Determinants of resumption of vaginal intercourse in puerperium period in Ogbomoso: consideration for early use of contraceptives

Background: Early postpartum period for mothers is characterized with high demand for neonatal care, adjusting to sudden withdrawal of hormones of pregnancy and dealing with sexual desires of the husband. The study aimed at determines the timing, factors influencing postpartum resumption of vaginal intercourse and the contraceptive usage.Methods: Women in puerperium were interviewed with structured questionnaire on their socio-demographic status, obstetric history, sexual activities, contraception usage and reason for sexual abstinence.Results: About 40% (143) of participants had resumed vaginal intercourse within puerperium with mean resumption period of 3.2 ± 1.8 weeks. Only 12% (48) of them used modern contraceptive. Educational status (P <0.001); occupation (P <0.001); educational status of the husband (P <0.001); occupation of the husband (P <0.001); parity (P <0.05); husband’s income (P <0.05) and use of modern contraception (P <0.001) showed significant statistical difference between the women who had resumed vaginal sexual intercourse and those who have not. Logistic regression showed that educational status of the participants (OR = 0.48, CI = 0.246-0.938; P = 0.032) and parity (OR = 0.34, CI = 0.196-0.591; P = 0.001) were the most significant factors associated with early resumption of vaginal intercourse. One hundred and eighty-five (72%) of women who were yet to resume coitus, did so because of fear of pregnancy.Conclusions: Significant number of women resumed vaginal intercourse during the puerperium despite low contraception usage. There is need to initiate a contraception method before discharge home following delivery.  

Barriers to utilization of cervical cancer screening services among non-medical female personnel in tertiary hospitals in south west Nigeria.

Context: Cervical cancer is the second most common cancer among women and contributes significantly to cancer related deaths among women worldwide. Women knowledge and practice of screening for pre malignant lesions vary significantly. Studies on this subject had focused mostly on either medically informed health care workers or lay community persons but hardly on non-medically informed hospital workers who forms the bulk of health workers and influences health behaviors equally or even more.Objectives: To assess women's knowledge, attitude and practices towards cervical cancer screening and the barriers to utilizing cervical cancer screening services among non-medical female personnel in two tertiary centers in South West NigeriaStudy Design. Setting and Subjects: The study is a deseriptive cross-sectional study among female nonmedical personnel in OOUTH Sagamu and LAUTECH Ogbomosho in southwestern Nigeria. A self administered questionnaire was used to collect data from 280 women, which was analyzed using SPSS 21 statistical software.Main Outcome Measures: The study measured knowledge, practices and barriers to utilization of screening services.Results: Awareness is 84.3% and knowledge of screening is 77.5%. Utilization rate is low at 15%; indecision, 32 .4% feeling of good health, 28.2% and fear of positive results, 18.1 % are the main reasons for not screening. Low level of education and poor knowledge orthe disease are discovered as the most significant barriers and determinants of utilization Conclusion and Recommendation: Women education in context specific terms is recommended as the intervention to improve screening practices amongst women of reproductive age group

Determinants of Perinatal Mortality in Twins at Ibadan

Context: Twinning being a very important high-risk condition in our environment requires detailed study. There are several studies reviewing factors in twin perinatal mortality in our environment but there is a need to ascertain the relative contributions of each of these factors. Objectives: To assess the relative contributions of maternal and fetal factors to perinatal mortality in twins. Materials and Methods: Data was extracted from the birth register of a Nigerian tertiary health institution to identify maternal and fetal factors associated with a higher risk of perinatal mortality. Outcome Measures: Perinatal deaths among twin pairs (ranked). Results: The twinning rate was 32.3/1000(3.2%). Risk of perinatal death had linear correlation with birth asphyxia (r = 0.412, p < 0.01), birth weight of the second twin (r = 0.358, p < 0.01), birth weight of the smaller twin (r = -0.344, p < 0.01), presence of birth weight discordance (r = 0.278, p < 0.01), gestational age at delivery (r = -0.211, p < 0.05), birth weights of first and larger twins (r = -0.275, p < 0.01) and (r = -0.206, p < 0.05) respectively. The maternal age and parity showed no significant correlation with risk of perinatal death. Conclusion: Birth asphyxia was the greatest predictor of perinatal death in twins among the variables studied. Key Words: Twins, Birthweight Discordance, Perinatal Mortality [Trop J Obstet Gynaecol, 2002, 19: 36-38]

Domestic Violence: The Role of the Nigerian Obstetrician

Context: Domestic violence is increasingly recognized as an important public health issue, resulting in significant physical, psychological and social impairment. It occurs everywhere and at anytime of the day but under-reported in Nigeria. Victims are at a higher risk of several common gynaecological disorders and complications in pregnancy where the health and safety of two potential victims are placed in jeopardy. Objective: To assess the attitude and practice of Obstetricians towards the problem of domestic violence in Nigeria. Methodology: A self-administered questionnaire survey of 138 residents and consultants practing Obstetrics and Gynaecology in Nigeria who attended either the National Postgraduate Medical College of Nigeria update course in Ibadan in September 2002 or the 6th International Congress of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abuja in November 2002. Results: Most (97.8%) of the respondents agreed that Obstetricians have a role to play in the management of domestic violence. The roles to play include counselling (68.9%) treatment of injuries and prevention of complications (57.8%), education and public awareness (28.3%) and advocacy and instituting policies (13.3%). Conclusion: Obstetricians and Gynaecologists have a medical and ethical obligation to recognize and intervene on behalf of the abused patient. We cannot solve the problem alone, but sensitivity and commitment can begin to make a difference. Key Words: Domestic, Violence, Obstetricians, Nigeria. [ Trop J Obstet Gynaecol, 2004;21:46-48

Reliability of ultrasound findings acquired with handheld apparatuses to inform urgent obstetric diagnosis in a high-volume resource-limited setting

Objective: To evaluate the reliability of obstetric handheld smartphone-based point-of-care ultrasound (POCUS) in a resource-limited high-volume setting. Methods: A single-center prospective observational study among women requiring urgent diagnosis and admitted to a maternity referral hospital in Sierra Leone from March to April 2019. Pre-specified ultrasound findings were obtained with a handheld POCUS device; a comprehensive ultrasound examination was then performed by an experienced operator using conventional full-feature apparatus. Agreement was assessed by diagnostic accuracy and Cohen κ-statistics. Results: Overall, there were 307 participants. The mean aggregated diagnostic accuracy was 95.5% (κ-statistic, 0.90; 95% confidence interval [CI], 0.89–0.93; P 90%; κ-statistic, >0.80). Detection of low-lying placenta or placenta previa was the least reliable (κ-statistic, 0.53; 95% CI, 0.13–0.93; P < 0.001). Conclusion: Handheld POCUS findings were found to be reliable for detecting pre-specified urgent obstetric findings in a high-volume resource-limited referral hospital

Lung ultrasound for detection of pulmonary complications in critically ill obstetric patients in a resource-limited setting

Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15-28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7-14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome