Five-year review of copper T intrauterine device use at the University of Calabar Teaching Hospital, Calabar

Christopher U Iklaki, Anthony U Agbakwuru, Atim E Udo, Sylvester E Abeshi Department of Obstetrics and Gynaecology, University of Calabar, Calabar, Nigeria Background: The intrauterine devices (IUDs) are widely used contraceptive methods all over the world today. They are effective and recommended for use up to 10 years. They are not without side effects, which often prompt the users to request for removal. Objective: To determine the utilization rate of copper T intrauterine contraceptive device (IUCD), side effects, and request for removal at the University of Calabar Teaching Hospital, Calabar. Methods: The data on usage of the various forms of temporary contraception provided by the Family Planning Clinic of this center from January 1, 2006 to December 31, 2010 were collated. The records of usage of IUCD during same period were carefully studied. Results: During this period, a total of 10,880 users were provided with various forms of contraceptives. Copper T IUD was the commonest form of contraception used at the University of Calabar Teaching Hospital Family Planning Unit over the period under review (2006–2010) with a rate of 4,069 (37.40%). There was a yearly higher request for IUCD over other forms of contraceptives over the period. Of a total of 4,069 users of the copper T IUD method over the period, 1,410 (34.65%) belonged to the age group of 25–29 years. Eleven (4.61%) of the users requested for its removal due to abnormal vaginal bleeding, while five (2.08%) removed theirs due to abnormal vaginal discharge. The major reason for removal was the desire for pregnancy that accounted for 165 (70.26%), while one (0.51%) was removed due to dysmenorrhea. Conclusion: The copper T380A was very effective, safe with fewer side effects, and easily available in this study. The request for removal is also low in our environment. Keywords: copper T380A, contraception, request for remova

Use of combined oral contraceptive pills among teenage girls in Calabar, Nigeria

Christopher U Iklaki,1 John E Inaku,2 John E Ekabua,1 Patience O Odusolu,1 Charles O Njoku11Department of Obstetrics and Gynaecology, University of Calabar, Calabar, Nigeria; 2Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, NigeriaAbstract: The objective of this study was to find out about the use of combined oral contraceptive pills by women in Calabar, Nigeria, with a particular interest in single nulliparous teenage women. During the period from 2006 to 2010, a total of 1980 women seen in the University of Calabar Teaching Hospital's family planning unit used various methods of contraception. Of these, 316 (15.96%) used combined oral contraceptive pills. Twenty girls aged between 13 and 19 years accounted for 6.3% of those who used combined oral contraceptive pills. There were 296 (93.6%) women between the ages of 20 and 34 years who accounted for the remaining users. Of these women, 195 (61.5%) were educated to the secondary level, and 34 (10.8%) were educated to primary level. No women without formal education used combined oral contraceptive pills during the period of study. The majority of the users were nulliparous (128; 40.4%); the rest had parity values of at least one to more than four. One hundred thirty-seven (43.4%) of the users were single, 112 (35.4%) were married, and the remaining 67 (21.1%) were separated, divorced, or widowed. There is a growing need to educate young Nigerian women about the use of combined oral contraceptive pills; this medication is suitable and effective for most young women, and it also has additional noncontraceptive health benefits.Keywords: combined, oral, contraception, pill

Current trends in caesarean section in University of Calabar Teaching Hospital Calabar-Nigeria

The rising caesarean section rate is becoming a cause for concern among many obstetricians all over the world more so in developing countries where there is strong aversion to caesarean section. A five year study was conducted between 1998 to 2002 to evaluate incidence of caesarean section in the University of Calabar Teaching Hospital and factors that influence the rising trend in caesarean section rate in our environment and also to find out the case fatality rate associated with this surgical operation. Caesarean section accounted for 19.8% of the total deliveries while spontaneous vaginal delivery accounted for 75.6%. Other modes of deliveries included assisted breech delivery (2.8%), vacuum (1.5%), forceps – (0.5%), destructive operations (0.14%). The caesarean section rate increased progressively from 17.9% in 1998 to 21.9% in 2002. Emergency caesarean sections (80.0%) were more frequently performed than elective cases (20.0%). Majority of the patients (82.9%) were booked while only 17.1% were unbooked. The commonest indication for emergency caesarean section was obstructed labour due to cephalopelvic disproportion (25%), followed closely by fetal distress (13.9%). The case fatality from caesarean section was calculated as 1.29%. It is obvious that there is increase in the caesarean section rate in our environment, which is in line with what is happening in the developed countries where the operation is more liberally used. In consonance with finding in other Teaching Hospitals, caesarean section appears to be on the increase in Nigeria. Although it has been suggested that increased rates of caesarean section would reduce the unusually high perinatal mortality in this area, this has not been subjected to objective scientific analysis. Keywords: caesarean section, cephalopelvic disproportion, obstructed labour Mary Slessor Journal of Medicine Vol. 5(1), 2005: 41-4

Spousal communication in contraceptive decisions among antenatal patients in Calabar, Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 14(4) December 2005: 405-40

Haemoperitoneum following coitus with no associated vaginal injury

Postcoital haemoperitoneum resulting in shock rarely occur without evident vaginal injury. A 24 year old Para 0 ±4 women presented to the emergency unit in shock with a history of fainting attack and severe absominal pain of 6 hours duration. Pain was felt immediately after coitus and was so severe that the patient had a blackout. Ultrasound scan revealed a left adnexal mass and fluid in the peritoneal cavity. At laparatomy more than 2 litres of fresh blood was found in the peritoneal cavity. The left ovary was enlarged by a haemorrhagic cyst with 3 bleeding points. The left fallopian tube was slightly oedematous with 2 areas of haemorrhagic spots but no obvious bleedig. Left ovarian cystectomy was done. Haemostasis was secured. Mary Slessor Journal of Medicine Vol. 5(2) 2005: 70-7

A Seven Year Clinical Review of Macrosomic Births in Calabar

Pregnancies associated with fetal macrosomia in the University of Calabar Teaching Hospital, Calabar, over a seven years period were studied. The aims were to establish the incidence of fetal macrosomia and possible risk factors associated with macrosomic births. The incidence of macrosomic births was 4.0% or 1 in 25 deliveries. Mean maternal age was 27.2 years. About 58% of women were para 5 and above. Sex ratio of babies showed a male predominance of 2.1 to 1. History of previous macrosomic birth was obtained in 28.0% of cases. Maternal weight greater than 90kg was observed in 31.4%, gestational diabetes in 2.6% and post-term pregnancies in 9.6% of cases. Main disorder of labour were obstructed labour (14.4%) and prolonged second stage of labour (5.2%). The use of instrumental vaginal delivery was significantly higher in macrosomic than in non-macrosomic births (x2 = 14.34 p=0.0001). However the use of abdominal delivery in macrosomic birth was not significantly higher than in non-macrosomic births (x2=0.22 p=0.6415). Fetal macrosomia is a cause of peri-natal morbidity and mortality in Calabar. There is a call for a high index of suspicion whatever the identified risk factors are present. Key Words: Fetal macrosomia, incidence, and associated risks. Mary Slessor Journal of Medicine Vol.4(1) 2004: 32-3

Complications associated with macrosomic fetus in Calabar South Eastern Nigeria

A retrospective study to determine adverse perinatal outcome associated with macrosomic births was carried out at the University of Calabar Teaching Hospital, Calabar (1994-2000). The incidence of macrosomic births was 1 in 25 deliveries. Perinatal mortality rate (PNMR) was 83 per 1000 births was highest in the birth weight range of 4.0 – 4.4kg (P = 0.004) and in macrosomic babies born by caesarean section (P=0.0019). The commonest indication for abdominal delivery was obstructed labour (14.4%) with an associated PNMR of 21.8 per 1000 births. Perinatal morbidity and mortality were seen in 25.3% of cases. Perinatal mortality is significantly high in the birth weight range of 4.0-4.4kg and in babies born abdonminally, mainly because of obstructed labour and ruptured uterus. Intervention before these complications occur may significantly reduce the adverse pregnancy outcome associated with macrosomic births. Keywords: fetal complications, macrosomia Mary Slessor Journal of Medicine Vol. 5(2) 2005: 5-