Sa Uzoigwe

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.

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.