Gynaecological bacterial infections: the physical and psychosocial consequences and challenges of management in resource-limited settings

Gynecological bacterial infections (GBIs) are prevalent in our environment and as a result pose a number of physical, social and psychological consequences. These infections are acquired through several ways. Treating GBIs is a daunting task making its control the most important strategy to alleviating its physical and psychosocial consequences. To highlight the physical, social, and psychological consequences of gynaecological bacterial infections in our resource limited setting. To highlight the hugely unresolved challenges associated with the management of gynecological bacterial infections in our resource-limited setting. Several databases (Medline, Google Scholar, Pubmed, WHO’s Hinari and Wikipedia) and some selected websites were searched using the following keywords: gynecological infections, vaginal infections and discharges, vaginal flora, sexually transmitted infections, pelvic inflammatory disease, syndromic management and challenges, psychosocial consequences, alternative medicine. A total of 5470 relevant articles were obtained between 1947 and 2018. Out of these only 256 relevant articles on the topic were reviewed. However, 213 were dropped for having an incomplete submission. Forty-three (43) articles were fully accessed and referenced. The high prevalence of GBIs poses a lot of burden on the reproductive and socio-economic lives of our women. This should be matched by behavioral changes, prompt diagnosis and early treatment; facilitated by accessible and affordable health care through improved government funding

Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria

Background: Early amniotomy is common in obstetric practice but, its effectiveness has not been proven.Objectives: To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal out- comes of uncomplicated pregnancies in Enugu, South-east Nigeria.Methods: A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved.Results: Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of con- trol group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin aug- mentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 – 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. Conclusion: Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.Keywords: Early amniotomy, duration of labour, oxytocin augmentation, term pregnancy, caesarean section rate, Enugu- Nigeria

Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria

Background: Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. Objectives: To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal out- comes of uncomplicated pregnancies in Enugu, South-east Nigeria. Methods: A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. Results: Mean duration of labour for the amniotomy group (279.4 \ub1 53.7 minutes) was significantly lower than that of con- trol group (354.4 \ub1 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin aug- mentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 \u2013 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. Conclusion: Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications

Some Biochemical Markers of Oxidative Stress in Pregnant Nigerian Women

Context: The increased generation of free radicals and reactive oxygen species in pregnancy results in oxidative stress. Antioxidants are used as defence mechanisms and their serum concentrations give oxidative stress levels. Objective: To determine serum levels of ascorbic acid, uric acid and bilirubin (antioxidants) , as simple markers of oxidative stress in pregnant Nigerian women. Study Design, Setting, Subjects and Methods: Pregnant women numbering sixty-five, aged between 20-38 years, in their second and third trimesters were selected from the antenatal clinic, University of Nigeria Teaching Hospital (UNTH) Enugu. A comparable group of 65 non-pregnant women (controls) were also recruited. Serum levels of ascorbic acid were determined by Roe and Kenther method, uric acid by Brown\'s method and bilirubin by Powell\'s method. Results: The serum levels of ascorbic acid, uric acid and bilirubin were each significantly lower in pregnant than in non-pregnant control subjects (

Emergency myomectomy during pregnancy: a case report

A 25 year old primigravida at 17 weeks gestation, whose pregnancy was complicated by uterine fibroid, is presented. Physical signs and ultrasonography suggested ovarian malignancy complicating pregnancy. Exploratory laparotomy done with the surgeons revealed a degenerated, ruptured, giant mass that weighed 11.6kg. The mass was attached to the right lateral side of the uterine fundus, by a thick and short pedicle. It was also adherent to the infracolic omentum, the pelvic and abdominal parietal peritoneum. Histopathological diagnosis was degenerated uterine fibroid. Pregnancy, labour and puerperium were uneventful, with a spontaneous vertex delivery of a life male baby. Keywords: pregnancy, uterine fibroids, myomectomy Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 79-8

Visual acuity and refractive changes among pregnant women in Enugu, Southeast Nigeria

Introduction: Pregnancy has been associated with changes in the eye which could be physiological, pathological, or exacerbation of pre-existing ocular conditions. Visual acuity (VA) and refractive error (RE) changes are part of the physiological changes that may occur during pregnancy. Objective: The objective of the present study was to investigate changes in VA and RE across two different trimesters and six weeks postpartum among pregnant women in Enugu, southeast, Nigeria. Materials and Methods: A longitudinal study was adopted and pregnant women in their second trimester attending antenatal clinic at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu were consecutively recruited. A questionnaire was used to obtain information on their sociodemographic and clinical characteristics. Visual acuity was measured and refractive error monitored in second and third trimesters and 6 weeks after delivery. Results: The mean age of women was 30.81 (±5.49) years and a majority of them were civil servants. There was a worsening of VA for distance in more women in the third trimesters compared to the second trimester. There was no significant change in VA for near throughout the study period. There was an increased myopic shift in more pregnant women during the third trimester (40; 40.0%) compared to second trimester (36; 36.0%). The most common refractive error found among the women was simple myopia. These changes resolved six weeks postpartum. Conclusion: Pregnancy worsened VA for distance and the most common RE in pregnant women was simple myopia. However, these changes resolved during the postpartum period

Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study

Objectives: This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria.Design: This was a case-control analytical study.Setting: Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria.Participants: Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control.Data Collection/Intervention: A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test.Statistical analysis/Main outcome measure: Pearson Chi-square, Fisher’s exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value < 0.05 was considered significant.Results: The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P < 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility.Conclusion: Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility