Failed bilateral tubal ligation; a rare but real phenomenon – case report.

Female sterilization by tubal ligation is the most commonly used method of fertility regulation world with over 190 million couples using it. All methods of tubal sterilization can fail but some sterilization methods have lower failure rates than others Case report: We report a 39-year-old grandmultipara who presented with an ongoing pregnancy 7 years after bilateral tubal ligation done during an emergency caesarean section. Conclusion: Failure after surgical tubal ligation although rare, can still occur especially in tubal ligation done at caesarean section

Outcome of twin deliveries at the University of Maiduguri Teaching Hospital: A 5-year review

Objectives: The objectives of the study were to determine the outcome of twin births at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in terms of morbidity and mortality and to recommend possible measures to curtail or reduce some of the preventable complications.Materials and Methods: This is a 5-year retrospective study, from January 2000 to December 2004, of twin births at the UMTH.Results: There were 196 twin deliveries in 8431 total deliveries, with a twin incidence of 2.3%. Dizygotic twins accounted for 63.4%. The increasing maternal age and positive family history of multiple pregnancies were associated with the increasing twinning rate. The main complications encountered were preterm labor, pregnancy-induced hypertension, and cord prolapse. The perinatal mortality rate of 107.5/1000 births was higher than that observed for singleton pregnancies in the same institution. Similarly, there was a higher Cesarian section rate of 24.7% compared to singletons within the same period. There were significantly higher perinatal mortality rates among the preterm (P = 0.000002) and low-birthweight (P = 0.000004) fetuses.Conclusion: Considering that fetal prematurity and low birth weight, sequelae to preterm labor, are the commonest causes of perinatal death in this study, efforts should be geared during the antenatal period toward the prevention of a premature birth

Autologous blood donation and transfusion in obstetrics and gynaecology at the University of Maiduguri Teaching Hospital Maiduguri, Nigeria.

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Ectopic pregnancy at the university of maiduguri teaching hospital-a ten-year review

Ectopic pregnancy is a common surgical emergency in gynaecology especially in the tropics where the patients usually present with the ruptured variety with the attendant peritoneal flooding and its clinical consequences. Objectives: To determine the incidence, demographic characteristics, risk factors, clinical features, treatment, and outcomes of patients with ectopic pregnancy in our center. Methods: A descriptive study of ectopic pregnancy seen at the University of Maiduguri Teaching Hospital from January 1995 to December 2004. Results: A total of 136 cases of ectopic pregnancies occurred during this period. With the 15,120 deliveries that occurred during the same period, the overall incidence of ectopic pregnancy was 0.9/1000 deliveries (0.9%). Majority of the patients (69.8%) were between 21 to 30 years of age, 57.4% were para 1 to 4 and 86.0% were married. The duration of amenorrhoea ranged between 2 to 14 weeks with a mean of 6.9 weeks and 58.1% of the patient had a period of amenorrhoea of 5- 8weeks. There were no historical risk factors for ectopic gestation in 30.1% of the patients but abortion, infertility, PID and previous ectopic pregnancy were found to be major risk factors. Lower abdominal pain (92.6%) was the commonest symptom and cervical excitation tenderness (51.5%) the commonest sign. The initial diagnosis was missed in 31.6% of the cases. In 69.8% the implantation site was the ampulla and the ectopic pregnancy was ruptured in 68.9% of the patients. All the patients were managed by laparatomy and the 57.4% of the patients that were transfused, were given homologous blood. There was a statistically significant association between blood transfusion and the initial packed cell volume (PCV) and the amount of haemoperitoneum found at operation. There was no maternal death and of 12 patients (8.1%) that developed complications, 8 (66.7%) had wound infection. Conclusion: As absent of risk factors does not in any way exclude the possibility of ectopic pregnancy as shown in thisreview, keeping high index of suspicion is vital in its diagnosis. Education of the populace especially women on ectopic and training and retraining of health care personnel in the management of this gynaecological emergency will reduce its occurrence and improve its management

Prevalence and Nature of Sexual Assault among Female Students in a Tertiary Institution in Maiduguri, Nigeria – A Cross Sectional Study

Purpose: Sexual assault is a violent crime against both the individual and society but is largely underreported. The objective of this study was to determine the prevalence and nature of sexual assault among female students in the University of Maiduguri. Methods: A crossectional descriptive study using a close ended, self –administered questionnaire administered to female students of a tertiary institution in Maiduguri was used to survey 400 female students in University of Maiduguri. Results: Most of the respondents were single 349 (87.3%) and in the age range of 20-24 {202 (50.5%)}. 205 (51.3%) of them reported to have been sexually assaulted. In 154 (87.2%) of the cases, the respondents had a close relationship with the assailant. The commonest location of the assault was in a party 101 (49.3%), which was followed by classroom 45 (22%). Most of the sexual assault reported (57.6%) occurred in the evenings and nights. In 35.6% of the cases, the respondents sustained extra-genital trauma, while others had psychological (24.9%) and genital trauma (15.6%). Conclusion: Sexual assault rate among female students in the University of Maiduguri is high and is associated with physical and psychological traumas.Keywords: Sexual assault, Physical trauma, Psychological trauma, Maiduguri

RECURRENT HYDATIDIFORM MOLE COMPLICATED BY TOXIC GOITRE.

Hyperthyroidism complicates few pregnancies, in many cases due to Graves' disease, Gestational trophoblastic disease is a rare cause of hyperthyroidism in which high levels of hCG causes activation of the thyrotrophin receptor to stimulate supraphysiological secretion of thyroid hormone with or without thyroid gland enlargement Molar pregnancies are usually not recurrent, however, women with a previous hydatidiform mole (HM) are at higher risk of having a second mole than women from the general population. After a prior molar pregnancy, the risk of having a second one is 540 times that of the general population, however familial molar pregnancies are exceedingly rare. Here we present a case of recurrent HM complicated by a toxic goiter in a patient with family history of molar pregnancy&nbsp

Perinatal outcome in patients with pre-eclampsia at the university of maiduguri teaching hospital, Nigeria

Pre-eclampsia, a common maternal disease in pregnancy is an important cause of perinatal morbidity and mortality especially in developing countries. Objectives: To determine the perinatal outcome of patients with pre-eclampsia in our environment. Methods: A retrospective review of the perinatal outcome of patients with pre-eclampsia managed at the University of Maiduguri Teaching Hospital from January 2005 to June 2007. Logistic regression analysis was used to determine sociodemographic and obstetrics factors that are independently associated with perinatal mortality in these patients. Results: During the study period, there were 84 cases of preeclampsia and 3,560 deliveries giving a pre-eclampsia prevalence of 2.36%. Sixty-nine cases (82.1%) were available for review. The mean booking diastolic blood pressure of the study group was 78.6±15.7 mmHg. Majority of the patients 55(79.7%) were in the age group 19-35 years and 33(47.8%) were primigravidae. In 36(52.2%) of the cases, the birth weight of the babies was <2.5 Kg and IUGR was diagnosed in 37(53.6%). There were 16 perinatal death giving a perinatal mortality rate of 262/1000 live birth. IUGR (OR=11.35, 95%CI=2.06-62.55, p=0.005) and diagnosis of PE at a gestational age <32 weeks (OR=3.39, 95%CI=1.09-10.55, p=0.04) were found to be independently associated with perinatal mortality in patients with preeclampsia. Conclusion: Pre-eclampsia is associated with adverse perinatal outcome, with early onset disease and IUGR being independently associated with an increase risk of perinatal mortality

Distributions of anthropometric measurements of new born babies among various ethnic groups in Maiduguri, Nigeria: a prospective study.

Weight and other newborn anthropometric measurements at birth are considered as the most important indicators of a newborn's chances of survival, growth, long-term health and psychosocial development. Objective: To determine the mean birth weight, birth length and head circumferences of new born babies among the various ethnic groups in Maiduguri. Method: A descriptive cohort study involving 854 pregnant women with their live singleton babies was carried out in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH) and the State Specialist Hospital (SSH), Maiduguri, over a 6-months period, between 2 February 2009 and 29 July 2009. Mothers' socio-demographic and obstetrics performances, baby's birth weights, birth lengths and head circumferences were obtained and recorded and data analyzed using SPSS version 16. Statistical significance was computed by t-test and Chi-square. A P value <0.05 was considered significant. Results: A total of 854 mothers together with their 854 live singleton babies were studied. There were 460 (53.9%) male and 394 (46.1%) female babies. Among these babies, 144 were low birth weight, 660 had normal birth weight while high birth weight was seen in 50 babies. The mean birth weight of all babies delivered in the study population was 3030.47±631g, with mean birth length of 47.8±3.1cm, and the mean head circumference was 34.2±2. All the parameters studied were significantly lower in those that were of LBW compared to babies that were not of LBW, and the mean difference was statistically significant (P value 0.000). Conclusion: All the anthropometric measurements were highest in Igbo newborns while Hausa/Fulani had the lowest among the various ethnic group studied in Maiduguri. Improving the socio-economic status especially of the disadvantage ethnic group and further community based research is recommended.&nbsp

The effect of intermittent preventive therapy for malaria on pregnancy outcome at the umth maiduguri.

The World Health Organisation (WHO) recommends the use of intermittent preventive therapy with sulphadoxine-pyramethamine (IPT-SP) for prevention of malaria in pregnancy and this is the priority of the Roll Back Malaria partnership. Objectives: To determine the effect of IPT-SP on pregnancy outcome in our environment. Methods: Four hundred pregnant women among a cohort recruited for a larger study evaluating the prevalence of malaria parasitaemia in pregnancy in UMTH Maiduguri from 24 July 2007 to 12 January 2008 were used for this study. All pregnancies and deliveries were supervised at the UMTH. They were followed from booking to delivery to observe the effect of IPT-SP on pregnancy outcome. Blood samples were collected at booking and delivery for malaria parasite and packed cell volume. Malaria parasite was also looked for in the cord blood and placenta. Socio-demographic characteristics and pregnancy outcome were also obtained. Results: The mean age and parity of the patients were 27.2+5.5 years and 2.3+2.1 respectively. Majority of the patients (80.0%) have had at least a dose of the IPT-SP. The prevalence of malaria parasitaemia at booking was 60.3% with a mean parasite density of 701.04 + 382.22parasites/µl. However, the prevalence at delivery fell to 28.8% (p<0.001) and the mean parasite density reduced to 405.187 + 310.43 parasites/µl (p<0.001). In spite of the similar mean parasite density at booking in the 3 groups, the mean parasite density at delivery was lowest in the patients that had 2 doses of IPT-SP and highest among those that did not take IPT-SP (P<0.001). The use of IPT-SP also significantly protects from maternal anemia at delivery, preterm delivery, low birth weight, placental malaria, and cord parasitaemia. Conclusion: There is a high prevalence of malaria parasitaemia with a high parasite density among pregnant women at booking, both of which decline remarkably at delivery most likely due to ITP-SP during antenatal care. It is recommended that the use of intermittent preventive treatment should be intensified.&nbsp

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria

Objective : To determine the trend and indications for the use of caesarean delivery in our environment. Method : A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results : During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion : Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate