AJFMED

Cervico-Vaginal Foetal Fibronectin for Predicting Preterm Birth in Women with Preterm Contrac-tion: A Cross-sectional Study at a Nigerian Maternity

Agbetoba H, Awowole I, Okusanya B, Ohihoin A, Omololu O — Sun, 21 Jul 2024 00:00:00 -0600

Introduction: Preterm birth contributes substantially to perinatal morbidity, mortality and long-term neuromorbidity among survivors. Its prediction, using foetal fibronectin, may reduce the associated mortality and morbidity. Cervico-vaginal foetal fibronectin (fFN) appears promising, but limited evidence is available on its applicability in low-income countries, with high burden of preterm birth, like Nigeria. This study evaluates the predictability of cervico-vaginal foetal fibronectin (fFN) for preterm birth. Materials and method: A cross-sectional study conducted at the Lagos Island Maternity Hospital; Nigeria evaluated foetal fibronectin in cervico-vaginal secretions of pregnant women. Participants presented with symptoms and/or signs of preterm birth between 28 weeks and 35 weeks’ gestation. Foetal fibronectin was estimated using a Fetal fibronectin testing kit manufactured by Nantong Egens Biotechnology Co., Ltd China ©rapid. Women were offered standard obstetric care as per institutional protocols and followed up till birth. Results: Thirty-three (18.4%) of 179 women had a positive fetal fibronectin result. At 7 days after testing, foetal fibronectin predicted preterm birth with sensitivity, specificity, positive and negative predictive value of 93.3%, 88.4%, 42.4% and 99.3% respectively. Foetal fibronectin predicted preterm birth before 37 weeks with sensitivity, specificity, positive and negative predictive value of 71.1%, 95.8%, 81.8%, and 92.5% respectively. Sixty-five per cent (116/179) of women had corticosteroids, while 73.2% had tocolysis. Conclusion: The cross-sectional study indicates fetal fetoprotein predicts preterm birth at 7 days with high sensitivity and negative predictive value. The routine use of fibronectin to predict preterm birth in low -income countries may improve the quality of care for women with symptoms of spontaneous preterm labour and perinatal morbidity and mortality in these settings.

Intravenous Acetaminophen in a Faith-Based Hospital in Nigeria: A Randomized Trial of a Labour Analgesic

Oyeyiola M.P. , Ogunbode O.O., Ogunbode A.M., Arowojolu A.O. — Sun, 21 Jul 2024 00:00:00 -0600

Background: The undesirable maternal and neonatal side effects of opioid analgesics, and less ready availability and affordability of epidural analgesia in resource poor settings has necessitated the search for a safe, efficacious, affordable and readily available labor analgesic. Aim: To determine the efficacy, safety and acceptability of intravenous acetaminophen as an intra-partum analgesic. Methods: A randomized controlled double-blinded study involving 162 consenting pregnant women in labor, assigned to two groups, each receiving either 900mg of intravenous acetaminophen or an equal volume of normal saline. The Numeric Rating Scale and Likert scale were used to measure the degree of pain experienced and the level of acceptability. Data was analyzed using IBM SPSS Statistics for Windows, version 24.0. The student’s T-test, Chi-square test (χ2), Hazard ratio and Mann-Whitney U test were used to test associations with level of statistical significance set at p < 0.05. Results: At 15, 60-, 120-, 180- and 240-minutes post-administration of medications, there was a statistically observed significant difference between the pain scores of women in the two groups (t = 3.71, 7.58, 9.45, 9.48, and 9.18 respectively, p < 0.001). The participants in the acetaminophen group had better pain relief than those in the placebo group (Hazard ratio = 0.51; 95% CI: 0.35 – 0.73; p < 0.001). There was no significant difference between the two groups in terms of side effects of administered agents. The difference between the maternal level of acceptability of acetaminophen and placebo as labor analgesia was found to be statistically significant (χ2 = 72.981, p < 0.001).Conclusions: In poor resource settings, intravenous acetaminophen is an effective alternative labor analgesic agent with no adverse maternal and neonatal side effects.

Knowledge and Skills of Basic Emergency Obstetrics Care Among Healthcare Providers in Selected Primary Health Centres in Ibadan, Southwest Nigeria

Famutimi EO, Oluwasola A.O., Okanlawon F.A. — Sun, 21 Jul 2024 00:00:00 -0600

Introduction: Healthcare providers (HCPs) need to be adequately informed and experienced in Basic Emergency Obstetric Care (BEmOC) techniques to ensure effective management of obstetric and neonatal emergencies. This study evaluated the knowledge and skills of HCPs in selected Primary Health Centres (PHCs) in Ibadan Metropolis, Nigeria. Method: This was a cross-sectional study comprising 319 HCPs working in 6 Local Government Areas within Ibadan metropolis. A structured, self-administered questionnaire was used to collect data on their knowledge and skills regarding BEmOC. Both self-reported as well as demonstrated knowledge and skills were considered while comparisons were made among various HCPs. The knowledge scores were categorized as good (≥85.0%) and poor (<85.0%), and Skills as good (≥ 75th percentile) and poor (<75^thpercentile). Statistical analysis was done using Statistical Package for Social Sciences (25.0) with p-value set at <5%. Results: The mean age of participants was 47.0±6.5 years with more than four-fifths, 261(81.8%), being Community Health Workers. Of all the participants, 228(71.5%), have been practicing for over 10 years while only about one-quarter, 83(26.1%), had ever been trained on BEmOC. Among those ever trained, 45(54.2%) had the training within the last five years. Overall, only 1.3% and 1.8% of the participants demonstrated good knowledge and skills of BEmOC respectively. Both self-reported and standard scores were statistically similar regarding knowledge (p=0.54) and skills (p=0.08). There was no statistically significant difference between the level of education and knowledge of BEmOC, (aOR=0.52; 95% CI 0.26-1.05), but those in practice for more than 10 years were less likely to have good knowledge (aOR=0.54; 95% CI 0.45- 0.65). Conclusion: There is an urgent need for periodic training and re-training of HCPs especially at PHCs to improve their knowledge and skills of BEmOC to make a positive impact on improving maternal and neonatal outcomes.

Despite the Long Learning Curve for Ultrasound, How Beneficial Is A 5-Day Basic Obstetric Ultrasound Training for Foetal Biometry

Enabudoso EJ, Awowole I, Thompson MO, Okoror CEM — Sun, 21 Jul 2024 00:00:00 -0600

Abstract

Objectives

To study the impact of a 5-day structured practical training in obstetric ultrasound scan on competence of ultrasound-naïve medical practitioners in fetal biometry.

Methods

Assessment was by a purpose-designed objective competency scoring proforma consisting of four domains before and after a 5-day structured hands-on training in basic obstetric ultrasound. Scores were compared using paired t-test. The overall composite score was 16 and a score of 12 was considered as the minimum for competence

Results

There were 23 participants consisting of 10 Medical Officers, 10 Obstetricians and 3 Resident Doctors. The pre-training evaluation showed that virtually no participant achieved a competence score in any of the parameters. Following training, greater than 50% of participants had competence score in at least two of the four basic fetal biometric parameters. The post-training competency scores were significantly higher than the pre-course scores. Also, the variability of the post-course scores were lower except for the FL. The pre-training competency score was a significant predictor of the final score.

Conclusion

A 5-day structured basic ultrasound scan workshop can impart competence on majority of ultrasound naïve medical practitioners in at least 2 basic fetal biometry domains while leading to improvement in all four biometry parameters.

The Trend of Caesarean Delivery in a Tertiary Mission Hospital in Nigeria: A 5 Year Survey.

Aworinde O, Ige R, Ayinde M, Adekunle A, Fijabiyi M, Aboyeji A — Sun, 21 Jul 2024 00:00:00 -0600

Background: Caesarean delivery (CS) is the commonest obstetric surgery worldwide. The rising rate in CS globally has been a source of concern. The aim of the study was to evaluate the incidence, indications, and outcomes of caesarean section at Bowen University Teaching Hospital (BUTH), Ogbomoso. Methods: A retrospective descriptive analysis of all the CS carried out at BUTH between 1st January, 2017 and 31^st December, 2021. The labor ward delivery and theatre operation register and mortality records were reviewed and data extracted. Results were presented using frequency tables and Chi-square test. Results: Out of 7,510 deliveries during the study period, 2,300 cases were by caesarean section, giving a CS rate of 30.6%. The rate was higher among booked patients 1680 (73.0%) and referred patients 1620 (70.4%). Previous scar was the commonest indication 460 (20.0%). There were 22 maternal deaths and 162 (6.6%) perinatal deaths. Conclusion: The rate of caesarean section has been increasing gradually and is associated with maternal and perinatal morbidity and mortality. There is need for education of the populace in order to reduce late presentation.

Vaginal Birth After Caesarean Section– A 5 Year Review in A Tertiary Hospital in South-West Nigeria

Adewumi B. A, Salufu S, Oladokun A, Olayemi O — Sun, 21 Jul 2024 00:00:00 -0600

ABSTRACT

Background

Vaginal birth after Caesarean section (VBAC) is an option of delivery that allows women who had undergone Lower Segment Caesarean section (LSCS) have vaginal deliveries and this option is considered safe in selected cases. However, it is observed that the rate of VBAC has decreased during the past 10 years, having a global rate of 10% as at 2005 compared to 40-50% rate of 1996. Nevertheless, VBAC, despite the known risks, 0.5-0.9% risk of uterine rupture, remains an attractive option for many patients and leads to a successful outcome in a high proportion of cases. VBAC is preferred to Elective Repeat Caesarean Delivery (ERCD) especially in women with one previous lower segment caesarean section. The success of VBAC is dependent on some VBAC predictive factors which include non-recurring indications of the previous CS, previous vaginal delivery or previous VBAC, cervical dilatation as at presentation, birthweight, inter-delivery intervals etc. With careful patient selection and good management of labour, it has been documented that a high success rate for vaginal birth after caesarean section (VBAC) can be achieved.

Objectives

This study was carried out to determine the incidence, success rate, predictive factors, and the outcome of Vaginal Birth after Caesarean Section (VBAC) at the University College Hospital (UCH), Ibadan, Nigeria.

Methods

This was a retrospective descriptive study analysing case records of all women who had VBAC between 1^st January, 2016 and 31^st December, 2020 at the University College Hospital (UCH), Ibadan, Nigeria. The data collected were analysed using a Statistical Product and Service Solution (SPSS) version 25. The dependent variable was successful VBAC which was binary in nature. The incidence rate of VBAC (VBAC rate) was determined from all the first Caesarean deliveries that occurred in the 5-year period and the proportion of successful VBAC calculated from the total number of women who were planned for VBAC. Descriptive statistics were used for variable, Pearson’s Chi square or the Fisher’s exact test and Independent Students’ t-test compared, as applicable, across groups for categorical and continuous data and a p-value of < 0.05 interpreted as a statistically significant correlation. Binary logistic regression analyses examined for associations between successful VBAC and the significant independent variables.

Results

There was a total of 9,559 deliveries during the studied period, of which 4,887 were Caesarean deliveries which puts the caesarean section rate (CSR) at UCH over the 5year period at 51.12%. There were 1,084 cases of first lower segment caesarean delivery. There were 162 women that presented for VBAC out of which 116 (71.6%) were planned for VBAC while 46 (28.4%) had no prior VBAC plan. The VBAC rate (number of VBAC out of the total number who had a previous CS) was 5.9% while the VBAC success rate was 50%. There was no maternal mortality associated with VBAC in the study while the perinatal mortality rate was 12.3 per 1000 birth. Being planned for VBAC by the Obstetrician, “previous vaginal delivery”, “previous VBAC” and “Bishop Score” of ≥7 at admission for delivery were the significant predictive factors associated with successful VBAC with p-values of 0.002, <0.001, <0.001 and <0.001 respectively.

Conclusion

This study showed that the VBAC rate and success rate in our centre are relatively low, and the figures can be improved by paying more attention to the positive predictive factors of a successful VBAC and instituting more health education and awareness about VBAC.

Prediction of Imminent Jeopardy for Growth Restricted Fetus Using Handheld Fetal Doppler as A Viable Alternative in Resource Constrained Environment: A Case Report

Onwusulu D.N., Mbachu I.I., Jombo S.E., James J., Ogbomade C. — Sun, 21 Jul 2024 00:00:00 -0600

Intensive, and sometimes very expensive antenatal monitoring is often required in fetal growth restriction (FGR) to prevent prematurity and intrauterine jeopardy. This may not be feasible in a low resource setting. We report a 31-year-old gravida 3 para 2 +0. She had static fetal growth from 31weeks. Umbilical artery doppler velocimetry revealed a resistance index of 0.71. A week later, she complained of reduced fetal movement. On the real time and cardiograph modes of handheld fetal doppler, fetal heart rate of 151 to 153beats per minute, and almost straight-line fetal heart rate tracing (absent baseline variability) were obtained; imminent fetal jeopardy was suspected. She declined immediate abdominal delivery, despite adequate counselling. Four days later, she had an intrauterine fetal death and still birth with weight of 1.3kg and no obvious abnormality. Simple handheld doppler can be used to predict imminent death of a growth restricted fetus, in low resource setting.

Successful Myomectomy for Huge Symptomatic Uterine Fibroid in Early Pregnancy: A Case Report.

Sun, 21 Jul 2024 00:00:00 -0600

Abstract

Although uterine fibroids usually remain asymptomatic during pregnancy, they may occasionally be associated with pregnancy complications requiring surgical intervention.

We present a 31-year-old primigravida at 13 weeks gestation with a 5-year history of progressive abdominal swelling and a one-week history of abdominal pain and difficulty in breathing. Examination revealed a 42-week-sized uterus while ultrasound showed a huge pedunculated subserous fibroid. She subsequently had a successful myomectomy at 13 weeks gestation, an uneventful antenatal period afterwards and was delivered of a live female neonate via an elective caesarean section.

Myomectomy during pregnancy in selected circumstances may be done to prevent adverse effects on the mother and/or foetus.