Autologous blood donation and transfusion in obstetrics and gynaecology at the University of Maiduguri Teaching Hospital Maiduguri, Nigeria.

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Acardiac acephalus twin: A case report

Acardiac acephalus twin is a rare complication of monochorionic twinning. A case of a 26year old who presented to the emergency unit of the University of Maiduguri Teaching Hospital [UMTH] with ultrasound report of non viablebut morphologically normal twin pregnancy is presented. She was delivered of a twin still born; one apparently normal and an acardiac twin.Key words: Multiple pregnancy, Ultrasound scan, Acardiac twi

A 10‑year Review of the Clinical Presentation and Treatment Outcome of Asherman’s Syndrome at a Center with Limited Resources

Background: Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA. Aim: This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman’s syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997–2006. Subjects and Methods: This is a retrospective study of cases of Asherman’s syndrome managed at the UMTH over a 10‑year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records’ Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi‑square and binary logistic regression were used for inferential statistics. Results: Asherman’s syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy‑associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley’s catheter insertion and estrogen‑progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent’s related risk factors associated with the development of Asherman’s syndrome. Conclusion: Asherman’s syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman’s syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored.Keywords: Asherman’s syndrome, Clinical presentation, Maiduguri, Treatment outcom

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria

Objective : To determine the trend and indications for the use of caesarean delivery in our environment. Method : A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results : During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion : Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate

Methods of Induction of Labour at the University Of Maiduguri Teaching Hospital, Maiduguri: A 4-Year Review

Background: Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol. Method: This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50μg of misoprostol, 57 women had 100μg of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion. Result: Induction of labour constituted 6.6% (468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8%, followed by pregnancy induced hypertension in 33.5%. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (x2=1.13, p=0.57). The mean induction delivery time was shortest for those induced with 100μg of misoprostol (6.38+2.25 hours), followed by 8.16+3.58 hours in those induced with 50ug of misoprostol and 9.73+4.32.43 hours in those induced with Foleys catheter/oxytocin (

Survival of infants and children born to women who died from pregnancy and laboour related complications

Objective: In response to concern raised on the high rate of maternal mortality in developing countries, this cross-sectional survey was conducted to assess the survival of infants born to mothers who died during the process of child birth. Methodology: The survey was conducted in Gwoza and Konduga Local Government Areas of Borno State, Nigeria over a 12 week period; January to March, 1996. Results: Sixty four live-born infants of 76 deceased mothers were studied. The majority of the infants were either nursed by the deceased's sister or mother. Alternative or donor breast milk by a surrogate mother (usually the deceased close relation), goat or cow milk were the common form of feeding from birth to 6 months of age followed by groundnut enriched pap.Twenty (31.3%) of the infants survived upto 5 years of age while 44 (68.6%) did not. Factors favouring infant survival include nursing, up-bringing and breast-feeding by a surrogate mother (who is usually either the deceased's sister or mother), infant feeding with goat's or cow's milk, Immunization, hospital treatment of aliments, hospital delivery or maternal death in the hospital and finally when the caretaker is of low party and upper social class status.Factors responsible for infant death included prematurity, cause of maternal death was due to sepsls as a result of prolonged labour or premature rupture of fetal membranes, birth asphyxia, tetanus, respiratory problems, fever, convulsions, diaorrhea and vomiting and malnutrition. Conculsion: These babies are readlly accepted by the society because it is believed that the caretaker would receive a lot of blessing from God. On the other hand,the death of such babies is considered a double loss even though there is a low expectation for their survival . Keywords: maternal death; Survival of infant born alive Nigerian Journal of Clinical Practice Vol.10 (1) 2007: pp.35-4