Factors Influencing The Use Of Episiotomy During Vaginal Delivery In South Eastern Nigeria

Background: Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries. Objective: To determine the prevalence of episiotomy at Aba in South Eastern Nigeria, examine factors influencing the performance of episiotomy and document complications associated with the procedure. Design: A hospital based retrospective study. Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria, from January 2001 to December 2005. Subjects: Four thousand, one hundred and seventy two mothers who delivered vaginally within the study period. Results: There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). When controlled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay. Conclusion: The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy. East African Medical Journla Vol. 85 (5) 2008: pp. 240-24

Pregnancy outcome in booked and unbooked mothers in Southeastern Nigeria

Background: In order for individual health institutions in Nigeria to contribute towards the achievement of the Millennium Development Goals (MDG) with regards to maternal health, there is need for research on the local causes of and factors influencing adverse maternal outcomes. This would enable care providers and policy makers appreciate the burden of the problem and know where to focus as they distribute resources.Objectives: To compare the socio-demographical characteristics, obstetrical complications and foetal outcome in booked verses unbooked mothers who delivered at this hospital.Design: A hospital based retrospective study.Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria.Subjects: Three thousand, seven hundred and thirty four mothers who delivered in the hospital between 1st January 2005 and 31st December 2007.Results: Unbooked mothers constituted 17.0% of the 3734 deliveries in the studied period. Compared to booked mothers, unbooked mothers were younger in age (28.2 ± 5.80 vs. 29.3 ± 6.04; p < 0.001) and had a lower educational status (

The Relationship between Tobacco Retailer Density and Neighborhood Demographics in Ohio

Introduction: Studies from various parts of the country suggest that tobacco-related health disparities are exacerbated by disparitiesin the distribution of tobacco retailers (convenience stores, tobacco shops, etc.). The purpose of the present study was to use advancedspatial modeling techniques for count data to estimate current disparities in tobacco retailer density in Ohio.Methods: We identified and geocoded 11,392 tobacco retailers in Ohio. Next, we obtained census tract-level information on race/ethnicity, poverty, and age and obtained county-level information on whether an area was Urban, Suburban, or Rural. Finally, we used negative binomial generalized linear models, adapted for residual spatial dependence, to determine the association between per capita tobacco retailer density and demographic characteristics—summarized by adjusted rate ratios.Results: There were more (from 1.4-1.9 times as many) retailers per capita in high-poverty vs. low-poverty tracts. Poverty also interacted with age: the association between high poverty and high retailer density was stronger for tracts with a low youth population. Density was also greater in tracts with a high (vs. low) prevalence of African Americans (1.1 times as many) and Hispanics (1.2 times as many). Finally, density was generally greater in rural (vs. suburban or urban) tracts, although the effect was modified by a three-way interaction: density was particularly high for rural tracts that also had both a high prevalence of poverty and a low youth population.Discussion: Overall, our findings indicate that Ohio’s vulnerable populations are exposed to a greater per capita density of tobaccoretailers. There is a need for state and local-level tobacco control policies that will improve equity and reduce health disparities

Rupture of the uterus in a primigravida: A case report

No Abstract

Características morfológicas, qualidade nutritiva e produção de metano de gramíneas tropicais no Brasil

O objetivo deste trabalho foi avaliar três espécies de gramíneas tropicais quanto à produção de metano (CH4) in vitro e à degradabilidade da matéria orgânica, para determinar as relações entre a qualidade nutritiva das gramíneas e a produção de CH4. O capim-colonião (Megathyrsus maximus), o capim-braquiarão (Urochloa brizantha) e o capim-decumbens (Urochloa decumbens) foram avaliados. O capim-braquiarão apresentou os maiores teores de matéria orgânica, fibra em detergente neutro, fibra em detergente ácido e lignina, e o menor teor de proteína bruta. O capim-decumbens apresentou os maiores teores de hemicelulose e de nitrogênio em fibra de detergente neutro, além do menor teor de celulose. O capim-colonião e o capim-decumbens apresentaram maior produção total de gases do que o braquiarão. Além disso, o capim-colonião apresentou maior produção de CH4, e o capim-braquiarão, menor degradabilidade verdadeira da matéria orgânica e reduzido fator de partição, em comparação ao capim-decumbens. Maior produção de CH4 foi verificada em casos em que os valores de hemicelulose e fator de partição foram menores. A qualidade nutricional e a produção de CH4 das forragens avaliadas podem ser utilizadas como parâmetros a serem empregados, que visem a sustentabilidade da produção de ruminantes.The objective of this work was to evaluate three tropical forage species for their in vitro methane (CH4) production and organic matter degradability, in order to determine the relationships between forage grass nutritive quality and CH4 production. Guinea grass (Megathyrsus maximus), palisade grass (Urochloa brizantha), and signal grass (Urochloa decumbens) were evaluated. Palisade grass showed the highest organic matter, neutral detergent fiber, acid detergent fiber, lignin, and lower-crude protein content. Signal grass had the highest values for hemicellulose and neutral detergent fiber-nitrogen, and the lowest-cellulose content. Guinea grass and signal grass showed a higher-total gas production than palisade grass. Besides, Guinea grass showed an increased CH4 production, and palisade grass showed lower value for truly degraded organic matter, and reduced partitioning factor, in comparison to signal grass. An increased CH4 production was observed in cases of lower hemicellulose and paratitioning factor. The nutritive value and CH4 production of forages may be employed as parameters, aiming at the sustainability of ruminant production

Learning curves for pediatric laparoscopy: how many operations are enough? The Amsterdam experience with laparoscopic pyloromyotomy

Few studies on the surgical outcomes of open (OP) versus laparoscopic pyloromyotomy (LP) in the treatment of hypertrophic pyloric stenosis have been published. The question arises as to how many laparoscopic procedures are required for a surgeon to pass the learning curve and which technique is best in terms of postoperative complications. This study aimed to evaluate and quantify the learning curve for the laparoscopic technique at the authors' center. A second goal of this study was to evaluate the pre- and postoperative data of OP versus LP for infantile hypertrophic pyloric stenosis. A retrospective analysis was performed for 229 patients with infantile hypertrophic pyloric stenosis. Between January 2002 and September 2008, 158 infants underwent OP and 71 infants had LP. The median operating time between the OP (33 min) and LP (40 min) groups was significantly different. The median hospital stay after surgery was 3 days for the OP patients and 2 days for the LP patients (p = 0.002). The postoperative complication rates were not significantly different between the OP (21.5%) and LP (21.1%) groups (p = 0.947). Complications were experienced by 31.5% of the first 35 LP patients. This rate decreased to 11.4% during the next 35 LP procedures (p = 0.041). Two perforations and three conversions occurred in the first LP group, compared with one perforation in the second LP group. The number of complications decreased significantly between the first and second groups of the LP patients, with the second group of LP patients quantifying the learning curve. Not only was the complication rate lower in the second LP group, but severe complications also were decreased. This indicates that the learning curve for LP in the current series involved 35 procedure

Abdominal Pregnancy: A Case Report And Review Of Literature

Abdominal pregnancy is a rare but potentially life – threatening form of extra uterine gestation. Diagnosis of abdominal pregnancy is difficult and often missed. A high index of suspicion is therefore required in makingthe diagnosis. This paper reports on a 22 year old nulliparous woman who presented with a 22 weeks secondary abdominal pregnancy. She had a laparotomy to remove the fetus and placenta. Her postoperativerecovery was uneventful.Key word – Abdominal pregnanc