Audit of stillbirths in a Nigerian teaching hospital

Prospective cohort study of prevention of mother to child transmission of hepatitis B infection and 9 months follow-up of hepatitis B-exposed infants at Ile-Ife, Nigeria

OBJECTIVES

Eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is central to WHO's target of reducing hepatitis B infection in children to <0.1% by 2030. While Nigeria accounts for 8.3% of the global burden, interventional studies on prevention of MTCT of HBV are hardly available. This study aimed to assess the impact of prevention of MTCT interventions on vertical transmission of HBV among pregnant women in Nigeria.

DESIGN

A prospective cohort study.

SETTING

A University Teaching Hospitals Complex in Nigeria between 2015 and 2021.

PARTICIPANTS

10 866 pregnant women and their pre-existing children.

INTERVENTIONS

Eligible pregnant women were screened for HBsAg using chromatographic immunoassay (Micropoint, USA). HbsAg-positive women had HBV serological assay done and their pre-existing children were screened. Women with HBV DNA ≥2 00 000 IU/mL and those positive for hepatitis B e-antigen (HBeAg) had 300 mg/day of Tenofovir Disoproxil Fumarate (TDF) in the third trimester. The newborns had hepatitis B vaccines and HB immunoglobulin (HBIG) administered, followed by testing for HBsAg at 9 months postnatally.

PRIMARY OUTCOME MEASURES

Prevalence of chronic hepatitis B infection in pregnancy, and the incidence of MTCT of HBV.

RESULTS

Overall, 395 women had chronic HBV infection, giving a prevalence of 3.64%. Their mean age was 31.51±5.71 years, with a median parity of 1.2. Thirteen women (5.2%) were positive for HBeAg, seven (3.1%) of the 225 pre-existing hepatitis B-exposed children were HbsAg positive and 17 women had prenatal TDF. Overall, 376 women completed the study, with mean birth weight of 3.21±1.86 kg and perinatal mortality rate of 29.2/1000 births. Hepatitis Bvaccine-HBIG combination was administered to 260 newborns, while the others had hepatitis B vaccine alone. All the children tested negative to the HbsAg at 9 months.

CONCLUSION

Eliminating MTCT of HBV infection through validated protocols in low and middle income countries with the highest burden of chronic HBV infections is feasible. National scale-up of such protocols is recommended.

The trend and characteristics of stillbirth delivery in a university teaching hospital in Lagos, Nigeria

Background:

The burden of stillbirth is so huge in sub-Saharan Africa, especially in Nigeria where many mothers and mothers-to-be are denied the joy of motherhood. Despite the frequent occurrence of this obstetric problem in our environment, little priority is placed on it.

Objectives:

The study aims to bring to the fore, the burden, trend, and characteristics of stillbirth delivery in Lagos, Nigeria.

Subjects and Methods:

This was a 5-year descriptive retrospective study of the case records of women who had stillbirth delivery at Lagos University Teaching Hospital from January 2009 to December 2013. Relevant information was obtained using a study pro forma, and data analysis was carried out using SPSS version 20.0.

Results:

The prevalence of stillbirth was 6.2%, and the rate was 61.8/1000 total births. Women who did not book for antenatal care accounted for 76.2% of the cases, and the antenatal and intrapartum stillbirths accounted for 64.6% and 35.4%, respectively. The mean gestational age was 35.5 ± 1.2 weeks, while the mean birth weight was 2.9 ± 1.0 kg. Majority of the stillbirths were male fetuses (54.5%). Previous history of stillbirth (36.0%), hypertensive disorders in pregnancy (33.0%), placental abruption (28.8%), intrauterine growth restriction (13.0%), and ruptured uterus (11.3%) were the common clinical risk factors identified.

Conclusion:

The burden of stillbirth is high in our environment, and majority is due to preventable or manageable obstetric conditions. There is a need to encourage early referral of complicated pregnancies and labor to specialized centers that can cater for them, so as to avoid unnecessary and preventable deaths.

Normative references and clinical correlates of fetal umbilical artery Doppler indices in southwestern Nigeria

OBJECTIVE

To derive normative references for umbilical artery (UA) Doppler indices, including pulsatility index (PI), resistance index (RI), and systolic/diastolic (SD) ratio, for singleton pregnancies in Ile-Ife, Nigeria, and compare them with reference values from other populations.

METHODS

A longitudinal study involving 415 women with a singleton fetus at 26-40 gestational weeks attending Obafemi Awolowo University Hospital, Ile-Ife, between July 2015 and March 2019. Fetal UA PI, RI, and SD ratio were measured every 4 weeks until delivery. Reference values from the 2.5th to the 97.5th centiles were derived from 1375 measurements. Correlations between indices and bio-demographic characteristics were assessed; regression equations were generated.

RESULTS

The RI, PI, and SD ratio decreased by 0.013, 0.027, and 0.71, respectively, for each additional week of pregnancy. There was a negative correlation between the three indices and birthweight (P<0.001), but not maternal parity, age, or fetal gender. Regression equations for RI, PI, and SD ratio were, respectively, 1.004 - 0.013x, 1.78 - 0.027x, and 4.77 - 0.71x, where x is gestational age (weeks).

CONCLUSION

The derived normative references for fetal UA Doppler indices are recommended for monitoring high-risk pregnancies in Nigeria. The indices are comparable to those derived from Norwegian, Thai, and British cohorts.