Monitoring Severe Pre-Eclampsia and Eclampsia Treatment in Resource Poor Countries: Skilled Birth Attendant Perception of a New Treatment and Monitoring Chart (LIVKAN Chart)

The lack of easy to use protocols and monitoring charts in the management of pre-eclampsia/eclampsia contribute to substandard care of women in resource poor settings. A treatment monitoring tool (LIVKAN chart) has been developed to improve the quality of care for these women. Based on feedback from skilled birth attendants (SBAs), a two page document which provides a visual record of the treatment and monitoring of women with severe pre-eclampsia/eclampsia over a 24?h period was developed. It also contains detailed treatment guidelines as well as a summary of the woman??s treatment. A two page document on instructions for use of the chart was also developed. The chart design was evaluated by different level SBAs via a semi structured questionnaire. There was a 92% (109) response rate. About 30% (33) and 58% (63) of the respondents provided care to women in Primary Health Care and referral health care facilities respectively. Ninety eight percentage of respondents indicated that the chart would be of additional benefit in their care of women with pre-eclamptic/eclampsia. Seventy three percentage of respondents indicated that the chart would also be useful to lower health care facility SBAs. The design of the chart ensures that guidelines for managing/monitoring of patients are instantly available on a concise easy-to-use chart which confers added advantage over other chart designs. Having been evaluated by SBAs, acceptability and utilization in poor resource settings should be high. A study has been designed to evaluate the acceptability and effectiveness of this new monitoring chart in both BEOCs and CEOCs in two sub-Saharan African countries.     

Uterine prolapse following fundal pressure in the first stage of labour: a case report

The use of fundal pressure to assist a woman in labor is a controversial procedure. Its benefits are yet to be scientifically confirmed and it is associated with complications such as perineal lacerations, uterine rupture and uterine inversion. A case is reported of a 28year old Gravida 5 Para ?? (3 Alive) who presented to Aminu Kano Teaching Hospital, (AKTH) Kano, Nigeria with uterine prolapse following fundal pressure done in the first stage of labor in a peripheral hospital. She was delivered by Cesarean section and the prolapse successfully reduced under general anesthesia. Health workers need education on the risks associated with fundal pressure. Alternative methods of aiding women in labor should be promoted.     

Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria

BACKGROUND/OBJECTIVE: To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. METHOD: A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. RESULTS: There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171 (82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116 (56%) of patients. The condition was antepartum in 68 (32.9%), intrapartum in 112 (54.1%) and postpartum in 27 (13%). 107 (51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180 (87%) of the babies were delivered alive while 27 (13%) died. CONCLUSION: Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.     

Behavioral and anticonvulsant effects of the standardized extract of Ficus platyphylla stem bark

Ethnopharmacological relevance

Decoctions of Ficus platyphylla Del.-Holl (Family: Moraceae) are used in Nigeria?s folk medicine for the management of epilepsy and their efficacies are widely acclaimed among the rural communities of northern Nigeria. The aim of the study is to examine the behavioral and anticonvulsant properties of the standardized methanol extract of Ficus platyphylla (FP) stem bark, in order to scientifically describe its potential values in the management of convulsive disorders.

Materials and methods

High performance liquid chromatography (HPLC) and preliminary phytochemical analysis of the methanol extract were utilized and the intraperitoneal median lethal dose (LD₅₀) determined in mice. The effects of FP were investigated on some murine models of behavior and its anticonvulsant effects studied on pentylenetetrazole (PTZ)-, strychnine (STN)-, picrotoxin (PCT)-, isoniazid (INH)-, aminophylline (AMI)- and maximal electroshock (MES)-induced seizures in mice.

Results

The intraperitoneal oral LD₅₀ of FP was estimated to be 5000 mg/kg. FP significantly reduced the locomotor activities including the total distance covered, speed, active time and rearing counts. It shortened the onset and prolonged the duration of diazepam-induced sleep, but had no effect on motor coordination on the rota-rod treadmill or beam-walking assay in mice at the doses tested. The extract protected the mice against PTZ- and STN-induced seizures and significantly delayed the latencies of myoclonic jerks and tonic seizures induced by all the standard convulsant agents (PTZ, PCT, INH, STN and AMI) used in this study, but failed to protect the mice against MES seizures at the doses tested. The HPLC fingerprint of the extract shows a spectrum profile characteristic of Ficus platyphylla, while the preliminary phytochemical screening revealed the presence of saponins, flavonoids and tannins.

Conclusion

Our study provides scientific evidence that FP may contain psychoactive principles with potential anticonvulsant properties, thus supporting further development of the psychoactive components of this plant as anticonvulsant agents.     

Introduction of an innovation for the reduction of maternal mortality in Kano State, northern Nigeria: a case study of magnesium sulphate

In this project, sponsored by the McArthur Foundation and the Population Council, magnesium sulphate was introduced in February 2007 to 10 general hospitals in Kano State, northern Nigeria. Changes were monitored via data collected at the hospital. At an initial training of the trainers' workshop, 25 master trainers were trained. They then conducted step down trainings and trained 160 clinical providers. Within 12 months, 1045 patients were treated with magnesium sulphate. The attributable deaths from eclampsia fell by 42.4%. The community became aware of an improved outcome for eclampsia. The providers expressed satisfaction with the outcome of the treated patients. Four of the master trainers trained 30 clinical providers from the other 25 general hospitals. Initiatives for the reduction of maternal mortality should be evidence-based.     

Maternal and Fetal Outcomes After Introduction of Magnesium Sulphate for Treatment of Preeclampsia and Eclampsia in Selected Secondary Facilities: A Low-Cost Intervention

The aim of this study was to evaluate whether a new low-cost strategy for the introduction of magnesium sulphate (MgSO₄) for preeclampsia and eclampsia in low-resource areas will result in improved maternal and perinatal outcomes. Doctors and midwives from ten hospitals in Kano, Nigeria, were trained on the use of MgSO₄. The trained health workers later conducted step-down trainings at their health facilities. MgSO₄, treatment protocol, patella hammer, and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analyzed using SPSS software. From February 2008 to January 2009, 1,045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9 % (95 % CI 18.7–23.2) to 2.3 % (95 % CI 1.5–3.5). The perinatal mortality rate was 12.3 % as compared to 35.3 % in a center using diazepam. Introduction of MgSO₄ in low-resource settings led to improved maternal and fetal outcomes in patients presenting with severe pre-eclampsia and eclampsia. Training of health workers on updated evidence-based interventions and providing an enabling environment for their practice are important components to the attainment of the Millenium Development Goals (MDG) in developing countries.     

Ecalmpsia: maternal and fetal outcome

Objective

To determine the incidence of eclampsia and examine the maternal and fetal outcome.

Methods

A hundred and twenty consecutive admissions with eclampsia managed in Aminu Kano Teaching Hospital, Kano, Nigeria, were prospectively collated and analysed. Maternal and fetal morbidity and mortality were recorded.

Results

The incidence of eclampsia was 1.2% of deliveries. Most (69.2%) of the patients had no antenatal care. In 93 (77.5%), the convulsions were controlled with diazepam, and 22.5% magnesium sulphate. Maternal complications rate was 39.2%, and use of Diazepam for control of convulsions increases complications (RR 3.12, 95% CI = 1.23–7.92, p= 0.02). Case fatality rate was 11.7%, diazepam use failed to achieve significant association with maternal death (RR 8.64, 95% CI = 0.53–140.29, p= 0.13). Stillbirth rate was 22.5% with significant association with diazepam use (RR 7.55, 95% CI= 1.07–3.09, p=0.04). Birth asphyxia was recorded in 39.1% and low birth weight in 25.8%.

Conclusion

The incidence of eclampsia in our hospital was very high, with corresponding high maternal and perinatal morbidity and mortality. Increased antenatal screening and use of magnesium sulphate to control convulsions will reduce the incidence and associated morbidity and mortality for both mother and fetus.     

The impact of cancer treatment on reproductive health in young women

The diagnosis of cancer can precipitate a re-evaluation of life at all ages. In children, adolescents and young adults, a cancer diagnosis and its treatment poses specific challenges that can affect all aspects of reproductive health resulting in considerable physical, psychological and psychosexual burden. Improved survival means that this cohort of patients is expanding and with an improving life span, the resulting morbidity is also extended. The demands of this group of patients are often not fully integrated in the operational functions of the health service with considerable variation in care. This review discusses the common reproductive morbidities amongst survivors of childhood, adolescent and young adult cancer whilst planning, delivering and following cancer treatment. This includes the current issues on the assessment of ovarian reserve and preservation of fertility.