Intrauterine adhesions in the University of Uyo Teaching Hospital, Uyo, South‑South, Nigeria: A ten year review

Background: Asherman’s syndrome is a clinical entity that can cause menstrual abnormalities and infertility.Objectives: This study was done to determine the risk factors, and management outcome of intrauterine adhesions in our hospital. Subjects and Methods: We carried out a retrospective study of the patients who were treated for intrauterine adhesions at the University of Uyo   Teaching Hospital over a 10 years period‑from January 1st 2006 to   December 2016. Results: During the study period, a total of 1977 gynecological surgeries were performed of which 83 were for intrauterine adhesions, giving a rate of 4.2%. However, only 52 folders were retrieved, giving a retrieval rate of 62.5%. Analyses, using ratios and percentages, was based on these. Most patients belonged to the 30‑34 age group (28.9%) followed by the 20‑24 age group (25.0%). The majority of the patients were nulliparous (58.9%), married (65.4%) and had a tertiary education (50.0%). Dilatation and curettage for induced abortion (42.3%), open myomectomy (26.9%), and caesarean section (19.2%) were the common risk factors. Amenorrhoea (65.4%), and hypomenorrhoea (30.8%) were the commonest modes of presentation. All the patients were managed by blind adhesiolysis, done overwhelmingly by the resident doctors, under anaesthesia with a significant percentage (65.3%) showing that there is no change in menstrual condition. Conclusion: Ashermans syndrome is a relatively common condition, and it is necessary to train doctors in the use of, and acquire, a hysteroscope, for the proper management of this condition. Meanwhile, more senior  personnel should be involved in the blind adhesiolysis, and Foley catheter that appears superior as a uterine splint to the intrauterine contraceptive device.Key words: Adhesiolysis, intrauterine adhesions; Uyo

The prevalence of syphilis in pregnant women in Akwa Ibom State, Southern Nigeria

Background: Treponema pallidum, the causative organism of syphilis has been a public health challenge for centuries. Syphilis is a significant cause of morbidities and mortalities in pregnant women, and information regarding its prevalence in Nigerian pregnant women is scanty particularly from the south‑south zone.Objective: To determine the prevalence of syphilis in women receiving antenatal care in twelve health care centres in Akwa Ibom State, Nigeria.Methodology: Pre‑coded structured questionnaires were administered to 911 participants over an eight week period. Venous blood samples were collected from each participant and tested with a Treponema pallidum immunochromatographic test.Results: There were about 18 women (1.98%) tested positive to syphilis. Prevalence rates in urban and rural areas were 2.63% and 1.32% respectively. The women from urban areas had a 3.22 (95% CI 1.05‑9.85) increased risk of acquiring syphilis when compared to the rural dwellers. Women with tertiary level of education had a significantly reduced risk of acquiring syphilis compared to those with primary level education while having an unemployed husband increased the risk of acquiring the infection by 10 times.Conclusion: Though VDRL is part of routine antenatal care screening, a policy of its use in the screening of all women receiving antenatal care in Akwa Ibom state should emphasized and it should be incorporated into the state Government’s free antenatal care program. Preferably, a single rapid test should be employed for screening, so that women testing positive could be treated at same clinic visit. Economic empowerment of women should be accorded priority and the practice of safe sex and use of contraception, especially barrier methods should be promoted.Keywords: Akwa Ibom state; antenatal attendees; prevalence; syphili

A review of the prevalence and rate of utilisation of measures offered to HIV-positive women during delivery in a tertiary hospital in south-south Nigeria

Background: Vertical or mother-to-child transmission of HIV which accounts for over 90% of paediatric HIV infection is increasingly becoming a major mode of transmission in  developing countries. Aim: To determine the prevalence of HIV infection among pregnant women that deliver at the University of Uyo Teaching Hospital and also review the interventions they are offered when they present in labour. Methods: The case records of all HIV positive patients who delivered between 1st July 2005 and 31st December 2007 were reviewed. Results: There were 2,851 deliveries out of which 188 patients were HIV positive giving a prevalence of 6.6%. The modal age group of the HIV-positive patients was 26-30 years (40.4%). Most (68.6%) of the patients were multiparous and 89.3% of them had regular antenatal care in the hospital. HIV was diagnosed in the antenatal clinic in 71.8% of the patients.  Most (72.3%) of them had a single dose of nevirapine in labour while 5.8% received highly active anti-retroviral therapy. About 63.8% of the patients had spontaneous vertex delivery while 33.5% were delivered by Caesarean section. All the babies had single doses of nevirapine within 72 hours of birth. Most (84.0%) of the mothers chose to feed their babies exclusively with breast milk substitutes. There were 3 maternal (1.6%) and 16 (8.5%) perinatal deaths. Conclusion: The prevalence of HIV infection among women who deliver in our hospital (6.6%) is relatively high. The treatment of HIV positive pregnant women in labour with respect to the prevention of mother-to-child transmission fell short of acceptable standards in some of our patients. Efforts should be made to ensure the adoption of anti-retroviral therapy as recommended in the Nigerian national guidelines.   Keywords: HIV prevalence, Delivery, Vertical transmission, Prevention, Uy

Contraceptive practice in a tertiary hospital in south-south Nigeria

Background: The high maternal and infant mortality in sub-Saharan Africa has been associated with unplanned pregnancy, high parity and short birth intervals. Use of effective contraceptive methodssignificantly reduce maternal and infant mortality and improved quality of life. This study determines the contraceptive practice among clients in a tertiary hospital. Method: The record cards of all clients that accepted contraceptive methods in the family planning clinic at the University of Uyo Teaching Hospital, Uyo over a 7-year period were reviewed. Results: There were 1094 new contraceptive acceptors during the study period. The modal age group of the clients was 25 – 34 years (59.3%); majority of the clients were multiparous (59.8%), christians (99.6%) and 71.0% had at least secondary school education. The most commonly accepted contraceptive methods were the intrauterine contraceptive device (45.0%) and oral contraceptive pills (28.1%), while clinic personnel (63.1%), and friends and relatives (20.1%) were the most common sources of information on contraception. Conclusion: Intrauterine contraceptive device and oral contraceptive pills were the most frequently accepted methods of contraception. We advocate increase in the contraceptive options including implants. The print and electronic media should be more involved in the awareness programs on contraception

Profile of Intrauterine Contraceptive Device Acceptors at the University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available, are particularly suitable for women in developing countries as they are affordable, convenient to use, do not require re-supply visits and are very cost-effective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors, the pattern of insertions and complications at the University of Uyo Teaching hospital, Uyo. Method: The record cards of all clients who had intrauterine contraceptive device inserted at the family planning clinic over a six-year period were reviewed. Results: During the study period, there were 852 new contraceptive acceptors out of which 39.7% accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5%). Acceptance of intrauterine contraceptive device was most common among multiparous clients (65.1%). Majority of the acceptors were married (90.0%), Christians (98.8%) and 72.8% had at least secondary school education. Clinic personnel (65.7%) and friends/relatives (21.3%) were the most common sources of information on contraception. Most (93.5%) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5%) and vulval/vaginal itching (5.3%) were the most common complications. Conclusion: The acceptors of intrauterine contraceptive devices in our center were young, multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace, the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use.Arrière plan: Les méthodes mordernes de contraception en usage ont été présentées en vue de réduire l'avortement imprévu, le haut degré de parité et la mortalité maternelle. Les methods artificielles courantes qui comprennent des substances médicamenteuses destiné à être introduit dans le vagin. Ceś méthodes sont les plus efficaces et plus réversible particulièrement convénables pour les femmes dans les pays en voie de développement. Etant donné que ces substances médicamentenses sont moins chéres et accéssibles et elles n'exigent pas une surveillance médicale parce qúelles n'ont pas des contre-indications. L'objet de cette recherche est de déterminer la caractéristique socio-démographique de la substance médicamentense artificielle aux patients modes d'insertions et complications au centre-hospitalo-universitaire d'Uyo. Méthode: Les fiches de tous les patients qui ont sub ice traityement médicamenteux artificial physique dans le planning familial au-dela de six mois ont été ré-examineés. Résultats: Au cours de la période d'étude, il yavait 852 d'acceptors en général d'ont on a pu relever 39,7% qui ont vraiment accepté l'usage de cette nourelle contraception. L'âge modal des patients était de 25 à 29 ans (32,5%), son usage était plus frequent parmi les patients multipares 65,1%. Beaucoup d'accepteurs étaient maries (90, 0%) les chrétiens (98,8%) et (72,8%) sont celles qui ont reçu une éducation secondaire, le personnel de clinique (65,7%) les amis et les proches (21,3%). Toutes ces personnes ont été les sources authentiques d'informations sur la contraception. Beaucoup de patients (93,5%) ont reçu l,application de cette nouvelle méthode de contraception sous différentes maniéres en sept jours de menstruation. Le mauvais ressentiment dans le vagin était de 5,5% et la démangeaison du vagin 5,3% étaient les complications les plus remarquables. Conclusion: Les accepteurs de la contraception de substances médicamentenses dans notre centre hospitalo-universitaire étaient des jeunes, des multiparaes et les femmes édiquées. La multiplication des médias, et la dissémination d'informations concrétes concernant l'usage des méthods de substances médicamentenses physiques, l'introduction de l'usage de cette contraception lois de la période post-partum période qui suit un accouchement et la perioide qui attend un accouchement