Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime

Usefulness of Chlamydia serology in prediction of tubal factor infertility among infertile patients at Federal Medical Centre, Bida, North Central Nigeria

Background: Infertility is a major public health problem in developing countries where pelvic inflammatory disease due mainly to Chlamydia trachomatis and Neisseria gonorrhea infection have been implicated. The role of Chlamydia serology in predicting tubal factor infertility (TFI) has been demonstrated by many researchers elsewhere. However, there are limited data in our environment. This prospective cross-sectional study aims to determine the usefulness of Chlamydia Serology as a screening tool for TFI at Federal Medical Centre, Bida, North Central Nigeria.Methods: 125 women with infertility who met the inclusion criteria were enrolled into the study. Relevant information on their socio-demographic characteristics, gynaecological symptoms and risks factors for infertility were obtained. Participants had Hysterosalpingography (HSG) as part of their fertility work-up while 5ml of venous blood was withdrawn to check for Immunoglobulin G antibody to Chlamydia trachomatis using rapid test kits. The HSG findings were correlated with the result of Chlamydia serology. Data was analyzed using the computer software, Statistical Package for Social Science (SPSS) version 20. The level of significance (p value) was set at 0.05.Results: A total of 120 infertile women completed the study, 5 had incomplete investigations and were excluded from the analysis. The prevalence of TFI was 47.5%, while that of positive chlamydia serology was 36.5%. The prevalence of chlamydial seropositivity was 59.6% for patients with TFI but 15.9% for non-TFI. There was a significant association between positive chlamydia serology and TFI p< 0.05. The study revealed moderate sensitivity 59.6%, and negative predictive value 69.7% but high specificity 84.1% and positive predictive value of 77.2%. In this study the odds for diagnosing tubal infertility was 7.8.Conclusions: Chlamydia serology is useful in predicting TFI and should be incorporated in the routine work up for infertility

Unavailability of Essential Obstetric Care Services in a Local Government Area of South-West Nigeria

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal morta-lity in a local government area (LGA) of South-West Nigeria. The objectives were to determine the avail-ability of essential obstetric care (EOC) services in the LGA and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. Twenty-one of 26 health facilities surveyed were public facilities, and five were privately owned. None of the facilities met the criteria for a basic EOC facility, while only one private facility met the criteria for a comprehensive EOC facility. Three facilities employed a nurse and/or a midwife, while unskilled health attendants manned 46% of the facilities. No health worker in the LGA had ever been trained in lifesaving skills. There was a widespread lack of basic EOC equipment and supplies. The study concluded that there were major deficiencies in the supply side of obstetric care services in the LGA, and EOC was almost non-existent. This result has implications for interventions for the reduction of maternal mortality in the LGA and in Nigeria

Total laparoscopic hysterectomy: A case report from ILE‑IFE, Nigeria

Total laparoscopic hysterectomy (TLH) is an advanced gynecological laparoscopic procedure that is widely performed in the developed world. However, its feasibility in resource‑poor settings is hampered by obvious lack of equipments and/or skilled personnel. Indeed, TLH has never been reported from any Nigerian hospital. We present a 50‑year‑old multipara scheduled for hysterectomy on account of pre‑malignant disease of the cervix, who had TLH with bilateral salpingo‑oophorectomy in the Obafemi Awolowo University Teaching Hospitals Complex, Ile‑Ife, southwestern Nigeria and was discharged home on the first post‑operative day. She was seen in the gynecology clinic a week later in stable condition and she was highly pleased with the outcome of her surgery. This case is presented to highlight the attainability of operative gynecological laparoscopy, including advanced procedures like TLH in a resource‑constrained setting, through the employment of adequate local adaptation and clever improvisation.Keywords: Laparoscopy, endoscopy, hysterectomy, NigeriaNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201

Detection of indices of violence against women by health professionals in a Nigerian teaching hospital

Context: Violence against women (VAW) is the commonest form of violence existing in human race and is a major reproductive health issue of our time because of its many negative reproductive health consequences. Health care providers have important roles to play to build capacity of their employees to meet the challenges of diagnosing, managing and preventing this societal problem. This can be started by assessing their training needs. Objective: To determine the extent to which Health Professionals can recognize some indices that may suggest VAW. Design, Setting and Subjects: This is a descriptive study. Using a structural questionnaire a survey was done among a randomly selected Doctors, Nurses and Social Workers in OAUTHC, Ile-Ife in Osun State of Nigeria. Information on their socio demographic characters were obtained and they were also asked to identify the degree of association between a set of signs and symptoms in relation to violence against women. Results: Divorce/separation during pregnancy, alcohol and drug abuse in women, attempted suicide were the indices (with scores of 85.8% and 79.9% respectively) that would mostly prompt suspicion of VAW. About 31.1% of the respondents may not appropriately detect VAW. There is no significant difference in the ability with regard to sex, years of experience and the professional group. Conclusion: Health Professionals in OAUTHC will benefit from training and retraining programme on how to detect VAW. Similar baseline surveys are recommended for other Health Institutions as the first step in meeting this great challenge of the twenty-first century. Keywords: violence against women, suspicion indices, health professionals Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 27-3

A review of clinical experience with progesterone-only injectable contraceptives at OAUTHC, Ile-Ife

Background: Progestogen-only injectable contraceptives (POICs) remain the most popular contraceptive method in Nigeria. Considering how widely used POICs are worldwide, there is little published evidence of their safety and effectiveness. There is also a paucity of research to determine associations between the influence of age and parity and the preferred choice of POICs in women. Aim: This study was to determine the use prevalence and the influence of age and parity on the preferred choice of POIC, and also the reasons for discontinuation among users of POICs at the family planning clinics of OAUTHC, Ile-Ife. Materials and Methods: A retrospective record of 324 women who chose POICs out of a total of 1,029 clients seen at the family planning units of the hospital was collected for the period between January and December 2015. Information relevant to this study objectives was extracted using a purpose-designed proforma. Data were analyzed with SPSS version 16, and results were presented as frequencies and percentages. Pearson Chi-square test was used as test of significance where applicable and a P value < 0.05 was considered statistically significant. Results: The prevalence of POIC during the study period was 31.49%. Depo-Provera (depot medroxyprogesterone acetate [DMPA]) was the most popular injectable preferred by the women. Age and parity had significant effects on the preferred injectable contraception with P values of 0.032 (CI 0.088-0.099) and 0.002 (CI 0.009-0.013), respectively, as younger clients with lower parity preferred Noristerat while preference for DMPA increased with age and parity. Majority (67%) did not experience any side effect; secondary amenorrhea was the most common side effect experienced by 27% of the clients. Only 34% continued with the method for the duration of study while 66% discontinued for different reasons. Conclusion: POICs are very effective and safe long-acting reversible method of contraception. While DMPA may be the more popular overall choice, norethisterone enanthate (NET-EN) is preferable in younger women of low parity

The effect of an educational intervention programme on reproductive health: decision-making among couples in south west Nigeria

Context: Decision making process in reproductive health in Sub-Saharan Africa is a complex activity dictated by the customs, religious beliefs, socio-economic factors, and cultural innovations. The central role played by men in this process gives a strong justification for health education intervention with a primary focus on men. Objective: To find out how educational intervention programme will influence reproductive health decision making among couples. Study Design: This is a quasi-experimental study among couples in 3 towns in Osun State (Ode-Omu, Ejigbo and Otan-Ayegbaju) of Nigeria. Ode-Omu and Ejigbo served as the intervention towns while Otan-Ayegbaju served as the control. The study had 3 phases: baseline survey lasting 3 months, intervention phase of 12 months and postintervention period of 3 months. Interventions: Imparting information and educating members of the community on issues related to reproductive health with emphasis on the role of men using posters, handbills, public lectures, workshops and films. Main Outcome Measures: Decision making on and timing of pregnancy, seeking of post-abortion care, and husbands' support of wives during pregnancy. Results: After the intervention, more couples took joint decisions on timing of pregnancies; more husbands supported their wives during pregnancy and seeking of post-abortion care increased significantly in the intervention towns. Conclusion: Enlightenment of men is a faster and effective short-term measure to improve women's utilization of reproductive health resources. Keywords: men's role, reproductive health, decision-making Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 4-

THE BURDEN OF VESICO-VAGINAL FISTULA IN ILE-IFE, SOUTH WESTERN NIGERIA

Background: Vesicovaginal fistula is a major cause of severe morbidity and potential mortality, which can result in marital disruption, rejection, and eventual destitution. Methodology: A retrospective study of all cases of vesicovaginal fistula managed over a 30 year period between 1st January 1984 and 31st December 2013 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Relevant data were obtained from the case notes and analyzed for the demographics, clinical features, management and outcome using SPSS version 20. Result: There were 213 patients with vesicovaginal fistula over the period of the study with aprevalence of 3.9 per 1000 deliveries. The age range was 15-45 years with a mean age of 24.8 years. Most of them were primiparous, (52.1%) and of the low social class (84.5%). Obstetric fistula accounted for 93.9%. The majority of them (64.8%) did not have antenatal care during the antecedent pregnancy. Labor was attended by unskilled attendants in about 90% of them while 92% labored for at least 24hours. The juxta-cervical fistula was the most common anatomical type (47.0%). The overall success rate at repair was 76.4%. Stillbirth rate in the antecedent pregnancy was 67.5%. Other associated morbidities included chronic vulva excoriation, obstetric palsy, and secondary amenorrhea. Conclusion:Vesicovaginal fistula (VVF) is a major public health problem in developing countries with too many calamities as shown in this study. Improving the educational and economic status of women in Nigeria will go a long way in empowering them to access quality antenatal care. This will also enhance hospital delivery thereby preventing prolonged obstructed labor which is a strong etiological factor for VVF. Decentralization of treatment centers and training of specialists in fistula surgery is very important to improving treatment outcomes

Badanie porównawcze wytrzymałości mięśni brzucha u kobiet nierodzących i kobiet po porodzie

Background: Normative databases on abdominal muscles performance in women are essential in the diagnosis of musculoskeletal impairment and as reference values for post-partum rehabilitation targets. This study quantified and investigated the predictors of the static and dynamic abdominal muscles endurance of nulliparous and parous women.Methods: Two hundred and fifty five consenting volunteers (131 nulliparous and 124 parous women) participated in this study. Partial curl-up test of the Canadian Standardized Test of Fitness was used to assess Static Abdominal Muscles Endurance (SAME) and Dynamic Abdominal Muscles Endurance (DAME) respectively. Demographic and anthropometric data were also obtained. Data were analyzed using descriptive and inferential statistics. The Alpha level was set at 0.05.Results: The mean SAME and DAME of all the participants were 33.90 ±20.78 seconds and 16.26 ±8.76 repetitions respectively. Nulliparous women exhibited significantly higher mean SAME (42.71 ±22.59 vs. 24.59 ±13.50 seconds) and DAME (19.45 ±8.96 vs. 12.88 ±1.17) (p=0.001) values respectively. Both SAME and DAME values differed significantly (p&lt;0.05) across the parous group. The primiparae had higher SAME and DAME values than their multiparae counterparts (p&lt;0.05). A significant correlation existed between SAME and DAME (p=0.001). Age, number of births and anthropometric parameters were significant predictors of SAME and DAME (p&lt;0.05).Conclusion: This study established a set of reference mean values for static and dynamic abdominal muscles endurance in nulliparous and parous women. Parity was associated with a significant decrease in the static and dynamic abdominal muscles endurance capacity. Age, high level of adiposity and the number of births were significant predictors of decreased abdominal muscles endurance. It is adduced that decreased abdominal muscles endurance in women may be precipitated and perpetuated by parity.Wprowadzenie: Wartości normatywne siły mięśni brzucha u kobiet są istotne zarówno w diagnostyce zaburzeń mięśniowoszkieletowych, jak i stanowią punkt odniesienia w ustalaniu celów rehabilitacji po porodzie. Niniejsze badanie określa wielkość oraz analizuje predyktory statycznej i dynamicznej wytrzymałości mięśni brzucha u kobiet nierodzących i rodzących. Metody: W badaniu wzięło udział dwieście pięćdziesiąt pięć kobiet (131 nierodzących i 124 rodzących). W celu oceny statycznej i dynamicznej wytrzymałości mięśni brzucha (ang. Static Abdominal Muscles Endurance, SAME; Dynamic Abdominal Muscles Endurance, DAME) wykorzystano test Partial Curl-Up Test (test częściowego unoszenia tułowia wykonywany w pozycji leżenia tyłem o nogach ugiętych) będący składową testu sprawności Canadian Standardized Test of Fitness. Od badanych uzyskano także dane demograficzne i antropometryczne. Do analizy danych wykorzystano statystyki opisowe oraz dedukcyjne. Wartość alfa ustalono na poziomie 0,05. Wyniki: Średnie wyniki SAME i DAME wszystkich uczestniczek wynosiły odpowiednio 33,90 ±20,78 sekund i 16,26 ±8,76 powtórzeń. Kobiety nierodzące odznaczały się znamiennie wyższą średnią wartością pomiarów SAME (42,71 ±22,59 vs. 24,59 ±13,50 sekund) oraz DAME (19,45 ±8,96 vs. 12,88 ±1,17) (p=0,001). Wartości pomiarów SAME i DAME także różniły się znamiennie (p<0,05) w obrębie samej grupy kobiet rodzących. Kobiety, które urodziły 1 dziecko odznaczały się wyższymi wartościami pomiarów SAME i DAME niż te, które rodziły więcej razy (p<0,05). Stwierdzono znamienną korelację pomiędzy wartościami pomiarów SAME i DAME (p=0.001). Wiek, ilość porodów oraz zmienne antropometryczne okazały się być znamiennymi predyktorami wartości SAME i DAME (p<0,05). Podsumowanie: Wyniki niniejszego badania pozwalają na stworzenie zestawienia referencyjnych wartości średnich wytrzymałości statycznej i dynamicznej mięśni brzucha u kobiet rodzących i nierodzących. Ciąża wpływa znamiennie zarówno na spadek wytrzymałości statycznej, jak i dynamicznej mięśni brzucha. Wiek, otyłość i liczba porodów są ważnymi predyktorami spadku wytrzymałości mięśni brzucha. Wskazuje się, że zmniejszenie wytrzymałości mięśni brzucha może być wywoływane i utrwalane przez macierzyństwo