcus) gaining prominence. Cephalosporin and quinolones were shown to be very effective against the organisms causing UTI in these pregnant women.Keywords: antibiotic sensitivity pattern, pregnancy, urinary tract infection, uropathogen

Ruptured Ectopic in Heterotopic Pregnancy: Management and Spontaneous Vertex Delivery of a Live Baby at Term

Spontaneous heterotopic pregnancy is an uncommon clinical condition in which there is a simultaneous development of intrauterine and extrauterine pregnancies. It is a life‑threatening emergency when the ectopic ruptures. We present Mrs. EC, a 27‑year‑old G1P0 + 0 with a family history of multiple gestations who had a heterotopic pregnancy at a gestational age of 7 weeks. She presented with features of threatened miscarriage at early pregnancy with an ultrasound confirmation of intrauterine pregnancy. The diagnosis of ruptured ectopic pregnancy coexisting with intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Thereafter, pregnancy was carried to term, and she delivered a live male baby that weighed 3.0 kg. Heterotopic pregnancy should be sort for in all pregnancies during the early scan, especially in those with predisposing factors for multiple gestations and risk factors for ectopic gestation. A high index of suspicion is necessary for making a diagnosis in women with intrauterine pregnancy, with or without symptoms of ectopic gestation, and irrespective of the existence of risk factors for ectopic pregnancy.Keywords: Exploratory laparotomy, heterotopic pregnancy, live baby, ruptured ectopic, vaginal deliver

Trends and factors associated with maternal mortality in Abakaliki, Nigeria.

Maternal health indices are poor in Nigeria. Regular audit of maternal deaths is vital to planning and maternal care delivery. The aim of the study was to evaluate and determine the trend of maternal mortality ratio in a Federal Medical Centre and analyze associated factors. A retrospective review of available data on all maternal deaths between January 2000 and December 2005 at the Federal Medical Centre Abakaliki was carried out.The 38 maternal deaths recorded out of 4193 deliveries during the study period resulted in a maternal mortality ratio (MMR) of 906 per 100,000 live births. In the two triennial intervals (Jan.2000- Dec.2002 and Jan.2003-Dec.2005) reviewed the MMR were 1017 and 799 per 100,000 live births respectively. The unbooked parturient accounted for over 74% of the deaths. Grandmultiparity, primigravidity, poor educational background, extremes of reproductive age and economic adversity were major factors associated with such deaths. Haemorrhage was the commonest cause of mortality during the period. Women\'s education and empowerment, provision of adequate and subsidized maternal care especially immediate postpartum are advocated to reduce maternal mortality to the barest minimum in Nigeria. Keywords: trend, maternal death, delay, unbooked, referral. Ebonyi Medical Journal Vol. 6 (1) 2007 pp. 30-3

The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria

Lucky O Lawani,1 Azubuike K Onyebuchi,2 Chukwuemeka A Iyoke,3 Robinson C Onoh,2 Peter O Nkwo31School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, NigeriaBackground: Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success.Objectives: This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria.Methods: This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS.Results: The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1%) in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7%) practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8%) and cultural practices (28.5%). Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity.Conclusion: Exclusive breastfeeding is predominately the infant feeding choice among HIV-infected parturients in South East Nigeria, but there is still a gap between infant feeding preference and adherence to standard practice as a result of sociocultural challenges associated with risk for mixed feeding and the risk for mother-to-child-transmission of HIV by nursing mothers.Keywords: PMTCT, HIV, infant feeding, challenges, HAART, adherenc

Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria

Azubuike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Peter O Nkwo,3 Chukwuemeka Anthony Iyoke,3 Robinson Chukwudi Onoh,1 Leonard O Ajah1 1Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria Background: Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period. Methods: This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0. Results: The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45–5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval. Conclusion: Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes. Keywords: determinants, decision-to-intervention time, emergency, therapeutic outcome, gynecological surgeries, clinical ris

Seroprevalence of human T-cell lymphoma/leukemia virus type-1 (HTLV-1) antibodies among blood donors at Enugu, Nigeria

Augustine Ejike Okoye,1 Obike Godswill Ibegbulam,2 Robinson Chukwudi Onoh,3 Ngozi Immaculata Ugwu,1 Chukwudi Simon Anigbo,2 Charles Emeka Nonyelu2 1Department of Haematology and Immunology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2Department of Haematology and Immunology, University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu State, Nigeria; 3Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria Background: Human T-cell lymphotrophic/leukemia virus (HTLV-1) is a retrovirus implicated in transfusion-transmitted infection. Objective: The objective of this study was to determine the seroprevalence of HTLV-1 antibodies among blood donors at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria. Methods: A cross-sectional study was carried out on consented participants over 4 months. A total of 300 blood donors were recruited consecutively from the blood bank. The serum of the collected 5 mL of blood obtained from each participant was stored at -20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich ELISA (enzyme-linked immunosorbent assay) kit. Participants' demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17. Results: Of the 300 blood donors, 288 (96%) were male, while 12 (4%) were female. The average age of the blood donors was 26.85±8.52 years. The age group with the highest representation among the blood donors were those aged between 21 and 25 years. Only 22.3% of the blood donors were above 30 years. None of the 300 screened blood donors tested positive to HTLV-1 antibodies. Hence, the seroprevalence of HTLV-1 infection among blood donors was 0%. Of the blood donors, 5% had history of previous sexually transmitted disease, while 34.7% used condoms during sexual intercourse. Conclusion: The seroprevalence obtained in this study cannot statistically support the justification of routine screening of blood donors for HTLV-1 infection. More prospective and multicentered studies are required to determine the infectivity of HTLV-1 in blood donors in Nigeria. Keywords: retrovirus, transfusion, blood-borne infection, screening, Afric

Anemia Among Unbooked Parturients With Asymptomatic Malaria Parasitemia At A Tertiary Institution Southeast Nigeria

Conclusion: Anemia in pregnancy was common among unbooked pregnant women. It was also common among parturients with asymptomatic malaria parasitemia