A decade of instrumental vaginal deliveries in Jos University Teaching Hospital, North Central Nigeria (2007–2016)

Background: Instrumental vaginal deliveries are witnessing a steady decline despite its usefulness in improving obstetric outcomes in resource‑limited settings. This decline in instrumental deliveries is enhanced by dearth of information on good outcomes thereby making its use unpopular among younger generations of obstetricians. The study was aimed at determining the rate of instrumental deliveries and associated outcomes in Jos University Teaching Hospital (JUTH).Materials and Methods: This study was a 10‑year retrospective hospital‑based study carried out between January 2007 and December 2016 in JUTH which compared the use of vacuum extractors and forceps to effect vaginal deliveries and the delivery outcomes encountered following such deliveries.Results: Of the 16,614 deliveries during the study period, 71 were instrumental vaginal deliveries with an incidence of 0.4% for the study period. Vacuum accounted for 97.2% of the deliveries and forceps 2.8%. Prolonged second stage was the indication for instrumental delivery in 85.9% of parturients and there were no significant differences in Apgar scores between babies that had instrumental deliveries and those that did not. Age and parity were not significantly associated with instrumental deliveries. The instrumental delivery rates were, however, significantly lower than earlier reports from this center, and that globally recommended.Conclusion: Instrumental vaginal deliveries are fast declining in JUTH and the few instrumental deliveries carried out showed a faster decline in forceps deliveries. Efforts have to be made to revive the art of instrumental vaginal delivery in the center to save it from extinction.Keywords: Complications; forceps; instrumental vaginal delivery; North Central Nigeria; outcomes; trends; vacuum deliver

Maternal fasting blood lipids: a marker of severity of pre-eclampsia in Jos, north-central Nigeria

Background: Pre-eclampsia is a common medical disorder of pregnancy, in Nigeria, and has been reported to be characterized by blood lipid derangements with oxidative stress and endothelial dysfunction.Objective:Methods and materials: This was comparative cross-sectional study, amongst women with Preeclampsia. Fasting venous blood samples were taken into plain vacuitainers and analyzed in batches after days for serum lipids using Cobas C-III Roche auto analyzer machine. The data were analysed using Epi-info version 3.5.4 The duration of study was for about seven month's periodResults: The mean serum levels of triglycerides in mild pre-eclampsia was 1.13±0.50mmo/L, while in severe pre-eclampsia=2.22±0.92mmo/L, p-value=0.00001. Other lipid components: Total cholesterol, High density lipoprotein, Low density lipoprotein were not significantly different in the two studied groups (p>0.005) Multiple linear regressions model revealed serum triglycerides had the highest standardized absolute coefficient of 0.332 and lead value of 0.591.Conclusion: Serum triglycerides alone, appear to be a significant predictor of severity of pre-eclampsia; hence can serve as a surveillance tool during conservative management of pre-eclampsia.Keywords: Maternal, Serum, lipids, Pre-eclampsia, Triglycerides, Total cholesterol, Low-density lipoprotein and High-density Lipoprotei

Choice of place of antenatal care among women of reproductive age in a semiurban population in northcentral Nigeria

Background: Antenatal care has an important role in identifying high‑risk pregnancies and improving the chances of safe motherhood particularly in developing countries where obstetric indicators are still poor. The objective of this study was to determine the choices women of reproductive age in Vom, a semirural town at the outskirts of Jos the capital of Plateau State Nigeria made to have antenatal care.Materials and Methods: This was a cross‑sectional study carried out between January and March 2015 in Vom, a semirural area about 30 km from Jos the capital of Plateau State among 2,641 (Two thousand six hundred and forty one) women of reproductive age.Results: Fifty‑eight percent of the respondents opted for antenatal care in government‑owned hospitals while 29% chose faith‑based institution which was in their vicinity, 11% favored private hospitals for antenatal care, while 1% chose traditional birth attendants (TBAs) and prayer houses to receive antenatal care. The majority of the respondents (32%) were females between the ages of 40 and 44 years while 22% were aged between 25 and 29 years of age. They were predominantly farmers of the Berom ethnic group and 47% of them had completed primary level of education.Conclusion: Females in the reproductive age in this rural setting in northcentral Nigeria favored government‑owned hospitals as places to receive antenatal care. Their choices were not affected by their educational status varied according to the age ranges of the respondents.Keywords: Antenatal care; reproductive age women; semiurban populatio

Trends and operators of instrumental vaginal deliveries in Jos, Nigeria: A 7‑year study (1997–2003)

Context: Instrumental vaginal delivery is one of the lifesaving functions of emergency obstetric care to reduce perinatal and maternal morbidity and mortality.Objective: To determine the instrumental vaginal delivery rate, the trends, and the status of their operators in Jos University Teaching Hospital, Nigeria (JUTH) over a 7‑year period (1997–2003).Study Design: A 7‑year cross‑sectional study of obstetric service data from 1st January 1997 to 31st December 2003.Patients and Methods: A register was kept for all cases of instrumental deliveries at JUTH from 1st January 1997 to 31st December 2003. This register with the patient case notes and neonatal ward records was used to conduct this study.Results: During the study period, there were a total of 17,888 deliveries and 349 instrumental vaginal deliveries, giving a rate of 1.95%. Out of these, 238 (68.2%) were vacuum extraction and 111 (31.8%) were forceps delivery. There was a 67% decline in the use of these instruments from 84 (3.18%) in 1997 to 34 (1.05%) in 2003. Majority 313 (90%) of the procedures were performed by residents (Registrars 49%, Senior Registrars 41%). Consultants performed 10%, and all were in the first four years of the study. Forceps delivery rate 0.62% and vacuum delivery rate was 1.33%. There was a strong negative correlation with the performance of IVD in JUTH. At the current trend, no forceps delivery (R = −0.93008) will be performed in JUTH in 2005 while only 4 vacuum deliveries (R = −0.80015) will be conducted in in the same period.Discussion: There is a low instrumental vaginal delivery rate in JUTH with a strong negative correlation in the performance of these procedures. Most procedures are performed by residents, and vacuum is the preferred procedure.Conclusions: Instrumental vaginal delivery in JUTH is a dying art. Training and re‑training of resident doctors on this lifesaving function is recommended.Keywords: Instrumental vaginal delivery; Jos; Nigeri

Pelvic abscess at Jos University teaching hospital, Jos, north central Nigeria

Background: Despite the availability of antibiotics and surgery, pelvic abscess remains one of the major gynaecological problems of developing societies. It remains a source of concern because of its potential for life threatening morbidity and mortality which may approach 100% if not effectively managed. Objectives The study objectives were to determine the incidence of pelvic abscess in this institution, identify risk factors, review the management of these patients and suggest ways of improving the services offered. Methods A retrospective analysis of 35 cases of pelvic abscess admitted and managed at the Jos University Teaching Hospital over a three year period (January 1998- December 2000) was carried out. The data extracted from the case notes include the age of patient, ethnicity, religion, parity marital status, complications and interventions instituted Results During the period, there were 2135 gynaecological admissions; thus the incidence of pelvic abscess in the hospital was 1.79% (35). Most of the patients (82.7%) were aged below 30 years, and 86% were of parity 2 and below. In 19 patients (54.3%), the abscess followed induced termination of pregnancy. After an initial preparation with intravenous fluids, broad spectrum antibiotics, correction of fluids and electrolytes imbalance and blood transfusion (where indicated), for about 24- 9 72 hours, the patients were subjected to definitive surgery; laparotomy. Conclusion Pelvic infection is a disease of the young and low parity woman and there is a strong relationship between induced abortion and pelvic abscess in this environment. Laparotomy and drainage is advocated after adequate pre-operative resuscitation so as to decrease mortality and morbidity.Key words: management, pelvic abscess, Jos University Teaching Hospital

Induced abortion; a continuing tragedy

Background: Induced abortion remains one of the gravest problems associated with women’s reproductive health in Nigeria. Induced abortion is commonly practiced in Nigeria with a prevalence ranging from 25-53% amongst adolescents in schools and 88-94% amongst out of school single women. It is a major contributor to maternal mortality and serious morbidity in Nigeria Objectives: The objectives of this review were to assess the socio-demographic characteristics of patients that procure induced abortions, determine the gestational age at which these abortions occurred, as well as to determine common complications associated with induced abortions Methods: This was a retrospective study of induced abortions that were seen at the Gynaecology Emergency unit of the Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos Nigeria between January 2001 and December 2003. The data were retrieved from the medical records department and analyzed using Epi-info version 3.2.2. Results: The mean age of the women was 22.1years (range 14-45years). More than half, 41 (56%) had secondary school education. Seventy five percent (54) of the patients were unmarried. Fifty four percent (39) of the patients were students. Doctors in private hospitals procured majority (34.7%) of the abortions. Retained products of conception, pelvic abscess, uterine perforation and gut injury were the common complications encountered. There were 4 mortalities in the study giving a mortality rate of 5.6%. Conclusion: Single and none working women were more likely to have induced abortions. The common complications following these procedures were retained products of conception, sepsis, gut injury, and maternal death.Key Words: Induced Abortion, single women, retained products of conception, Jos University Teaching Hospital

Indications for abdominal hysterectomy at the Jos University Teaching Hospital.

Objective: Abdominal Hysterectomy is an everyday procedure in the Department of Obstetrics and Gynaecology of the Jos University Teaching Hospital. There is, however, dearth of data on the indications for and, pattern of morbidity and mortality of this procedure from this centre. This prompted the review. Methodology: This was a retrospective study of all Abdominal Hysterectomies done in the Department of Obstetrics and Gynaecology of the Jos University Teaching Hospital (JUTH), Jos, Plateau state, North Central Nigeria over a four year period (2002-2005). Results: Abdominal hysterectomy accounted for 10.8% of all major gynaecological operations during the study period. The age group of 40-44 years accounted for 50% of the patients that had total abdominal hysterectomy. Uterine fibroid was the commonest indication, which accounted for 89.5% of cases. The morbidity rate was 33% and there was no mortality. Conclusion: Hysterectomy for Uterine fibroids was the commonest indication for l Abdominal Hysterectomy. Though postoperative morbidity was high (33%), there was no mortality.Key words: Abdominal Hysterectomy, Uterine Fibroids, morbidity, Jos  University Teaching Hospital

The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria

Introduction: Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. Methods: Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. Results: We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. Conclusions: Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women’s ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations. © 2023, The Author(s).Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]