Tu Agan

Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999–2009

Background Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general. Objective The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital. Methodology This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009). All pregnancy-related deaths of patients managed at the hospital were included in the study. Results A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3%) of the deaths were in women aged 20–34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%), followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%). About 69.26% of these women had no antenatal care. The majority (61.04%) died within the first 48 hours of admission. Conclusion Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially Type III delay. Efforts must be put in place by government, hospital management, and society to reduce these figures further. Above all, there must be an attitudinal change towards obstetric emergencies by health care providers.

Prevalence of anemia in women with asymptomatic malaria parasitemia at first antenatal care visit at the University of Calabar Teaching Hospital, Calabar, Nigeria.

Background: Anemia in pregnancy in malaria endemic areas is a public health challenge that has contributed either directly or indirectly to maternal morbidity and mortality in our environment. Anemia and malaria during pregnancy are highly preventable and treatable. Objective: The aim of this study is to assess the prevalence of anemia in asymptomatic malaria parasitemic women at first antenatal visit in a tertiary hospital facility. Method: The study was conducted at the antenatal clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria over a three-month period. Five hundred and forty-five pregnant women were recruited after obtaining an informed consent. A structured questionnaire was administered to each participant and two thin and thick blood films were used to identify the malaria parasites and estimate density. The average of two packed cell volumes at booking was determined using two capillary tubes and read from a Hawksleys microhematocrit reader. Results: A total of 545 pregnant women participated in the study. The mean ages of primigravidas and multigravidas were 21.4 ± 3.1 and 24.3 ± 4.0 years. Two hundred and ninety (53.2%) were primigravidas while 255 (46.8%) were multigravidas. The parasite density in primigravidas was 1297 ± 1234 while that for multigravidas was 661 ± 497 (t = 7.7, P < 0.001). The prevalence of anemia in the study population was 59.6%. There was no statistically significant difference in the prevalence of anemia among the primigravidas (60.3%) and the multigravidas (58.8%) (χ2 = 1.3, P = 0.08). There was a statistically significant association between severity of parasitemia and degree of anemia (χ2 = 441.1, P < 0.001). There was a statistically significant association between antimalarials use before booking and severity of parasitemia (χ2 = 36.52, P < 0.001). Conclusion: Anemia at first antenatal booking was significantly associated with malaria parasitemia. Routine screening for anemia and malaria parasites at booking, prompt parasite clearance, use of intermittent preventive treatment (IPT) during pregnancy and correction of anemia can reduce the prevalence of malaria related anemia and obstetric complications associated with it.

Factors associated with contraceptive use and initiation of coital activity after childbirth

The aim of the study is to identify the factors influencing contraceptive use and initiation of sexual intercourse after childbirth. This was a cross-sectional descriptive survey involving 256 consecutive women who delivered between April and October 2007 presenting at the Immunization Clinic University of Calabar Teaching Hospital Nigeria in April 2008. Data was obtained using an interviewer-administered structured questionnaire. Women who had antenatal and postnatal counseling were significantly more likely to use contraceptives than those who did not have counseling (odds ratio (OR) 0.29; 95% confidence interval (CI) 0.14-0.59; P = 0.0002 and OR 0.18; 95% CI 0.08-0.38; P = 0.0000002 respectively). Other variables significantly associated with contraceptive use included education (P = 0.0470) and reproductive goal (P = 0.0303). Linear regression analysis showed direct relationship between caesarean section and episiotomy as modes of delivery and initiation of coitus (r² = 0.439 and 0.45 respectively). Concerning residence after childbirth staying at home and with in-laws showed direct relationship with initiation of coitus (r² = 0.208 and 10.750 respectively). The number of women abstaining from intercourse showed a decreasing trend with increasing months after childbirth. Initiation of coitus was significantly associated with resumption of menstruation (P < 0.0001) and non-contraceptive use (P = 0.0089). In conclusion this study shows the need for use of postpartum contraception before fecund women become susceptible to pregnancy.

Obstetric outcomes of booked teenage pregnancies at University of Calabar Teaching Hospital, Nigeria

Background Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH) in Nigeria. Methods A retrospective comparative analysis of teenage pregnancies and mature mothers at UCTH was carried out from January 2011 to December 2011. A total of 82 teenage pregnancies and 72 mature pregnancies were compared. Results There were 145 teenage deliveries from a total of 2313 deliveries, ie, 6.3% of total deliveries. There was no statistically significant difference in the mode of delivery (cesarean section, spontaneous vaginal delivery, instrumental delivery) between the groups of mothers. There was also no difference in risk of complications, including obstructed labor, retained placenta, uterine atony, pre-eclampsia/eclampsia, and antepartum hemorrhage. However, teenage mothers had more perineal lacerations (P = 0.02) and more preterm labor (P = 0.05), and delivered more low-birth-weight babies (P = 0.02). Conclusion Supervised teenage pregnancy may not be as hazardous as previously thought.

Haemoperitoneum following coitus with no associated vaginal injury

Postcoital haemoperitoneum resulting in shock rarely occur without evident vaginal injury. A 24 year old Para 0 ±4 women presented to the emergency unit in shock with a history of fainting attack and severe absominal pain of 6 hours duration. Pain was felt immediately after coitus and was so severe that the patient had a blackout. Ultrasound scan revealed a left adnexal mass and fluid in the peritoneal cavity. At laparatomy more than 2 litres of fresh blood was found in the peritoneal cavity. The left ovary was enlarged by a haemorrhagic cyst with 3 bleeding points. The left fallopian tube was slightly oedematous with 2 areas of haemorrhagic spots but no obvious bleedig. Left ovarian cystectomy was done. Haemostasis was secured. Mary Slessor Journal of Medicine Vol. 5(2) 2005: 70-72