Sociodemographic characteristics and handling of life‑threatening obstetric cases by traditional birth attendants in Cross River State, Nigeria

Background: Majority of pregnant women, especially in remote rural areas still desire to be delivered by traditional birth attendants (TBAs) who neither have the skills nor the equipment to treat life‑threatening complications.Objective: To determine the sociodemographic characteristics of TBAs and how they manage life‑threatening obstetric cases.Methodology: This was a prospective study carried out over a 3‑month period during the training of TBAs in the state on the reduction of maternal mortality. A total of 540 TBAs from 18 Local Government Area of the state participated in the study. Data obtained were sex, age, levels of education, number of deliveries conducted per month, difficult cases encountered, and how they managed them. The data were analyzed using Epi Info version‑7 and presented in tables.Results: TBAs are mostly females, i.e. 538 (99.6%) and only 2 (0.4%) were males. Majority of the TBAs were above the age of 55 years, i.e. 488 (88.9%); had primary education 416 (77.0%); married 396 (71.6%); and grand multiparous 293 (54.3%). Most TBAs deliver 4 newborn monthly, i.e. 148 (22.6%), and the mean number of newborn delivered monthly was 3.9. Concerning the mode of handling of the difficult cases, majority, i.e. 338 (62.6%) have a nurse/midwife they always call for assistance while only 147 (27.2%) refer their life‑threatening cases directly to the nearby hospital.Conclusion: TBAs still plays a role in deliveries in most rural and urban areas. Majority of TBAs do not refer their life‑threatening cases directly to the nearby hospital. Therefore, TBAs should be trained on how to identify life‑threatening cases and promptly refer to hospitals for better outcome.Keywords: Cross River State; delivery; emergency obstetrics; maternal mortality; traditional birth attendant

Prevalence and risk factors for stillbirths in a tertiary hospital in Niger Delta area of Nigeria: a ten year review

Background: Stillbirth is a silent but major cause of perinatal mortality and source of foetal wastage. Aim: To determine the prevalence of stillbirth, demographic characteristics and identify the possible risk factors in our Hospital.Methods: This was a ten year cross-sectional retrospective study of stillbirths between 1st January, 2004 and 31st December, 2013. All cases of stillbirths from 28 weeks of gestation or the foetal weight of at least 1000g were included in the study.Results: There were a total of 19,347 deliveries with 937 stillbirths, giving a stillbirth rate of 48.4/1,000 total births or 4.8%. Of the 937 stillbirths identified, only 582 (62.1%) case files could be retrieved and was used for analyses. There were 381(65.5%) macerated and 201(34.5%) fresh stillbirths. Stillbirth rate were higher among grand multiparous women, women with primary education and unbooked women. There were 309(53.1%) male stillbirths and 273(46.9%) female stillbirths. Male foetuses were higher among fresh stillbirth (54.9%) while female foetuses had more macerated stillbirths (48.8%) than fresh stillbirths (45.1%). The major causes of stillbirths were hypertensive disorders of pregnancy (18.9%), prolonged/obstructed labour (13.6%), anaemia in pregnancy (12.2%) and abruption placentae (9.3%). A total of 121(20.8%) of the stillbirths were unexplained.Conclusion: The prevalence of stillbirth in our environment is high. Identified factors such as grandmultiparity, low education, unbooked pregnancy, anaemia in pregnancy, obstructed labour and ruptured uterus are modifiable. Every effort directed at reducing these factors must be made by all healthcare givers including policy makers to reduce stillbirths.Key words: Stillbirth, miscarriage, perinatal mortality, anaemia in pregnancy, obstructed labour, uterine ruptur

Vesicovaginal fistula presenting as urogenital prolapse

Vesicovaginal fistula (VVF) is an abnormal fistulous communication between the bladder and the vagina that allows continuous involuntary discharge of urine into the vagina. It is one of the most abhorred morbidities in obstetric practice because of the profound effect on the patient’s emotional well‑being. Here, we present a case of VVF presenting as urogenital prolapse following an automobile accident. A large fistulous defect with complete bladder base prolapse was successfully repaired with adequate flap mobilization after two failed attempts by a surgical team. VVF should be considered in cases of urogenital prolapse especially following traumatic pelvic injuries.Keywords: Bladder base; trauma; urogenital; vesicovaginal fistul