The Unbooked Pregnant Woman: Experience From A Rural Tertiary Hospital South-South Nigeria

This retrospective study was carried out to determine the obstetric outcome of unbooked pregnant women who presented at the University of Uyo Teaching Hospital over a five year period. Five thousand nine hundred and sixty two women presented at the labour ward out of which 617 (10.3%) were unbooked. Majority of the patients were multiparous (61.2%) and the most common clinical presentations were obstructed labour (28.8%) and eclampsia (19.8%). There were 255 still births and 5 early neonatal deaths resulting in a perinatal mortality rate of 420/1000. Maternal mortality ratio was 7,800/100,000 live births and this was mostly from eclampsia (28.8%) and obstetric haemorrhage (19.8%). Grass-root education in our various communities highlighting the importance and advantages of formal antenatal care and the inclusion of this in the health education curriculum of primary and secondary schools is advocated. KEY WORDS: Unbooked pregnant women, Uyo, obstetric outcom

Spontaneous Heterotrophic Pregnancy with Tubal Rupture and Delivery of a Live Baby at Term: a Case Report

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine gestations. It is associated with significant maternal morbidity andmortality particularly in low resource settings. Spontaneous heterotopic pregnancy is very rarely seen with documented incidence of 1 in 30,000 pregnancies. We present the first case of heterotopic pregnancymanaged in our center with the delivery a live female baby at term.The case of a 25 year nulliparous lady who presented in our center with lower abdominal pains, amenorrhoea and an ultrasound report confirming an intrauterine pregnancy is presented. Examination revealed mild right iliac fossa tenderness, cervical motion tenderness and a bulky uterus. A trans-vaginal ultrasound scan confirmed a right fimbrial ectopic gestation. A right salpingectomy was performed. The patient subsequently had an uneventful antenatal period and spontaneous vaginal delivery of a live female baby at term. We also review literatures on heterotopicpregnancy and its management. Spontaneous heterotopic pregnancy, apotentially fatal condition though rare can occur in our environment. Clinicians should maintain a high index of suspicion in all patients presenting with amenorrhoea and abdominal pains even if an intrauterine pregnancy has been confirmed and a thorough evaluation of theadnexae using a trans-vaginal ultrasound scan should be routinely performed in such cases.Keywords: Spontaneous heterotopic pregnancy, live baby, Uy

Seminal Fluid Indices Of Male Partners Of Infertile Couples In Uyo, Nigeria

This retrospective study analyzes the seminal fluid indices of 633 male partners of infertile couples at the University of Uyo Teaching Hospital over a four year period. All the laboratory records on seminal fluid analysis between 1st January 2003 and 31st December 2006 were reviewed. The seminal fluid characteristics of the patients were determined and the abnormalities classified according to the World health organisation guidelines. Five hundred (79.0%) of the men had abnormal seminal fluid parameters. About 56.0% of the subjects were asthenozoospermic, 38.9% were oligozoospermic, 2.8% had teratozoospermia while 7.0% had azoospermia. The significant contribution of the male factor to infertility in our environment is highlighted. The need for the encouragement of male partners of infertile couples to avail themselves for proper infertility evaluation and the advantages of early detection and treatment of sexually transmitted infections in men is stressed. KEY WORDS: Male infertility, seminal fluid indices, Uy

Cervical Cancer Screening in Uyo, South-South Nigeria

Context: Cervical Cancer is the commonest female genital tract  malignancy in the developing world. Though preventable by early detection and treatment of pre-invasive disease, majority of patients in Nigeria still present with advanced disease.Objective: To review the cervical cancer screening exercise of the Medical Women Association of Nigeria and determine the incidence of pre-malignant lesions of the cervix during the study period (1996-2001).Study Design: A descriptive study of women who participated in the exercise and the results of the pap smear.Results: During the exercise 332 women were screened, but only 276 smears (83.1%) were adequately taken and consequently reported. Majority of the smear (75.7%) were normal smears, Cervical Intraepithelial Neoplasia (CIN) was found in 33 smears (12%) and invasive cancer in 1 smear (0.36%). Majority of women with CIN were multiparous and in their 4th and 5th decades of life.Conclusion: The prevalence of CIN is high, thus there is need for routine cervical cancer screening of all sexually active women. Where this is not feasible due to cost and logistics, selective screening of high risk women and use of visual inspection with acetic acid is recommended

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Introduction: Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman’s life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods: The case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied. Results: There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were  unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. Conclusion: Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.Key words: Emergency peripartum hysterectomy, extensive uterine rupture, uncontrollable haemorrhage, Uy

Perforation of the Rectum by a Copper-T Intrauterine Contraceptive Device with Retrieval per Rectum: A Case Report

Intrauterine contraceptive devices are among the most effective forms of contraceptives available. They provide long term reversible protection from pregnancy and are currently the most popular and widely use reversible contraceptive method. Though they are associated with few side effects, perforation of the uterus remains the most serious. We report the case of a grandmultiparous lady whose copper-IUCD perforated her rectum 8 years after its insertion. We advocate the inclusion of rectal examination in theevaluation of patients for missing IUCDs and removal of the devices per rectum if partially embedded rather than resorting to surgery.Key Words: Rectum, Perforation, IUC

Beliefs And Practice Concerning Pregnancy Delivery And Puerperium In Rural Akwa Ibom State

Focus group discussions involving 100 rural women in five communities of Akwa Ibom State, Nigeria were carried out over a six-month period. The aim was to determine if the beliefs and practices of our rural dwellers are such that contribute to maternal morbidity. The discussions revealed that the participants had a shallow knowledge of the causes of complications in pregnancy. Complications were largely attributed to spirits and other harmless events. Reducing physically demanding activities in pregnancy was ascribed to laziness and sexual intercourse was largely to be avoided. There was no food taboos specific to pregnancy, but food restrictions were described. Antenatal and intrapartum care by spiritual and traditional midwives was considered superior to orthodox care. Practices by the midwives include turning a baby in an abnormal lie, massaging the vagina with oil in labour; conducting delivery without gloves, pulling on the cord, manually removing or squeezing out the placenta if delivery is not spontaneous. Management of complications involves divinations, use of herbs and other concoctions, anointing oil, prayers and fasting. Puerperal seclusion practiced to varying degrees and maybe beneficial. Most beliefs and practices of our rural women are potential contributors to maternal morbidity. A few are harmless or even beneficial. Public enlightenment and education of our rural dwellers while incorporating the harmless/beneficial practices into modern obstetric care services will help reduce maternal morbidity. KEYWORDS: Pregnancy, Beliefs and Practice

Utilization of insecticide treated nets during pregnancy among postpartum women in Ibadan, Nigeria: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Pregnant women are susceptible to symptomatic malaria due to invasion of the placenta by plasmodium. Malaria increases the risk of adverse pregnancy outcomes for mothers, the foetuses and newborns. The effective use of Insecticide Treated Nets (ITNs) would be of benefit to these vulnerable women. Previous studies have focused on prenatal-women but this study sought to explore the actual trend of utilization of the proven strategy across all the pregnancy stages among postpartum women in Ibadan.</p> <p>Methods</p> <p>This cross-sectional survey utilized a validated structured questionnaire for data collection. A calculated sample of 335 postpartum women was proportionately recruited from three fee-paying facilities within Ibadan, Nigeria using a simple random sampling technique. These hospitals have high client flow for maternity cases and are known for provision of care under traditional ANC model. The data collected were analyzed using descriptive and inferential statistics by means of Statistical Package of Social Sciences (SPSS) version 15. The level of significance was set at = 0.05.</p> <p>Results</p> <p>The women's age ranged between 18 and 47 years, mean age was 29.4 ± 0.8 years. Various irregularities marked the traditional model of ANC provided at the settings and no exposure to preconception care. Also, 276 (82.4%) had heard of ITNs. Antenatal clinics formed the major source of information. Low utilization and compliance rates were observed. One hundred and twenty-seven (37.9%) of the women had high knowledge of Malaria in Pregnancy (MIP) but only 70 (20.9%) demonstrated positive attitude towards the use of ITNs. Participants' educational status, family types, employment and residential areas significantly influenced ITNs utilization.</p> <p>Conclusions</p> <p>The women knew and learned about ITNs from ANC visits. Majority of the women did not own ITNs because of lack of access to free distribution. The existing traditional model of ANC was marked by irregularities and none of the women was exposed to preconception care. In addition, negative attitude in spite of increased knowledge of MIP was observed among the women. Therefore, evaluation of free distribution of ITNs is recommended. Integration of focused ANC and preconception care are advocated to promote early access to health information.</p

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Current concepts in contraception

No Abstract. Nigerian Journal of Medicine Vol 15 (4) October-December: 364-37