Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria

Background: Early amniotomy is common in obstetric practice but, its effectiveness has not been proven.Objectives: To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal out- comes of uncomplicated pregnancies in Enugu, South-east Nigeria.Methods: A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved.Results: Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of con- trol group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin aug- mentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 – 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. Conclusion: Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.Keywords: Early amniotomy, duration of labour, oxytocin augmentation, term pregnancy, caesarean section rate, Enugu- Nigeria

Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria

Background: Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. Objectives: To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal out- comes of uncomplicated pregnancies in Enugu, South-east Nigeria. Methods: A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. Results: Mean duration of labour for the amniotomy group (279.4 \ub1 53.7 minutes) was significantly lower than that of con- trol group (354.4 \ub1 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin aug- mentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 \u2013 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. Conclusion: Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications

Trends of tuberculosis prevalence and treatment outcome in an under-resourced setting: The case of Enugu state, South East Nigeria

Background: The burden of tuberculosis (TB) in Nigeria is high. Unfortunately, the data from the TB programme of the States′ ministries of health are usually unpublished, which possibly contribute to the prevailing ignorance and poor attitude of Nigerians to the disease. This study determined the trends of TB burden and treatment outcome in Enugu state, Nigeria; and relate the State′s disease burden to that of the Nation. Materials and Methods: A descriptive study of secondary data from the TB control programme, Ministry of Health, Enugu state, the National annual report of 2008, and World Health Organisation (WHO) TB database for the 10-year period of 2000-2009. Results: The number of female TB cases was higher than males within the 0-14 age group only. The annual number of all TB cases showed a rising trend from 914 cases in the year 2000 to 1684 in 2009; but the proportion of new sputum smear (ss+) pulmonary tuberculosis (PTB) cases declined (Trend X[2] = 7.37, P = 0.007). The average number of extra-pulmonary TB cases increased fourfold from 2000-2004 to 2005-2009 (36 versus 150 cases). The median treatment success rate was 82% (range: 78-85). For the period 2004-2008, 2.0% of all new ss + PBT cases reported in Nigeria, originated from Enugu state. The proportion of new ss + PTB reported in Enugu state was significantly higher than national value (59.6% versus 52.6%) [P < 0.001, OR = 1.33 (95% CI: 1.26, 1.40)]. Conclusion: The burden of TB in Enugu state of Nigeria had increased over the period reviewed. However, the State′s contribution to the disease burden in Nigeria was low

Large Symptomatic Chorioangioma of Placenta; A Rare Complication of Pregnancy in Enugu, South East Nigeria

Chorioangioma is the most common non trophoblastic tumour of the placenta which can result to severe pregnancy complications with attendant maternal and fetal morbidity and mortality [1]. Most cases of chorioangiomas are small, microscopic and of no clinical important [2,3]. We present the very first case of large symptomatic chorioangioma managed successfully in University of Nigeria Teaching Hospital Enugu.&nbsp;The patient was referred to the University of Nigeria Teaching Hospital Enugu on account of suspected symptomatic chorioangioma, at a gestational age of 32 weeks. She was managed conservatively and had elective caesarean section at 36 weeks’ gestation with good outcome. There was a large solid and cystic lesion on the placenta measuring 8cm x10cm. Histological diagnosis of chorioangioma of capillary type was made.</p

Leiomyomatosis peritonealis disseminata in a Nigerian woman

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition. A 48‑year‑old multiparous woman was referred because of an incidental ultrasound finding suggestive of LPD. She had a 6‑year past history of use of combined oral contraceptive pills. LPD was also suspected at laparotomy and confirmed by histology. She had total abdominal hysterectomy, bilateral salpingo ophorectomy and infracolic omentectomy. Patient was being followed‑up. LSD is a rare gynecological condition which can pose a diagnostic challenge. Removal of estrogen sources as was done for the patient is the mainstay of treatment. Patient follow‑up is very important because of the risk of malignant transformation.Keywords: Laparatomy, leiomyoma, leiomyomatosis peritonealis disseminata, Nigeria, ophorectomyNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 201

The outcome of complementary and alternative medicine use among pregnant women in South-East Nigeria: a multi-centre prospective study

There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study’s ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value= <.05). In conclusion, CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.Impact Statement What is already known on this subject? There is an increasing trend of CAM use among pregnant women in the world. Pregnancy is associated with certain conditions that predispose women to CAM use. The clinical indications for CAM use by the pregnant women are nausea and vomiting, labour pain, induction of labour, pedal oedema and waist pain. What the results of this study add? CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of the babies when compared with non-CAM users. What the implications are of these findings for clinical practice and/or further research? CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them