Pattern of Complicated Unsafe Abortions in Niger Delta University Teaching Hospital Okolobiri, Nigeria: A 4 Year Review.

Background: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70,000 women die globally as a result, with majority occurring in the developing world. This study aims to determine the pattern of complicated unsafe abortions in Niger delta University Teaching Hospital (NDUTH) Okolobiri.Methods: The study is a four-year retrospective analysis of cases of complicated unsafe abortion managed at the Niger Delta University Teaching Hospital Okolobiri, Bayelsa state.Results: The prevalence of complicated unsafe abortion during the study period was 4.1% of all deliveries and 14.0% of all gynaecological admissions. Majority (55.6%) of the patients had secondary education, while 31.8% were teenagers. Two thirds had a history of previous termination of pregnancy and 87.3% of the patients had never used any form of modern contraceptive. 'Quacks' accounted for 47.6% of the abortions and 53.9% of the abortions were performed late in the first trimester. Genital sepsis, retained products of conception, pelvic abscess and septicaemia were the most frequent complications occurring in 88.9%, 82.5%, 22.2% and 19.1% respectively. Surgical management was employed in 87.3% of the patients. The case fatality ratio was 4.8%, contributing 17.6% of all maternal deaths during the study period. The commonest cause of death was septicaemia (66.7%).Conclusion: There is a high prevalence of unsafe abortions in our environment. It continues to be a major contributor to maternal morbidity and mortality in the Niger Delta. Most of its victims are single adolescent school girls. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective post abortal care services will reduce the problem.Keywords: Unsafe abortion, morbidities, outcome

Effect of Intramuscular Hyoscine-N-Butyl Bromide on Tubal Spasm and Pain Perception in Women with Infertility Undergoing Hysterosalpingography: A Randomised Controlled Trial

Background: A tubal patency test is essential in evaluating women with infertility. Hysterosalpingography (HSG) is the investigation of choice for assessing tubal patency. Objective: To evaluate the effect of intramuscular hyoscine-N-butyl bromide on tubal spasms and pain perception during hysterosalpingography. Methods: This randomized, controlled trial was conducted at the Radiology Departments and Infertility Clinics of four health institutions in Bayelsa State, Nigeria, between January 2021 and April 2022. Five hundred and twenty infertile women undergoing hysterosalpingography were randomized into two groups. Women in group I (control) received a placebo, while women in Group II (experimental) received 20 mg of intramuscular hyoscine-N-butyl bromide. Pain scores at different steps of the procedure were recorded. Results: The overall mean pain scores progressively decreased from contrast instillation (4.97 ± 2.08) through 30-minutes post-procedure (3.54 ± 1.54) to 24 hours post-procedure (1.96 ± 1.78). Pain scores at contrast instillation, 30 minutes and 24 hours after HSG were significantly lower in the hyoscine group compared to the placebo group (p = 0.001 each). There were significantly fewer women with tubal blockage in the hyoscine group compared to the placebo group [78 (30.0%) vs 131 (50.4%); p = 0.001]. Conclusion: Intramuscular hyoscine-N-butyl bromide before hysterosalpingography significantly reduces pain and tubal spasm during the procedure

Relationship Between Subchorionic Haematoma and Abdominal Massage in Pregnancy in the Niger Delta Region of Nigeria: A Pilot Study

Background: Abdominal massage (AM) in pregnancy is a common practice in the Niger Delta region of Nigeria. AM may cause events such as subchorionic haematoma (SAH) and increase the risk of miscarriages and adverse maternal and perinatal outcomes. Objective: To determine the relationship between AM and SCH in the Niger Delta region of Nigeria. Methods: A cross-sectional study was conducted from January to June 2022 at the Obstetrics and Radiology Units of four health facilities in Bayelsa State, Nigeria. Consenting eligible pregnant women presenting to the antenatal clinic during the first trimester were consecutively included. An obstetric ultrasound scan was performed transabdominal. Results: Of the 403 women recruited, 241 (59.8%) were aged (20 – 29 years). The mean age was 28.02 ± 5.99 years. The mean body mass index was 23.82±4.60 kg/m2. While 170 (42.2%) had undergone AM in the first trimester of the index pregnancy, 126 (31.3%) had vaginal bleeding, and SCH occurred in 109 (27.0%) women. Women who had AM had 210 (CI: 58 – 878) times the odds of having SCH and 3.3 (CI: 2.14 – 5.15) times the odds of vaginal bleeding than women who did not have AM. Only 2 (1.8%) women with SCH did not have AM. Conclusion: There exists a strong association between the occurrence of SCH among pregnant women who have had AM. More health education is needed for women in the Niger Delta region and Nigeria to eradicate the archaic practice and improve pregnancy outcomes