Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530 S441

O508

THE BURDEN OF DIRECT OBSTETRIC COMPLICATIONS IN

NIGERIA

S. Ochejele1, P.E. Ogwuche1, P. Odusolu2, A.E. Okwori1, D. Ifenne3,

I.O. Ujah4. 1Obstetrics and Gynaecology, Federal Medical Centre

Makurdi, Makurdi, Benue, Nigeria; 2University of Calabar teaching

Hospital, Calabar, Cross River, Nigeria; 3Benue State University,

Makurdi, Benue, Nigeria; 4Nigeria Institute of Medical research, Lagos,

Lagos, Nigeria

Objectives: To determine the incidence, and mortality from direct

obstetric complications.

Materials: Emergency Obstetric Care Register.

Methods: An eleven months prospective study of patients managed

in four health facilities in Makurdi, Nigeria.

Results: During the study period, there were 2,687 deliveries,

267 (10%) direct obstetric complications and 26 (1%) maternal

deaths. Five direct obstetric complications account for 24 (92%)

of these deaths [Severe pre-eclampsia/Eclampsia (33%), Puerperal

sepsis (25%), Post Partum Haemorrhage (17%), Obstructed labour

(13%) and ruptured uterus (13%)]. The incidence varied from 0.3%

for Abruptio placentae to 4.4% for incomplete abortion. Placenta

praevia, ruptured ectopic pregnancy and incomplete abortion

accounted for 59% of the complications but were not associated

with maternal deaths. Puerperal sepsis had the highest case fatality

rate of 56%.

Conclusions: Direct obstetric complications have a low incidence,

but they are the commonest causes of Maternal mortality. There

is a need to re-organize service provision to give more priority

attention to the management of these complications.

O509

OUTCOME OF AN INTERVENTION TO IMPROVE CASE

MANAGEMENT OF ECLAMPSIA IN NIGERIA’S TEACHING

HOSPITALS

R.N. Ogu1, F. Okonofua2, J.T. Akuse3, I.O. Ujah4, A.O. Fabamwo5,

H. Galadanci6, E. Archibong7, C. Chama8, H.E. Onah9. 1Obstetrics &

Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria;2University of Benin, Benin City, Nigeria; 3Sefa Specialist Hospital,

Kaduna, Nigeria; 4University of Jos, Jos, Nigeria; 5Lagos State

University Teaching Hospital, Ikeja, Nigeria; 6Aminu Kano University

Teaching Hospital, Kano, Nigeria; 7University of Calabar, Calabar,

Nigeria; 8University of Maiduguri Teaching Hospital, Maiduguri,

Nigeria; 9University of Nigeria Teaching Hospital, Enugu, Nigeria

Objectives: To investigate the effectiveness of an intervention

aimed at improving the case management of eclampsia in Nigeria.

Materials: Design & Setting: A multi-centre intervention conducted

in six teaching hospitals in Nigeria.

Methods: Doctors and midwives in the selected hospitals were re-

trained in the contemporary management of eclampsia especially

the use of magnesium sulphate according to the Pritchard protocol.

Clinical records of eclampsia cases before and one year after the

intervention were collated.

Results: A total of 219 cases of eclampsia were managed over a

12-month period. There were a total of seven maternal deaths. The

post intervention mean case-fatality rate of 2.7% was significantly

less than the rate of 15.1% before the intervention (P< 0.001). Case

fatality declined in five of the six participating hospitals. Overall

maternal mortality ratio in the hospitals declined from 1199.2 to

954 per 100,000 deliveries, while perinatal mortality declined from

141.5 to 129.8 per 1000 births.

Conclusions: An intervention to build the capacity of care-providers

to use evidence-based protocol for the treatment of eclampsia in

Nigeria was successful in reducing associated case fatality rate. The

increased and widespread use of such an intervention in maternity

units will contribute to the reduction of maternal mortality in

Nigeria

O510

ASSESSMENT OF SUBLINGUAL MISOPROSTOL AS FIRST LINE

TREATMENT FOR PRIMARY POSTPARTUM HEMORRHAGE:

RESULTS OF A MULTICENTER TRIAL

R.N. Ogu1, F. Okonofua2, J.T. Akuse3, I.O. Ujah4, H. Galadanci5,

A.O. Fabamwo6. 1Obstetrics & Gynaecology, University of Port

Harcourt, Port Harcourt, Nigeria; 2University of Benin, Benin City,

Nigeria; 3Sefa Specialist Hospital, Kaduna, Nigeria; 4University of Jos,

Jos, Nigeria; 5Aminu Kano University Teaching Hospital, Kano, Nigeria;6Lagos State University Teaching Hospital, Ikeja, Nigeria

Objectives: To investigate the effectiveness of sublingual

misoprostol when used as first line drug for the treatment of

primary post-partum hemorrhage (PPH).

Materials: The study was conducted in six teaching hospitals

representing the six geo-political zones of Nigeria.

Methods: Intervention trial; Maternity care providers were re-

trained to more effectively use the active management of the

third stage of labor (AMTSL), and to administer 1000 microgram

sublingual misoprostol to women experiencing PPH at the time of

delivery. Outcome variables were: estimated blood loss (EBL) and

the need for additional treatment with other uterotonic drugs.

Results: One hundred and thirty one women with PPH were treated

with oral misoprostol as first line drug over six months. EBL ranged

from 500 to 2,500mls. Twenty women (15.3%) required additional

uterotonic drugs to control continuing blood loss. There were three

maternal deaths in one hospital, mainly due to women presenting

late in hospital, while 7 perinatal deaths were recorded overall.

Conclusions: We conclude that sublingual misoprostol alone is not

sufficient to effectively treat all forms of PPH in health care settings.

An additional back-up uterotonic and other ancillary treatment will

be required.

O511

MOESIN OVEREXPRESSION IS ASSOCIATED WITH INVASIVE

GROWTH OF ADENOMYOSIS

R. Ohara1, A. Shiba1, K. Satomi1, S. Sakashita1, J. Kano1, M. Nishida3,

H. Yoshikawa2, M. Noguchi1. 1Diagnostic pathology of Tsukuba

university, Tsukuba-shi, Ibaraki-ken, Japan; 2Obsterics and Gynecology

of Tsukuba university, Tsukuba-shi, Ibaraki-ken, Japan; 3kasmigaura

Medical Hospital, Tsuchiura-shi, Ibaraki-ken, Japan

Objectives: Although adenomyosis is a benign gynecological

disease, both endometrial gland cells and stromal cells show

invasive growth into the muscle layer, resembling the behavior

of a malignant tumor. The aim of this study was to demonstrate

the molecular mechanisms responsible for the invasive character

of adenomyosis as a pure model of malignant tumor invasion.

Materials: 1. Two cases of adenomyosis surgically resected

and fixed in formalin for proteomics 2. 14 fresh surgical

specimens for RT-PCR 3. 19 cases of formalin fixed specimens for

immunohistochemistry 4. OMC-9 cells for invasion assay.

Methods: 1. We selected two cases of adenomyosis that had

been surgically resected and fixed in formalin, and the protein

contents of both the invasive adenomyosis and peripheral normal

endometrium were extracted by tissue microdissection (AS LMD

Living Cell; Leica CTR6000®). The extracted proteins were examined

using an LC-MS/MS system (ZAPLOUS LC/MS Systems, AMR) and the

expression profiles of each region were compared. 2. The expression

of Moesin in adenomyosis was examined by RT-PCR using 14

fresh surgical specimens. 3. Nineteen formalin-fixed specimens of

adenomyosis were then examined for Moesin protein expression

using immunohistochemistry 4. We then performed an invasion

assay using the endometrial stromal sarcoma cell line OMC-9,

which expresses a high level of Moesin and shows invasive growth.

Results: 1. A total of 260 proteins were detected, and 76 of them

showed higher expression in adenomyosis than in normal tissue.

Among the genes encoding the 76 proteins, we selected three

(Lumican, Triosephosphateisomerase and Moesin) that have already