International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 12 (3), pp. 001-006, March, 2024. © International Scholars Journals

Full Length Research Paper

Addressing maternal mortality through emergency obstetric care in Benin City, South-south Nigeria

L. O. Omo-Aghoja¹*, O. A. Aisien², J. T. Akuse³, S. Bergstrom⁴ and F. E. Okonofua²

¹Department of Obstetrics and Gynecology, College of Medical Sciences, Delta State University, Abraka, Nigeria.

²Department of Obstetrics and Gynecology, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria.

³Sefas Medical Centre, Kaduna, Kaduna State, Nigeria.

⁴Department of Public Health, Karolinska Institute, Stockholm, Sweden.

Accepted 25 January, 2024

Abstract

To estimate the maternal mortality ratio, identify the contribution of Type III delays and assess the status of emergency obstetric services in a Nigerian Teaching Hospital, service delivery records of all maternities over 2 years were analyzed. Emergency care facilities in the hospital were physically verified and 10 senior medical/midwifery staff was interviewed in-depth. The maternal mortality ratio was 2,356/100,000 deliveries. The leading causes of death were HIV/AIDS (20.2%), eclampsia (12.4%), puerperal sepsis (11.9%), unsafe abortion (9.5%), and postpartum hemorrhage (4.8%). Associated causes of death were Type III delay (61.9%), Type I delay (28.6%), Type II delay (0%) and 9.5% of the women had no delay. Type III delay was due largely to delayed referral. Other causes were lack of blood, oxygen and necessary equipment in the hospital. Although the hospital had relevant emergency obstetric care facilities, there is inadequate midwifery staff, blood, oxygen supplies and intensive care facilities. Tertiary health institutions engaged in maternity care in Nigeria should step up their emergency obstetric services and reach out to other care providers to build greater understanding of issues relating to safe motherhood.

Key words: Maternal mortality, Nigeria, emergency obstetrics care, safe motherhood, millennium development goals, Type III delay.

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 12 (2), pp. 001-005, February, 2024. © International Scholars Journals

Full Length Research Paper

Understanding the quest for pain management in childbirth in Northeastern Nigeria

Bala Audu¹, Usman Yahaya², Mohammed Bukar¹*, Aliyu El-Nafaty², Hadiza Abdullahi¹ and Othman Kyari¹

¹Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.

²Department of Obstetrics and Gynaecology, Federal Medical Centre, Gombe, Gombe State, Nigeria.

Accepted 15 September, 2023

Abstract

Labour pain is a distressing and psychologically traumatizing experience to the parturient but little data exist in the Northeastern part of Nigeria regarding pain relief in labour, despite its many advantages. To determine the knowledge, desire and access to pain relief in labour as well as perception of labour pain. This is a cross sectional study of two hundred and fifty five women in two tertiary institutions in north-eastern Nigeria. Patients attending the antenatal clinics or staying in the lying in ward of the hospital after delivery were interviewed and questionnaires filled. One hundred and ninety (74.5%) were undelivered while 65(25.5%) were in the immediate postpartum period. One hundred women were interviewed at the University of Maiduguri Teaching Hospital (UMTH) while 155 were interviewed at the Federal medical Centre Gombe. The interviews centred on their perception of pain and duration of labour. The mean age and parity were 27.6 ± 5.7 and 2.8 ± 2.1 respectively. About 80% of those interviewed rated labour pain as severe to agonizing, 82% had no knowledge of pain relief in labour while 81.6 and 78.8% would like pain relief and recommended same, respectively. Only 11% of those interviewed were given pain relief in labour. The majority of women, 64.7% considered their labour as not prolonged. Parity (P = 0.0002), ethnicity (P = 0.020) and duration of labour (P = 0.00017) significantly influenced pain perception in labour while education (P = 0.25) and age (P = 0.4) had no significant influence on pain perception in labour. Although many of the women were not aware of pain relief in labour, the overwhelming majority would want and have recommended pain relief in labour.

Key words: labour pain, knowledge, desire.

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 12 (1), pp. 001-011, January, 2024. © International Scholars Journals

Full Length Research Paper

Maternal HIV status and infant feeding decisions: A comparative study in two Ghanaian districts

A. K. Laar¹*, W. Ampofo², J. M. Tuakli¹ and I. A. Quakyi¹

¹School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.

²Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.

Accepted 2 October, 2023

Abstract

Documentation of the feeding choices and experiences of HIV-positive mothers is needed to improve infant feeding counselling. The feeding behaviour and experiences of mothers receiving infant feeding counselling at two Ghanaian districts were explored. A postpartum survey involving 128 HIV-positive mothers, and in-depth interviews involving a purposively selected sample of 10 HIV-positive mothers were conducted. Exclusive breastfeeding rate was 62%. About six percent of the infants were given breast milk and infant formula, while 33% received breast milk and other feeds. Perceived stigma of formula feeding (odds ratio [OR] 7.50; p < 0.05), and perceived cost of infant formula (OR 0.37; p < 0.05) were significantly associated with exclusive breastfeeding for three months. In our multiple regression analysis, perceived stigma of formula feeding (OR 15.62; p < 0.05), and perceived cost of infant formula (OR 4.60; p < 0.05) were significantly associated with exclusive breastfeeding. Social pressure to mix-feed, local norms and “the baby friendly hospital initiative” also influenced infant feeding implementation efforts of mothers. Mothers face various barriers in implementing their feeding intentions. Policy makers and service providers in these districts need to address these issues in order to improve feeding practice.

Key words: Infant feed choices, infant feeding experiences, HIV-positive mothers, Ghana.

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 11 (7), pp. 001-009, July, 2023. © International Scholars Journals

Full Length Research Paper

Obstetric trauma admissions in a level 1 trauma centre in South Africa: a 5-year retrospective review

Brian Madikizela¹, Douglas Motshekga² and John Mgoqi³

¹School of Clinical Medicine, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa.

²Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

³Department of Anaesthesia and Peri-operative Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia.

Accepted 05 December, 2022

Abstract

Purpose: The accurate incidence of trauma in pregnancy is not well known, but trauma complicates 6 to 8% of pregnancies and it is one of the leading causes of morbidity and mortality in pregnancy and remains the most common cause of fetal mortality worldwide. Methods: A retrospective review of data of all pregnant patients admitted to Chris Hani Baragwanath Academic Hospital from 01 January 2015 to 31 December 2019 with trauma. Data collected included demographic data, mechanisms of injury, clinical interventions, as well as maternal and fetal outcomes. Results: Data of 800 patients was included in the study during the five-year period. The mean age was 31.00 years and the mean gestational age was 26.00 weeks. The majority of patients were black Africans (89.1%). Five hundred and sixty-two patients were of single marital status (70.3%) and 484 identified as unemployed (60.5%). Assaults were the most frequent cause of trauma (41.3%), followed by falls (33.1%) and motor vehicle accidents (25.5%). Conclusion: Trauma in pregnancy is associated with significant morbidity and negative pregnancy outcomes. The implementation of strategies aimed at detecting and preventing intimate partner violence as well as road safety may contribute significantly to a reduction of maternal and fetal mortality.

Keywords: Trauma, pregnancy, gender-based violence, blunt abdominal trauma, penetrating abdominal trauma, pregnancy outcomes, Critical care.

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 11 (6), pp. 001-029, June, 2023. © International Scholars Journals

Full Length Research Paper

Perinatal Genetic Carrier Screening: Could a sequential perinatal carrier screening approach be a better way?  (Scoping Review)

R Douglas Wilson MD MSc FRCSC                                                                                        

Professor Emeritus University of Calgary Cumming School of Medicine Department of Obstetrics and Gynecology. Email doug.wilson@ahs.ca. Mobile: +1- 403-470-7229

Accepted 16 May, 2023

Abstract

The gestational time separated genetic carrier screening process with preconception, post conception, and neonatal testing options is complex, poorly provided; poorly implemented; and poorly understood. Methods: scoping review process is used to discuss the opportunity for the development of a sequential perinatal carrier screening process. Results / Discussion: an integrated perinatal genetic carrier screening proposal compared to the separated gestationally timed genetic carrier screening process is introduced using a predelivery informed consent and counselling process to consider the patient or couple personal reproductive carrier plan using 5 possible options: maternal-fetal well-being screening only; fetal aneuploidy / congenital anomalies screening only; expanded fetal genetic screening with next generation sequencing technology; parental-fetal genetic carrier screening prevention (preconception or post conception) using pan-ethnic or focused carrier screening; fetal-neonatal carrier screening treatment (post conception or neonatal screening) based on evidenced-based neonatal treatment score. Conclusion: This sequential perinatal genetic carrier screening proposal has evidence-supported outcomes to determine the access, equity, and validity of a sequential perinatal genetic carrier screening pathway but this proposal may require a clinical trial evaluation for further consideration.

Key Words: genetic carrier screening, preconception carrier screening, post conception carrier screening, neonatal metabolic /lysosomal carrier screening, neonatal therapy, informed consent, ethical carrier evaluation process.

International Journal of Obstetrics and Gynecology ISSN 2736-1594, Vol. 11 (6), pp. 001-006, June, 2023. © International Scholars Journals

Full Length Research Paper

Multiple preovulatory LH and FSH surges observed in mithun (Bos frontalis)

Dhali A¹*, Mishra DP², Mech A¹, Prakash B¹ and Rajkhowa C¹

¹N. R. C. Mithun, Medziphema, Nagaland – 797 106, India.

²Department of Pharmacology, 360D, Med Surge II, UC, Irvine, CA-92697, USA.

Accepted 17 April, 2023

Abstract

The experiment was conducted on 14 postpartum mithun (Bos frontalis) cows to establish the preovu-latory LH and FSH surge patterns during estrus in peripheral circulation. Blood samples from jugular vein were collected every 2 h until 72 h and on alternate days till day 22 (day 0 = day of estrus) following the day of estrus onset. Plasma progesterone (P4), LH and FSH levels were estimated. Plasma P4 profile of the estrous cycle indicated that all the animals were ovulated following the onset of estrus. Also plasma LH and FSH concentrations were found to be significantly (p<0.01) higher around estrus. Two different preovulatory LH and FSH surge patterns were observed during the study. Pattern-1 indicated multiple and concomitant LH and FSH rises during estrus (43% animals, 6 out of 14), while pattern-2 showed multiple LH rises without concomitant FSH rises during estrus (57% animals, 8 out of 14). The basal concentrations of LH and FSH, the area under LH and FSH curves and the number of LH peak did not vary significantly during estrus between the patterns. However, the amplitude of LH and FSH peaks (p<0.05) and the number of FSH peak (p<0.01) were found to be significantly higher during estrus in pattern-1. The result indicated that the multiple preovulatory LH surges along with increased FSH activities were responsible for ovulation in mithun.

Key words: LH surge, FSH surge, estrus, mithun.