eterminants of seizure occurrence in preeclampsia before commencing and during treatment with magnesium sulphate

Background: Eclampsia is considered as a consequence of severe preeclampsia, with magnesium sulphate regarded as gold standard in seizure treatment and prophylaxis. Convulsions have however been noted when criteria for severe preeclampsia were not met and in patients undergoing treatment with magnesium sulphate.Methods: A secondary analysis of data obtained from a prospective cross sectional study, involving assessment of clinical and biochemical markers of preeclampsia including magnesium in 75 patients with severe preeclampsia who were given magnesium sulphate using the Pritchard regimen.Results: Headache (p = 0.002), vomiting (p = 0.005) and prior occurrence of seizures before presentation (p = 0.001), were significant risk factors for occurrence of convulsions. In addition, serum magnesium levels were significantly lower (1.61±0.32 mg/dL) among patients who had seizures than in those who did not (2.01±0.25 mg/dL), (p<0.001). Systolic blood pressure (p = 0.22), diastolic blood pressure (p = 0.29), mean arterial blood pressure (p = 0.17) and proteinuria (p = 0.18) however did not determine the occurrence of seizures. Only 3/49 (6.1%) of the patients with severe hypertension (MAP≥125 mmHg) fitted, compared to 6/26 (23.1%) with mild hypertension (MAP<125mmHg) who convulsed (p = 0.04). Convulsion during treatment with MgS04 was associated with significantly lower levels of serum magnesium (4.04±0.5 mg/dL), than 4.63±0.5 mg/dL observed among patients with severe preeclampsia who did not convulse (p = 0.04).Conclusions: Headache, vomiting, prior convulsion and low serum magnesium levels preceded the occurrence of fits before treatment while, prior convulsion and low serum magnesium level consistently preceded the occurrence of fits during treatment of preeclampsia with magnesium sulphate

Contraceptive uptake among women attending family planning clinic in a Nigerian tertiary health facility: a 6 year review

Background: Contraceptive uptake is one of the most important determinants of pregnancy rates and birth rates in the world. Aim: To determine the principal trends in contraceptive use from 2004-2009 in the family planning unit of a tertiary health centre in South-Western Nigeria, and to identify the effect of age, marital status and parity on the choice of contraceptive method.Methods: The record of 1,862 clients attending the Family Planning unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun-State, Nigeria for the period between 2004-2009 were reviewed. Information related to the age, marital status, parity and the choice of contraception were obtained using a structured proforma and the data analyzed with SPSS version 16. Pearson chi-square test was used as test of significance where applicable.Results: Within the study period, the contraceptive uptake was 13.2%. Copper-T IUCD was the most commonly used method of contraception (77.9%), followed by the progestogen only injectable contraceptives (12.6%), then oral pills (4.1%) and progestin implants (2.3%). Single women and women of low parity are more likely to use pills than IUCD (69% vs. 38.3%) while long acting reversible contraception (injectables and IUCD) are preferred by women with higher parity (P=0.000).Conclusions: IUCD is the most popular method of contraception in Ife-Ijesha area of Nigeria. Contraceptive uptake is relatively low among the women. Age and parity are key influences on the uptake and choice of contraception practiced by the women, while the influence of marital status is not statistically significant

Is menarche really occurring earlier? A study of secondary school girls in Ile-Ife, Nigeria

Context: A secular trend of progressively earlier attainment of menarche has been described in various populations. The existence of this trend in Ile-Ife, Nigeria, has not been documented. Aim: To determine the current age of menarche and its trend in comparison with previous studies among secondary school girls in Ile-Ife, Nigeria. Settings and Design: School-based cross-sectional analytical study. Materials and Methods: Three-hundred secondary school girls in the lower four classes (JSS 1--SSS 1) were studied. Sociodemographic and menstrual data such as cycle length, duration of menstrual flow, and presence of dysmenorrhoea were obtained using a structured self-administered questionnaire. The mean age at menarche was compared with figures from previous local studies to determine the trend in Ile-Ife. Menstrual characteristics were also analyzed. Statistical Analysis: Data was analyzed with SPSS version 20. Means and standard deviations were generated for continuous variables, while frequencies and proportions were determined for categorical variables. Results: Out of the 300 subjects studied, a total of 198 (66%) had attained menarche at the time of this study. Their reported ages at menarche ranged from 11 to 17 years with a mean of 13.08 ± 1.61 years. This was lower than the 13.98 ± 1.30 and 13.94 ± 1.31 years reported in Ile-Ife in 1992 and 1997, respectively. These three figures show a trend of progressive decline in the mean age at menarche. The subjects' mean duration of menstrual flow was 4.26 ± 0.87 days, with 97.5% of them reporting flow of ≤5 days. Only 22 (11.1%) of the respondents had a cycle length of 28 days. Dysmenorrhoea was reported by 75% of the respondents and 24% reported loss of concentration during periods. Conclusion: Similar to the widely reported secular trend, menarche indeed appears to be occurring progressively earlier in Ile-Ife, Nigeria

THE BURDEN OF VESICO-VAGINAL FISTULA IN ILE-IFE, SOUTH WESTERN NIGERIA

Background: Vesicovaginal fistula is a major cause of severe morbidity and potential mortality, which can result in marital disruption, rejection, and eventual destitution. Methodology: A retrospective study of all cases of vesicovaginal fistula managed over a 30 year period between 1st January 1984 and 31st December 2013 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Relevant data were obtained from the case notes and analyzed for the demographics, clinical features, management and outcome using SPSS version 20. Result: There were 213 patients with vesicovaginal fistula over the period of the study with aprevalence of 3.9 per 1000 deliveries. The age range was 15-45 years with a mean age of 24.8 years. Most of them were primiparous, (52.1%) and of the low social class (84.5%). Obstetric fistula accounted for 93.9%. The majority of them (64.8%) did not have antenatal care during the antecedent pregnancy. Labor was attended by unskilled attendants in about 90% of them while 92% labored for at least 24hours. The juxta-cervical fistula was the most common anatomical type (47.0%). The overall success rate at repair was 76.4%. Stillbirth rate in the antecedent pregnancy was 67.5%. Other associated morbidities included chronic vulva excoriation, obstetric palsy, and secondary amenorrhea. Conclusion:Vesicovaginal fistula (VVF) is a major public health problem in developing countries with too many calamities as shown in this study. Improving the educational and economic status of women in Nigeria will go a long way in empowering them to access quality antenatal care. This will also enhance hospital delivery thereby preventing prolonged obstructed labor which is a strong etiological factor for VVF. Decentralization of treatment centers and training of specialists in fistula surgery is very important to improving treatment outcomes

Comparative study of proguanil and sulphadoxine–pyrimethamine in the prevention of malaria in pregnancy

Background: Intermittent preventive treatment of malaria in pregnancy with sulphadoxine–pyrimethamine (SP) is recommended for prevention of malaria in pregnancy. However, chemoprophylaxis with proguanil (PG) is being used in pregnancy for preventing malaria in selected cases. Objective: To compare the efficacy of daily PG and intermittent monthly SP in preventing malaria and its complications during pregnancy. Patients and Methods: This was a prospective comparative study conducted among 270 consenting pregnant women with parity ≤2 at gestational age of 18–24 weeks. Participants were enrolled and randomized to PG or SP group following a baseline hemoglobin estimation and blood film negative for malaria parasite. At 36 weeks of gestation, maternal blood sample was checked for hemoglobin concentration and malaria parasitaemia, and the infant birth weight was assessed at delivery. Statistical Analysis: Appropriate univariate, and bivariate analysis employed and level of significance set at P < 0.05. Results: One hundred and thirty-five participants in each group (246) completed the study. Ten (8.5%) had malaria parasitaemia in the PG group at 36 weeks compared to 15 (11.7%) in the SP group (P = 0.40); 5 (4.3%) in the PG compared with 6 in SP group (4.7%) had anemia (Hb <10 g/dl) at 36 weeks (P = 0.86). In addition, 6 (5.1%) participants in the PG group developed clinical malaria compared to 3 (2.3%) in the SP group (P = 0.25). The mean infant birth weight in the PG and SP groups were 3.05 kg and 3.00 kg, respectively (P = 0.24). Conclusion: PG and SP were comparable in efficacy and outcome for malaria prevention during pregnancy. IPT-SP is recommended for prevention of malaria in pregnancy. However, PG is beneficial in selected patients with known adverse reactions to sulphonamide

Suspected pulmonary embolism postcesarean section in a patient with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetically inherited kidney disease worldwide. It is however relatively underdiagnosed in Africans because its diagnosis is often incidental. During pregnancy, ADPKD is associated with increased risk of preeclampsia and venous thromboembolism. The case of a 33‑year‑old lady incidentally diagnosed with ADPKD during pregnancy is presented. She developed preeclampsia at term and had cesarean delivery of twins. She however suffered cardiopulmonary arrest postoperatively and this created a treatment dilemma because therapeutic anticoagulation which was the primary treatment for her suspected pulmonary embolism was absolutely contraindicated if the actual cause of her collapse was ruptured cerebral aneurysm which was also a feature of ADPKD. We decided to resuscitate aggressively and perform an urgent cranial computed tomography which ruled out intracranial hemorrhage. We then commenced anticoagulation and she made an excellent recovery. This case illustrates the importance of a timely multidisciplinary approach to patient management

Total laparoscopic hysterectomy: A case report from ILE‑IFE, Nigeria

Total laparoscopic hysterectomy (TLH) is an advanced gynecological laparoscopic procedure that is widely performed in the developed world. However, its feasibility in resource‑poor settings is hampered by obvious lack of equipments and/or skilled personnel. Indeed, TLH has never been reported from any Nigerian hospital. We present a 50‑year‑old multipara scheduled for hysterectomy on account of pre‑malignant disease of the cervix, who had TLH with bilateral salpingo‑oophorectomy in the Obafemi Awolowo University Teaching Hospitals Complex, Ile‑Ife, southwestern Nigeria and was discharged home on the first post‑operative day. She was seen in the gynecology clinic a week later in stable condition and she was highly pleased with the outcome of her surgery. This case is presented to highlight the attainability of operative gynecological laparoscopy, including advanced procedures like TLH in a resource‑constrained setting, through the employment of adequate local adaptation and clever improvisation.Keywords: Laparoscopy, endoscopy, hysterectomy, NigeriaNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201

Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial

Objective: Hyoscine butyl bromide (HBB) is known for its antispasmodic action and has been in use for over five decades, there is however no consensus on its effectiveness in the labor process. The aim of this study was to determine the effect of HBB on the duration of the active phase of labor. Materials and methods: A randomized double-blind placebo-controlled clinical trial involving 160 parturient who received either intravenous Hyoscine butyl-bromide (20 mg in 1 ml; n = 80) or intravenous normal saline (1 ml, n = 80). The mean duration of active phase of labor was compared between the two groups. Results: The observed mean duration of the active phase of labor was significantly shorter (P = 0.001) in the Hyoscine butyl-bromide group (365.11 ± 37.32 min, range = 280–490) than in the Placebo group (388.46 ± 51.65 min, range = 280–525). There was no significant difference between the two groups in the mean duration of the second and third stages of labor (20.46 ± 10.46 vs. 23.38 ± 18.95 min, P = 0.43 and 8.96 ± 4.34 vs. 9.23 ± 5.92 min, P = 0.75, respectively). The mean 1-min APGAR scores were also comparable (8.08 ± 1.54 vs. 7.64 ± 1.60, P = 0.08). The mean postpartum blood loss was significantly less in the Hyoscine butyl-bromide group (303 ± 96.52 vs. 368 ± 264.19 ml, P = 0.04). Conclusion: Hyoscine butyl-bromide was effective in shortening the duration of the active phase of labor. It was also associated with significantly less postpartum blood loss