Ado Danazumi Geidam

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria

OBJECTIVE To determine the trend and indications for the use of caesarean delivery in our environment. METHOD A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. RESULTS During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. CONCLUSION Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate.

Trends in maternal mortality in a tertiary institution in Northern Nigeria

OBJECTIVE To look at the trends in maternal mortality in our institution over 5 years. METHODS Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. RESULTS There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (chi2=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with chi2=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (chi2=64.69, P =0.00000; and chi2=18.52, P =0.0000168, respectively). CONCLUSION In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.

A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria

OBJECTIVE To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. METHODOLOGY Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. RESULTS Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had a higher case fatality of 24.0% compared to 15% among book cases, while those with formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11 (21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. CONCLUSION Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

Child labor and sexual assault among girls in Maiduguri, Nigeria

To determine the relationship between child labor and sexual assault among girls in Maiduguri, Nigeria.

Polygamy and the use of contraceptives

To compare contraceptive use among women in monogamous and polygamous marriages in Nigeria.

Outcome of twin deliveries at the University of Maiduguri Teaching Hospital: a 5-year review.

OBJECTIVES The objectives of the study were to determine the outcome of twin births at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in terms of morbidity and mortality and to recommend possible measures to curtail or reduce some of the preventable complications. MATERIALS AND METHODS This is a 5-year retrospective study, from January 2000 to December 2004, of twin births at the UMTH. RESULTS There were 196 twin deliveries in 8431 total deliveries, with a twin incidence of 2.3%. Dizygotic twins accounted for 63.4%. The increasing maternal age and positive family history of multiple pregnancies were associated with the increasing twinning rate. The main complications encountered were preterm labor, pregnancy-induced hypertension, and cord prolapse. The perinatal mortality rate of 107.5/1000 births was higher than that observed for singleton pregnancies in the same institution. Similarly, there was a higher Cesarian section rate of 24.7% compared to singletons within the same period. There were significantly higher perinatal mortality rates among the preterm (P = 0.000002) and low-birth-weight (P = 0.000004) fetuses. CONCLUSION Considering that fetal prematurity and low birth weight, sequelae to preterm labor, are the commonest causes of perinatal death in this study, efforts should be geared during the antenatal period toward the prevention of a premature birth.

Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year

Background: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. Materials and Methods: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. Results: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30–49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of <30% (P=0.081). Conclusion: Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.

Burden of Symptomatic Renal Stones in Pregnancy Managed Till Normal Delivery: A Case Report in Developing Nation

Although urolithiasis occurs in pregnancy, its management remains a great challenge in our region. It creates a diagnostic puzzle due to many differentials that can simulate the symptoms in pregnancy. This is further challenged by the limitations of the accepted imaging investigations, burden of monitoring the pregnancy and managing urolithiasis till delivery at term. We present a case of intractable flank pain due to left renal calculus in an eighteen year old primigravida which was successfully managed. Where possible, treatment of urolithiasis before conception should be our focus in addition to general preventive measures of urolithiasis.