Postmaturity and fetal macrosomia in Jos, Nigeria

Background: One of the risk factors of post term pregnancy is fetal macrosomia. The excessively large infant presents a recurring and potentially serious obstetric problem.Methods: This was a retrospective study of all consecutive births in the maternity unit, Jos University Teaching Hospital, Jos, Nigeria, between January 1998 and December 2001. The case records of all mothers of babies born with weight of 4000g and above were retrieved and data collated and analyzed for total deliveries, maternal and fetal characteristics, complications and outcome of pregnancy. Results: Macrosomic infants (4000g and above) were 286 cases representing 2.9% of all deliveries. Ten (3.5%) of the infants with macrosomia were preterm, 90.9% were term, and 5.6% were post-term. The mean age and parity of the mothers with pregnancies at term was 29.2 years, and 3.2 respectively. The post term mothers had a mean age and parity of 32.7 years and 3.8 respectively. Maternal morbidity included increased caesarean delivery, and vaginal trauma (episiotomies, tears and bruises) in both groups. Caesarean section was the mode of delivery in 31.3% of post term and 27.6% term infants, while the indication for caesarean section was cephalopelvic disproportion in 80% and 87.3% for post term and term infants respectively. Fetal complications were birth asphyxia and stillbirth. There were no gross fetal abnormalities recorded in the series. Still birth rate was 8.1% and 12.5% in term and post term infants respectively.Conclusion: Post term pregnancies account for macrosomic babies in our facility, posing an increased risk to the mother and fetus. Early diagnosis, intrapartum fetal monitoring and recourse to operative delivery may improve the fetal outcome of these infants.Keywords: fetal macrosomia, maternal morbidity, fetal complicationsRésumé Introduction: L\'un des facteurs de risque de la postmaturité de la grossesse est la macrosomie foetale. Un enfant qui est excessivement grand provoque un problème obstétrique qui est récurrent et potentiellement grave.Méthodes: Il s\'agit d\'une étude rétrospective de toutes des naissances consécutives dans le service d\'obstétrique, centre hospitalier universitaire de Jos, Jos, Nigéria, entre janvier 1998 et décembre 2001. Les dossiers médicaux de toutes les mères des enfants nés avec 4000g poids et de plus ont été tirés et les données rassemblées et analysées pour accouchement total, des caractéristiques materneles et foetales, complications et le résultat de la grossesse.Résultats: Enfants macrosomiques (4000g et lus) étaient 286 soit 2,9% de tous accouchements. Dix soit 3,5% des enfants avec macrosomie étaient préterme, 90,9% étaient terme. Et 5,6% étaient post terme. L\'âge moyen et la parité des mères avec des grossesses à terme étaient 29,2 ans, et 3,2 respectivement. Des mères post termes avaient un âge moyen et une parité de 32,7 ans et 3,8 respectivement. Morbidité maternelle comprend augmentation d\'accouchement césarien, et traumatisme vaginal. (Épisiotomies, déchirures et des blessures légères) dans les deux groupes. La césarienne était la méthode d\'accouchement en 31.3% des post termes et 27,6% des enfants à terme, tandis que l\'indication pour la césarienne était céphatopelvien dispropotionel en 80% et 87,3% pour des enfants post termes et à terme respectivement. Complications foetales étaient la naissance asphyxie et mort à la naissance. Il n\'y avait aucune abnormalité foetale grave notée dans la série. Taux de mort à terme et enfants nés à post terme respectivement.Conclusion: Grossesses post termes constituent des bébées macrosomique dans notre centre. Ceci provoque une augmentation de risque pour des mères et foetus. Un diagnostique précoce, surveillance d\'intrapatum foetal et recours au accouchement à travers l\'intervention chirurgicale pourrait améliorer le résultat foetal chez ces enfants.Mots clés: Macrosomie fœtale, morbidité maternelle, complications foetalesAnnals of African Medicine Vol. 4(2) 2005: 72–7

Postpartum contraception: determinants of intention and methods of use among an obstetric cohort in a tertiary hospital in Jos, North Central Nigeria

Background: Postpartum contraception reduces the risk of unintended and rapid repeat pregnancies. A comprehensive postpartum family planning (PPFP) service can enable women make adequate and informed choices on a preferred contraceptive method, initiating a method as well as encouraging them to use that method for a period depending on their reproductive intentions.Methods: This study aimed to determine women’s intention regarding uptake of postpartum family planning, the preferred methods and the factors associated with uptake. We conducted a cross-sectional study among women attending antenatal and postnatal clinics at the Jos University Teaching Hospital, Jos, Nigeria using structured questionnaires. Data was analyzed using descriptive statistics and chi square test of comparison.Results: Four hundred and five women participated in the study. The mean age of the respondents was 28.4+5.3 years. The previous contraceptive usage was 39.8%. A total of 262 (64%) women intend to use a method of postpartum contraception. The most preferred intended postpartum contraceptive was subdermal implant (19.2%) followed by injectables (18.4%) and intrauterine contraceptive device (14.7%). Reasons cited for nonuse of postpartum contraception include spousal refusal, effect on fertility, desire for further child bearing, religious beliefs.Conclusions: Counselling on postpartum contraception during the antenatal and postnatal period can help women make informed choices among the wide range of available contraception

Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria. Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births. Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ≥40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021. Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Quart de siècle de la stérilisation à Jos, Nigéria du centre.

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and recommended for integration into minor gynaecological procedures in our institutionsL’étude avait pour objectif d’évaluer les types et la fréquence de la stérilisation féminine entre janvier 1985 et décembre 2009 (26 ans) au Centre Universitaire Hospitalier de Jos, Nigéria du centre. Il y avait 25.313 accepteurs nouveaux des méthodes contraceptives modernes dont 4.951 (19,6%) étaient des stérilisations féminines. La méthode la plus commune de la stérilisation féminine était la minilaparotomie. L’anesthésie locale a été l’anesthésie la plus communément utilisée. Les femmes étaient dans la majorité des femmes relativement plus âgées, grandes mulipares et qui ont beaucoup d’enfants. Les femmes avaient en moyenne 38,4 ans et 60% avaient plus de cinq enfants le moment de la stérilisation. L’intervalle de stérilisation constituait 78,5% des stérilisations féminines. L’acceptation de la stérilisation féminine, pourtant, devient de moins en moins fréquente au cours des années au fur et à mesure que l’acceptation des implants des contraceptifs à effet prolongé augmente. On a trouvé que la stérilisation féminine à travers la minilaparatomie sous l’anesthésie locale est faisable, rentable et acceptable par la majorité des clientes ; elle est recommandé pour être intégrée dans les procédures secondaires dans nos établissement

Attitude of Reproductive Healthcare Providers to the Post-Partum Intrauterine Device (PPIUD) in Jos, Nigeria

Context: The knowledge, attitude and practice of the post partum IUD among staff in the obstetrics and gynaecological unit of the Jos University Teaching Hospital has been in doubt all along. Clients were not forth coming for this method of contraception despite the fact that it was readily available in the facility. Objective: To assess the knowledge, attitude and practice of the post partum IUD among the clinical staff of the obstetric and gynaecological unit of the Jos University Teaching Hospital, Jos Plateau State. Method: A semi-structured self-administered questionnaire was developed and administered to a sample of randomly selected health providers working in the Obstetrics and Gynaecology department of the Jos University Teaching Hospital. Of the 200 questionnaires that were distributed, 166 were completed and returned giving a response rate of 83%. All the returned questionnaires were analyzed. Results: The highest number of responders was within the 31-40 year age-group, and 59.6% were females. About 95% had heard about intrauterine devices, 30% had had a formal training in family planning, but none of them had had training in offering PPIUD services. Up to 60% thought that the IUD could be inserted at any time within 6 weeks of delivery. Most (67.5%) of the responders were not willing to recommend the use of PPIUD to anyone for contraception. The commonest reason for not recommending the method was that the complications were more that those inserted as interval procedures, followed by high fall out rate of the IUD. The practice of the method among the respondents was absent, as none of them had actually performed the procedure. Conclusion: There is need for proper education of the health workers themselves about the PPIUD and its benefits to our women especially at the various points of contact with both the obstetric and gynaecological services. This, we believe, would positively influence the attitude and subsequent practice of the method by the majority of the respondents who were clinicians. Key Words: Knowledge, Attitude, Practice, Postpartum Intrauterine Device (PPIUD) [Trop J Obstet Gynaecol, 2004 21:91-94

Experience With Manual Vacuum Aspiration in Jos, Nigeria

Context: The equipment for manual vacuum aspiration (MVA) has been in use in our institution for more than 10 years and there is need for operations research on its use. Objective: To evaluate the indication for use of the MVA equipment, the complications, and any other problems arising from its use. Method: This is a descriptive study of the cases that were admitted in our facility between January 1992 and December 2002, and had MVA performed on them for various indications. The records from the minor and major operating registers were collated and analyzed for the number, the ages, indications, anaesthetic methods used and any complications arising in patients who had the procedure. Results: There were 307 (21.5%) manual vacuum aspirations among 1,428 gynaecological patients seen during the period. The women on whom the instrument was used were all in their peak reproductive period with a mean of 27.6 years. Incomplete abortion was the indication for manual vacuum aspiration in 85.3% of the cases, missed abortion in 7.8%, and the evacuation of molar pregnancies in 6.2%. Sedation with Pentazocine (30mg) was the mode of pain control in all cases of incomplete abortion (85.3%). All cases of incomplete abortion spent less than 24 hours on admission for evaluation, basic investigation and definitive treatment with the Karman\'s syringe. The procedure was well tolerated by all the patients. There were no recorded major morbidities following the procedure. Conclusion: Manual vacuum aspiration (MVA) with the use of the Karman\'s Syringe has been accepted as the predominant method of treatment of incomplete abortions in our centre. It was found to be simple, safe and costeffective. It has eliminated the admissions of the patients to the ward for more than 24 hours, thereby drastically reducing costs from hospital bed charges. Key Words: Karman\'s Syringe, Manual Vacuum Aspiration (MVA), Abortion. [ Trop J Obstet Gynaecol, 2004;21:100-103

Fetal outcome in umbilical cord prolapse in Jos, Nigeria

Background: Cord prolapse is one of the obstetric emergencies in labour, posing a life-threatening emergency for the fetus. Timely delivery at detection with a live fetus is the hallmark of good clinical management to reduce the high perinatal morbidity and mortality in the fetus. Objective: To determine the incidence of cord prolapse, predisposing factors and fetal outcome of the cases of cord prolapse managed in the Jos University Teaching Hospital (JUTH). Study Design: A review of the fetal outcome of thirty-five (35) cases of cord prolapse managed at the JUTH, Jos, Nigeria from January 1999 to December 2003. Results: There were 12,536 deliveries with 35 cases of cord prolapse, giving an incidence of 0.28%, or 1 in 358 deliveries. The highest incidence occurred in women aged 30-34 years. Cord prolapse was seen to be mainly a problem of multiparous women, 96.8%. Prematurity was the highest contributing factor 12 (30.0%), followed by twin pregnancy 9 (22.5%). About 57% of the babies were dead on presentation to the hospital, mainly from patients booked outside JUTH. One baby with severe birth asphyxia died in the early neonatal period. Perinatal mortality was 629 per 1,000 deliveries. Conclusion: The perinatal mortality in the cases of cord prolapse is still high. Most fetal deaths were from patients that booked outside the hospital, presenting with intrauterine fetal death. The un-booked patient with cord prolapse is most likely to present with an intrauterine fetal death. Keywords: cord prolapse, fetal outcome, labour Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 30-3

The rise and fall of female sterilization in Jos, Nigeria: A cause for concern

Background: Female sterilization is a permanent form of contraception offered to women who have completed their family size. Other methods are all temporary and meant to be reversible. A high‑quality female sterilization service was introduced in Jos with the assistance of training in counseling and minilaparotomy under local anesthesia in May 1985. After training, female sterilization became available for couples desiring it on completion of family size. Materials and Methods: This was a retrospective study of all clients who had female sterilization for contraception between 1985 and 2019. The clinic register was retrieved and evaluated for acceptances of all contraceptive methods within the period and trends observed. Results: Over the 35 years, a total of 29,167 new clients accepted modern family planning methods. Out of these, a total of 5167 were female sterilizations, constituting 17.7% of the new acceptors. The temporary methods of contraception constituted 82.3%. The other methods used were the intrauterine device 8357 (28.7%), the oral pills 5125 (17.6%), the injectables 5235 (17.9%), and the contraceptive implants 5283 (18.1%). Although female sterilization was 4th among the five methods studied, there was however a gradual decline in its acceptance from a peak of 36.1% in 1992 to 1.4% in the year 2018. Conclusion: The acceptance of female sterilization rose to a peak in 1992 and declined to the lowest level in 2018, occasioned in part by the introduction of varieties of contraceptive implants providing long acting, reversible, and cheap contraception

Elective caesarean sections at the Jos University Teaching Hospital

Context: Elective caesarean sections have been pronounced safer for both mother and fetus compared with emergency caesarean sections. Emergency caesarean sections however have continued to constitute the lion share of caesarean sections in our facility. Objective: To determine the caesarean section rate, examine the trend of elective caesarean sections and the indications for elective caesarean sections amongst our patients. Methodology: This was a retrospective study of the clinical records of all patients that had caesarean section in Jos Nigeria from January 1985 to December 2002, an 18-year period. Data on the number and type of caesarean section, age of patients and the indication for the elective caesarean section were extracted and analyzed. Results: A total number of 41 470 deliveries were conducted within the period of study. Out of these deliveries, 6 557 were caesarean sections giving a caesarean section rate of 15.8%. Elective caesarean sections were performed in 970 (14.8%), and emergency caesarean sections in 5 587 (85.2%) of all the caesarean sections. The rate of elective caesarean section increased from 8.9% in 1985-1986 to a rate of 22.5% in the last two years of the study period. Repeat caesarean section was the commonest indication for elective caesarean sections in 51.9% of the cases, followed by bad obstetric history (BOH) in 10.8%. Conclusions: Elective caesarean section accounted for 1 out of every 6 caesarean sections in the center. The commonest single indication for the elective caesarean section was repeat caesarean section for 2 or more previous caesarean sections. Keywords: elective, emergency, caesarean section, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 39-4