O. N. Makinde

Evaluation of health workers' training in use of the partogram

To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers.

Decision -- caesarean delivery interval in a Nigerian university hospital: implications for maternal morbidity and mortality.

This is a 5-month prospective study to determine the decision emergency caesarean delivery interval in a Nigerian tertiary hospital, the factors responsible for the delays and the consequent maternal and perinatal complications. One hundred and thirty-four emergency caesarean deliveries were analysed and the main indications were failure to progress/ prolonged labour (35.4%), previous caesarean-section/failed trial of scar (27.9%), cephalopelvic disproportion (26.8%), fetal distress (19.5%), pre-eclampsia/eclampsia (15.3%) and obstructed labour/ruptured uterus (14.7%). The mean decision-caesarean delivery interval was 4.4 +/- 4.2 (SD) hours (range 0.5-26 hours), median 3.2 hours and mode 2 hours. Bottlenecks within the maternity unit were responsible for delays in 31.7% of cases. Unavailability of paediatrician (19.6%), non-availability of anaesthetic coverage (13.6%), unreadiness of the operation theatre (11.9%) and seeking second opinion (6.4%) were other major causes of delay. There were 15 perinatal deaths, five of whom were directly linked to the delays i.e. a perinatal mortality rate of 3.7%. Four maternal deaths were directly attributable to delay, a maternal mortality rate of 3%. Other direct consequences of the delays were severe haemorrhage (10.3%), uterine rupture (2.3%) and disseminated intravascular coagulopathy (1.5%). Suggestions on how to minimise delays in emergency services and overall improvement in quality assurance control are discussed.

Risk factors for preterm delivery in South Western Nigeria

This was a case–control study to determine the risk factors of preterm delivery among Nigerian women seen at Obafemi Awolowo University teaching hospital, Ile-Ife, Nigeria over a period of 9 months. All women delivering preterm were recruited into the study, with two consecutive term deliveries after each preterm delivery serving as controls. Information obtained from the women includes socio-demographic characteristics, past reproductive and present pregnancy history and outcome. Laboratory investigations were conducted as necessary. Bivariate analysis revealed 21 potential risk factors, however, following adjustment by multiple logistic regression only previous preterm delivery (OR 4.68, 2.24–6.31), previous second trimester spontaneous abortion (OR 4.48, 2.32–8.54), heavy and stressful occupation (OR 3.56, 1.05–6.45), premature rupture of fetal membrane (OR 3.46, 1.04–6.45), maternal medical disorders (OR 3.13, 1.56–5.16), body mass index at delivery of less than 23 (OR 3.01, 1.56–5.43), antepartum haemorrhage (OR 2.73, 1.18–6.34), maternal febrile illness (OR 2.84, 1.32–4.52), intrauterine growth retardation (OR 2.14, 0.98–2.34) and multiple pregnancy (OR 1.98, 1.02–2.68) remained as significant factors.

Determinants of mission house delivery among booked patients in a Nigerian teaching hospital

This study examines the determinants of Mission House Delivery among booked patients in Ile-lfe, Nigeria. During the 12 months of the study (1 May 199930 April 2000) 196 booked patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife who delivered at mission houses were analysed. All ages and parity groups, educational level and social classes were involved. The majority (73%) were of low socio-economic class. The reasons for mission house delivery included financial constraints (41%), fear of possible caesarean section (46%), industrial action by health-care workers (39%), transport difficulty at night (26%), previous deliveries in mission houses (16%) and communal feud (12%). Four maternal deaths occurred (MMR 978/100 000 births) and 20 perinatal deaths (PNMR 118/1000 total births). Reduction of hospital user fees, provision of transportation and efficient telecommunication facilities at all times, conflict resolution and proper remuneration of health care workers are urgent needs to be addressed. Legislation against delivery in unsafe places and establishment of appropriate facilities by churches interested in maternity services is highly recommended.This study examines the determinants of Mission House Delivery among booked patients in Ile-Ife, Nigeria. During the 12 months of the study (1 May 199930 April 2000) 196 booked patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife who delivered at mission houses were analysed. All ages and parity groups, educational level and social classes were involved. The majority (73%) were of low socio-economic class. The reasons for mission house delivery included financial constraints (41%), fear of possible caesarean section (46%), industrial action by health-care workers (39%), transport difficulty at night (26%), previous deliveries in mission houses (16%) and communal feud (12%). Four maternal deaths occurred (MMR 978/100 000 births) and 20 perinatal deaths (PNMR 118/1000 total births). Reduction of hospital user fees, provision of transportation and efficient telecommunication facilities at all times, conflict resolution and proper remuneration of health care workers are urgent needs to be addressed. Legislation against delivery in unsafe places and establishment of appropriate facilities by churches interested in maternity services is highly recommended.

Goitre prevalence in pregnant women attending antenatal clinic in a teaching hospital

This study aimed to determine goitre prevalence in pregnant women. Seven hundred pregnant women attending the antenatal clinic at Wesley Guild Hospital, Ilesa, were interviewed and examined. The mean age of the subjects was 27.8 years, with mean parity of 2.65. Mean gestation was 28.5 weeks. A total of 97.4% were resident in Ilesa and surrounding towns and villages. Well or stream was the main water supply for nearly all the subjects. Only 7.3% of the subjects showed no thyroid enlargement. Early enlargement (1 a and 1 b ) occurred in 441 (63%) patients, Grade 2 enlargement in 166 (23.2%) and a grossly enlarged goitre in 40 (5.7%). The goitre rate was correlated with the age and parity of the patients.

Retained placenta: a cause of reproductive morbidity in Nigeria

This study analysed the reproductive morbidity associated with 91 cases of retained placenta at the Obafemi Awolowo University Hospital in Nigeria. The incidence of retained placenta in the hospital was 1.4% of all deliveries. Over 42% of the patients were admitted in haemorrhagic shock; 56.5% were anaemic, 10.6% severely; 17% had puerperal sepsis while 67% of the women received blood transfusions. There was one maternal death (1%). Unbooked patients (74%) constituted the largest proportion of cases while inappropriate management of the third stage of labour featured in many of the patients. Retained placenta was treated with manual removal in 90% of cases. Properly supervised delivery is an important component in efforts to reduce the incidence of morbidity associated with retained placenta in Nigeria.

Changes in sexual practices and responses among ante-natal clinic attendees in a Nigerian teaching hospital

Summary A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

HELLP syndrome: The experience at Ile-Ife, Nigeria

Summary Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0–5 and the estimated gestational age from 18–41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

Pregnancy in Nigerian women with liver cirrhosis: a report of three cases

She was readmitted to hospital at 30 weeks gestation with a 2-day history of rigors, pyrexia and dyspnoea at rest with associated leftsided chest pain. A pneumothorax was excluded and the diagnosis of acute infective exacerbation of asthma with concurrent urinary tract infection was made. She was commenced on oral clarithromycin and salbutamol and ipratropium nebulisers. A full blood count revealed neutropenia with white cells of 2·8 × 10×9/1. The coagulation profile showed an elevated APTT at 45·3 seconds and APTT ratio of 1·5. The diagnosis of febrile neutropenia was made with an associated coagulopathy. She was transferred to a general hospital where her condition improved with supportive management over the following 3 days and she was discharged. She subsequently had an uncomplicated vaginal delivery of a live infant at 36 weeks gestation. The postpartum period was uncomplicated.