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Pattern of Referral of Obstetric Patients at a Tertiary Care Hospital in Southern Nigeria

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Advances in Reproductive Sciences 2024年第2期12卷 116-124页

作者： Osita Celestine John justina omoikhefe alegbeleye Department of Obstetrics and Gynaecology Faculty of Clinical Sciences University of Port Harcourt Port Harcourt Nigeria

Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient’s biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre o

关键词： Referral Pattern Obstetrics Southern Nigeria

Prevalence and Predictors of Anxiety and Depression among Gynaecological Cancer Patients at a Tertiary Health Facility in Southern Nigeria

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Journal of Biosciences and Medicines 2023年第7期11卷 96-111页

作者： justina omoikhefe alegbeleye Olusegun Biyi-Olutunde Department of Obstetrics and Gynaecology University of Port Harcourt Teaching Hospital Port Harcourt Nigeria Department of Radiation and Clinical Oncology University of Port Harcourt Teaching Hospital Port Harcourt Nigeria

Background: Cancer patients frequently suffer from mental health problems because of their reactions to their cancer diagnosis, cancer type, treatment effects, recurrence, fear of the end-of-life, survival, and financial burden. Some hospitals have integrated mental health assessments into cancer care, but our centre has little experience with this practice. Aim and Objectives: To ascertain the prevalence and predictors of anxiety and depression in patients with gynaecological cancer at a tertiary health facility in southern Nigeria. Materials and Methods: This was a facility-based cross-sectional descriptive study of 75 women with histologically confirmed gynaecological cancer managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 1, 2022, to December 31, 2022. Individuals having a history of drug addiction, severe cognitive impairment, non-consenting patients, and those with communication difficulties were excluded from the study. A data collection form was used to obtain socio-demographic, reproductive, and clinical characteristics, while the Hospital Anxiety and Depression Scale (HADS) was used to assess for anxiety and depression. Data was analyzed using descriptive statistics to determine the association of variables with anxiety and depression. Results: Most 27 (36.0%) of the respondents were in 40 - 49 age group with a mean age of 50.4 ± 12.3 years. The study showed that 39 (52.0%) of the respondents exhibited symptoms of anxiety, of which 14 (35.9%) were mild, 20 (51.3%) had moderate anxiety and 5 (12.8%) experienced severe anxiety. In addition, 46 (61.3%) of them showed symptoms of depression, of which 17 (37.0%) were mild, 15 (32.6%) were moderate and 14 (30.4%) experienced severe depression. The ratio of respondents who showed anxiety to those that showed symptoms of depression was 5: 6. The factors associated with anxiety were partner’s educational level (X2 = 4.745, p = 0.029), parity (X2 = 6.651

关键词： Prevalence Predictors Anxiety Depression Gynaecological Cancer

Eclampsia: A Continuous Scourge in a Tertiary Hospital in Southern Nigeria

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 209-225页

作者： Celestine Osita John justina omoikhefe alegbeleye Department of Obstetrics and Gynaecology Faculty of Clinical Sciences University of Port Harcourt Port Harcourt Nigeria

Background: Eclampsia is responsible for over 50,000 maternal deaths with incidence of 1 death in about 100 - 1500 deliveries in developing nations. In sub-Saharan Africa, Nigeria accounts for the highest maternal mortality ratio of 512 deaths per 100,000 live deliveries and the highest neonatal fatality of 67 per 1000 live births. Factors such young age, nulliparity, multifetal gestation, unbooked cases, preterm delivery (<32 weeks), lack of proper access to antenatal care, poor hospital care, financial constraints and inappropriate diagnosis, have all been identified as risk factors promoting eclampsia. Objectives: In this study, we investigated the prevalence of eclampsia in Rivers State, Nigeria and established the correlation between social demographic factors and the feto-maternal outcomes among the eclampsia patients. Methodology: A prospective observational study using a detailed data sheet was conducted on 1244 pregnant women admitted at the Obstetrics and Gynecology Department of University of Port Harcourt Teaching Hospital, for 1-year duration. Data analysis was conducted using statistical packages for social sciences (SPSS) version 22. Results: Demography showed that age range (20 - 24) occurred in 40.7%, nulliparous mothers were dominant with 40.7% while 70.1% of the study population had secondary level of education. 27 cases of eclampsia were diagnosed from the 1244 pregnant women, which signified 2.13% prevalence among the studied population. The feto-maternal outcome showed that out of the 27 mothers, 19 were alive (70.4%) while 8 died (29.6%), while fetal outcome showed that 16 were alive (59.3%) and 11 died (40.7%). Only parity and education showed significant correlation at 0.01 and 0.05 levels respectively with maternal outcome. Conclusion: The prevalence of eclampsia with associated poor feto-maternal outcome rates is high in this study. Its contribution to the maternal and perinatal morbidities and mortalities necessitates the narrative of ecl

关键词： Eclampsia Preeclampsia Prevalence Maternal Fetal Mortality Booked Un-booked

The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

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Advances in Reproductive Sciences 2024年第1期12卷 37-50页

作者： William Amebeobari Mube justina omoikhefe alegbeleye Ngozi Clare Orazulike Department of Obstetrics and Gynaecology University of Port Harcourt Teaching Hospital Rivers State Port Harcourt Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

关键词： Uterine Tourniquet Open Abdominal Myomectomy Ovarian Reserve Anti-Mullerian Hormone Nigeria

Outcome of Maternal Anaemia on Cord Haemoglobin of the Newborn in Port Harcourt, Nigeria

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Journal of Biosciences and Medicines 2020年第5期8卷 142-152页

作者： justina omoikhefe alegbeleye Dagogo Semenitari Abam Ngozi Clare Orazulike Department of Obstetrics and Gynaecology University of Port Harcourt Port Harcourt Rivers State Nigeria

Background: Anaemia is a common medical disorder in pregnancy especially in developing countries. Iron deficiency anaemia during pregnancy may be associated with adverse pregnancy outcomes Objectives: To?determine the cord blood haemoglobin and the correlation between maternal haemoglobin concentration and perinatal outcome at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a prospective cross-sectional study of 155 pregnant women who presented at the labour ward of the department of Obstetrics and Gynaecology from October 1, 2018 to December 31, 2018. Blood sample was collected from the women in labour into ethylenediamine tetra-acetic acid (EDTA) bottles, red blood cell haemoglobin was determined. Umbilical cord blood sample was also collected at delivery and red cell haemoglobin was done. Socio-demographic characteristics, risk factors and perinatal outcome were obtained, entered into a spreadsheet and analyzed using SPSS 22.0. Bivariate logistic regression analysis was performed for multivariate analysis and statistical significance was considered at p Results: The mean age of the women was 31.08 ± 4.39 years, the mean maternal haemoglobin concentration was 11.54 ± 1.86 g/dl while the mean umbilical cord haemoglobin concentration was 12.92 ± 1.92 g/dl. Majority (86.45%) of the women were compliant with the prescribed haematinics. Moderate anaemia was observed in 17.42% of the women, followed by mild anaemia (15.48%) and severe anaemia (1.29%) respectively. Maternal complications were observed in 24.5% of women. There was a significant association between maternal haemoglobin concentration and cord blood haemoglobin concentration (p = 0.001). However, the study did not show an association between parity, mode of delivery, birth weight, Apgar scores, gestational age and maternal haemoglobin concentration (p > 0.05). Conclusion: The mean Haemoglobin in our newborns was less than previously reported values. Cord blood haemoglobin d

关键词： Maternal Haemoglobin Cord Blood Haemoglobin Perinatal Outcome Nigeria