ObjectiveTo investigate the burden and causes of life‐threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.DesignNationwide cross‐sectional study.SettingForty‐two tertiary hospitals.PopulationWomen admitted for pregnancy, childbirth and puerperal complications.MethodsAll cases of severe maternal outcome (SMO: maternal near‐miss or maternal death) were prospectively identified using the WHO criteria over a 1‐year period.Main outcome measuresIncidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO).ResultsParticipating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near‐misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre‐eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life‐threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non‐availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care.ConclusionsImproving the chances of maternal survival would not only require timely application of life‐saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.Tweetable abstractOf 998 maternal deaths and 1451 near‐misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus. Key words: abdominal pregnancy, term, live fetus RésuméCe cas clinique se rapporte à une grosses abdominale qui s'est déroulée jusqu'à terme avec un fétus vivant. L'ignorance, la pauvreté et l'absence de consultation prénatale ont abouti à une consultation tardive. Un saignement par voie vaginale, une douleur abdominale persistante, une perte de poids et une pâleur étaient les éléments caractéristiques au plan clinique. Elle a bénéficié d'une laparotomie avec accouchement d'un foetus vivant.

The therapeutic index of magnesium is said to be low, hence, there are fears of toxicity when used as anticonvulsant in eclamptic patients. The objective of this study was to determine the serum levels of magnesium in eclamptic patients treated with magnesium sulphate and relate the levels with clinical indicators. It was a prospective study involving consecutive eclamptic patients that were managed between January and December 2002, with magnesium sulphate as the sole anticonvulsant agent, using a modified Pritchard regimen. Blood samples were taken before the administration of the loading and maintenance doses of magnesium sulphate and serum levels of magnesium were estimated using the Jenway 605 colorimeter. There were 19 patients and 72 blood samples. The mean baseline serum magnesium was 0.72 0.10mmol/L while serum magnesium levels when the patients were on treatment ranged from 1.95 to 2.82mmol/L. No serum magnesium level was greater than 3.0mmol/L and none of the patients had clinical evidence of magnesium toxicity. We conclude that serum magnesium levels in these patients were within the therapeutic range, therefore, routine estimation of this cation is not necessary. Even where the laboratory facility is available, it is suggested that serum estimation be limited to cases where clinical monitors suggest toxicity.

Background: So much has been written on vesicovaginal fi stula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fi stula and their attitude toward measures that would prevent future occurrence. Methods: The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. Results: One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-fi ve (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confi rmed that pre and post-operative counseling were inadequate. Conclusion: Even though majority (70%) of the patients knew the cause of their fi stula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fi stula in order to prevent a recurrence.

The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required.