Babasola O. Okusanya

Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia

The pharmacokinetic basis of magnesium sulphate (MgSO4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.

Maternal deaths: initial report of an on-going monitoring of maternal deaths at the Federal Medical Centre Katsina, Northwest Nigeria

Abstract Objectives: To assess the maternal mortality ratio (MMR) from data collected as maternal deaths occurred over a 4-year period. Methods: A Departmental database established in 2008 was used to keep data on deliveries and maternal deaths as they occurred. The causes of death were decided after a meeting reviewed the case. Analysis was done using Microsoft Excel software and results presented in means and frequencies. Results: Eight thousand two hundred and twenty live deliveries that occurred were complicated by 68 maternal deaths. The MMR was 827/100 000 live births. The MMR for unbooked women was four times higher than for booked women. Obstetric haemorrhage was the main (21.6%) direct cause of death followed by preeclampsia/eclampsia (18.9%). While anaemia was the leading (8.1%) indirect cause of death, tetanus in the puerperium reared its head as an emerging (5.4%) indirect cause of maternal death. None of the women ever used contraceptives. Most deaths occurred in teenage mothers (23.5%), unbooked women (86%) and in the postpartum period (69%). Conclusion: The MMR was high and tetanus in puerperium emerged as an indirect cause of maternal deaths. There is a need to curb the emergence of tetanus in the puerperium as a cause of maternal death.

Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis.

There remains no consensus on the best timing of deinfibulation in women with type III female genital mutilation (FGM).

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta‐analysis

Deinfibulation is a surgical procedure carried out to re‐open the vaginal introitus of women living with type III female genital mutilation (FGM).

Supportive psychotherapy or client education alongside surgical procedures to correct complications of female genital mutilation: A systematic review

Supportive psychotherapy, in individual or group settings, may help improve surgical outcomes for women and girls living with female genital mutilation (FGM).

Maternal serum lipid in women with preeclampsia in Lagos: a case control study

Abstract Objective: This was to determine the serum lipid profile of preeclamptic women and their association with severity of preeclampsia. Methods: This was a case control study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria. Blood samples for serum lipid estimation were collected after an overnight fast. The National Cholesterol Education Program – Adult Treatment Panel (ATP) III criteria were used to define dyslipidemia. Results: Two hundred forty women participated in the study. The mean total cholesterol of preeclamptic and normotensive women was 309.9 ± 10.4 mg/dl and 237 ± 6.8 mg/dl, respectively. Both groups of women had higher than normal mean levels of triglycerides (TG) (203.3 ± 11.0 mg/dl versus 157.5 ± 7.1 mg/dl); low-density lipoprotein (LDL)-c (156.5 ± 11.0 mg/dl versus 109.7 ± 6.9 mg/dl); high-density lipoprotein (HDL)-c (63.2 ± 2.5 mg/dl versus 55.4 ± 1.8 mg/dl) and very low-density lipoprotein (VLDL) (39.5 ± 2.0 mg/dl versus 31.5 ± 1.4 mg/dl). Fewer women with preeclampsia had isolated hypertriglyceridemia (95 versus 99%). Maternal serum total cholesterol (TC), TG, and LDL was significantly (p < .001) higher in severe, compared to mild preeclampsia. Pearson’s correlation indicated that all lipids, including total cholesterol (r = 0.406) had positive correlation with preeclampsia. Conclusion: There is elevated serum lipid in pregnancy irrespective of preeclampsia developing. The positive correlation of maternal serum lipids to preeclampsia suggests a casual relationship.

Maternal near-miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey

To investigate life‐threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals.

Impact of using eHealth tools to extend health services to rural areas of Nigeria: protocol for a mixed-method, non-randomised cluster trial

Introduction eHealth solutions that use internet and related technologies to deliver and enhance health services and information are emerging as novel approaches to support healthcare delivery in sub-Saharan Africa. Using digital technology in this way can support cost-effectiveness of care delivery and extend the reach of services to remote locations. Despite the burgeoning literature on eHealth approaches, little is known about the effectiveness of eHealth tools for improving the quality and efficiency of health systems functions or client outcomes in resource-limited countries. eHealth tools including satellite communications are currently being implemented at scale, to extend health services to rural areas of Nigeria, in Ondo and Kano States and the Federal Capital Territory. This paper shares the protocol for a 2-year project (‘EXTEND’) that aims to evaluate the impact of eHealth tools on health system functions and health outcomes. Methodology and analysis This multisite, mixed-method evaluation includes a non-randomised, cluster trial design. The study comprises three phases—baseline, midline and endline evaluations—that involve: (1) process evaluation of video training and digitisation of health data interventions; (2) evaluation of contextual influences on the implementation of interventions; and (3) impact evaluation of results of the project. A convergent mixed-method model will be adopted to allow integration of quantitative and qualitative findings to achieve study objectives. Multiple quantitative and qualitative datasets will be repeatedly analysed and triangulated to facilitate better understanding of impact of eHealth tools on health worker knowledge, quality and efficiency of health systems and client outcomes. Ethics and dissemination Ethics approvals were obtained from the University of Leeds and three States’ Ministries of Health in Nigeria. All data collected for this study will be anonymised and reports will not contain information that could identify respondents. Study findings will be presented to Ministries of Health at scientific conferences and published in peer-reviewed journals. Trial registration number ISRCTN32105372; Pre-results.

Peripartum hysterectomy in a Nigerian university hospital: An assessment of severe maternal outcomes with the maternal severity index model.

Background: Peripartum hysterectomy is life-saving and a life-threatening criterion of the World Health Organization (WHO) maternal near-miss concept. The maternal severity index (MSI) model was developed to assess the outcome of severe maternal morbidities. This study assessed severe maternal outcomes of peripartum hysterectomy using the MSI model and related maternal severity score with mortality. Subjects and Methods: Records of women with peripartum hysterectomy over a 20-year period were retrieved and the documented WHO life-threatening conditions (severity markers) extracted. Severity markers were related with booking status, the level of specialist care and mortality. Comparison of dichotomous variables was done with Mantel–Haenszel statistics, and with one-tailed Fishers exact test when the variable was <5, at 95% confidence interval andP< 0.05. Results: There were 30,553 deliveries and 145 women had a peripartum hysterectomy with an incidence of 4.8/1000 deliveries. Fifty women (50/116; 43%) had no associated severity markers. Fifty-eight (58/116; 50%) and 5% (6/116) women, respectively, had one and five severity markers. All women without a severity marker survived, but there was an exponential increase in mortality to 20.7% (12/58) in women with massive blood transfusion (MBT) and 66.7% (12/18) in women with both MBT and disseminated intravascular coagulopathy. Overall, peripartum hysterectomy case fatality was 13.8%. Other morbidities were anaemia (100%), febrile morbidities (55.2%), urinary tract infection (20.7%) and ureteric injuries (5.1%). Conclusion: The onset of severity markers was positively related to mortality. There should be early intervention to improve survival when an indication for peripartum hysterectomy occurs.

Authors' reply re: Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia: a systematic review

western countries, may tilt the balance in the opposite direction. In conclusion, the current pharmacokinetic evidence suggests that, as affirmed by the reviewers, the therapeutic level of magnesium sulphate for seizure control is much lower than was suggested in early studies. Therefore, the low-dose regimen should be widely tried along with pharmacokinetic studies in low-resource countries with lower average maternal weight. Moreover, there could be a qualitative effect of the drug, as the magnesium ion works through more than 300 enzymes in the human body, and the quantity required may be very small. This hypothesis, however, requires rigorous exploration with basic research. Although we highly commend the authors’ effort to enrich us with a succint synthesis of otherwise incomprehensible scattered data addressing an important clinical issue, further information could be gleaned from the existing literature.&