5‑year retrospective review of instrumental vaginal deliveries in Uyo, Akwa Ibom State, Nigeria

Context: Instrumental vaginal deliveries are deliveries conducted using obstetric forceps or vacuum extractor and are an essential component of basic emergency obstetric care.Objective: To determine the rate of instrumental deliveries and their outcome over a 5‑year period (2013–2017) at the University of Uyo Teaching Hospital.Study Design and Methods: A 5‑year retrospective review of maternity delivery records. A survey of 16 resident doctors of the department was also done to determine their views on the rate of instrumental deliveries in the hospital.Results: During the study period, there were 6,754 deliveries; of these 109 (1.61%) were instrumental deliveries. Vacuum extractions accounted for 97 (88.99%) of the instrumental deliveries and there were only 12 (11.01%) forceps deliveries. The majority of the instrumental deliveries were carried out on booked women (78; 82.98%), with low parity (Para 1; 73.83%), term mothers (59.4%), and normal birth weight babies. There were only five stillbirths (4.59%), all of which were vacuum extractions and were comparable to 4.5% among spontaneous vertex deliveries and less than 6.2% among caesarean sections and 45.5% among breech deliveries. This was statistically significant, χ2 = 114.03, P < 0.001. Most of the resident doctors cited lack of proper training as responsible for low rate of instrumental deliveries.Conclusion: The rate of instrumental vaginal deliveries in the University of Uyo Teaching Hospital is low with adverse consequences on the training of resident doctors. There is thus need to prioritize training on this life‑saving skills.Keywords: Instrumental vaginal deliveries; neonatal outcome; trends; Uy

Attitude of antenatal attendees to people living with HIV/AIDS in Uyo, south-south Nigeria

Background: Stigmatization and discrimination of people living with HIV/AIDS has a negative impact on the global efforts to control the HIV/AIDS pandemic. Due to fear of stigmatization and discrimination, many people are reluctant to undergo voluntary counseling and testing, infected individuals are often unwilling to disclose their status and some of them still engage in high-risk behaviours leading to increased transmission of the virus. Study design and setting: A study of the attitudes to people living with HIV/AIDS was carried out among antenatal clinic attendees at the University of Uyo Teaching Hospital with the aim of developing site-specific information and counseling interventions to reduce stigmatization and discrimination of people living with HIV/AIDS. Information was elicited from 265 randomly selected women who booked for antenatal care between September and December 2005 with the use of a self-administered questionnaire. Results: 263 questionnaires were duly completed and analyzed. The mean age of the respondents was 27 ± 5.1 years, majority of them (52.1%) were either unemployed or unskilled workers and 42.9% of them had tertiary education. Awareness and knowledge of HIV/AIDS was high, (95.8%) and (86.7%) respectively. Majority of the respondents (55.6%) were also assessed as having a positive attitude to people living with HIV/AIDS (PLWHA). There was a statistically significant association between good knowledge of HIV/AIDS and a positive attitude to PLWHA (P=0.000) and a high educational status with a positive attitude to PLWHA (P=0.009). Conclusion: combating stigma and discrimination is an important process in controlling the epidemic. Specific information and counseling interventions aimed at dispelling misconceptions about HIV/AIDS should be reinforced

Factors contributing to uterine rupture in women having vaginal births after caesarean section

Context: Ruptured gravid uterus is a common occurrence in our environment with higher risk in scarred uterus. Some women will attempt vaginal delivery at home after a caesarean section had been performed for cephalopelvic disproportion. Objective: To evaluate the various reasons put forward by our women for attempting vaginal delivery at home despite previous caesarean section. Subjects and Methods: Patients with ruptured gravid uterus during labour with history of previous caesarean section were studied using structured interview formats. Their demographic characteristics, social class, booking status, place of attempted vaginal delivery and various reasons for seeking unorthodox care. Close relative of patients were interviewed in unconscious or moribund patients. Results: Some 24(96.0%) of the patient had no antenatal care in the index pregnancy and had laboured in spiritual churches or in traditional birth attendants homes. Ninteen (76.0%) were of low social class. Various reasons for attempting vaginal delivery at TBA's or spiritual churches included lack of funds 9(37.5%) husbands or close relative not available to take decision for hospital delivery 6(25.0%), not appreciating the need for hospital delivery 3(12.5%) and no reason 1(4.2%). There were 12 maternal deaths giving a case fatality rate of 48%. Conclusion: The study shows socio economic factors, dependency on family decisions and belief in supernatural powers as major reasons our women chose unorthodox delivery despite prior caesarean section and recommend ways of preventing it.Keywords: vaginal birth after caesarean section, uterine rupture Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 177-17

Outcome of twin pregnancy in Calabar, Nigeria

A ten year retrospective study (between January 1989 to December 1998) to determine the incidence, pregnancy complication and outcome of twin births at the University of Calabar Teaching Hospital was carried out. There were 342 twin births out of 12,877 deliveries giving a twin delivery incidence of 26.5/1000 births. The highest twining rate was found in women aged 25 to 29 years (33.5%) and para 2 mothers (23.5%). The main complications encountered were preterm labour (41.2%), pregnancy induced hypertension (11.1%), hyperemesis gravidarum (8.7%) and anaemia (6.8%). The caesarean section rate was 26%. The perinatal mortality rate was 100.6 per 1,000 births and the main cause of perinatal mortality was prematurity. To reduce the associated high maternal morbidity and perinatal mortality, early booking and improvement in existing neonatal facilities are recommended. (Global Journal of Medical Science, 2004, 3 (1&2): 13-15

Prevalence of Anaemia among Pregnant Women at Booking in the University of Uyo Teaching Hospital, Uyo, Nigeria

Background. Anaemia with an estimated prevalence of 35–75% among pregnant women is a major cause of maternal deaths in Nigeria. Objective. To determine the prevalence of anaemia, associated sociodemographic factors and red cell morphological pattern among pregnant women during booking at the University Teaching Hospital, Uyo. Material and Methods. A cross-sectional analytical study of 400 women at the booking clinic over a 16-week period. The packed cell volume and red cell morphology of each pregnant woman were determined. Their biodata, obstetric and medical histories, and results of other routine investigations were obtained with questionnaires and analyzed with SPSS Package version 17.0. Results. The mean packed cell volume was 31.8% ±3.2 and 54.5% of the women were anaemic. The commonest blood picture was microcytic hypochromia and normocytic hypochromia suggesting iron deficiency anaemia. Anaemia was significantly and independently related to a history of fever in the index pregnancy (OR=0.4; P=0.00; 95% CI=0.3–0.7), HIV positive status (OR=0.2; P=0.01; 95% CI=0.1–0.6), and low social class (OR=0.3; P=0.00; 95% CI=0.2–0.7). Conclusion. Women need to be economically empowered and every pregnant woman should be encouraged to obtain antenatal care, where haematinics supplementation can be given and appropriate investigations and treatment of causes of fever and management of HIV can be instituted

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation