Pub Date : 2019-09-01DOI: 10.4103/TJOG.TJOG_102_19
O. Badejoko
Background: The death of Folake Oduyoye at the Lagos University Teaching Hospital (LUTH), Nigeria on 13th December 2014 triggered a protest march against the hospital, by a coalition of civil society organizations and human rights activists, and a legal suit was instituted against the government. Although a Federal High Court ruled in 2018 to overturn Oduyoye's case on a technicality, this ruling is currently being appealed. Objective: To perform a sociological analysis of the Oduyoye/LUTH case and another managed in OAUTHC Ile-Ife; as a means of providing insight into the current state of patient safety in maternity, in Nigeria. Methodology: This sociological analysis was conducted using secondary data, sourced from a combination of detailed online searches of published literature, news items, and social media posts; along with personal observations and reviews of patient's records. Results: Patient safety issues in maternity are prevalent in Nigeria. Responsible macrosociological factors include lack of clarity regarding the political economy of healthcare in Nigeria, dubious justiciability of citizens' right to healthcare, poor resource allocation to healthcare, and dismal coverage of national health insurance, along with poor regulation of health services, and nonintegration of healthcare with partner social institutions. At the mesosociological and microsociological levels are lack of public confidence in Nigerian healthcare, gross infrastructural decay from chronic neglect, understaffing and inadequate training of personnel, lack of institutional risk management and clinical governance. Conclusion: The state of patient safety in maternity in Nigeria is quite worrisome. Various sociological factors were identified and viable solutions proffered.
背景：2014年12月13日，Folake Oduyoye在尼日利亚拉各斯大学教学医院（LUTH）死亡，引发了民间社会组织和人权活动家联盟对该医院的抗议游行，并对政府提起了法律诉讼。尽管联邦高等法院在2018年裁定以技术性问题推翻Oduyoye的案件，但这一裁决目前正在上诉中。目的：对Oduyoye/LUTH病例和OAUTHC Ile Ife的另一例病例进行社会学分析；作为深入了解尼日利亚产妇患者安全现状的一种手段。方法：这项社会学分析是使用二级数据进行的，二级数据来源于对已发表文献、新闻项目和社交媒体帖子的详细在线搜索；以及对患者记录的个人观察和审查。结果：产妇的患者安全问题在尼日利亚很普遍。负责任的宏观社会因素包括对尼日利亚医疗保健的政治经济缺乏明确性，公民医疗保健权的可司法性可疑，医疗保健资源分配不足，国家医疗保险覆盖率低下，医疗服务监管不力，医疗保健与伙伴社会机构不整合。在中社会学和微观社会学层面，公众对尼日利亚医疗保健缺乏信心，长期忽视导致基础设施严重衰退，人员人手不足和培训不足，缺乏机构风险管理和临床治理。结论：尼日利亚产妇的患者安全状况令人担忧。确定了各种社会学因素，并提出了可行的解决方案。
{"title":"Patient safety in maternity: The Nigerian context","authors":"O. Badejoko","doi":"10.4103/TJOG.TJOG_102_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_102_19","url":null,"abstract":"Background: The death of Folake Oduyoye at the Lagos University Teaching Hospital (LUTH), Nigeria on 13th December 2014 triggered a protest march against the hospital, by a coalition of civil society organizations and human rights activists, and a legal suit was instituted against the government. Although a Federal High Court ruled in 2018 to overturn Oduyoye's case on a technicality, this ruling is currently being appealed. Objective: To perform a sociological analysis of the Oduyoye/LUTH case and another managed in OAUTHC Ile-Ife; as a means of providing insight into the current state of patient safety in maternity, in Nigeria. Methodology: This sociological analysis was conducted using secondary data, sourced from a combination of detailed online searches of published literature, news items, and social media posts; along with personal observations and reviews of patient's records. Results: Patient safety issues in maternity are prevalent in Nigeria. Responsible macrosociological factors include lack of clarity regarding the political economy of healthcare in Nigeria, dubious justiciability of citizens' right to healthcare, poor resource allocation to healthcare, and dismal coverage of national health insurance, along with poor regulation of health services, and nonintegration of healthcare with partner social institutions. At the mesosociological and microsociological levels are lack of public confidence in Nigerian healthcare, gross infrastructural decay from chronic neglect, understaffing and inadequate training of personnel, lack of institutional risk management and clinical governance. Conclusion: The state of patient safety in maternity in Nigeria is quite worrisome. Various sociological factors were identified and viable solutions proffered.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46721175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Elevated impedance to blood flow in the placenta is reflected by abnormal umbilical artery (UA) indices as seen in intrauterine growth restriction (IUGR). Aims: To correlate abnormal UA Doppler velocimetry parameters with birth weight and mode of delivery in IUGR. Material and Methods: A prospective study was conducted in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, IGMC Shimla HP, over a period of one year from August 2017 to July 2018. The study included a total of 120 consecutive clinically suspected cases of singleton IUGR pregnancies, at 34–40 weeks of gestation. Umbilical artery (UA) Doppler indices including systolic/diastolic (S/D) ratio, pulsatility index (PI), and resistive index (RI) were measured. The decision regarding mode delivery was based on absent or reversal of diastolic flow, abnormal fetal heart tracing, and other maternal and fetal conditions, e.g., preeclampsia or abnormal biophysical profile. The birth weight, mode of delivery, and the reasons for emergency cesarean section were noted. Statistical analysis was performed using Statistical Package for Social Sciences, version 16.0 and a P value <0.05 was considered statistically significant. Results: Abnormal UA PI (>1.42) was seen in 24 fetuses. Among these, 69% (n = 16) underwent a cesarean delivery, and 91% (n = 22) had a birth weight less than 2.5 kg. Statistically significant association was noted with abnormal UA PI (P-value: <0.01), abnormal UA RI (P-value: <0.001), and abnormal UA S/D (P-value: <0.001) and cesarean delivery. The main indication for cesarean section was fetal distress. Conclusion: Abnormal UA Doppler indices are significantly associated with cesarean deliveries and low birth weight babies.
背景:子宫内生长受限(IUGR)中脐带动脉(UA)指数异常反映了胎盘血流阻抗升高。目的:探讨IUGR中异常UA多普勒测速参数与出生体重和分娩方式的关系。材料和方法:从2017年8月到2018年7月，在Kamla Nehru国立妇幼医院IGMC Shimla HP的妇产科进行了一项前瞻性研究。本研究共纳入了120例妊娠34-40周单胎IUGR妊娠的连续临床疑似病例。测量脐动脉(UA)多普勒指数，包括收缩期/舒张期(S/D)比、搏动指数(PI)、阻力指数(RI)。关于分娩方式的决定是基于舒张期血流缺失或逆转、异常的胎心示踪和其他母婴状况，如先兆子痫或异常的生物物理特征。记录了出生体重、分娩方式和紧急剖宫产的原因。采用社会科学统计软件包(Statistical Package for Social Sciences, version 16.0)对24例胎儿进行统计分析，P值为1.42。其中69% (n = 16)接受剖宫产，91% (n = 22)出生体重低于2.5 kg。UA PI异常(p值<0.01)、UA RI异常(p值<0.001)、UA S/D异常(p值<0.001)与剖宫产有统计学意义。剖宫产的主要指征是胎儿窘迫。结论:UA多普勒指数异常与剖宫产和低出生体重儿有显著相关性。
{"title":"Correlation of abnormal umbilical artery Doppler Indices and mode of delivery in intrauterine growth restriction","authors":"S. Ganju, B. Dhiman, N. Sood","doi":"10.4103/TJOG.TJOG_79_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_79_19","url":null,"abstract":"Background: Elevated impedance to blood flow in the placenta is reflected by abnormal umbilical artery (UA) indices as seen in intrauterine growth restriction (IUGR). Aims: To correlate abnormal UA Doppler velocimetry parameters with birth weight and mode of delivery in IUGR. Material and Methods: A prospective study was conducted in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, IGMC Shimla HP, over a period of one year from August 2017 to July 2018. The study included a total of 120 consecutive clinically suspected cases of singleton IUGR pregnancies, at 34–40 weeks of gestation. Umbilical artery (UA) Doppler indices including systolic/diastolic (S/D) ratio, pulsatility index (PI), and resistive index (RI) were measured. The decision regarding mode delivery was based on absent or reversal of diastolic flow, abnormal fetal heart tracing, and other maternal and fetal conditions, e.g., preeclampsia or abnormal biophysical profile. The birth weight, mode of delivery, and the reasons for emergency cesarean section were noted. Statistical analysis was performed using Statistical Package for Social Sciences, version 16.0 and a P value <0.05 was considered statistically significant. Results: Abnormal UA PI (>1.42) was seen in 24 fetuses. Among these, 69% (n = 16) underwent a cesarean delivery, and 91% (n = 22) had a birth weight less than 2.5 kg. Statistically significant association was noted with abnormal UA PI (P-value: <0.01), abnormal UA RI (P-value: <0.001), and abnormal UA S/D (P-value: <0.001) and cesarean delivery. The main indication for cesarean section was fetal distress. Conclusion: Abnormal UA Doppler indices are significantly associated with cesarean deliveries and low birth weight babies.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47520175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postpartum suicidality is a major public health concern that has been identified as one of the major contributors to the global mortality burden. It poses a profound risk to women in the postpartum and the community in general. Aim: To determine the prevalence and correlates of suicidality among Nigerian postpartum women. Subjects and Methods: This is a cross-sectional descriptive study involving 347 Nigerian women recruited during the postpartum period. They completed a study-specific sociodemographic and pregnancy-related questionnaire, the Edinburgh Postpartum Depression Scale, Suicidal Behaviors Questionnaire-Revised, and the Brief version of the World Health Organization Quality of Life Questionnaire. Results: The prevalence of lifetime suicidal ideation, plans, and attempts was 10.4%, 2.9%, and 1.7% respectively. In addition, 5.2% of the respondents reported suicidal ideation in the past year, while 4.0% of the respondents indicated the likelihood of suicide attempts in the future. Depression, lower quality of life, preterm delivery, complications during pregnancy, poor support from the husband and the in-laws, stressful infant care, and baby's hospitalization were significantly associated with suicidality. Conclusion: Suicidality is relatively common among Nigerian postpartum women. Therefore, postpartum women should be routinely screened for suicidal behaviors.
{"title":"Suicidality among Nigerian postpartum women: Prevalence and correlates","authors":"T. Opakunle, O. Aloba, O. Opakunle","doi":"10.4103/TJOG.TJOG_43_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_43_19","url":null,"abstract":"Background: Postpartum suicidality is a major public health concern that has been identified as one of the major contributors to the global mortality burden. It poses a profound risk to women in the postpartum and the community in general. Aim: To determine the prevalence and correlates of suicidality among Nigerian postpartum women. Subjects and Methods: This is a cross-sectional descriptive study involving 347 Nigerian women recruited during the postpartum period. They completed a study-specific sociodemographic and pregnancy-related questionnaire, the Edinburgh Postpartum Depression Scale, Suicidal Behaviors Questionnaire-Revised, and the Brief version of the World Health Organization Quality of Life Questionnaire. Results: The prevalence of lifetime suicidal ideation, plans, and attempts was 10.4%, 2.9%, and 1.7% respectively. In addition, 5.2% of the respondents reported suicidal ideation in the past year, while 4.0% of the respondents indicated the likelihood of suicide attempts in the future. Depression, lower quality of life, preterm delivery, complications during pregnancy, poor support from the husband and the in-laws, stressful infant care, and baby's hospitalization were significantly associated with suicidality. Conclusion: Suicidality is relatively common among Nigerian postpartum women. Therefore, postpartum women should be routinely screened for suicidal behaviors.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42764750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Group B streptococci (GBS) is considered as an important cause of neonatal morbidity and mortality. The Centers for Disease Control and Prevention (CDC) recommends recto-vaginal sampling of pregnant women and the use of selective broth medium for GBS isolation. This study was done to evaluate the GBS yield from only vaginal, only rectal, and both rectal and vaginal swabs collected. In addition, the drawbacks of using the selective broth mediums for GBS isolation were also analyzed. Methodology: This was a prospective study that was done to screen 300 pregnant women for vaginal and rectal GBS colonization. Vaginal and rectal swabs were inoculated separately in Todd Hewitt Broth and later subcultured on blood agar for GBS isolation. Results: The GBS detection rates from both vaginal and rectal swabs were 42.9%, indicating heavy colonization in these women. In addition, our study noted certain drawbacks with the use of selective Todd Hewitt Broth medium used for GBS isolation. Conclusion: GBS isolation rate was higher when both rectal and vaginal swabs were collected. Our study also concluded that there was a need to develop alternative culture media for GBS isolation in view of the drawbacks encountered with the selective Todd Hewitt Broth medium.
{"title":"Analysis of vaginal and rectal sampling methods for maternal group B streptococcal isolation","authors":"V. Sharmila, T. Babu","doi":"10.4103/TJOG.TJOG_36_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_36_19","url":null,"abstract":"Background: Group B streptococci (GBS) is considered as an important cause of neonatal morbidity and mortality. The Centers for Disease Control and Prevention (CDC) recommends recto-vaginal sampling of pregnant women and the use of selective broth medium for GBS isolation. This study was done to evaluate the GBS yield from only vaginal, only rectal, and both rectal and vaginal swabs collected. In addition, the drawbacks of using the selective broth mediums for GBS isolation were also analyzed. Methodology: This was a prospective study that was done to screen 300 pregnant women for vaginal and rectal GBS colonization. Vaginal and rectal swabs were inoculated separately in Todd Hewitt Broth and later subcultured on blood agar for GBS isolation. Results: The GBS detection rates from both vaginal and rectal swabs were 42.9%, indicating heavy colonization in these women. In addition, our study noted certain drawbacks with the use of selective Todd Hewitt Broth medium used for GBS isolation. Conclusion: GBS isolation rate was higher when both rectal and vaginal swabs were collected. Our study also concluded that there was a need to develop alternative culture media for GBS isolation in view of the drawbacks encountered with the selective Todd Hewitt Broth medium.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44375666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted disease worldwide and is now being considered as an emerging “obstetric pathogen”. It is an enemy to the human reproductive system causing infertility, adverse pregnancy and perinatal outcomes but its role in causing spontaneous miscarriage is still unclear. Objective: To assess the association between genital Chlamydia trachomatis and spontaneous miscarriage in black women. Materials and Methods: Eighty three women with spontaneous miscarriage (case group) were compared with 83 women with on-going pregnancy beyond 28 weeks' gestation (control group). Sera of both groups were tested for the presence of Chlamydia trachomatis Immunoglobulin G (IgG) antibody using ELISA. Results: Seroprevalence of IgG to Ct was 8.4% and 3.6% among women with spontaneous miscarriage and on-going pregnancy, respectively. Ct IgG seropositivity was not significantly different between the two groups (P = 0.192; OR = 0.41, CI 0.10 – 1.63). Conclusion: Chlamydia trachomatis IgG seropositivity is not associated with spontaneous miscarriage in this study. However, multicentre study with larger sample size and using polymerase chain reaction as a diagnostic technique is recommended.
{"title":"Does genital Chlamydia trachomatis cause spontaneous miscarriage in black women?","authors":"R. Aliyu, A. Adesiyun, S. Aliyu","doi":"10.4103/TJOG.TJOG_75_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_75_19","url":null,"abstract":"Background: Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted disease worldwide and is now being considered as an emerging “obstetric pathogen”. It is an enemy to the human reproductive system causing infertility, adverse pregnancy and perinatal outcomes but its role in causing spontaneous miscarriage is still unclear. Objective: To assess the association between genital Chlamydia trachomatis and spontaneous miscarriage in black women. Materials and Methods: Eighty three women with spontaneous miscarriage (case group) were compared with 83 women with on-going pregnancy beyond 28 weeks' gestation (control group). Sera of both groups were tested for the presence of Chlamydia trachomatis Immunoglobulin G (IgG) antibody using ELISA. Results: Seroprevalence of IgG to Ct was 8.4% and 3.6% among women with spontaneous miscarriage and on-going pregnancy, respectively. Ct IgG seropositivity was not significantly different between the two groups (P = 0.192; OR = 0.41, CI 0.10 – 1.63). Conclusion: Chlamydia trachomatis IgG seropositivity is not associated with spontaneous miscarriage in this study. However, multicentre study with larger sample size and using polymerase chain reaction as a diagnostic technique is recommended.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46294477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Ibo, L. Ajah, Johnbosco Ifunanya Nwafor, K. Ekwuazi, O. Okoro, C. Obi, J. Mamah
Introduction: As life expectancy increases, most women spend a larger part of their lives in the postmenopausal state. This period is associated with other medical comorbidities which affect the quality of life. Knowledge and perception of postmenopausal symptoms could help them cope with such a situation. Aim: To determine the knowledge and perception of postmenopausal symptoms among postmenopausal women presented to the gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Methods: This was a cross-sectional study carried out at the Gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Around 408 women were administered structured questionnaires. The information obtained was analyzed using SPSS version 20. Results: Majority (50%) of the respondents were 50–54 years age group and the least (6.9%) were 55–59 years. The commonest menopausal symptom reported was hot flushes by 300 (73.5%) respondents. Tiredness and vaginal dryness were reported by 188 (46.1%) and 180 (44.1%) respondents, respectively. The knowledge of hormone replacement therapy was low (7.8%). The study showed that 356 (87.3%) women have no knowledge of hormone replacement therapy. Conclusion: There is a need for educating women in the clinics regarding menopause and hormone replacement therapy which would further enable women to make informed choices about their health postmenopause.
引言:随着预期寿命的增加，大多数女性在绝经后的生活中度过了更长的时间。这一时期与其他影响生活质量的医学合并症有关。对绝经后症状的了解和认知可以帮助她们应对这种情况。目的:了解到阿巴卡利基亚历克斯·艾克乌梅联邦大学附属医院妇科门诊就诊的绝经后妇女对绝经后症状的认识和认知。材料和方法:本研究是在Abakaliki Alex Ekwueme联邦大学教学医院妇科诊所进行的一项横断面研究。大约408名女性接受了结构化问卷调查。使用SPSS version 20对所得信息进行分析。结果:50-54岁年龄组占多数(50%)，55-59岁年龄组占最少(6.9%)。300名(73.5%)受访者报告的最常见的更年期症状是潮热。疲倦和阴道干燥分别有188人(46.1%)和180人(44.1%)报告。激素替代疗法的知晓率较低(7.8%)。研究显示356名(87.3%)女性对激素替代疗法一无所知。结论:有必要在诊所对妇女进行关于更年期和激素替代疗法的教育，这将进一步使妇女能够对绝经后的健康做出知情的选择。
{"title":"Knowledge and perception of postmenopausal symptoms among postmenopausal women presented at the gynecological clinic of a tertiary health institution in Abakaliki","authors":"C. Ibo, L. Ajah, Johnbosco Ifunanya Nwafor, K. Ekwuazi, O. Okoro, C. Obi, J. Mamah","doi":"10.4103/TJOG.TJOG_61_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_61_19","url":null,"abstract":"Introduction: As life expectancy increases, most women spend a larger part of their lives in the postmenopausal state. This period is associated with other medical comorbidities which affect the quality of life. Knowledge and perception of postmenopausal symptoms could help them cope with such a situation. Aim: To determine the knowledge and perception of postmenopausal symptoms among postmenopausal women presented to the gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Methods: This was a cross-sectional study carried out at the Gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Around 408 women were administered structured questionnaires. The information obtained was analyzed using SPSS version 20. Results: Majority (50%) of the respondents were 50–54 years age group and the least (6.9%) were 55–59 years. The commonest menopausal symptom reported was hot flushes by 300 (73.5%) respondents. Tiredness and vaginal dryness were reported by 188 (46.1%) and 180 (44.1%) respondents, respectively. The knowledge of hormone replacement therapy was low (7.8%). The study showed that 356 (87.3%) women have no knowledge of hormone replacement therapy. Conclusion: There is a need for educating women in the clinics regarding menopause and hormone replacement therapy which would further enable women to make informed choices about their health postmenopause.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43799635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johnbosco Ifunanya Nwafor, V. Obi, B. Onwe, D. Ugojis, V. Onuchukwu, C. Obi, C. Ibo
Background: Despite advances in care, postpartum hemorrhage has continued to contribute disproportionately to maternal morbidity and mortality in developing countries due to delayed and/or substandard care in the diagnosis and management of hypovolemic shock. Aim: To compare the performance of the shock index with conventional vital signs for prediction of maternal outcome following postpartum hemorrhage and to establish alert thresholds for use in low-resource settings. Materials and Method: This is a 7-year retrospective cohort study of 289 women treated for primary postpartum hemorrhage at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, and shock index measured at the time of diagnosis of postpartum hemorrhage were analyzed. Adverse maternal outcomes such as intensive care unit admission, blood transfusion ≥5 units, hemoglobin level <7 g/dL, surgical interventions, end-organ failure, and death were reviewed. The area under the receiver operating characteristic curve (AUROC) for each vital sign was used to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were calculated to determine the thresholds of the best predictor. Results: Shock index had the highest AUROC to predict invasive surgical procedures (0.70 for SI [95% CI 0.66–0.80] compared with 0.69 [95% CI 0.61–0.76] for pulse rate). Shock index was a consistent superior predictor for other outcomes. Shock index (SI) ≥0.9 had 100% sensitivity (95% CI 74.6–100) and 46.7% specificity (95% CI 34.9–56.5) for prediction of intensive care admission, and SI ≥1.7 had 46.9% sensitivity (95% CI 19.8–62.8) and 98.9% specificity (CI 91.1–100) for prediction of maternal death. Conclusion: Shock index is a consistent superior predictor of adverse maternal outcomes following postpartum hemorrhage when compared with conventional vital signs. SI <0.9 provides reassurance, whereas SI ≥1.7 indicates a need for urgent intervention to prevent maternal mortality.
背景:尽管护理取得了进步，但在发展中国家，由于低血容量性休克的诊断和管理方面的延迟和/或不合格的护理，产后出血继续不成比例地导致孕产妇发病率和死亡率。目的:比较休克指数与传统生命体征在预测产后出血后产妇结局方面的表现，并建立在低资源环境下使用的警报阈值。材料和方法:这是一项为期7年的回顾性队列研究，研究对象是在Abakaliki的Alex Ekwueme联邦大学教学医院治疗原发性产后出血的289名妇女。分析诊断产后出血时的收缩压、舒张压、平均动脉压、脉压、心率、休克指数等数据。不良产妇结局，如重症监护病房入院、输血≥5单位、血红蛋白水平<7 g/dL、手术干预、终末器官衰竭和死亡。每个生命体征的受试者工作特征曲线下面积(AUROC)用于预测不良产妇结局。计算敏感性、特异性和阴性和阳性预测值，以确定最佳预测器的阈值。结果:休克指数预测侵入性手术的AUROC最高(SI为0.70 [95% CI 0.66-0.80]，而脉搏率为0.69 [95% CI 0.61-0.76])。休克指数是其他预后的一致的优越预测指标。休克指数(SI)≥0.9预测重症监护入院的敏感性为100% (95% CI 74.6-100)，特异性为46.7% (95% CI 34.9-56.5); SI≥1.7预测孕产妇死亡的敏感性为46.9% (95% CI 19.8-62.8)，特异性为98.9% (CI 91.1-100)。结论:与传统生命体征相比，休克指数是产后出血后产妇不良结局的一致的优越预测指标。SI <0.9提供了保证，而SI≥1.7表明需要紧急干预以防止孕产妇死亡。
{"title":"Comparison of performance of shock index and conventional vital sign parameters for prediction of adverse maternal outcomes following major postpartum hemorrhage in Abakaliki, Southeast Nigeria","authors":"Johnbosco Ifunanya Nwafor, V. Obi, B. Onwe, D. Ugojis, V. Onuchukwu, C. Obi, C. Ibo","doi":"10.4103/TJOG.TJOG_60_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_60_19","url":null,"abstract":"Background: Despite advances in care, postpartum hemorrhage has continued to contribute disproportionately to maternal morbidity and mortality in developing countries due to delayed and/or substandard care in the diagnosis and management of hypovolemic shock. Aim: To compare the performance of the shock index with conventional vital signs for prediction of maternal outcome following postpartum hemorrhage and to establish alert thresholds for use in low-resource settings. Materials and Method: This is a 7-year retrospective cohort study of 289 women treated for primary postpartum hemorrhage at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, and shock index measured at the time of diagnosis of postpartum hemorrhage were analyzed. Adverse maternal outcomes such as intensive care unit admission, blood transfusion ≥5 units, hemoglobin level <7 g/dL, surgical interventions, end-organ failure, and death were reviewed. The area under the receiver operating characteristic curve (AUROC) for each vital sign was used to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were calculated to determine the thresholds of the best predictor. Results: Shock index had the highest AUROC to predict invasive surgical procedures (0.70 for SI [95% CI 0.66–0.80] compared with 0.69 [95% CI 0.61–0.76] for pulse rate). Shock index was a consistent superior predictor for other outcomes. Shock index (SI) ≥0.9 had 100% sensitivity (95% CI 74.6–100) and 46.7% specificity (95% CI 34.9–56.5) for prediction of intensive care admission, and SI ≥1.7 had 46.9% sensitivity (95% CI 19.8–62.8) and 98.9% specificity (CI 91.1–100) for prediction of maternal death. Conclusion: Shock index is a consistent superior predictor of adverse maternal outcomes following postpartum hemorrhage when compared with conventional vital signs. SI <0.9 provides reassurance, whereas SI ≥1.7 indicates a need for urgent intervention to prevent maternal mortality.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43965029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood transfusion in obstetrics should be administered to save the patient's life. Severe blood loss could lead to hypovolemic shock which requires an immediate blood transfusion to prevent organ failure and death. Transfusion of blood and blood components must be approached like the use of medicines. They must be used only after weighing the benefits against the risks as well as in the right dose, right indication, and schedule. This review article deals with preparation, indications, administration of blood components, and its complications in obstetrics.
{"title":"Role of blood transfusion in obstetrics","authors":"L. Reshma, S. Sreelatha","doi":"10.4103/TJOG.TJOG_68_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_68_19","url":null,"abstract":"Blood transfusion in obstetrics should be administered to save the patient's life. Severe blood loss could lead to hypovolemic shock which requires an immediate blood transfusion to prevent organ failure and death. Transfusion of blood and blood components must be approached like the use of medicines. They must be used only after weighing the benefits against the risks as well as in the right dose, right indication, and schedule. This review article deals with preparation, indications, administration of blood components, and its complications in obstetrics.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43785037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cervical cancer is a public health problem affecting women all over the world. Persistent infection with high-risk types of human papillomavirus (HPV) is a key risk factor for the development of cervical cancer. Besides, HPV vaccines and cervical cancer screening have been established as the primary and secondary preventive measures, respectively, yet studies have documented low uptake of these preventive measures. This study was designed to identify factors associated with uptake of HPV vaccination and cervical cancer screening among female undergraduates in Obafemi Awolowo University, Ile-Ife, Nigeria. Methods: This is a cross-sectional descriptive study employing a semi-structured, self-administered questionnaire to elicit information from 240 female undergraduates on sociodemographics and factors associated with uptake of HPV vaccines and screening for prevention of cervical cancer. The data collected was analyzed using the statistical package for social sciences (SPSS) version 20.0. Descriptive statistics were used to present data in tables and frequencies. Results: Findings from the study revealed that 80% of the respondents have heard of cervical cancer; however, only 48.3% and 41.7% have information about HPV vaccination and cervical cancer screening, respectively. The key factors identified for low uptake of HPV vaccination and cervical cancer screening were inadequate information about HPV vaccines (96.7%) and lack of detailed information about cervical cancer screening (94.6%), respectively. However, the least identified factors for low uptake of the primary and secondary preventive measures were some of the respondents considered their age too young to receive HPV vaccines (15%) and lack of time (42.1%) for the uptake of cervical cancer screening. Conclusion: There is a high level of knowledge about cervical cancer, but does not translate to high uptake of the prevention services. Thus, there is a great need to put in place measures to improve the uptake of HPV vaccination and cervical cancer screening services among the target population.
{"title":"Low uptake of human papillomavirus vaccination and cervical cancer screening among female undergraduates of a Nigerian University","authors":"E. Afolabi, O. Ogunsanwo, S. Oyebamiji, O. Ani","doi":"10.4103/TJOG.TJOG_96_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_96_19","url":null,"abstract":"Background: Cervical cancer is a public health problem affecting women all over the world. Persistent infection with high-risk types of human papillomavirus (HPV) is a key risk factor for the development of cervical cancer. Besides, HPV vaccines and cervical cancer screening have been established as the primary and secondary preventive measures, respectively, yet studies have documented low uptake of these preventive measures. This study was designed to identify factors associated with uptake of HPV vaccination and cervical cancer screening among female undergraduates in Obafemi Awolowo University, Ile-Ife, Nigeria. Methods: This is a cross-sectional descriptive study employing a semi-structured, self-administered questionnaire to elicit information from 240 female undergraduates on sociodemographics and factors associated with uptake of HPV vaccines and screening for prevention of cervical cancer. The data collected was analyzed using the statistical package for social sciences (SPSS) version 20.0. Descriptive statistics were used to present data in tables and frequencies. Results: Findings from the study revealed that 80% of the respondents have heard of cervical cancer; however, only 48.3% and 41.7% have information about HPV vaccination and cervical cancer screening, respectively. The key factors identified for low uptake of HPV vaccination and cervical cancer screening were inadequate information about HPV vaccines (96.7%) and lack of detailed information about cervical cancer screening (94.6%), respectively. However, the least identified factors for low uptake of the primary and secondary preventive measures were some of the respondents considered their age too young to receive HPV vaccines (15%) and lack of time (42.1%) for the uptake of cervical cancer screening. Conclusion: There is a high level of knowledge about cervical cancer, but does not translate to high uptake of the prevention services. Thus, there is a great need to put in place measures to improve the uptake of HPV vaccination and cervical cancer screening services among the target population.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47451160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Access to modern contraception can save lives. Sayana Press® is a 3-month injectable contraceptive that has a small needle and comes in a prefilled syringe, which makes it easy to use and less painful. Subjects and Methods: A mix method cross-sectional study was carried out in the Federal Capital Territory (FCT) and 3 states chosen across Nigeria: Nassarawa, Benue, and Oyo states. Quantitative data were collected using an interviewer-administered questionnaire while the qualitative data were collected using focus group discussions with selected youths, teachers, family planning service providers (caregivers), and parents. Results: Despite its years of introduction into the family planning market, Sayana Press® awareness was low, with 37.7% (43) of the 114 respondents in the quantitative study being aware of its existence as a new family planning method. The qualitative data also reinforced the crucial role of contraceptive knowledge (benefits and side effects) and cost on the uptake of Sayana Press®. Conclusion: Government and donor support for centralizing the procurement and distribution of contraceptives is a key determinant of Sayana Press® awareness and uptake.
{"title":"Awareness, knowledge, and perception about Sayana press® contraceptive technology in Nigeria","authors":"F. Eremutha, V. Gabriel","doi":"10.4103/TJOG.TJOG_81_19","DOIUrl":"https://doi.org/10.4103/TJOG.TJOG_81_19","url":null,"abstract":"Background: Access to modern contraception can save lives. Sayana Press® is a 3-month injectable contraceptive that has a small needle and comes in a prefilled syringe, which makes it easy to use and less painful. Subjects and Methods: A mix method cross-sectional study was carried out in the Federal Capital Territory (FCT) and 3 states chosen across Nigeria: Nassarawa, Benue, and Oyo states. Quantitative data were collected using an interviewer-administered questionnaire while the qualitative data were collected using focus group discussions with selected youths, teachers, family planning service providers (caregivers), and parents. Results: Despite its years of introduction into the family planning market, Sayana Press® awareness was low, with 37.7% (43) of the 114 respondents in the quantitative study being aware of its existence as a new family planning method. The qualitative data also reinforced the crucial role of contraceptive knowledge (benefits and side effects) and cost on the uptake of Sayana Press®. Conclusion: Government and donor support for centralizing the procurement and distribution of contraceptives is a key determinant of Sayana Press® awareness and uptake.","PeriodicalId":23302,"journal":{"name":"Tropical Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70848369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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