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Postpartum length of hospital stay among obstetric patients in Ibadan, Nigeria.
(2024) Adeoye, I.A.; Aleka, B.U.; Afolabi, R.F.; Oluwasola, T.A.O.
Background Postpartum Length of hospital stay (PLOHS) is an essential indicator of the quality of maternal and perinatal healthcare services. Identifying the factors associated with PLOHS will inform targeted interventions to reduce unnecessary hospitalisations and improve patient outcomes after childbirth. Therefore, we assessed the length of hospital stay after birth and the associated factors in Ibadan, Nigeria. Methods We used the Ibadan Pregnancy Cohort Study (IbPCS) data, and examined the 1057 women who had information on PLOHS the mode of delivery [spontaneous vagina delivery (SVD) or caesarean section (C/S)]. The outcome variable was PLOHS, which was described as the time interval between the delivery of the infant and discharge from the health facility. PLOHS was prolonged if > 24 h for SVD and > 96 h for C/S, but normal if otherwise. Data were analysed using descriptive statistics, a chi-square test, and modified Poisson regression. The prevalence-risk ratio (PR) and 95% confidence interval (CI) are presented at the 5% significance level. Results The mean maternal age was (30.0 ± 5.2) years. Overall, the mean PLOHS for the study population was 2.6 (95% CI: 2.4–2.7) days. The average PLOHS for women who had vaginal deliveries was 1.7 (95%CI: 1.5–1.9) days, whereas those who had caesarean deliveries had an average LOHS of 4.4 (95%CI: 4.1–4.6) days. About a third had prolonged PLOHS: SVD 229 (32.1%) and C/S 108 (31.5%). Factors associated with prolonged PLOHS with SVD, were high income (aPR = 1.77; CI: 1.13, 2.79), frequent ANC visits (> 4) (aPR = 2.26; CI: 1.32, 3.87), and antenatal admission: (aPR = 1.88; CI: 1.15, 3.07). For C/S: maternal age > 35 years (aPR = 1.59; CI: 1.02, 2.47) and hypertensive disease in pregnancy (aPR = 0.61 ; CI: 0.38, 0.99) were associated with prolonged PLOHS. Conclusion The prolonged postpartum length of hospital stay was common among our study participants occurring in about a third of the women irrespective of the mode of delivery. Maternal income, advanced maternal age, ANC related issues were predisposing factors for prolonged LOHS. Further research is required to examine providers’ perspectives on PLOHS among obstetric patients in our setting.
Intraoperative uterine packing with abdominal mops as adjunct to management of postpartum haemorrhage in a low resource setting.
(2021) Akintan, A. L.; Oluwasola, T. A. O.; Aderoba, A. K.; Owa, O. O.; Oyeneyin, L. O.
Background: Postpartum haemorrhage (PPH) remains a leading contributory factor to maternal morbidity and mortality especially among women undergoing caesarean deliveries. Despite concerted efforts being made towards prevention, recurrent limiting factors in low-resource settings warrant the adoption of mechanisms that would further assist in combating the scourge. This study reviewed the outcome of intra-operative uterine packing of bleeding uteri in limiting blood loss from PPH. Methods: We reviewed the hospital records of patients who had postpartum haemorrhage over a period of five months retrospectively and present the outcome of 17 consecutive cases which were managed with intrauterine packing with abdominal mop as an adjunct measure. Structured proforma was used to obtain information on age, parity, socioeconomic status, mode of delivery, indications for surgery and history of intrauterine packing from the hospital records while data analysis was done using the statistical package for social sciences, SPSS, version 23.0. Results: Most common cause of intraoperative PPH was uterine atony, 13 (76.5%), and the mean blood loss was 1841.2±1165.4mL. Mean duration of intrauterine packing was 36.7±15.0 hours and average number of days on admission was 4.0±2.5.An average of 2 abdominal mops was used per packing and most procedures were performed by the medical officers (10, 58.8%). Overall, there was no case of maternal mortality among the patients managed and no abnormality was detected on follow up at 6 weeks. Conclusion: Uterine gauze packing is effective in reducing blood loss from intra-operative PPH in low resource-settings. It, therefore, deserves reconsideration as an addition to the armamentarium of available resources for reducing mortalities from PPH in developing countries.
Blood transfusion requirement during caesarean delivery: risk factors
(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2015-06) Eyelade, O. R.; Adesina, O. A.; Adewole, I. F.; Adebowale, S. A.
Background: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. Methods: This was a prospective cross-sectional study. A total of 706 pregnant patients scheduled for emergency or elective Caesarean section at the University College Hospital, Ibadan, Nigeria between March and August 2011 were recruited. Participants were followed-up from the date of delivery till the end point of the study which could fall into either of the following conditions: satisfactory postoperative clinical status up to 48 hours post-delivery or death. Transfusion rate was determined and Chi-square test was used to determine if there exist an association between blood transfusion status and preoperative haematocrit level, years of experience of obstetrician, indication for Caesarean Section(CS), CS type (primary or repeat) and HIV status. Results: Transfusion rate was 9.1 %; variables found to be significantly associated with blood transfusion were; preoperative haematocrit less than 26%, increasing parity, years of experience of resident obstetrician, indication for CS (bleeding or not bleeding) and estimated blood loss. Being HIV positive does not increase the need for blood transfusion. Conclusion: Preoperative anaemia, increasing parity and severe blood loss at surgery significantly contribute to the requirement for blood transfusion in patients undergoing caesarean section.

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