Prevalence and pregnancy outcomes in patients with antepartum haemorrhage in a tertiary hospital in Ibadan, Nigeria

Background: Antepartum haemorrhage (APH) as one of the major obstetric emergencies contributing greatly to maternal and fetal morbidity and mortality is of serious concern in the developing world. A retrospective analysis of the APH cases and evaluation of its impact on fetal and maternal outcomes was conducted.Methods: A retrospective study of cases managed between January 2013 and December 2014 at the University College Hospital Ibadan; all cases at a minimum of 28 weeks of gestation with antepartum bleeding were selected. Data was retrieved from the hospital records.Results: Around 5.8% prevalence rate of APH was documented during the study period with placental abruption and placenta praevia accounting for 46.8% and 39.2% of these cases respectively. Only 28.5% of cases were booked. Three-fifths of the women had anemia, 17.7% suffered hypovolemic shock, 33.9% also had primary PPH while 4 out of every 10 (39.8%) were transfused with blood. Seven out of every ten premature deliveries (prior to 34weeks gestation) were due to placental abruption with p value of <0.001. There were 2 maternal deaths (1%), 61 (31%) still births and 11 (5.6%) early neonatal deaths giving a perinatal mortality rate of 35.6%.Conclusions: Antepartum hemorrhage was associated with poor maternal and neonatal outcome in this study. There is need to improve on infrastructures, such as functional blood banks, appropriate antenatal care and referral system in our health facilities to be able to cope with increasing challenges of this obstetric hemorrhage

Effect of Pregnancy and Childbirth on Sexuality of Women in Ibadan, Nigeria

A study of 375 antenatal attendees to assess women's views and experience in sexual matters during pregnancy and following childbirth. Explanatory variables included the perception women had of sex during pregnancy and after childbirth. Outcome variables were frequency and satisfaction of sexual activity. The commonest reasons for having coitus in pregnancy were marital harmony and facilitation of delivery. Libido rose throughout pregnancy but orgasms were less often experienced. The man-on-top position became less practised. Vaginal intercourse remained the commonest type. Masturbation and anal intercourse increased, while oral sex declined throughout. Marriage (OR 9.0, 95% CI 1.0–79.5) and current cohabitation (OR 13.6, 95% CI 1.6–113.4) were predictors of sex in pregnancy. Dyspareunia and partners' extramarital affairs were deterrent. Vaginal delivery and episiotomy were not significant predictors of postnatal sex. The respondents and their partners seem able to adapt to pregnancy changes and enhance their marital bonds. Anticipatory guidance and informed counselling may encourage this

Female Genital Tuberculosis Among Infertile Women and Its Contributions to Primary and Secondary Infertility: A systematic review and meta-analysis

Female genital tuberculosis (FGTB) is an infectious widespread disease among young women. This meta-analysis study aimed to investigate the prevalence of Female Genital Tuberculosis among infertile women and its contribution to primary and secondary infertility. A PubMed, MEDLINE, world cat log, Lens.org, direct Google search, Google Scholar, and Researchgate, from 1971 to July 17, 2021, were searched using the keywords; prevalence, epidemiology, urogenital tuberculosis, FGTB, infertile women, infertility complaints, and FGTB testing methods. Data extracted and meta-analysis was performed. 42 studies were selected with a total of 30918 infertile women. Of these, the pooled prevalence of FGTB was 20% (15-25%; 95%CI; I2 99.94%), and the prevalence of overall infertility, primary infertility, and secondary infertility among FGTB-population were 88%, 66% and 34%, respectively. The proportion of FGTB is remarkable among infertile women globally. The biggest burden of the disease is presented in the low-income countries followed by the lower middle-income, and upper-middle-income countries

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]

Obstetric Performance of Nigerian Obese Parturients

Context: Obesity constitutes a health hazard and the greater the degree of obesity, the greater the health risks. This is especially so in obstetric practice where complications of pregnancy are reportedly greater in obese patients. Objectives: To determine the prevalence of obesity and to compare the outcome of pregnancy between obese and non-obese patients. Material and Methods: A review of the case records over a five-year period at a Nigerian teaching hospital to identify obese patients who delivered babies was done. Outcome of pregnancy in the 205 obese patients identified (using a weight of 90 kg and above as cut-off) was compared with 206 controls. Results: The incidence of obesity in pregnancy was 7.4%. The obese patients were older than the controls (

Pregnancy Outcome in Diabetic Patients at the University College Hospital, U.C.H., Ibadan

Context:Diabetes mellitus is one of the common medical complications in pregnancy, which if not properly controlled, can lead to significant perinatal and maternal morbidity and mortality. Objective:To determine the incidence of diabetes mellitus in pregnancy in this centre, and to assess the effect of maternal glucose control on the obstetric performance as well as perinatal outcome of pregnant diabetics managed at the University Collage Hospital, Ibadan. Study Design:A review of the obstetric outcome for 49 diabetic women who delivered at the University College Hospital, U.C.H, Ibadan, Nigeria during a 10-year period (January, 1991 to December 2000) is presented. Results:The incidence rate of diabetes in pregnancy was 0.74 per 1000 deliveries per year. Most patients (89.8%) booked for antenatal care and delivery in this centre. Good control was achieved in 77.6% of patients and the mean birth weight was 3.37 ± 1.52kg. There was no significant difference in the birth weight and fetal outcome if a patient had pre-existing or gestational diabetes. However, the outcome was significantly related to the level of control. With good control there was a better Apgar score at 5 minutes, which was prognostic for fetal outcome. The perinatal mortality rate was 98/1000 births and this was significantly associated with poor control when compared with good control (p < 0.05). There was no maternal death. Conclusion:Further improvement in the management is needed. Preconception control, early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome. Key Words: Gestation, Diabetes Mellitus, Perinatal Outcome [Trop J Obstet Gynaecol, 2003, 20: 52-55

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country's socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a two-day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer

Current Practice of Forceps and Vacuum Deliveries by Nigerian Obstetricians

Obstetricians should be competent and confident in the use of both the forceps and vacuum extractor to assist vaginal delivery. Objective : To asses the current practice of forceps and vacuum deliveries by Nigerian Obstetricians. Methodology: A self administered questionnaire survey of 57 Obstetricians that attended the 6th International Congress of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abuja in November 2002. Results: Most (94.7%) of the Obstetricians surveyed performed these deliveries. The vacuum extractor was used by slightly more Obstetricians (81.5% compared to 79.6% using the forceps). The mean number of forceps and vacuum deliveries performed annually were 17.44 + 16.84 and 9.30 + 10.16 respectively. Most of the respondents believed that these instruments have a place in modern Obstetric practice with more favouring the vacuum to the forceps (89.4 % compared to 77.2%). The most common severe maternal complication experienced by them from both instruments was perineal and lower genital lacerations, while scalp injuries and cephalohaematoma were the most common severe fetal complications from forceps and vacuum deliveries respectively. Maternal and fetal mortality occurred only with the forceps. Conclusion: Assistance with the birth process may be desirable and can be life saving and should always be available. Operative vaginal deliveries are an art that can safely and quickly deliver the fetus in skilled hands. Obstetricians should be trained in their use. Key Words: Forceps, Vacuum, Operative, Vaginal, Delivery, Obstetricians. [Trop J Obstet Gynaecol, 2004;21:40-43

Lived experiences and perspectives of women who had undergone perinatal loss in Nairobi county, Kenya: a qualitative study

Background This study explored the lived experiences and perspectives of women who had suffered a perinatal loss in Nairobi county, Kenya. Existing research works have established that perinatal loss often comes with a significant psychosocial burden, which has been made worse by negative cultural beliefs and practices. Despite this, perinatal loss grieving is rarely recognised or socially legitimated in many countries. This study aimed to shed light on the experiences of bereaved women to come up with effective interventions and combat the stigma associated with perinatal loss.Methods The study used a qualitative research design employing a descriptive phenomenological approach targeting women of reproductive age who had experienced perinatal loss within the previous 3 years. The study was conducted in three subcounties of Nairobi. Purposive sampling was used to identify and recruit 22 women to participate in focus group discussions. After the discussions, the audio recordings were transcribed, translated and analysed thematically. Triangulation was then done per thematic area to allow for a deeper understanding of the experiences and perceptions of the study participants.Results The research identified 3 themes and 7 subthemes: (1) ‘Psychosocial challenges of perinatal loss’ with five subthemes;—‘Emotional trauma and grief’, ‘Multiple losses and reproductive pressure’, ‘Broken relationships,’ ‘Violence and abuse’ and ‘Familial stigmatization’. (2) ‘Healthcare experiences.’ (3) ‘Stigma and cultural influences’ with 2 subthemes ‘Societal stigmatisation’, and ‘Cultural perceptions and norms surrounding perinatal loss’.Conclusion Women who have experienced perinatal loss often suffer psychological torture, discrimination, abuse, stigma and trauma. The findings from this study highlight the urgent need to set-up robust support systems to assist individuals coping with perinatal loss. This will require a range of interventions, including implementing trauma management programmes, training of healthcare workers, advocacy, sensitisation and establishing support networks to address discrimination and stigma faced by those affected