Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria

ObjectiveTo estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.DesignRetrospective observational study.SettingA total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.PopulationPregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.MethodsSecondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.Main outcome measuresRisk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.ResultsObstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.ConclusionsModifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions

The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria

Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6΁2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6΁8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered