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Background: Pregnancies complicated with antepartum-haemorrhage is high risk pregnancies associated with adverse maternal, fetal-and-perinatal-outcomes. It contributes significantly to fetal and maternal mortality especially in the developing countries. Proper antenatal care and prompt intervention is necessary to forestall adverse and improve outcome. Objective: To determine the prevalence, sociodemographic characteristics, risk factors, fetomaternal outcome of pregnancies with antepartum haemorrhage. Methods: The case files of the patients were retrieved from the medical records department. The total number of deliveries within the study period was obtained from the labour ward records. The feto-maternal-outcome-measures were; prevalence of caesarean-section, postpartum-haemorrhage, hysterectomy, need for blood-transfusion, maternal-death, prematurity, need for admission in intensive-care-unit and still births. The data was analysed using SPSS version 21. Chi-square was used to test for significance. Results: Within the 5-year period under review, out of a total of 6974 deliveries, 234 had antepartum-haemorrhage (3.4% prevalence rate). Abruptio-placentae was the commonest cause and accounted for 69.5% of the cases (prevalence of 2.1%) while placenta praevia accounted for 28.2% of the cases (prevalence rate of 0.9%). The mean age of the women was 31.8±5.3 years. The mean parity was 3.4±1.7 and majority (63.8%) of the women were unbooked. The commonest identifiable risk factors were multiparity and advanced maternal age. One-hundred-and sixty-six (77.9%) women were delivered through the abdominal route. Postpartum-haemorrhage occurred in 22.1% (47) of the cases while prematurity was the commonest fetal complications. Maternal mortality was 0.47% (1) while still birth was 44.1% (94). Conclusion: There is high prevalence of antepartum-haemorrhage in our environment. Abruptio-placentae was the commonest cause and associated with significant adverse fetomaternal-outcome when compared with placenta-praevia. Thus, good and quality antenatal care as well as high index of suspicion, prompt diagnosis and treatment remain the key to forestall these complications and improve fetomaternal-outcome.

The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year.Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme.Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool.This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).

Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi.This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire.The mean age of the respondents was 30.46 +/- 4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p0.001). Also a significantly higher proportion of condom users (99%) than pill users (1%) described their health status as 'excellent' (p0.02). The same significantly higher proportions of 'excellent' response were given by subjects who engage in social support activities (p0.001), who practice good feeding (p0.01) andpersonal hygiene (p0.01).Access to family planning services and HAART, participation in support group activities and positive lifestyle practices tend to improve subjective health status and should be comprehensively encouraged among the HIV positive mothers.

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 +/- 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%). There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks.

We present the first laparoscopically assisted vaginal hysterectomy (LAVH) performed in our centre and indeed in southeast Nigeria.The case records of a 60 year old post menopausal woman; Para 6(+2) with moderate cystocele, treated at the Nnamdi Azikiwe University Teaching Hospital in July 2007 was retrieved for presentation.A 60 year old post menopausal woman, Para 6(+2) with moderate cystocele, no descent of the cervix and narrowed vagina. LAVH and anterior colporraphy was performed. She had an uneventful post operative stay and was discharged home. She has not experienced any complication one year after the procedure.LAVH is our first major gynaecological laparoscopy surgery and we consider it an important breakthrough worthy of reporting.

A lot of challenges face the current efforts at reducing Mother to Child transmission of HIV infection (MTCT) in Sub Saharan Africa due to limited access to Highly active antiretroviral therapy (HAART) and breast feeding practices. A regular review of progress is necessary in order to identify areas of need.This is a one year prospective descriptive study of seven hundred and twenty six mother-infant pairs managed in the PMTCT programme in Nnamdi Azikiwe University Teaching Hospital, Nnewi Southeast Nigeria. The babies HIV status was tested with PCR for HIV DNA while the mothers provided information on infant feeding pattern and the use of antiretroviral (ARV) drugs including prophylaxis for the baby. Information was augmented from the antenatal records.The transmission rate was 2.8% for mothers, who were on HAART, did not breastfeed and whose babies received ARV prophylactic therapy. But for mothers who did not receive HAART, did breastfeed and whose babies did not received ARV prophylactic therapy, the transmission rate was 37.5%. When both the mother and child received ARV drugs, the transmission rate was significantly lower in those who did not breastfeed (2.8%) than in those who breastfed (12.5%)(P0.001). When both the mother and child did not receive ARV drugs, the transmission rate significantly lower in those who did not breastfeed (21.1%)than in those who breastfed (37.5%) (P0.02).The use of HAART in PMTCT programme in the under resourced areas can achieve similar success rates to that in the industrialized countries. Breastfeeding reduces the efficacy achieved by the use of ARV drugs. Provision of wider access to HAART as well as adequate counselling and support for safer infant feeding practices is recommended.