The impact of pre-menarcheal training on menstrual practices and hygiene of Nigerian school girls

Background: The menstrual practices of adolescents derive largely from health issues associated with their adjustment to reproductive life. The objective of the study was to assess the effect of pre-menarcheal training on the menstrual and hygiene practices of Nigerian school girls. Methods: A cross-sectional questionnaire-based survey of randomly selected post-menarcheal school girls using a pre-tested, semi-structured questionnaire was done. Results: The mean age of the school girls was 14.9 ± 1.7 years. Pre-menarcheal training was given to 273 (55.2%) of them. Mothers (74.7%) were the more common source of information. Inappropriate experience of menarche, adverse effect of menstruation on schooling and social life and the use of unhygienic menstrual absorbents were common in girls who had no pre-menarcheal training than those who did. Conclusion: Lack of timely information results in inappropriate menstrual experiences and poor menstrual hygiene practices. Ways to promote menstrual education and hygiene practices are suggested

Complete utero vaginal prolapse in a woman with prolapsed submucous fibroid

Background: Uterine fibroids are benign tumors of the uterus and those located beneath the uterine mucosa may present as prolapsed fibroid in the vagina. Prolapsed submucous fibroid associated with complete uterovaginal prolapse is however uncommon. Case: A case of irreducible complete utero-vaginal and infected sub-mucous fibroid prolapse, in a 45-year-old grandmultiparous woman, is reported. Bed rest and antibiotics failed to relief edema and infection of the vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later resulted in a satisfactory outcome.Keywords: Fibroid, Interval vaginal hysterectomy, Utero‑vaginal prolapse, Vaginal myomectom

Abdominal Fascial Closure in Obstetrics: Comparison of Outcome Between Layer and Mass Closure *

Background: Midline laparotomies are in common use in obstetrics for caesarean section and other obstetric laparotomies. Current challenges in this surgical approach include the best approach to the repair of the abdominal wall incision, the optimal suture material for its fascial repair and poor cosmetic outcome of the scar.Objective: The study was to compare the outcome of layer and mass closure for midline abdominal incisions following caesarean section.Methodology: A randomized prospective study was carried out at the Colliery Hospital Enugu between 2001 and 2006. One hundred and six consenting parturients were randomized into layer (52) and massclosure (54) groups. Outcome measures were defined and the patients followed up at six weeks, 6 months and in the next pregnancy. Statistical analysis utilized Chi-square test and p-value of less than 0.05 was regarded as significant.Results: The mean age of the parturients was 30.0 ± 5.1 years and the majority of parturients were multiparous (65%). The average duration of surgery was significantly shorter in mass closure than layer closure (43.1 vs 53.4 minutes; p <0.001). There was no statistically significant difference in the duration of hospitalization between the two groups. The incidence of wound sepsis was higher in the mass closure than layer group (5.5% vs 1.9%) but intra-abdominal and peritoneal adhesions were commonerin the layer group. The only case of incisional hernia (1.5cm) was in the mass closure group.Conclusion: Mass closure reduces operative time, exposure to anaesthesia and is cost effective. It is recommended as a relatively safe method of abdominal fascial closure in caesarean section. Key Words: Abdominal Fascia, Suturing, Layered Closure, Mass Closur

Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu

Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.Results: There were 5298 deliveries within the study period, out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 } 5.9 years. Twenty.five (21.4%) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 } 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 } 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic mellitus (2.7%). Fifty.nine women (50.4%) had vaginal deliveries, 5 (4.3%) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3%) were delivered by caesarean section. Forty.eight (41%) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26, 95%CI:0.93.5.53) and those that had cephalic presentation of the leading twin, P = 0.0002 (OR = 4.7 95% CI:2.6.8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg, P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two.hundred and seventeen (92.7%) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3%) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6%) than those delivered vaginally (29.7%). Indications for admissions into the special baby care units were; prematurity 33 (40.2%), birth asphyxia 15 (18.3%), low birth weight 12 (14.6%), neonatal jaundice 10 (12.2%), and twin-twin transfusion 4 (4.9%). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4%) and twin 2 (11.9%) than those delivered by Caesarean section, 3.8 and 3.5%, respectively.Conclusion: Cephalic presentation of the leading twin, birth weight less than 2.5 kg, and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women.Keywords: Maternal and neonatal outcome, mode of delivery, twin pregnancyNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Perinatal outcome of preterm cesarean section in a resource-limited centre: A comparison between general anaesthesia and subarachnoid block

Background: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria.Objective: The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and subarachnoid block (SAB) with the aim to ascertain any difference in outcome between the two methods.Materials and Methods: Aretrospective observational study of consecutive preterm cesarean deliveries at the University of Nigeria Teaching Hospital from May 1999 to April 2008. Data entry and statistical analysis utilized the SPSS statistical package for the social sciences, 2008 version 15.0 for windows (SPSS Inc, Chicago IL, USA). Chi.square test was done to determine statistical significance and P . 0.05 were considered to be significant at 95% confidence interval. The delivery characteristics were compared by logistic regression analysis to ascertain any associated confounding effect on perinatal outcome in those exposed to either anesthetic technique.Results: There were 7568 deliveries and 1961 cesarean sections giving a cesarean section rate of 25.9%. A total of 236 cesarean sections were for preterm deliveries giving a preterm cesarean section rate of 3.1%. Of these, 151 women delivered under GA while SAB was used in 85 cases. The mean gestational ages for preterm cesarean sections were 33.2 ± 2.6 weeks and 33.8 ± 2.2 weeks for those who had GA and SAB respectively. The mean Apgar scores were 6.4 ± 3.1 and 7.6 ± 3.1 at 5 min for GA and SAB respectively. There were 24 stillbirths (15.9%) in cesarean deliveries done under GA and 7 stillbirths (8.2%) in women who had SAB (P = 0.09). Twenty-two (14.6%) babies delivered through GA and 14 (16.4%) delivered under SAB, died within 1 week of delivery (P = 0.7). There were more babies with low Apgar scores in parturient delivered under GA (P = 0.0004). More preterm babies delivered under SAB were discharged from the New Born Special Care Unit within 10 days of delivery (P = 0.006). Hypertensive disorders, though not statistically significant was the most common  indication for preterm cesarean delivery among those with GA and SAB. No maternal death occurred during the study period.Conclusion: The study infers a strong association between anesthetic technique and immediate Apgar scores and outcome of resuscitation following preterm cesarean section. This however, failed to translate into higher differences in perinatal mortality.Key words: General anesthesia, perinatal.outcome, preterm cesarean section, subarachnoid bloc

Percutaneous injuries and accidental blood exposure in surgical residents: Awareness and us of prophylaxis in relation to HIV

No Abstract

Vulvovaginal Candidiasis in Reproductive Age Women in Enugu Nigeria, Clinical versus Laboratory‑assisted Diagnosis

Background: Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low‑resource area may lead to overdiagnosis and treatment. Objective: The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical‑based diagnosis versus laboratory test supported diagnosis and patients’ characteristics that affect accuracy. Materials and Methods: This study surveyed patients seen in a gynecologic clinic for VVC using a semi‑structured, pretested, and interviewer‑administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P ≤ 0.05 were considered to be statistically significant. Results: The mean age of 209 women surveyed was 35.9 (standard deviation [SD] ±9.0) years. Their mean parity was 2 (SD ± 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty‑one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self‑reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis. Conclusion: Clinically based diagnosis of VVC has an unacceptably high false‑positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.Keywords: Candidiasis, clinical laboratory diagnosis, vulvovagina

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

BACKGROUND: Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. METHODS: The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. RESULTS: Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. CONCLUSIONS: Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction