Significant Bacteriuria Among Asymptomatic Antenatal Clinic Attendees In Ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria

Genetic counseling and testing for gynecological cancers: Perception of female undergraduates of universities in Ibadan, Nigeria

Introduction: Genetic education and counseling give individuals an opportunity to make informed choices related to risks, benefits, and limitations of genetic testing for social and medical purposes. We aimed to assess the perception of female undergraduates of universities in Ibadan to genetic counseling and testing (GCT) for gynecological cancers and their willingness to participate in the twin procedure. Materials and Methods: This was a cross-sectional study involving consented female students from the two universities within Ibadan metropolis – University of Ibadan and Lead City University, Ibadan. Using a self-administered, semi-structured questionnaire, information on their understanding of GCT, perception of implications, and willingness to participate in the procedure were obtained. Results: There were 943 respondents with mean age of 20.0 ± 3.4 years, 908 (96.3%) had ever heard of cancers, but only 252 (26.7%) provided proper definition. Overall, 484 (51.3%) were aware of GCT although three-quarters, 712 (75.5%), wished to know their inheritable risk of developing gynecologic cancer. All the respondents were willing to participate in the counseling procedure, but only 815 (86.4%) would be willing to proceed with testing if indicated. Possible surgical intervention reduced willingness to test from 82.3% to 45.7%. Conclusion: The female undergraduates of universities in Ibadan were willing to partake in GCT provided there are no surgical interventions. There is a need for an increased awareness and encouragement of GCT for at-risk groups and also in the prevention and/or early detection to reduce the burden of familial gynecologic cancers

The influence of health-seeking behavior on the incidence and perinatal outcome of umbilical cord prolapse in Nigeria

Christopher A Enakpene1, Akin-Tunde O Odukogbe3, Imran O Morhason-Bello2, Akinyinka O Omigbodun3, Ayo O Arowojolu31SUNY Downstate Medical Center, Brooklyn, New York, USA; 2Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria; 3Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Nigeria and University College Hospital, Ibadan, NigeriaObjectives: To determine the influence of health-seeking behavior of urban women in ­South-West Nigeria on the incidence and perinatal outcome of umbilical cord prolapse (UCP).Methods: A retrospective study comparing two groups of urban women using information extracted from medical records of patients who had UCP, and were managed at the University College Hospital Ibadan, Nigeria from January1st 1995 to December 31st 2005. The data was analyzed using SPSS software (version 15). Analysis included simple tabulation, proportion and comparison of incidence, perinatal morbidity, and mortality of UCP between the two groups of women using Chi-square or Fisher’s exact test. Odds ratio (OR) and 95% confidence intervals (CI) were calculated whenever necessary. P-value of 0.05 or less was statistically significant.Results: Women without prenatal care were more likely to have fetuses with UCP (54, 75%), than in women who had prenatal care (18, 25%). The risk of perinatal death from UCP was higher in women without prenatal care, as compared with those who received prenatal care (OR 3.02, 95% CI: 0.879 to 10.356; P-value = 0.061). The risk of perinatal morbidity and neonatal intensive care admission was also higher among women without prenatal care as compared with women who received prenatal care (OR 4.09, 95% CI: 1.03 to 16.30; P-value = 0.041). The overall perinatal mortality rate in the study population was 403 per 1000 total births, and this was five times more than that of the hospital perinatal mortality rate of 80 per 1000 total births during the study period. The perinatal mortality rate was higher among women without prenatal care, 463 per 1000 total births, as compared with 222 per 1000 total births in women who received prenatal care. Perinatal death before arrival at the hospital is less likely to occur in women with prenatal care when compared with women without prenatal care (OR 0.0635; 95% CI: 0.0052 to 0.776; P-value = 0.03).Conclusion: A high index of suspicion and an identification of risk factors, with early diagnosis, prompt intervention, and provision of health care facilities can reduce the incidence and poor outcome of UCP in developing countries.Keywords: prenatal care, incidence, apgar scores, perinatal morbidity, perinatal mortalit

Hypoxaemia During Gynaecological Laparoscopy Under Local Anaesthesia and Sedation

Context: Laparoscopy is a procedure with significant potential for hypoxaemia due to the respiratory changes accompanying pneumoperitoneum and the Trendelenberg position used. Hypoxaemia may be critical when the procedure is conducted under local anaesthesia and conscious sedation. Objective: The aim of this study was to determine the extent to which hypoxaemic episodes occurred during gynaecological laparoscopy performed under conscious sedation. Study Design, Setting and Subjects: This was a cross-sectional study of consecutive patients undergoing investigative laparoscopy at the University College Hospital, Ibadan. Informed consent was obtained from patients and they were prepared for the procedure on a day-care basis. The demographic data and vital signs were recorded. Pentazocine (60 mg) and diazepam (10 mg) were administered intravenously. Main Outcome Measures: The respiratory rate, pulse rate, blood pressure and oxygen saturation were measured pre-, intra-, and post-operatively. Results: Thirty-two patients were recruited into the study. They had no intercurrent medical diseases. Mean age was 33 years (SD 4.2) and mean Body Mass Index (BMI) was 24.49 (SD 2.87). Oxygen saturation was normal in every patient pre-sedation. Post sedation, 19 (54%) of the patients desaturated in the period before surgical stimulation. Oxygen saturation remained between 90% and 95% in 6 (19 %) patients intraoperatively. There were no postoperative episodes of desaturation. There was no correlation between the BMI and the degree of desaturation. Conclusion: A significant degree of desaturation occurs during gynaecologic laparoscopy under pentazocine and diazepam sedation. It is recommended that oxygen should be administered to all patients during the procedure. Key Words: Gynaecological Laparoscopy, Sedation, Hypoxaemia. [Trop J Obstet Gynaecol, 2002, 19: 4-7]

Prevalence of Hypertension at Antenatal Booking and Delivery in Ibadan

Context: Hypertension is the second commonest medical condition in pregnancy and it occurs in up to 10% of all pregnancies. It is responsible for several cardiovascular events and accounts for about 12% of all maternal deaths, which is about 1500 per 100, 000 livebirths in Nigeria. Objectives: We assessed the prevalence of hypertension at antenatal booking and delivery among pregnant patients at the University College Hospital, Ibadan, Nigeria in other to evolve a special management plan for the control of this disease among them. Methods: Pregnant subjects attending the antenatal clinic of the University College Hospital, Ibadan were recruited consecutively into the study. They had repeated blood pressure measurements and were followed up from antenatal clinic registration till delivery. Results: Four hundred and nine pregnant subjects were examined and recruited into the study at booking, but only 187 of them completed the study and delivered at UCH. The frequency of hypertension at booking was 9.8%, rising to 26.2% at delivery, a statistically significant difference (&#967;2 = 27.25; p < 0.001). The mean SBP (127.1 ± 19.9mmHg) and DBP (80.5 ± 13.0mmHg) after delivery among the subjects were significantly higher than at booking (SBP, 114.2 ± 2.1mmHg & DBP, 73.4 ± 24mmHg; p < 0.001) Conclusion: Prevalence of hypertension as well as the mean SBP and DBP were significantly higher post partum than at booking among the subjects. Previous personal and family history of hypertension were strong determinants of hypertension in pregnancy in them. There was no correlation between parity and level of blood pressure. Key Words: Blood Pressure, Hypertension, Pregnancy, Antenatal [Trop J Obstet Gynaecol, 2003, 20: 49-51

Comparative effectiveness of 50g glucose challenge test and risk factor based screening in detection of gestational diabetes mellitus in Ibadan, Nigeria.

Context: Gestational diabeles mellitus (GDM) complicates 3- 5% of pregnancies. Prompt diagnosis helps to prevent its subsequent complications and one-step effective screening method is desirable for our environment.Objective: To compare the effectiveness of 50g glucose challenge test (GCT) with risk factors alone in screening for GDM.Study Design: Prospective study of booked, consenting pregnant women with no previous history of diabetes mellitus.Fasting sample ofvenous blood was obtained for plasma glucose, followed by administration of 50g oral glucose and collection of blood sample an hour later. The process was repeatedafter a week using 75g oral glucose; each patient serving as her own control. Threshold blood glucose of 140mg/dl was used for both post-ingestion tests. Statistical analysis was done using SPSS version 17.Results: All the seventy-nine study participants completed the 2 arms.Mean maternal and gestational ages at recruitment were 30.8+1.2 years and 24.2+1.6 weeks respectively.Among the respondent, 35( 44.3%)were nulliparous while24(30.3%) had positiverisk factors for GDM. The 50g GCT was abnormal in 10 patients (12.7%) while GDM was confirmed in 2 patients giving an incidence rate of 2.5%. The 50g GCT was normal in 89.6% of women with normal 75g OGTT and it was more predictive ofGDM (Positive Predictive Value, PPV - 20%) compared to risk factors only (PPV- 11.1%).Conclusion: Using 50g GCT will enhance selection of patients for confirmatory test for GDM as compared to risk factorsalone. It would therefore be of great benefit in this environment.Keywords: 50g Glucose Challenge Test, Gestational Diabetes Mellitus, Screenin

Medical students’ choices of specialty in The Gambia: the need for career counseling

<p>Abstract</p> <p>Background</p> <p>Understanding preferences for specialties by medical students and the factors driving choices assists policy makers in ensuring optimal spread of personnel across disciplines.</p> <p>Methods</p> <p>This cross-sectional survey using self-administered structured questionnaires was conducted on consenting students of the first medical school in The Gambia, established in 1999. Data collection was in June/July 2011. Questions were on sociodemographic characteristics of students, their parents, factors related to career preferences and opinions about counseling services. Data were analysed using JMP 8.0 software.</p> <p>Results</p> <p>Respondents were 52.4% of 202 eligible students. Mean age was 24.1 ± 5.0 years. Females constituted 54.7%. Muslims were 72.7% while Gambians formed 77.0%. Commonest specialties chosen by females were Obstetrics/Gynaecology, Paediatrics and Surgery in that order, while males preferred Internal Medicine, Surgery and Obstetrics/Gynaecology. Commonest factors influencing choices by females were ‘focus on urgent care’ (65.5%) and ‘intellectual content of specialty’ (56.9%). For males, these were ‘intellectual content of specialty’ (60.4%) and ‘focus on urgent care’ / ‘individual’s competence’ (50.0% each). More females (30.0%) than males (23.0%) had ever received career counseling, but all students desired it.</p> <p>Conclusions</p> <p>Significant gender differences exist in specialty choices and factors influencing these choices amongst these students. All want career counseling.</p