Contraception with combined oral contraceptive pills in Port Harcourt, Nigeria

Background: Millions of women worldwide use the combined oral contraceptive pill (COCP) as an effective form of contraception. This has contributed immensely to population control and improvement of maternal wellbeing.Aim: To determine the acceptability, efficacy and side effect of COCP in Port Harcourt and compare with the experience elsewhere.Methods: This was a retrospective study of all clients who accepted COCP between 1st   January 1997, and 31st  December 2006 at the Family Planning Clinic of University of Port Harcourt Teaching Hospital (UPTH). Information obtained included sociodemographic characteristics, side effects, reasons for discontinuing the method and source of information.Results: A total of 4,160 clients accepted contraception during the study period, out of which 360 used COCP, giving a prevalence rate of 8.7%. The mean age and parity of acceptors were  27.14 ± 4.68 years and 1.82±0.45 respectively. Among the clients, 99.4% had formal education while 66.1% were single and 49.7%% were students. Prevalent side effects were menstrual disruptions (47.9%), weight gain (33.7%), hypertension and headaches (5.4% each) amongst others. The common reasons for discontinuing COCP were weight gain (28.6%), menstrual disruptions (28.5%) and non-compliance (14.2%). Mass media was the commonest source of information, and one accidental pregnancy occurred (Pearl index 0.03 per 100 woman years). Conclusion: This study shows that combined oral contraceptives pills appear to be acceptable, safe and effective in Port Harcourt. This compares to world wide experience. Concerted effort should be made in improving information dissemination on COCP especially amongst students and single clients. Keywords: Contraception, Combined oral contraceptive pills, Port Harcour

Post-operative Anaemia and Prevalence of Blood Transfusion In Surgical Patients at The Rivers State University Teaching Hospital

Blood transfusion following surgical procedures may be a life saving venture especially in anaemic patients. Even though there is no universal accepted consensus on blood transfusion in surgical patients there should be clear cut indications prior to blood transfusion. The prevalence varies from centers and regions in the world. To determine post-operative anaemia and prevalence of blood transfusion in surgical patients at the Rivers State University Teaching Hospital (RSUTH). This was a six-month retrospective study of post-operative patients at the Surgery and Obstetrics/Gynaecology department of the Rivers State University Teaching Hospital. Ethical clearance was obtained from ethical committee of the Rivers State Hospital Management Board. The cut- off for anaemia was 33% in line with the World Health Organisation (WHO). Structured profoma was used to extract information from patients case notes and analysed using SPSS version 25. The subjects for the study were 370, comprising of 146 (39.5%) males and 224 (60.5%) females. The mean age was 31 years of which 194 (52%) were obstetrics and gynaecological surgeries while 176 (47.6%) were non-gynaecological surgeries. The commonest indication for surgery was ceasaren section representing 126 (34.1%) of the subjects; 259 (70%) had anaemia, of which 168 (64.8%) were females while 91 (35.2%) were males. Eighty-four (22.7%) of the subjects had blood transfusion. The prevalence of post-operative anaemia and blood transfusion in surgical patients at the RSUTH were 70% and 22.7% respectively. Optimizing surgical patients prior to operative procedures as well as taking measures to reduce blood loss intra-operatively cannot be overemphasized.&nbsp

Obstetric risk assessment and referral to tertiary healthcare facilities from primary and secondary healthcare settings in Nigeria

Obstetric risk assessment is an integral part of obstetric care needed to classify patients into low and high risk categories, thereby aiding appropriate referral cascade. Unfortunately, in Nigeria, its effectiveness is saddled with uncertainty. The aim of the study therefore was to determine the appropriateness of obstetric risk assessment and referral from primary and secondary healthcare facilities to the tertiary Centre Rivers State University Teaching hospital (RSUTH) in Rivers State, Nigeria. It was a prospective cross-sectional study involving 475 patients who were managed on admission to the labour ward and the appropriateness of their referrals was assessed, using a preformed evidence-based guideline. The outcome measures were as follows: percentage of patients that had appropriate risk assessment, referred appropriately, referred late and those that needed referral at booking. Data was analysed using Epi Info 2020. Out of the 475 study population, only 50 (10.53%) were of low risk category at presentation and were appropriately referred when complications developed in pregnancy. 15 (3.16%) of them, although of low risk at booking, needed earlier referral when complications developed while majority 410 (86.32%) were of high risk category because they either had complications in their previous pregnancies or had pre-existing diseases or both and therefore needed to be referred at booking (11-13+6 weeks) but were not. The findings underscored the urgent need for structured retraining of skilled obstetric practitioners in both primary and secondary healthcare settings in Rivers State

Prevalence of Hypertension among Clients Attending the Obstetrics and Gynaecology Clinic in Rivers State University Teaching Hospital

Hypertension is a common medical condition in surgical patients globally. There are myriad of predisposing factors for hypertension especially as it concerns obstetrics and gynaecology. these include family history, age of the patient unhealthy diet, harmful intake of alcohol, sedentary life style, obesity just to mention a few. Approximately 20% of global population lives with hypertension. To determine the prevalence of hypertension in obstetrics and gynaecology patients that had surgeries at the Rivers State University Teaching Hospital (RSUTH). This was a one year retrospective cross – sectional study in surgical patients at the RSUTH. Data was obtained from the patients' case notes. The information was analysed using SPSS version 25.Two hundred and fifty subjects were recruited for the study. The age range was 22 years to 64 years.. The mean age was 31 years. Two hundred (80%) were obstetrics surgeries while 50 (20%) were gynaecological surgeries. One hundred and eighty (72%) of the subjects had caesarean section making it the commonest surgical procedure; 35 (14%) had hypertensive diseases. Eclampsia and pre-eclampsia contributed to 25 (10%) of surgical patients with hypertension. The study revealed the prevalence of hypertension in obstetrics and gynaecologic patients who had surgery at the RSUTH as 14%. Majority of the surgical patients had eclampsia and pre-eclampsia. Multidisciplinary approach to the management of such patients involving the cardiologist and other specialties is the key for a favourable outcome

Practical Approach to Sub-specialty Training in Maternal Foetal Medicine (MFM) in Nigeria

The heavy burden of maternal and perinatal morbidities and mortalities in Nigeria, most of which are MFM-related has stimulated the introduction of subspecialty training in MFM. Unfortunately in the available curriculum, less attention was paid to the ultrasound-related aspect of the training and also there was less clarity on the order of navigation through the various modules of the training. The objective of the present study therefore was to design a sub-specialty training curriculum in MFM with practical approach to its execution, taking into consideration the Nigerian ethno- cultural peculiarities, its disease topography and the level of its economic development. It was of mixed design study, with both observational and review components. A literature search and telephone communication with MFM specialists in tertiary health institutions in Nigeria on the subject were carried out. There was no structured training program in MFM in Nigeria. A competency-based modular training framework whereby acquisition of ultrasound-based competencies intertwined with the maternal medicine components of the training was proposed. The ultrasound modules to be covered were as following: first trimester scan at 11+0 to 13+6 weeks, the 20 + 0 to 23 + 6 weeks scan, growth and doppler ultrasound, cervical assessment, foetal echocardiography, application of ultrasound in the management of labour, screening for and diagnosis of placenta accrete spectrum and invasive procedures. Successful completion of the training modules, including rural posting, rotation in allied disciplines will earn the trainee an exemption from the dissertation component of the part II fellowship examination and award of fellowship or diploma in MFM, depending on whether the trainee completed the invasive module or not