Ngozi Orazulike

Changes in Maternal Serum Transforming Growth Factor Beta-1 during Pregnancy: A Cross-Sectional Study

Changes in circulating levels of maternal serum transforming growth factor beta-1 (TGF-β1), collected from 98 women (AGA) at different gestational ages (10–38 weeks) were measured and comparisons were made between levels in pregnant and nonpregnant controls and also between 10 women with small-for-gestational age (SGA) and 7 with appropriate-for-gestational age (AGA) fetuses. Maternal serum TGF-β1 levels at all stages of pregnancy were higher than those in normal healthy nonpregnant adults. The mean TGF-β1 levels in SGA pregnancies at 34-week gestation (32.5 + 3.2 ng/mL) were significantly less than those in AGA pregnancies (39.2 + 9.8 ng/mL) while at 38-week gestation, the levels were similar in the two groups (36.04 + 4.3 versus 36.7 + 7.0 ng/mL). This differential change in TGF-β1 levels is probably an important modulating factor in the aetiopathogenesis of abnormal intrauterine fetal growth.

Maternofetal outcome of asymptomatic bacteriuria among pregnant women in a Nigerian Teaching Hospital

Introduction Asymptomatic bacteriuria has been reported to be associated with adverse pregnancy outcome. This study sought to determine the prevalence and complications of asymptomatic bacteriuria amongst parturient in the University of Port Harcourt Teaching Hospital (UPTH). Methods The study was a prospective cohort study involving 220 eligible antenatal attendees. Urine culture and sensitivity was conducted for each participant and the fetomaternal outcome between affected and unaffected women were compared and p value <0.05 was considered significant. Results Sixty-five of the participants had asymptomatic bacteriuria giving a prevalence of 29.5%. Twenty-three (35.4%) cultures yielded Klebsiella spp while Fifty-eight (89%) of the cultured organisms were sensitive to Nitrofurantoin. There was no statistical difference in the rate of prelabour rupture of membranes, preeclampsia, preterm delivery, birth asphyxia and low birth weight between affected and unaffected women. Conclusion Contrary to widely held view, there was no significant increase in adverse pregnancy outcome amongst affected women.

A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt, Nigeria

Purpose To determine the causes of death and associated risk factors among women of reproductive age (WRA) in a tertiary institution in Port Harcourt, Nigeria. Patients and methods This was a retrospective survey of all deaths in women aged 15–49 years at the University of Port Harcourt Teaching Hospital that occurred from January 1, 2013 to December 31, 2015. Data retrieved from ward registers, death registers, and death certificates were analyzed with Epi Info version 7. Comparison of socioeconomic and demographic risk factors for maternal and nonmaternal deaths was done using a multivariate logistic regression model. Results There were 340 deaths in the WRA group over the 3-year period. The majority (155 [45.6%]) of the women were aged 30–39 years. There were 265 (77.9%) nonmaternal deaths and 75 (22.1%) maternal deaths. Among the nonmaternal deaths, 124 (46.8%) had infectious diseases, with human immunodeficiency virus being the most common cause of infection in this group. Breast cancer (13 [4.9%]), cervical cancer (12 [4.5%]), and ovarian cancer (11 [4.2%]) were the most common malignant neoplasms observed. Hypertensive disorders of pregnancy (31 [41.3%]) and puerperal sepsis (20 [26.7%]) were the most common causes of maternal deaths. Age and occupation were significantly associated with deaths in WRA (p<0.05). Older women aged >30 years (odd ratio =1.86, 95% CI =1.07–3.23) and employed women (odds ratio =2.55, 95% CI =1.46–4.45) were more likely to die from nonmaternal than maternal causes. Conclusion Most of the deaths were nonmaternal. Infectious diseases, diseases of the circulatory system, and malignant neoplasms were the major causes of death among WRA, with maternal deaths accounting for approximately a quarter. Public health programs educating women on safer sex practices, early screening for cancers, benefits of antenatal care, and skilled attendants at delivery will go a long way to reducing preventable causes of deaths among these women.

Erratum to: Cervical Cytology or Colposcopy in the Identification of Cervical Intraepithelial Neoplastic Changes in Human Immunodeficiency Virus Positive Patients in an African Population?

Background Effective screening methods for early detection of cervical premalignant lesions among women with human immunodeficiency virus are needful since cervical cancer is one of the AIDS-defining malignancies.

Obstetric Hysterectomy As A Surgical Intervention in the Management of Obstetric Haemorrhage At the University of Port Harcourt Teaching Hospital, Nigeria.

Objectives: To determine the incidence, indications, maternal and perinatal outcome of obstetric hysterectomy. Materials and Methods: A retrospective study of 80 women who had obstetric hysterectomy at the Obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH) Nigeria, between January 1, 2007 and December 31, 2011 was conducted. Data was obtained from the theatre records, labour ward register and case notes of patients and entered into a proforma. Epi Info Version 6.04d was used for data analysis. Results: The prevalence of obstetric hysterectomy during the period under review was 5.3/1000 births. The most common indication was uterine rupture (57.1%), followed by haemorrhage due to uterine atony (25.7%). The mean age of the patients was 28.1 ± 1.78 years, and it was commoner in the Para 1-2 group (40%). Majority (94%) of the patients were transfused and the average unit of blood transfused was 5. The crude morbidity rate was 66.3% with anaemia occurring in 40% of the women. There were 26 maternal deaths, giving a maternal mortality ratio of 325/100,000 deliveries. Twenty-four (92.2%) maternal deaths were unbooked while 2 (7.8%) were booked (p < 0.05). Half (50%) of the women died from primary post-partum haemorrhage. The overall perinatal mortality rate was 575/1000 births. Conclusion: Uterine rupture and postpartum haemorrhage due to uterine atony were the most common indications for obstetric hysterectomy. Maternal death was significantly higher among the unbooked. Effective antenatal care and availability of skilled attendants at all deliveries will reduce the incidence, morbidity and mortality from obstetric hysterectomy.

Maternal and Fetal Outcome after Assisted Conception in Port Harcourt, Nigeria

Background: The introduction of assisted reproductive technology (ART) has played a major role in reducing the burden of infertility among couples. Although most pregnancies following assisted conception will progress normally without any increased risk to the mother or baby, studies have shown that some women who conceive in this manner as well as their babies are indeed at increased risk of complications. Objective: To evaluate the maternal and neonatal outcome after assisted reproductive technique (ART) in Port Harcourt, Nigeria. Materials and Methods: A retrospective case control study of 51 women who conceived via ART (subjects) and 51 women who conceived spontaneously (control) managed at the obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH), Nigeria over an 8-year period was conducted. Data obtained from theatre records and case notes of patients were analysed using the statistical package SPSS 20. Results: The rate of multiple pregnancy was 47% (24 women) in the ART group compared with Original Research Article Orazulike and Alegbeleye; BJMMR, 19(7): 1-9, 2017; Article no.BJMMR.30044 2 6% (3 women) in the control group and this was statistically significant (p = 0.001). Thirty-one (61%) of the women had adverse outcomes in the ART group compared to 9 (18%) in the control group and this was statistically significant (p = 0.001). Early pregnancy bleeding (p =0.03), hypertensive disorders of pregnancy (p = 0.05), pre term delivery (p = 0.002) caesarean delivery (p = 0.001), low birth weight (p = 0.001) neonatal admission (p = 0.02) and perinatal deaths (p = 0.03) were significantly commoner in the assisted conception group. The rates of antepartum haemorrhage, diabetes mellitus, postpartum haemorrhage, maternal death and mild birth asphyxia were not statistically different between the two groups. Conclusion: ART pregnancies are associated with more adverse feto-maternal outcomes compared with spontaneously conceived pregnancies.

A five - year review of gestational trophoblastic diseases in Port Harcourt, Nigeria

Background: Gestational Trophoblastic Diseases (GTD) are a spectrum of inter-related but histologically distinct tumours originating from the placenta with good prognosis when diagnosed early. Aim: To determine the prevalence, clinical presentations, management of gestational trophoblastic disease at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Methods: A retrospective analysis of women treated for gestational trophoblastic disease from 1st January 2008 to 31 st December 2012. The information from patients records: age, occupation, educational level, husband′s occupation, parity, presenting symptoms, uterine size, mode of treatment and management options were collated and analysed. The Chi-square test was used to compare categorical variables with a p value of ≤ 0.05 as significant. Results: A total of 38 cases of GTD were treated with a prevalence of 2.3 per 1,000 deliveries. The mean age and parity were 31 ± 6.3 years and 2 ± 1.6 respectively. Maternal age less than 35 years and low socioeconomic status were significantly associated with GTD (p=0.0000). The mean gestational age at presentation was 16.24 ± 5.4 weeks. The commonest clinical presentation was amenorrhoea in 100% of patients. Twenty-five(65.8%) cases of hydatidiform mole and 13(34.2%) cases of choriocarcinoma were observed. Twenty-two (57.9%) patients had suction evacuation only for hydatidiform mole, 3(7.9.%) had suction evacuation and cytotoxic therapy for hydatidiform mole and subsequent persistent trophoblastic disease while 8(21.1%) had chemotherapy for choriocarcinoma. Five patients with advanced choriocarcinoma did not receive definitive treatment before demise. Twenty (52.6%)defaulted in their follow up schedule. Conclusion: There is high prevalence of GTD in Port Harcourt with high mortality among patients with malignancy. Most of the patients defaulted in their follow up; thus there is a need for education and sensitization of the populace on GTD, as well as proper counseling of patients treated on the benefits of follow up visits.

Procuring abortion with a wooden stick in a 13-year-old girl

treatment includes unilateral or bilateral oophorectomy, depending on the fertility-sparing desire of the patient, whereas complete staging surgery (including pelvic and para-aortic lymphadenectomy) is controversial due to the high sensitivity of these tumours to chemotherapy, trying to avoid a delay in the adjuvant treatment when needed (in stage IA it do not seem to off er any benefi t). Laparoscopic surgery in adnexal tumours off ers many advantages over laparotomy. Finally, in order to reduce the number of abdominal wall incisions, some options considering single access surgery have arisen. It could off er more benefi ts than conventional laparoscopy, such as less postoperative pain, faster recovery, better cosmetic outcome and fewer complications related to accessory trocars (Behnia-Willison et al. 2012). On the other hand, this technique has the disadvantage of reduced the possibility of movement, increased technical diffi culty and a longer learning curve. Our patient was a very young woman, so we thought she could benefi t from a single port access. Once the learning curve is completed and depending on the surgeon ’ s experience, the single incision technique can be easily used routinely for most adnexal pathology and simple hysterectomies. In conclusion, although the incidence of tumours in gonadal dysgenesis is around 20 – 30%, and most of them are benign, due to the possibility of malignant processes, it is mandatory in these patients to perform a bilateral oophorectomy. Th e single-port laparoscopy is feasible and a good and aesthetic alternative in these procedures.

Factors Influencing Gestational Age at Booking at The University of Port Harcourt Teaching Hospital South-South Nigeria

Aim: To assess the factors influencing registration for antenatal care in Nigerian pregnant women. Study Design: A cross-sectional study. Place and Duration of Study: The antenatal clinic of the department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital from January 2013 to June 2013. Methodology: A cross-sectional study involving 600 pregnant women attending the booking visit at the antenatal clinic in UPTH from January 2013 to June 2013 was undertaken using an interviewer administered structured questionnaire. Data management was done using Epi InfoTM 7.1.4 statistical software. Results: The mean gestation age at first antenatal attendance was 18.7±6 weeks. Only 133 women (22%) booked before 14 weeks gestation, most of these (89.5%) were primigravidae. Original Research Article Jeremiah et al.; IJTDH, 6(2): 52-57, 2015; Article no.IJTDH.2015.038 53 Majority of the women [409(68%)] had their first visit between 14 weeks and 28 weeks. Primigravida were significantly more likely to book early in pregnancy (p=0.01). Age and educational status did not appear to influence the gestational age at booking. Distance of residence from the hospital also affected the gestational age at booking as those residing more than 10 km from the hospital were significantly less likely to register early (p=0.03). However availability of funds was a major determinant of when a pregnant would register for antenatal care. Conclusion: Majority of our women register for antenatal care later in pregnancy than the prescribed first trimester due to poverty.