Prevalence and pregnancy outcomes in patients with antepartum haemorrhage in a tertiary hospital in Ibadan, Nigeria

Background: Antepartum haemorrhage (APH) as one of the major obstetric emergencies contributing greatly to maternal and fetal morbidity and mortality is of serious concern in the developing world. A retrospective analysis of the APH cases and evaluation of its impact on fetal and maternal outcomes was conducted.Methods: A retrospective study of cases managed between January 2013 and December 2014 at the University College Hospital Ibadan; all cases at a minimum of 28 weeks of gestation with antepartum bleeding were selected. Data was retrieved from the hospital records.Results: Around 5.8% prevalence rate of APH was documented during the study period with placental abruption and placenta praevia accounting for 46.8% and 39.2% of these cases respectively. Only 28.5% of cases were booked. Three-fifths of the women had anemia, 17.7% suffered hypovolemic shock, 33.9% also had primary PPH while 4 out of every 10 (39.8%) were transfused with blood. Seven out of every ten premature deliveries (prior to 34weeks gestation) were due to placental abruption with p value of <0.001. There were 2 maternal deaths (1%), 61 (31%) still births and 11 (5.6%) early neonatal deaths giving a perinatal mortality rate of 35.6%.Conclusions: Antepartum hemorrhage was associated with poor maternal and neonatal outcome in this study. There is need to improve on infrastructures, such as functional blood banks, appropriate antenatal care and referral system in our health facilities to be able to cope with increasing challenges of this obstetric hemorrhage

Factors associated with sexual dysfunction among female patients in a Nigerian ambulatory primary care setting

Background: Sexual dysfunction is a common but under-reported problem of public health importance among female adults in&nbsp; Nigeria. Empirical evidence on sexual dysfunction among female Nigerians is scarce.Objectives: To determine the prevalence and risk factors associated with sexual dysfunction among female patients presenting at the General Outpatient Clinic (GOPC), University College Hospital (UCH), Ibadan, Nigeria.Methods: This was a cross-sectional study of 480 married female patients who presented consecutively at the GOPC, UCH, Ibadan, Nigeria. The 28-item Sexual Function Questionnaire (SFQ-28) was used to determine sexual dysfunction. Information on their sociodemographic characteristics, obstetric and gynecological history were obtained. Bivariate and multivariate analyses were carried out and alpha was set at 0.05.Results: Point prevalence of sexual dysfunction was 80.0%. The most common sexual dysfunction was problems with sexual desire (99.4%), while the least common was problems with arousal cognition (5.8%). There was a significant association between the prevalence of sexual dysfunction and age, years of relationship, number of children alive, parity, level of education, age at coitarche and family dysfunction. Age (OR=0.893; 95% CI=0.821–0.972, p=0.008), parity (OR=3.093; 95% CI=1.174– 8.151, p=0.022), having family dysfunction (OR=2.096; 95% CI= 1.129–3.891, p=0.019) and having&gt;10 years of formal education (OR=4.808; 95% CI= 2.604–8.928, p&lt;0.0001) were found to be the predictors of sexual dysfunction.Conclusion: Sexual dysfunction among female married adults in our setting was high. We propose that modifiable factors such as socio-demographic and gynaecological variables should be evaluated during the consultation of female patients at first contact Keywords: Female, Sexual dysfunction, Primary care, Nigeri

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting

Objectives: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour.Materials and Methods: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to  receive either 25 µg or 50 µg of vaginal misoprostol for pre.labour  cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1st to May 31st 2006. A total of 128 patients were randomized; 65 patients received 25 µg and 63 patients received 50 µg of vaginal misoprostol.Results: Significantly higher number of patients in the 50 µg group   progressed to active labour as compared with the 25 µg group (95.2% versus 84.6%, P &lt; 0.05). The need for oxytocin augmentation of labour was higher among the 25 µg as compared with 50 µg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 µg group delivering vaginally within 24 hours as compared with the 25 µg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not  statistically different in the two groups (754 } 362 minutes and 885 } 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 µg group.Conclusion: Twenty.five microgram of misoprostol appears to be as  effective as 50 µg for pre.induction cervical ripening and labour induction. Though 50 µg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more  labour complications as compared with 25 µg of misoprostol.Key words: Cervical ripening, labour induction, misoprosto

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigeria

Pain relief in labor: A randomized controlled trial comparing intramuscular tramadol with intramuscular paracetamol at the University College Hospital, Ibadan, Nigeria

Background: Labor is considered to be one of the most painful experiences in life. Several efforts have been made over the years, particularly in the developed world, to relieve pain in labor. Unfortunately, the same attention has not been given to obstetric analgesia in most of Africa. Aim: To compare the analgesic efficacy, patient satisfaction, and side effects of intramuscular tramadol and paracetamol as pain relief among women in labor at University College Hospital (UCH), Ibadan, Nigeria. Materials and Methods: This was a prospective double-blind randomized controlled trial that recruited 142 parturients into two groups of 71 women. One group received intramuscular 600 mg paracetamol and the other 100 mg tramadol at recruitment with rescue dose at least 3 h apart. Maternal vital signs were monitored and labor pain was assessed using the numerical rating scale. Neonatal conditions were assessed by the use of APGAR scoring system and the need for admission into the Special Care Baby Unit. The parturients overall satisfaction with the analgesia were assessed 24 h postpartum. Results: The sociodemographic characteristics of the pregnant women in the two groups were similar, with the mean ages being 30.89 ± 3.50 and 30.93 ± 3.82 years, respectively. The study showed that intramuscular paracetamol was as effective as intramuscular tramadol for providing moderate pain relief during active phase of labor. Neither drug caused significant changes in maternal vital signs, with favorable neonatal outcome and good safety profile. Conclusions: This study showed that 600 mg intramuscular paracetamol provides similar and modest pain relief in labor when compared to 100 mg intramuscular tramadol. It also has fewer maternal adverse effects and favorable neonatal outcome such as tramadol. It is concluded that intramuscular paracetamol is simple, cost-effective, readily available, and feasible option as labor analgesics, especially for resource poor settings

Abdominal pregancy at the University College Hospital, Ibadan: a ten-year review

Fourteen cases of abdominal pregnancy managed at the University College Hospital, Ibadan, Nigeria, over a ten-year period (January 1994 to December 2003) were reviewed. The incidence ratio of abdominal pregnancy was one in 654 deliveries. It accounted for 4.3% of ectopic pregnancies. Age range was 20 to 43 years; 63.4% of the patients were unemployed and 50% were nullipara. Pre-operative diagnosis was possible only in half of the cases. Only two patients with advanced pregnancies and live fetuses (14.3%) were allowed to have conservative management while the others had immediate laparotomy. Live birth rate was 7.1%, but overall fetal survival rate was 0%. Fetal malformations were common, with talipes equinovarus and jaw abnormalities occurring in 49.2% and 14.3% respectively. Twelve patients (85.7%) who had complete removal of the placenta, though lost more blood, had better outcome than those with placenta left in-situ. The case fatality rate was 7.1%. RÉSUMÉ L'étude passe en revue quartorze cas de grossesse abdominale traités au Centre Hospitalier Universitaire d'Ibadan, Nigéria, au cours d'une période de dix ans (janvier 1994 au décembre 2003). L'indice de fréquence de grossesse abdominale était 1 sur 654 accouchements. Elle était responsable de 4,3% de grossesses éctopiques. L'âge variait entre 20 et 43 ans; 63,4% des patients étaient en chômage et 50% étaient des nullipares. Le diagnostique pré-opératoire n'était possible que chez la moitié des cas. Deux malades dont les grossesses étaient avancées et qui avaient de foetus vivants (14,3%) ont été autorisées d'avoir un traitement conservateur alors que les autres ont subi la laparotomie. Le taux de naissance vivante était de 7,1%, mais le taux global de survie de foetus était de 0%. Les malformations de foetus étaient communes alors que se présentaient le pied bot varus équin et les anormalitiés de la mâchoire chez 49,2% et 14,3% respectivement. Douze malades (85,7%) dont les placentas ont été complètement enlevés ont perdu davantage de sang, ont eu un meilleur résultat que celle dont les placentas sont restés in situ. Le taux de cas de fatalité était de 7,1%. Afr J Reprod Health Vol.9 (1) 2005: 123–12

CASE REPORT - Term quadruplet pregnancy: a case report

Higher order multiple pregnancies are rare and often associated with complications. Term delivery is uncommon. This is a report of a 22 years old G3 p2 + 0 (1 alive) teacher who had quadruplet pregnancy following ovulation induction is presented. She had elective caesarean section at term with the delivery of two live male and two live female infants with birth weights ranging between 1750gram and 2850grams. Term delivery in quadruplet pregnancy is possible as demonstrated in this case, and has the advantage of improved perinatal outcome. Bed rest early detection and management of antenatal complications, and planned elective delivery are probably the keys to a successful outcome

Sexual dysfunction among women in a Nigerian gynecological outpatients unit

Background: Sexual dysfunction is an important public-health problem, which is often less reported or explored through opportunistic evaluation during medical consultations. Objective: This study was designed to determine the prevalence and patterns of female sexual dysfunction (FSD) including the sexual quality of life among female patients attending a gynecological outpatients unit in Southwest Nigeria. Materials and Methods: This is a cross-sectional descriptive study of 146 consenting women who attended the gynecological outpatients' clinic of the University College Hospital, Ibadan, Nigeria, during the study period. Participants were selected using multistage sampling technique. The survey instruments were previously validated questionnaires such as Sexual Function Questionnaire (SFQ28), Sexual Quality of Life-Female Questionnaire (SQOL-F), and the Family Adaptation, Partnership, Growth, Affection and Resolve (APGAR) score. The results were analyzed using Statistical Package for Social Sciences version 17 and P value was set at 5%. Results: The mean age was 33.8 ± 5.7 years. Most (85.6%) respondents had at least one form of sexual dysfunction. The commonest dysfunction was arousal-sensation (62.4%) while the least was pain (3.4%). The mean SFQ28 and SQOL-F scores were 58.0 ± 12.57 and 28.0 ± 11.94, respectively. There were no statistically significant differences in the SFQ28 and SQOL-F scores across sociodemographic factors. Women classified as belonging to dysfunctional family on Family APGAR score similarly had poorer scores for sexual dysfunction (100%, P = 0.016). Conclusion: FSD is common among women attending gynecological outpatients clinic. Managing clinicians should be aware of this condition and proffer appropriate care in addition to the main presenting complaint