Factors affecting birth weight at the jos university teaching hospital, jos, plateau state, north central nigeria

Background: Birth weight is one of the most easily assessed parameters in the new born. It can be used as an assessment of intra uterine fetal life and as a predictor of neonatal and later life. There are various factors both maternal and fetal that have been shown to be determinants of birth weight. The objective of this study was to assess the factors that affect birth weight at the Jos University Teaching Hospital. Materials and method: A 3 year retrospective observational study was conducted looking at the 4279 babies born during this period and evaluating which factors could lead to heavier babies and some immediate obstetric consequences of such babies to their mothers. The required data was collected from the labour ward records and analysis using Excel 16.0. Results: The results showed that fetal sex, parity, maternal age and educational level all have a role to play in the eventual weight of babies. It also showed that higher birth weights did not lead to worse perineal tears. Conclusion: The conclusion was that the factors affecting birth weight in this study reflect similar studies with additional factor of educational level and buttressing the thinking that larger birth weight does not predispose to more severe perineal tears

Clinical improvement of status epilepticus after delivery: A case report

Status epilepticus is a rare neurological complication of pregnancy, associated with significant maternal and fetal morbidity and mortality. Termination of pregnancy is not currently a management strategy. The clinical case was 35‑year‑old known epileptic presented with complaints of multiple convulsions of 2 days and loss of consciousness of a day. On examination, she was unconscious, with Glasgow Coma Scale 5/15, having repeated seizures, and blood pressure was normal. The assessment was status epilepticus and she was shortly admitted into the intensive care unit. She was eventually paralyzed and put on mechanical ventilation. She had a spontaneous delivery, subsequently improved, and was discharged on oral carbamazepine. Key aspects of this patient’s management buttressed that status epilepticus can mimic eclampsia. That she significantly and progressively improved following delivery and that previous similar cases have been reported brings to bear that delivery might need to be considered as a management strategy for refractory status epilepticus.Keywords: Convulsion; delivery; pregnancy; status epilepticu

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

Modification of WHO diagnostic criteria for gestational diabetes: implications for classification of hyperglycemia in pregnancy

Background: Low and medium income countries (LMICs) especially in sub-Saharan Africa face unique challenges in screening and diagnosing hyperglycaemia in pregnancy. The implications of applying the 2013 WHO modifications for assessing hyperglycaemia in pregnancy in low resource settings are not known. We evaluated the significance of these recent changes in classification of hyperglycaemia among pregnant Nigerian women.Methods: We reviewed the records of Oral glucose tolerance test conducted on 600 pregnant women at the Jos University Teaching Hospital (JUTH) between July 2012 and June 2016. The collected data were analyzed using Statistical Package for Social Sciences version 18 (SPSS Inc., Chicago, IL, USA). Test for association was done using Fisher’s exact test. P < 0.05 was set as the level of significance.Results: The results show that 15.9%, 20.2% and 15.7% of the women had GDM according to WHO (1999), IADPSG and WHO (2013) diagnostic criteria respectively while 4.8% of the women had DM in pregnancy by WHO 2013 criteria. Overall, 30.2% and 23.9% of women who were classified as GDM by WHO 1999 criteria and IADPSG criteria respectively were qualified to be classified as DM in pregnancy according to the WHO 2013 criteria.Conclusions: The recent Modifications by the WHO 2013 guideline for classifying hyperglycemia in pregnancy may create non-uniform interpretation of OGTT. The confusion in classifying hyperglycemia among pregnant women referred between health centres may become more pronounced. There is an urgent need for a streamlined globally acceptable approach to assessing and classifying hyperglycemia in pregnant women

Hydatidiform mole in Jos, Nigeria

Background: Hydatidiform mole is a relatively common gynecological problem which could present like spontaneous abortion, one of the commonest gynecological emergencies. It has the propensity to become malignant but can easily be identified and treated. The aim of this study was to determine the demographics, clinical features, treatment options and outcome of patients with hydatidiform mole in our environment. Materials and Methods: This was a retrospective review of all the cases of hydatidiform mole seen at the Jos University Teaching Hospital (JUTH), Jos, Nigeria over a 5-year period. Results: There were 34 cases of hydatidiform mole giving an incidence of 1 in 357 deliveries. However only 25 case notes were available for analysis and the mean age of patients was 28±3 years. Vaginal bleeding (92%), honeycomb appearance on ultrasound scan (84%), and passage of vesicles (60%) were the most common clinical findings while suction curettage was the mode of treatment for all the patients in this study. Twenty-eight percent of cases were confirmed by histology. No patient came for follow-up after the third month of diagnosis. Twenty percent of the patients booked for antenatal care within 9 months of diagnosis while 12% of patients presented as gynecological emergencies with features of malignant disease within six months of diagnosis. Conclusion: Hydatidiform mole is common in Jos, North Central Nigeria, and presents most commonly with vaginal bleeding with over 10% becoming malignant. Hence all patients who present with vaginal bleeding should be screened for HM. None of the patients completed the recommended duration of follow-up and only about ¼ had histology reports. Concerted efforts need to be made to address the challenges of patients adhering to recommended follow-up protocols and having to pay first before investigations are done

Obstetric referrals: the practice by community health workers

Background: Maternal mortality is a major health challenge in Nigeria. Improper/late referral of obstetric patients is a major contributor to these deaths. This cross-sectional study documents the practice of referral of obstetric patients and the challenges faced by community health extension workers attending a Community Health Officers Training programme in a teaching hospital in NigeriaMethods: Pretested self- administered questionnaires were administered to students undergoing the Community Health Officers training programme at the Jos University Teaching Hospital. Focused group discussions were also conducted.Results: Majority of the respondents (93.8%) referred patients to other healthcare facilities and the reasons proffered for referring patients include complications (54.7%), for proper care (34.4%) and based on guidelines/protocol (6.3%). Majority of respondents 89.1%, 84.4% and 78.1% referred patients with eclampsia, abnormal lies and presentation and antepartum haemorrhage respectively while about half of the respondents referred primigravidae, grandmultigravidae and women with multiple gestation. Half of the respondents had encountered challenges while referring patients to other health facilities. The challenges highlighted during the group discussions in referring patients include absence of feedback from referred hospitals, insults from health workers at the referred centres, patients refusing to go to other hospitals due to lack of funds and complaints of poor treatment/care by health workers in those hospitals.Conclusion: The practice of referrals of obstetric patients by community health workers is poor. Health workers should be trained on proper patient referral with the use of clearly written guidelines/protocols.Keywords: Community health workers, Obstetrics, Practice, Referral

In-Vitro Fertilization: Awareness and perception among infertile women at the Jos University Teaching Hospital

Background: The prevalence of infertility is high in the developing world, sub-Saharan Africa inclusive with its attendant medical and social consequences. Tubal factor and male factor are responsible for the majority of cases of infertility in this environment. In-Vitro fertilization (IVF) is the treatment of choice for these cases. Though the services are available in some parts of the country including Jos, the uptake appears to be low. We sought to assess the awareness and willingness to accept IVF services among infertile women inJos University Teaching Hospital. Method: A cross-sectional descriptive study involving 149 patients from the Gynaecological clinic of the Jos University Teaching Hospital was carried out. Data were obtained using a pretested questionnaire and analyzed using SPSS version 21.0. Results: The mean age of the respondents was 30+6 years. Only 45.6% had heard about IVF. The information they had on IVF was inaccurate in 52.9% of respondents. The majority (77.9%) of the respondents had no idea of the success rate of IVF but believed the process guaranteed pregnancy. Most respondents (74.5%) preferred to have multiple pregnancies if given a choice, however, the majority (72.7%) were unaware of the complications associated with multiple pregnancies. Conclusion: Efforts to improve the awareness about IVF should be adopted to increase the uptake of the IVF services. Keywords: IVF, awareness of IVF, infertility, Nigeri

Seroprevalence of rubella virus infection in women with recurrent miscarriage: a case control study in Jos, Nigeria

Background: Recurrent pregnancy loss is an emotionally and physically tasking situation for couples, especially in developing countries where lack of children is a cultural taboo. Rubella infection in early conception has a 90% probability of developing congenital rubella&nbsp; syndrome (CRS) or miscarriage. The aim of this study was to compare the seroprevalence of rubella virus infection in women with and without recurrent miscarriage. Methods: It was a hospital based case control study. Sampling was done by purposive. Subjects were recruited consecutively until the&nbsp; required number was reached. Control subjects were selected by simple random sampling. Healthy postnatal women who consented for the study were asked to pick a piece of paper from a covered container, those who picked yes were then recruited. A semi structured researcher administered questionnaire was used to collect data. Enzyme-Linked Immunosorbent Assay (ELISA) was used to check for rubella specific IgG and IgM. We compared the prevalence of rubella virus infection in cases and controls by Chi-square analysis. A p-value &lt; 0.05 was considered significant. Results: The overall mean age of the participants was 30.62±3.60 years. None of the participants had received rubella virus vaccination. The seroprevalence rates of rubella IgG and IgM among the cases were 85% and 16.7%, while in the controls were 80% and 13.3%. The prevalence of Primary + + rubella infection (IgG IgM ) was 10 (16.7%) and 8 (13.3%) among the cases and the controls respectively. Rubella virus + - seropositivity (IgG IgM ) was 68.3% among cases versus 66.7% - - among controls, and rubella virus seronegativity (IgGIgM) was 15.0% and 20.0% among cases and control respectively. Conclusion: The high seroprevalence of rubella virus infection observed in this study suggest that majority of women in our setting are exposed to rubella virus infection before pregnancy. There was no significant difference in the seroprevalence of rubella virus infection between women with and those without a history of recurrent miscarriage

Maternal satisfaction with intrapartum care at the Jos University Teaching Hospital

Background: A woman's satisfaction with the delivery service may have immediate and long term effects on her health and subsequent utilization of the services. Maternal satisfaction is an essential indicator of the quality and efficiency of health care systems. Providing skilled and satisfying care during pregnancy, intrapartum and postpartum period saves lives of both mother and neonates and so increases service utilization. Women play a principal role in the upbringing of children and the management of family affairs, and their loss from pregnancy related causes is a significant social and personal tragedy. Hence we sought to assess maternal satisfaction with the delivery service in Jos University Teaching Hospital and to determine satisfaction in relation to three dimensions; interpersonal care, information and involvement in decision making and physical birth environment Methods: A cross sectional study of postnatal women that attended the family health clinic between January to March 2015. A simple random sampling was used on eligible participants. An interviewer administered questionnaire that included respondents sociodemographic characteristics and validated 14 items maternal satisfaction with intrapartum care scale was used. Data was analysed using SPSS version 23. Results: A total of 173 mothers were interviewed, of which 64.6% of the respondents were between the ages of 20-34 years. All the respondents were married and had a mean age of 27.3±3.2 years. Greater than half of the participants (50.9%) had secondary level of education, 67.1% were multiparous while 32.9% were primiparous. Overall maternal satisfaction level with the delivery services rendered at the hospital was 86.7%. Conclusion: Although the majority of the participants were satisfied with the services given to them during delivery, lack of satisfaction by the minority group will limit their ability to engage in health facility delivery which will further contribute to maternal mortality. Thus, mechanisms should be devised to increase maternal satisfaction in this health institution

Pattern of gynaecological malignancies in Jos

Context: Female cancer is a public health problem the world over. The malignancies of the female genital organs are major causes of morbidity and mortality which necessitates data for policy formulation and health planning.Objective: To document the relative frequency, age distribution and histological patterns of gynaecological malignancies seen at the Jos University Teaching Hospital (JUTH).Methodology: A retrospective 5 year review of all gynaecological malignancies seen at the JUTH. Main outcome measures: frequency, age distribution and histological patterns of gynaecological malignanciesResult: Female genital tract cancers account for 5.4% of gynaecological disorders in JUTH. The complete records of 203 out of 250 patients with gynaecological malignancies were retrieved giving a retrieval rate of 81.2%. Of these 203 case records, 152(74.9%) cases were from the uterine cervix while 31(15.3%) and 13(6.5%) cases were from the ovary and uterine corpus respectively. The vagina and vulva accounted for 3(1.4%) and 4(1.9%) cases respectively. Squamous cell carcinoma accounted for 93.4% of cervical cancers and 100% of vaginal and vulval cancers. Epithelial tumours accounted for 61% of ovarian tumours while choriocarcinoma accounted for 53.8% of cancers of the corpus uteri.Conclusion: Squamous cell cervical cancer is still the most common gynaecological malignancy in Jos. The challenges of HIV/AIDS and cervical screening need to be addressed to reduce its incidence.Keywords: Gynaecological cancers, pattern, frequency, histology, JosTrop J Obstet Gynaecol, 30 (1), April 201