Indications and Feto-Maternal Outcomes of Caesarean Section at University Calabar Teaching Hospital: A Six Year Review (Published)
Caesarean section is one of the most common surgical procedures. With an increasing prevalence of caesarean section globally, periodic review is pertinent in order to determine the prevalence, indications and outcomes in our environment.The delivery records in the maternity unit of UCTH between 1st January 2013 and 31st December, 2018 were reviewed and relevant data obtained. Data were analyzed and presented as percentages.Caesarean section was the commonest major obstetric operation in university of Calabar Teaching Hospital over the period under review with a rate of 38.8%.The commonest indication being repeat caesarean section which accounted for 29.5% followed by Cephalo-pelvic disproportion (CPD) 17%. A total of 78% clients had emergency caesarean section while 22% of the caesarean sections were elective cases. The study demonstrated a high caesarean section rate in UCTH, Calabar (38.8%). Intensive effort should be invested towards reducing the prevalence by reducing the rate at which primary Caesarean section is performed. This can be achieved by encouraging operative vaginal deliveries; vaginal breech deliveries and vaginal birth after caesarean section to stem the tide of increasing caesarean section rate.
Randomized Controlled Trial of Sublingual and Rectal Misoprostol Administration on Blood Loss at Elective Caesarean Section (Published)
Background: Misoprostol is widely used in the prophylaxis and treatment of Postpartum Hemorrhage (PPH). However, there is paucity of information on its effect on the volume of blood loss with regard to the route of administration in patients undergoing elective caesarean section. Aim: This study compares the effect of sublingual versus rectal administrations of misoprostol on blood loss in subjects undergoing elective caesarean section. Methodology: An open-label controlled trial was conducted on 72 women undergoing elective caesarean section randomized either to receive 600 mg misoprostol rectally (36 subjects) or sublingually (36 subjects). Blood loss, Hemoglobin (Hb) concentration and Packed Cell Volume (PCV) where measured using Standard Techniques. These in addition to side effects of misoprostol were compared in both groups. Results were expressed as Mean ± S.D were analyzed using Student’s t-test and Chi-square and p < 0.05 was considered statistically significant. RESULTS: Mean intraoperative blood loss was significantly less in the sublingual group compared to the rectal group (602.87±131.96 vs 705.83 ± 142.24 ml, p = 0.002. Mean postoperative Hb (g) was higher in the sublingual group 10.00 ± 1.13g/dl vs 9.63 ±0.76 g/dl, p = 0.463. Perioperative Hb fall was less in the sublingual group (1.17 ± 1.08 g/dl vs 1.49 ± 0.99 g/dl, p = 0.193.CONCLUSION: Study suggests that sublingual administration of misoprostol is more effective in reducing intraoperative blood loss at elective Caesarean than rectal administration.
Management Outcome of Uterine Fibroids in Pregnancy in a Secondary Health Facility in Calabar, South-South Nigeria (Published)
Uterine fibroid is the commonest benign tumors of the uterus and may lead to several complications in pregnancy. The objective was to determine the maternal and foetal outcome of fibroids in pregnancy. This prospective study was conducted in Nigerian Navy Hospital, Calabar over 2 year among women with fibroids in pregnancy. Result showed that a total of 889 women booked for antenatal care during the period, of which 72 had fibroids in pregnancy giving the incidence of 8.1%. Majority of the women were within the age group of 30-39 years 39(54.2%) and nulliparae 32(44.4%). A total of 3(4.2%) had 1st trimester miscarriages, 4(5.2%) had preterm delivery, 22(30.6%) had spontaneous normal vaginal delivery at term while 37(51:3%) had caesarean section. In conclusion, uterine fibroid is a common finding in pregnancy and the manifestation varies depending on their size and site. Pregnancies with uterine fibroid are high risks and are commonly associated with complications such as caesarean sections, primary post partum haemorrhage, miscarriage and preterm labour.