Predictors of poor maternal and perinatal outcome among singleton maternal delivery referral cases to the obstetrics unit of a tertiary health facility in Port Harcourt, Nigeria

Background: The high maternal and perinatal mortality rates in Nigeria continue to be issues of concern. That antenatal care improves both perinatal and maternal outcomes is now well established. The study seeks to identify the predictors of poor maternal and perinatal outcome among singleton maternal delivery cases referred to Rivers State University Teaching Hospital (RSUTH).Methods: A longitudinal study was employed; the patients referred to RSUTH were followed up to ascertain maternal and neonatal outcomes. A sample size of 460 was used. Selection of cases was done by systematic sampling. Data obtained in the study were demographic, obstetric and perinatal findings. Maternal and perinatal outcome were dichotomized into poor and good outcomes. Bivariate and multivariate analyses were performed using SPSS version 20.0.Results: A total of 460 cases were recruited. The mean age±SD was 28.7±4.6 years. There was poor maternal outcome in 65 (14.1%) and poor perinatal outcome in 291 (63.3%). There was one maternal death (rate 0.2%), perinatal mortality rate was 26.5%, low birth-weight rate was 6.3% and asphyxia rate was 23.3%. There is an association of multiparity and unbooked status with poor maternal outcome, while poor perinatal outcome was influenced by unbooked status.Conclusions: Perinatal and maternal mortality were high amongst all referral cases. There is a positive correlation of multiparity with poor maternal outcome and between unbooked status and an increased risk of both maternal and perinatal adverse outcomes

Conservative management of single fetal death in a twin pregnancy

Intrauterine death of a single fetus in a twin pregnancy during the second or third trimester is an uncommon complication and poses management challenge to the obstetrician. It also causes psychological stress and concern for the patient and her partner. We report a case of single fetal demise in a twin pregnancy, managed conservatively with a favourable outcome. A 31 years old lady, Para 1+1, referred from a cottage hospital, at a gestational age of 27 weeks, on account of demise of the leading twin, made on ultrasonography, following complaint of reduction in fetal movement of one-week duration. The patient was counselled and admitted to hospital for close monitoring. However, at 33 weeks gestation, six weeks following admission, she went into spontaneous labour and was subsequently delivered vaginally of a dead female leading twin (papyraceus) and a live female second twin. They weighed 300g and 2100g respectively, with a diamniotic-dichorionic placentation. Mother and baby were discharged home in stable state. The primary concern for single fetal demise in a twin pregnancy is its effect on the surviving fetus and mother. Regular antenatal care and routine ultrasonography in pregnancy are needed to make a diagnosis. Close monitoring of the wellbeing of the surviving twin and coagulation profile of the mother are crucial to manage possible complications.  

Intravaginal misoprostol 100 µg for cervical ripening and induction of labour in nulliparous women with term pregnancy and unfavourable cervix: a case series report

Cervical ripening is a prerequisite for induction of labour in women adjudged to have an unfavourable cervix. Misoprostol administered intravaginally has previously been shown to be effective for cervical ripening and labour induction. It is often used in dosages of 25 µg or 50 µg in single or repeated dose regimen as per guidelines. Higher doses or shorter dosing intervals were reportedly associated with a higher incidence of side effects, especially uterine hyperstimulation syndrome. Studies and clinical experience have shown that 50 µg dose was not as effective in nulliparous women as it was in multiparous women, which implies that this dose might not be optimal for nulliparous women. We report a series of seven carefully selected patients in whom we used 100 µg of misoprostol intravaginally for cervical ripening and induction of labour at term. We achieved a short induction delivery interval, had good improvement in Bishop’s score, with less need for oxytocin augmentation and good safety parameters.

Modern contraceptives discontinuation, method switching and associated factors among clients at the family planning clinic of a tertiary hospital in Port-Harcourt, Nigeria

Background: Contraceptive discontinuation and switching to less effective methods, often leads to unintended pregnancies and reduces the impact of family planning programs. To understand what drives contraceptive use behavior, it is important to identify factors that influence discontinuation and switching. This study sought to determine the discontinuation rates, reasons for discontinuation or switching, and assess associated factors among women in Port Harcourt.Methods: A retrospective descriptive study, of women 15-48 years who accepted a modern method, over a five-year period from 1st January 2014 to 31st December 2018 was carried out. Information on age, parity, education, contraceptive use intention, method and duration of use, reason for discontinuation, and method switching, were extracted from their hospital records. Coded data were entered into Excel spreadsheet and exported to SPSS version 20 for statistical analysis at significance level of P<0.05.Results: There were 349 women with complete data. Their mean age was 32±56 years and median parity was 3. The all-method discontinuation rate was 29.0% at 12 months and 31.5% by 24 months. Method specific discontinuation at 12 months were injectables 53.3%, IUCD 38.2% and implants 23.8%, the difference was significant P=0.018. Reasons for discontinuation were reduced need-64.5%, method problems-26.8% and expiration-7.2%. Majority 79.7% abandoned further use, 6.5% renewed their method and 13.8% switched to other methods.Conclusions: The discontinuation rate was high, with associated poor switching behaviour. Proper counseling on contraceptive options and reinforcing switching are critical to reduce unwanted pregnancies that might result from poor method use and discontinuation

Prevalence and predictors of episiotomy and perineal tear at a tertiary hospital in Port-Harcourt, Nigeria

Background: Despite many years of it being practiced, episiotomy has remained a controversial operation. The rate is on the decline in developed countries but remains high in developing countries. This study seeks to determine the prevalence of episiotomy and perineal tear, and to assess the associated factors, at the Rivers state university teaching hospital (RSUTH).Methods: A retrospective study over a two-year period, from 01 January 2018 to 31 December 2019, was carried out. All women who had singleton spontaneous vaginal deliveries (SVD) with episiotomy or perineal tear at the RSUTH with complete records were included, those with twin delivery and incomplete data were excluded. Data was retrieved from the birth registers and case notes using a proforma. Information on maternal age, parity, gestational age (GA), type of injury, birth weight, head circumference and Apgar scores were extracted. Data were analyzed using statistical package for the social sciences (SPSS) version 20.Results: There were 2150 vaginal deliveries, with 440 (20.5%) receiving episiotomy, while 21 (1.0%) had perineal tear. The mean age±standard deviation (SD) was 29.52±4.97 years, median parity was 1, and mean GA±SD was 37.35±1.71 weeks. The mean birth weight±SD was 3.33±0.52 kg and mean head circumference±SD was 34.76±1.90 cm. There was significant association between maternal parity and fetal birth weight with the occurrence of episiotomy and perineal tears.Conclusions: The rate of episiotomy and perineal tear was higher than recommended, with an increasing trend. The lower the parity and the higher the fetal birth weight, the likelihood to receive an episiotomy. More efforts are needed to reduce the rate

Determinants of cervical cancer screening via Pap smear among female staff in a tertiary hospital in Niger-Delta of Nigeria

Background: Cervical cancer remains a leading cause of death among women in the developing world, with poor prognosis attributed to lack of awareness about the disease and its prevention. Hospital workers’ attitude and practice to such an issue might positively or negatively influence people they come into contact with. This study is to assess the determinants of cervical cancer screening via Pap smear among Female Staff in a Tertiary Hospital in Nigeria.Methods: A hospital-based cross-sectional study was conducted between September and November 2015. A structured self-administered questionnaire was used to collect data from 265 female hospital workers on socio-demographic characteristics (age, parity, educational level and occupational category) and awareness and utilization of Pap smear test. The data obtained were analyzed using SPSS version 20.0.Results: Of the 265 respondents, only 40 (15.1%) had Pap smear test done at least once previously. Bivariate analysis of socio-demographic factors and Pap smear test uptake among the respondents was statistically significant for younger maternal age ≤35 years, not being married, higher educational level, professional occupation category and awareness of Pap smear. However, only maternal age, marital status and awareness of Pap smear remain statistically significant after multivariate analysis.Conclusions: Uptake of Pap smear test as a screening test for cervical cancer is low among female hospital workers. Identified determinants of cervical cancer screening via Pap smear test were younger age ≤35 years, not being married, higher educational level, professional occupational category and awareness of Pap smear

Non-puerperal uterine inversion due to huge submucosal uterine myoma: a case report

Uterine inversion is a rare clinical entity with challenging diagnosis and management. Reports of successfully managed cases contribute to knowledge and aid future management of cases among practitioners. We report a case of a 46 year old para-3 with protrusion of a mass from her vagina and vaginal bleeding of 7 days duration. She was managed as a case of chronic uterine inversion. She was resuscitated and had vaginal myomectomy, Haultin’s procedure and subsequently total abdominal hysterectomy due to ischaemic necrosis of parts of the uterus.

Hysterectomy for primary gynaecological malignancies in a non-cancer centre: prevalence, indications and surgical outcomes at a tertiary hospital in Port-Harcourt, Nigeria: a six-year review

Background: Gynaecological malignancies continue to be an important public health problem globally and are among the leading causes of morbidity and cancer-related deaths worldwide. In developing countries there is poor awareness and late presentation, and specialized cancer treatment centers are few, necessitating the gynaecologists at the tertiary hospitals to render surgical care for some cancer patients. The objective of the study was to determine the prevalence, indications, and surgical outcome of hysterectomy for primary gynaecological malignancies and assess the associated factors.Methods: This was a retrospective review of hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on age, parity, indication, length of surgery, blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using Statistical package for social sciences (SPSS) version 20.Results: Of 1240 major gynaecological surgeries, 26 were hysterectomies for malignant conditions giving a prevalence of 2.1%. Commonest indication was Endometrial cancer 16 (61.5%), followed by cervical cancer 3 (11.5%) and ovarian malignancy 3 (11.5%). There was a significant relationship between age (p=0.027) with the indications for hysterectomy. Commonest complication was anaemia 6 (23.1%) and wound sepsis 5 (19.2%). Anaemia was significantly associated with duration of surgery (p=0.004) and estimated blood loss (p=0.005).Conclusions: The prevalence of 2.1% for a non-cancer center is a fair contribution to efforts at caring for cancer patients. All surgeries were simple TAH±BSO and more than half were done for endometrial cancer. Further training of cancer surgeons and establishment of a Cancer Centre in the State is needed

African traditional abdominal massage in pregnancy resulting in antepartum uterine rupture, abruptio placenta and foetal demise – a case report

The practice of abdominal massage dates to years ago and associated with foetal and maternal morbidity and mortality when undertaken by untrained traditional birth attendants in our setting. We present a 30-year old G3P2+0 with uterine rupture and intra-uterine foetal death following abdominal massage. She was resuscitated and had emergency exploratory laparotomy and repair of uterine rupture

Maternal and perinatal outcome in severe preeclampsia and eclampsia at the Rivers State university teaching hospital, Nigeria

Background: Severe preeclampsia and eclampsia remain a challenge in tropical obstetric practice. It is a major contributor to feto-maternal morbidity and mortality in developing countries. This study seeks to determine the prevalence, associated risk factors and the feto-maternal outcome of severe preeclampsia and eclampsia at the rivers state university teaching hospital (RSUTH).Method: A retrospective study of all women who had severe preeclampsia and eclampsia and were delivered at the RSUTH in a two-year period, 1ST January 2018 to 31ST December 2019, was carried out. Data on patients’ age, parity, education, booking status, gestational age at delivery, diagnosis, complications, mode of delivery and fetal sex, birth weight and Apgar scores were retrieved using structured pro-forma. Data were analyzed using SPSS version 20.Results: There were 4496 deliveries of which 128 had severe preeclampsia and eclampsia, giving a prevalence of 2.85%. Of these, 94 (73.4%) had severe preeclampsia and 34 (26.6%) had eclampsia. The mean age of the women ± SD was 29.84±5.44 years, median parity was para 1, and mean gestational age ± SD was 35.38±3.84 weeks. There were 10 maternal deaths giving case fatality of 7.8%. The mean birth weight ± SD was 2.61±0.91 kg and stillborn rate was 14.4%. There was significant association with maternal age, education, booking status, method of delivery and Apgar score of the baby.Conclusion: The prevalence in this study is high with associated high maternal mortality and stillborn rates. Timely and appropriate intervention including primary management and judicious termination of pregnancy will reduce mortality of mother and fetus