No abstract

Background:A retrospective observational study on the seasonal variation in the admission of eclampsia patients to the multi-disciplinary intensive care unit (ICU) of National Hospital, Abuja, Nigeria over a five-year span (March 2000 – March 2005) was carried out.Method:The patient’s case files and ICU records were used to extract the needed data. The diagnosis of eclampsia was based on clinical and laboratory findings by the obstetricians.Results:There were a total of 5,987 deliveries during the study period. Forty-six eclamptics were admitted to the ICU during the study period giving an ICU admission rate of 7.6/1000 deliveries. The average age of the patients was 28.6 years. Six patients (13%) were booked for antenatal care in the hospital, while forty patients (87%) were referred. Average duration of stay in the ICU was 4.6 days (range 1–42 days).Thirty-one eclamptics (67.4%) were admitted to the ICU during the rainy season (April to October) and fifteen (32.6%) during the dry season (November to April). The rainy season is associated with a lower average high temperature and a higher humidity than the dry season. There is a view that holds that increasing humidity and a lower temperature is associated with increased incidence of eclampsia. There were thirteen deaths giving a case fatality rate of 28.2%. The causes of death were HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome in six patients, disseminated intravascular coagulation in two patients, and acute renal failure (ARF) in two patients. Septicemia, lobar pneumonia/heart failure and cerebrovascular accident accounted for one death each.Conclusion:In this study, we found an association between the rainy season and the incidence of eclampsia to our intensive care unit. This association should be further explored.

General anaesthesia is recognised as a cause of maternal mortality/morbidity in caesarean deliveries, and regional anaesthesia is believed to reduce anaesthesia-related maternal/fetal morbidity and mortality. The aim of this study is to present the trends of different forms of anaesthesia for caesarean section in Eastern Nigeria. We conducted a retrospective survey of hospital records of caesarean deliveries in this unit over a 4-year period from January 2003 to December 2006. There were 2,968 deliveries and 3,140 births (2,959 live births), with 729 women (24%) delivered by caesarean section. There was a yearly increase in the use of regional anaesthesia from 18% in 2003 to 48% in 2004 and 72.6% in 2005, but it fell to 71% in 2006. There were 59 stillbirths giving a stillbirth rate of 81/1,000 caesarean deliveries. The total number of stillbirths in the hospital during the study period was 179 giving a stillbirth rate of 60/1,000 deliveries. A total of 42 (71%) stillbirth deliveries were associated with general anaesthesia and 17 (29%) associated with spinal anaesthesia. Of the 32 neonates with an Apgar score of 3-5 at 5 min after birth, 21 (66%) delivered under general anaesthesia and 11 (34%) delivered under spinal anaesthesia. There were eight hysterectomies in patients with ruptured uterus, all under general anaesthesia. There was one maternal death in a patient who was delivered under general anaesthesia. The fetal loss in this study is high and may indicate that most data on stillbirths from parts of the developing world may be underestimates. In conclusion, in developing country such as Nigeria there is a changing trend towards the use of regional anaesthesia during caesarean section. Its use should be encouraged in the developing world, especially resource-poor environments because it is cheaper to provide.

No abstract

We conducted a retrospective study of the management and outcome for eclampsia patients in the intensive care unit (ICU) of National hospital, Abuja between November 2001 and April 2005 (42 months). The patients' case files and ICU records were used to extract the necessary data. During the study period, there were a total of 4857 deliveries, with 5051 total births (including multiple births) and 4854 live births. Forty eclamptics were admitted to the ICU, giving an ICU admission rate of 8.2/1000 live births. The records of two patients were incomplete. The average age of the patients was 28.4 years (range 17-4 years). Six patients (15.8%) were booked and 32 (84.2%) were not. The average duration of stay in ICU was 5 days. Twenty patients (52.6%) had antepartum eclampsia, 12 (31.6%) had postpartum eclampsia and six (15.8%) presented with intrapartum eclampsia. Twenty-nine (76.3%) gave birth via caesarean section and nine (23.7%) delivered per vagina augmented by oxytocin infusion. Seventeen (45%) received mechanical ventilation; 20 (53%) received oxygen via nasal prongs, nasal catheters or variable performance facemask. One patient (2%) did not receive oxygen therapy. All the patients were admitted postpartum. There were 11 maternal deaths, giving a case fatality rate of 29%. There were five (45.4%) deaths due to haemolysis, elevated liver enzymes and low platelet count syndrome and two (18.2%) due to disseminated intravascular coagulation. The remaining deaths were due to cerebrovascular accident (9.1%), lobar pneumonia (9.1%), acute renal failure (9.1%) and multiple organ failure (9.1%). All patients were admitted postpartum. This fatality rate is higher than that detailed in the reports reviewed in this study. Early referral of eclamptics or at risk patients to a tertiary care institution may help reduce morbidity and mortality. In addition, early referral to a facility providing basic essential obstetric care or comprehensive essential obstetric care is also important. Another important factor is the correct diagnosis of pre-eclampsia during antenatal and postpartum care by screening, noting blood pressure levels, performing urinalysis for protein and asking about warning signs such as headache, blurred vision, epigastric pain, etc.