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Objective: The objective of this study was to monitor the maternal mortality ratio (MMR) in 19 general hospitals after introducing quality assurance in four states in Nigeria. Methods: Data collection with a structured maternity record book started in 2008 in ten rural hospitals in Kano and Kaduna State. In 2011, five hospitals from Federal Capital Territory Abuja were added, whilst in 2013 four hospitals were added from Ondo State. The routine data collection was conducted by experienced midwives and supervised by obstetricians from each of the states. However, the data from all four states were collated centrally at Aminu Kano Teaching Hospital for analysis. Results: From 2008 to 2013, 121,808 deliveries were evaluated; MMR fell from 1380 to 360/100,000 in Kaduna State, whilst for Kano State there was a gradual reduction of MMR from 2100/100,000 in 2008 to 1070/100,000 in 2011, and then it increased to 2150/100,000 in 2013. Ondo state had the lowest MMR of 180/100,000 in 2013 followed by Abuja with 240/100,000. The median cesarean section rate was 8.19%, (range 0.97-22.53%), eclampsia/preeclampsia was 4.43% (range 0-56.55%), and postpartum hemorrhage was 3.36% (range 0.81-11.4%). Conclusions: Quality assurance in rural hospitals generates the awareness necessary to improve maternal health and lead to reduction of MMR. [ABSTRACT FROM AUTHOR]

Objective: To achieve Millennium Development Goals 4 and 5 in Nigeria, a quality assurance project in obstetrics in 10 hospitals in northern Nigeria was established to improve maternal and fetal outcome., Methods: The project commenced in January 2008 with assessment and improvement of the structure of the 10 hospitals. Continuous maternal and fetal data collection and analysis were conducted from 2008 to 2009 by means of a maternity record book and structured monthly summary form. The quality of hospital infrastructure and equipment was also assessed., Results: The mean maternal mortality ratio (MMR) was reduced from 1790 per 100000 births in the first half of 2008 to 940 per 100000 births in the second half of 2009. The average fetal mortality ratio (FMR) decreased slightly from 84.9 to 83.5 per 1000 births. There was an inversely proportional relationship between the total number of deliveries in a hospital and MMR and FMR. There was a close correlation between the MMR and the equipment status and hygiene conditions of the hospitals., Conclusion: Continuous monitoring of quality assurance in maternity units raised the awareness of the quality of obstetric performance and improved the quality of care provided, thereby improving MMR., (Copyright © 2011 International Federation of Gynecology and Obstetrics. All rights reserved.)

Background: In Nigeria, perinatal mortality remains a major health problem with the balance heavily tilted towards the stillbirth component. Knowledge of the relative importance of the different causes of stillbirth is lacking, even in hospital settings., Objective: To determine the stillbirth rate in a Nigerian mission hospital and document its risk factors., Methods: In this retrospective study, the case records of 131 mothers who had stillbirths were studied and the data obtained analyzed. The relevant hospital delivery registers were also examined., Results: Stillbirth rate was 39.7 per 1000 births with 51.9% and 48.1% being macerated and fresh stillbirths respectively. Antepartum haemorrhage, pre-eclampsia/ eclampsia and prolonged/obstructed labour were the three leading risk factors for stillbirth. Low birthweight babies were also at increased risk of foetal death. Majority (61.8%) of mothers whose babies were still-born belonged to low social class., Conclusion: Our stillbirth rate remains unacceptably high and strategies to reduce it must focus on antenatal and intrapatum emergency obstetric care and early referrals in hospital setting.

Background: The incidence of twin delivery in Nigeria may have changed, in view of the worldwide increase in the rates of twinning attributed to increasing maternal age and use of fertility therapies., Objective: To determine the current incidence of twin delivery in Benin City and document the foetal outcome in twins., Methods: A four-year descriptive (cross-sectional) study of twin deliveries in a Nigerian mission hospital was conducted. The foetal outcome in 115 sets of twin was compared with that of 230 singleton controls., Results: The current incidence of twin delivery was 25.3 per 1000 deliveries or one in 40 births, representing a reduction by 24.2%. Sex ratio was 0.98 : 1 in favour of females. Seasonal variation was observed in the incidence of twin delivery with a significantly higher incidence in wet than in dry season (p < 0.001). Twin pregnancies are at a significantly higher risk of adverse foetal outcome such as low birth weight (LBW), preterm delivery, birth asphyxia and Caesarean delivery compared to singleton pregnancies (p < 0.001)., Conclusions: Although the incidence of twin delivery remains high in Benin City, it appears to have dropped. Twin pregnancy is associated with increased risk of adverse foetal outcome.

Background: Maternal mortality, for which preeclampsia is a major cause, is a problem in Nigeria. Accurate data are available for caesarean sections in the University of Nigeria Teaching Hospital, Enugu. We therefore studied the outcome of caesarean section among these high-risk patients., Method: We conducted a retrospective survey of hospital records of patients with preeclampsia/eclampsia who had caesarean delivery in this unit over a four-year span from July 1998 to June 2002., Results: There were 3926 deliveries and 4036 births (3611 live births), with 898 women (23%) delivered by caesarean section. Of these, 125 (14%) had preeclampsia/eclampsia, 103 (82.4%) presenting for emergency caesarean delivery and 22 (17.6%) elective. General anaesthesia was used in 116 patients (92.8%) and spinal in nine. The major indications for surgery were severe preeclampsia/eclampsia in patients with unfavourable cervix (68%), fetal distress/intrauterine growth restriction (7.2%) and previous caesarean section (6.4%). There were six maternal deaths, all with general anaesthesia, giving a case fatality rate of 5.2% of general anaesthetics or 4.8% of caesarean deliveries. The cause of death was anaesthetic in three patients, cerebrovascular accident and pulmonary oedema in two and intraoperative haemorrhage in one. There were 13 stillbirths and 10 neonatal deaths., Conclusion: Maternal and fetal mortality were high. Poverty, late presentation, lack of equipment and inexperienced management were major contributory factors. Use of spinal anaesthesia should be encouraged in view of recent favourable reviews and cheaper cost.

Background: Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus., Objective: To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution., Design: Retrospective review over a 12 year period from January 1988 to December 1999., Setting: Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria., Subjects: All cases of retained second twin managed during this period., Main Outcome Measures: Causes, sources of referral, perinatal and maternal complications., Results: The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively., Conclusion: The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres.