Choice of contraception after previous operative delivery at a family planning clinic in Northern Nigeria

Context: Effective contraceptive use is important after a caesarean or operative delivery because of the possible risks a woman may face in subsequent pregnancies.Objectives: The objective of the present study was to determine the uptake and choices of contraception among women with previous operative delivery.Materials and Methods: A retrospective study was conducted at the Barau Dikko Teaching Hospital from 1st January, 2000 to 31st March, 2014. Family planning cards were retrieved, and relevant information was collected and analyzed using the Statistical Package for Social Sciences version 15. Chi‑square test was used as a test of association, with significance level established at a P value of < 0.05.Results: Of the 5992 cards retrieved, 164 (2.7%) had previous operative delivery; 152 caesarean sections and 12 laparotomies for ruptured uterus. Only 17.7% initiated contraception within 6 months. More women were spacers (86.6%) rather than limiters (13.4%). Age, education, religion, parity, prior contraception, and interval from the last delivery were significantly associated with the current choice of contraception (P < 0.05), whereas breast feeding status was not (P > 0.05). Overall, when comparing the pattern among those with a previous operative delivery and those without, there was no significant difference between both the groups; injectables was the most popular method chosen followed by intrauterine devices, oral contraceptive pills, and implants.Conclusion: Most women with a previous operative delivery were at risk of unwanted pregnancies because they did not initiate contraception within 6 months of their last delivery. Their preferred forms of contraception were injectables and intrauterine devices, which was not significantly different from the methods chosen by other women.Keywords: Contraception; family planning; northern Nigeria; previous caesarean; previous operative deliver

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Obstetrician/Gynaecologist and The National Health Insurance Scheme

The Decree establishing the National Health Insurance Scheme was promulgated in 1999; however, actual implementation commenced in 2002 and has remained at a rudimentary stage. This is despite the very laudable reasons for establishing the NHIS, to provide a financial lifeline to health care delivery in Nigeria. As stakeholders in the NHIS, obstetricians/gynaecologists have a very important role to play to ensure its successful implementation and sustenance. This is especially so in view of the unfavorable reproductive health indices in Nigeria, to which poverty is an important contributory factor. In this article, some background information on health insurance and the NHIS deemed relevant to the obstetrician/gynaecologist is given. Subsequently, the role expected of, and the benefits to be derived by the obstetrician/gynaecologist are presented. [Trop J Obstet Gynaecol, 2004; 21:172-176

Self medication with vaginal misoprostol in a term pregnancy: case report

The case of a woman with one previous Caesarean section, and severe pre-eclampsia at term, who self administered misoprostol by the vaginal route - without its being prescribed - in an attempt to avoid repeat caesarean section, is described. She eventually had vaginal delivery of a live female infant with cardiopulmonary depression; the delivery was not complicated by symptomatic uterine rupture. The potential for abuse of misoprostol, and the need to control distribution of the drug are discussed. Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 83-8

Choice of contraception after previous operative delivery at a family planning clinic in Northern Nigeria

Context: Effective contraceptive use is important after a caesarean or operative delivery because of the possible risks a woman may face in subsequent pregnancies. Objectives: The objective of the present study was to determine the uptake and choices of contraception among women with previous operative delivery. Materials and Methods: A retrospective study was conducted at the Barau Dikko Teaching Hospital from 1 st January, 2000 to 31 st March, 2014. Family planning cards were retrieved, and relevant information was collected and analyzed using the Statistical Package for Social Sciences version 15. Chi-square test was used as a test of association, with significance level established at a P value of < 0.05. Results: Of the 5992 cards retrieved, 164 (2.7%) had previous operative delivery; 152 caesarean sections and 12 laparotomies for ruptured uterus. Only 17.7% initiated contraception within 6 months. More women were spacers (86.6%) rather than limiters (13.4%). Age, education, religion, parity, prior contraception, and interval from the last delivery were significantly associated with the current choice of contraception (P 0.05). Overall, when comparing the pattern among those with a previous operative delivery and those without, there was no significant difference between both the groups; injectables was the most popular method chosen followed by intrauterine devices, oral contraceptive pills, and implants. Conclusion: Most women with a previous operative delivery were at risk of unwanted pregnancies because they did not initiate contraception within 6 months of their last delivery. Their preferred forms of contraception were injectables and intrauterine devices, which was not significantly different from the methods chosen by other women

Trend of modern contraceptive uptake and its predictors among women accessing family planning service in a tertiary hospital in Northwestern Nigeria, 2000–2014

Background: Client preference and availability of contraceptives are important determinants of uptake in developing countries. In this study, we investigated the trend of contraceptive uptake and factors associated with client choice among women accessing family planning services in an urban tertiary hospital in Northwestern Nigeria. Subjects and Methods: Time-trend analysis was performed on registry data of contraceptives dispensed between January 2000 and December 2014 at the family planning unit of Barau Dikko Specialist Hospital, Kaduna, Northwestern Nigeria. Five-year periods (2000–2004, 2005–2009, and 2010–2014) were identified, and the prevalence of contraceptive methods for each period is expressed as moving averages. Predictors of client choice were determined by logistic regression expressed as odds ratio [OR] (95% confidence interval [CI]). Results: A total of 5992 family planning consultations were made during the 15-year study period. Compared with the intermediate 5 years, there was a rise from 1723 (2000 to 2004) to 2128 (2005–2009) and a decline in the final 5 years to 1912 (2010–2014). Cumulatively, the most preferred contraceptive was injectables (40.7%). Women aged ≥35 years showed significant positive association with contraceptive uptake (OR 2.243, 95% CI = 1.489–3.380; P < 0.05) for injectables (OR 13.609, 95% CI = 6.317–29.318 and OR = 0.019, 95% CI = 0.012–0.030; P < 0.05) for oral contraceptive pills. Women who had completed secondary school or more had greater odds of using intrauterine contraceptive device or implants, OR 2.278, 95% CI = 1.869–2.776, P < 0.05 and OR 5.012, 95% CI = 2.346–10.79, P < 0.05, respectively. Conclusion: Injectable contraceptive was the most common method used. Women's age and educational attainment were the major factors influencing choice and uptake of modern contraceptives