Obstetric Outcome in Grandmultiparous Women in Jos University Teaching Hospital

Background: The grandmultipara is traditionally regarded in Obstetrics as a high risk in pregnancy. However, some authors believe that if matched for age and socioeconomic status in a setting of satisfactory health care conditions, grandmultiparity should not be considered dangerous. This study determined the maternal morbidity and mortality and perinatal outcomes associated with grandmultiparity among women who came to deliver in Jos University Teaching Hospital.Method: This hospital based prospective case control study was carried out between June 2008 and January 2009 in the labour ward of the maternity unit of Jos University Teaching Hospital among 250 consecutive grandmultiparous women and another 250 consecutive women of parity 2 to 4 who were matched for age and socioeconomic status.Result: The 250 grandmultiparous women and their matched multiparous group had an average age of 32.9 ± 4.6 years. Grandmultiparous women were significantly more likely to develop hypertensive disease in pregnancy, have malpresentaion and develop postpartum haemorrhage. Their fetuses were significantly more likely to have fetal distress in labour, to be low birth weight babies and be admitted to the special care baby unit (SCBU).Conclusion: In the developing countries where the health care delivery system is still facing a lot of challenges, the grandmultipara should still be considered a high risk in pregnancy

Spinal anaesthesia in lower abdominal and limb surgery: A review of 200 cases

Background: Modern technology has produced better equipment than was available hitherto with the result that spinal anaesthesia is undoubtedly simpler, cheaper and above all, safer than it used to be. These notwithstanding, it is used infrequently. The aim of the study was to evaluate the safety, benefits and applicability of subarachnoid spinal anaesthesia in a tertiary referral centre in a developing country.Methods: This was a prospective analysis involving 200 patients requiring anaesthesia for lower abdominal and limb surgery at the Jos University Teaching Hospital, Jos. Subarachnoid spinal anaesthesia was performed through the L2/L3 or L3/L4 interspace employing either 0.5% bupivacaine hydrochloride in 8% glucose monohydrate (Marcain heavy Astra) 2-4mls or 5% lignocaine (heavy xylocaine Astra) 1-2mls. Patients with uncorrected or undercorrected hypovolaemia, uncorrected anaemia or heart disease, local sepsis and those on anticoagulant therapy or who had bleeding disorders were excluded. Also excluded were children. Results: A total of 200 patients with age range of 15-90 years and a mean age of 34.48 years were studied. The male to female ratio was 1:1.74. Eighty of them underwent caesarean section (38 emergency and 42 electives), 26 prostatectomy, 24 appendicectomy, 19 herniorraphy, 11 haemorrhoidectomy, 9 fissurectomy, 7 total abdominal hysterectomy, 5 Manchester operation, 4 myomectomy, while the remaining 15 were for other procedures involving the lower abdomen or limb. Complications noted were: nausea (17.50%) and vomiting (3.5%), pain at injection site (15.5%), chills/shivering (15.0%), post-spinal headache (0.5%) and hypotension (3.0%). Subarachnoid anaesthesia was non-fatal. One hundred and ninety patients (95%) were satisfied with spinal anaesthesia. Conclusion: Spinal anaesthesia though safe is not without hazards. Spinal anaesthesia may be used for most operations in the lower abdomen (including caesarean section), perineum or leg. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 226-23

Obstetric performance of elderly primi gravida in Jos University teaching hospital, Jos, Nigeria.

Background: Obstetric complications have been associated with elderly primigravidaeworld wide and they continue to increase hence the need to review obstetric performance of elderly primigravida.Objective: To compare the maternal and perinatal outcome of nulliparous women aged 35 years and older at time of delivery to that of nulliparous women aged 20-34 years old in Jos University Teaching Hospital.Methods: A one year prospective study was carried out on allprimigravid women with singleton pregnancy that came to deliver in the labour ward unit of Jos University Teaching Hospital (JUTH), JosNigeria from 1st May, 2010 to 30th April,2011Main outcome measures: gestational diabetes, chronic and pregnancy induced hypertension, antepartum haemorrhage, prelabour rupture of membranes, and preterm labour, breech presentation, cephalopelvic disproportion, failure to progress,increased cesarean deliveries, fetal asphyxia. Results: Maternal age of thirty five years and older at the time of first child birth had higher obstetric and perinatal complications than younger maternal age group.During the study period, 411 primigravidae delivered in the labour ward unit of Jos University Teaching Hospital. Out of these, 397 (96.6%) were aged ≤ 34 years while only 14 (3.4%) were aged ≥ 35 years. The commonest obstetric complication was failure to progress in labour (FTP),18(4.4%). Three hundred and thirteen (76.2%) of the women had spontaneous vaginal delivery, 97(23.6%) had caesarean delivery while 1(0.2%) had assisted vaginal delivery using vacuum. Twenty three (5.6%) of the babies were asphyxiated while 382(92.9%) were of normal APGAR scores.Conclusion: Maternal age of thirty five years and older at the time of first child birth had higher obstetric and perinatal complications than younger maternal age group. Women who were thirty five years and older at the time of first delivery had worse maternal and perinatal outcome than women who were thirty four years and younger at the time of first delivery.Keywords: Obstetric, Elderly, primigravida, Nulliparous, Maternal age, perinatal

How much do antenatal care attendees in a tertiary hospital in Jos, north central Nigeria know about gestational diabetes?

Background-The increasing prevalence of GDM has attracted global concern. The associated hyperglycaemia is a source of perinatal morbidity and mortality. Knowledge of GDM is known to prevent complications to mother and baby through adoption of life style modification behaviour and good health seeking behaviour.Methodology- It was a cross sectional study conducted over a 3 month period. Women were recruited into the study from the antenatal clinic. A structured questionnaire was used to extract information from the respondents. Data was analyzed with EPI INFO 3.5.4 CDC Atlanta, USA.Results- The response rate was 96.2%. The mean age of the respondents was 29±6 years. Only 2% had no formal education while 46.6% had tertiary education. Most of the women (55.3%) were unemployed and 53.0% of the women were multiparous. The respondents generally have a good knowledge of GDM with an average score of 9±3. The awareness on GDM and its risk factors and awareness on screening and treatment were good. Only 41.5% of the women knew GDM resolves after pregnancy. Knowledge on the other  consequences of GDM was good. Health professionals and friends and family served as source of information on GDM in 80.9 and 60.1% of the women respectively.Conclusion- the knowledge of antenatal women in our centre is good. Continuous training of health workers and women empowerment are strategies that can maintain and improve this knowledge. Key words: Gestational diabetes, Antenatal care attendees, Knowledg

Safe Chemical Handling by Agrochemical Users in Plateau State, Nigeria

Agrochemical use has been increasing in both developing and the developed nations. The unsafe handling and use of agrochemicals can lead to accumulation of hazardous chemicals in the body, causing adverse effects on health. This quantitative cross sectional study sought to understand the level of awareness, practices, and perceptions of safe chemical handling by agrochemical using the Theory of Planned Behavior. This study was conducted among 260 farmers in Plateau State, Nigeria. Data on background knowledge and practices of safe agrochemical handling by farmers were collected using a structured paper based, interviewer-administered questionnaire. Descriptive statistics revealed that the most practiced precautions by participants were washing work clothes separately (56.9%) and taking a shower soon after application of agrochemicals (53.6%). Findings from this study suggest that farmers had good knowledge of safe use of agrochemicals and majority of them 91.9% were knowledgeable about the possible effects of these chemicals on health. A Chi square test showed a statistically significant association between marital status and engagement in safe agrochemical handling X2 (2, N = 260) = 7.34, p \u3c. 05 and level of education X2 (4, N = 260) = 35.12, p \u3c. 05. Results of Binary logistic regression indicated that the variable training on safe agrochemical handling with an odds ratio 8.31 was a good predictor for safe agrochemical handling An important finding in this study however was a low level of adoption for the use of Personal Protective Equipment. Priority should be given to developing safety educational and certification programs for farmers with emphasis on the safe handling practices

Analysis of some risk factors for abruptio placentae in Jos, northern Nigeria

No Abstract

Serum Alpha Feto Proteins of pregnant women in selected primary health centers in Bukuru Plateau State

Background: Alpha Feto Protein (AFP) is a Tumour biomarker normally produced in the yolk sac, epithelial cells of the gastrointestinal tract and liver during embryonic development. In pregnancy, AFP enters the amniotic fluid through fetal blood, via the placenta into maternal blood. The serum concentration of maternal AFP predicts foetal and/or maternal disorders during gestation. Aim: The study sought to evaluate serum levels of non-virally infected women in first, second and third trimester Method: A total of 130 participants: 95(73.1%) pregnant women and 35(26.9%) non pregnant women as controls, all above 15 years, were enrolled in this study. All sera samples were analysed using Enzyme Linked Immunosorbent Assay (ELISA) technique. All data were subjected to statistical analyses using SPSS version 21.0 with statistical significance set at P˂0.05 and these statistical instruments were used to analyse the data. Mean, Standard Deviation of Mean, ANOVA and Independent student’s T-test was used to test for significance of parameters. Results: Elevated serum AFP was recorded in 1(0.77%) among all the participants. There was a statistical significance between mean of AFP at first (:53.00 ± 31.37), second (29.58±4.80) and third trimesters (94.16±29.2), all in mg/ml. There was a significant difference between control and test participants (p<0.05) except between first and second trimesters. Mean±SD weight of the pregnant women based on their trimesters was 60.14±5.49, 64.79±10.92 and 72.42±15.13 (kg) respectively. Conclusion: This work reveals increase in serum AFP with age of pregnancy with no variation with age of the subjects

The Outcome of Preoperative HIV Screening for Gynaecological Patients in North Central Nigeria

Background: The incidence of HIV is high in sub-Saharan Africa including Nigeria despite interventions to check the disease. This study aimed to determine the prevalence of HIV among women with gynaecological conditions.Patients and Methods A retrospective analysis of women undergoing gynaecological operations between 2008 and 2010. Results A total of 109 (42%) patients were screened for HIV pre operatively. Their mean age was 31.6 years. Six (5.5%) of the 109 patients tested positive for HIV. All the patients who tested positive were married. Conclusion There appears to be a high prevalence of HIV infection among women with gynaecological conditions in our setting.Keywords: HIV, prevalence, women, gyanecological operation