Outcome of obstetric admissions in the intensive care unit of Jos University teaching hospital: a six year review

No Absract

Forgotten intrauterine contraceptive device: A rare cause of infertility

No Abstract

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

Malaria parasitaemia amongst antenatal women in a tertiary health facility in the Savanna

Context: Malaria is a major public health problem in Nigeria. Pregnant women are particularly susceptible because of their reduced natural immunity and the presence of a unique form of the disease – placental malaria. Peripheral parasitaemia may be a guide to the presence or absence of placental malaria with its attendant sequelae.Objectives: The goal of the study was to determine the prevalence of malaria parasitaemia in the Jos University Teaching Hospital and the socio-demographic risk factors for malaria parasitaemia.Methodology: A descriptive cross sectional study was carried out at the antenatal clinic of Jos University Teaching Hospital from 1st August to 30th September 2008. A structured interviewer-administered questionnaire was used to collect information about socio-demographic characteristics and blood samples obtained for malaria parasitaemia, blood group, haemoglobin solubility and HIV test. All the information obtained was analyzed using Epi-info 3.5.1, Atlanta, USA.Results: The prevalence of malaria parasitaemia at booking antenatal visit in JUTH was 39.7%. The presence of sickle cell trait, use of insecticide treated nets, and those aged less than 20 years were protected against malaria parasitaemia. HIV seropositivity, primiparity and those with anaemia were more likely to have parasitaemia. Blood group, previous history of fever and the use of anti-malarial drugs did not have any association with malaria parasitaemia.Conclusion: The prevalence of malaria parasitaemia in pregnancy is still high in spite of the availability of evidencebased and cost-effective interventions to prevent malaria in pregnancy

A 10-year audit of gynaecological surgeries performed in the paediatric age group at the Jos University Teaching Hospital

Background: Surgeries performed for gynaecological conditions in children and adolescents are not common in our environment. Adequate facilities and the skill to perform the required procedures may also be lacking. We were interested in reviewing the practice of paediatric gynaecological surgery in our facility. Patients and Methods: A retrospective study of case files and theatre records of children below the age of 16 years who had surgeries at the Jos University Teaching Hospital over a 10 year period was undertaken. Results: A total of 89 surgeries were performed in this age group during the period under review. Twenty-eight (33.4&#x0025;) of the patients were below the age of 11. The most common surgical procedure was for the management of septic abortion (21.3&#x0025;). Correction of congenital malformations of the genital tract accounted for 21.4&#x0025; (19) of the surgeries performed. Fourteen (15.7&#x0025;) laparotomies were performed for ovarian cysts. Conclusion: Though the number of surgeries performed on children for gynaecologic reasons may appear small, the skills required to manage them should be enhanced and the requisite facilities provided

An Audit of Perineal Trauma and Vertical Transmisson Of HIV

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.Keywords: HIV positive; perineal trauma; episiotomy; perineal tear; MTC

The febrile child: how frequent should we investigate for urinary tract infection

Background: Febrile illness in children remains the most common cause of emergency room visit. In many tropical countries where malaria is endemic, children presenting with fever are treated for malaria presumptuously. Current evidence suggests however that malarial parasitaemia in febrile children is declining and the prevalence of other causes of fever apparently on the increase. Therefore, highlighting such causes of fever as urinary tract infection (UTI) is indispensable. This is much so as UTI not only is common in younger children and often neglected but also associated with long term complications.Methods: Children aged 6- 59months with fever of less than 2weeks were consecutively recruited. Each child had both clinical evaluation and preliminary laboratory assessment such as dipstick urinalysis. Further microbiological and radiological evaluations were performed where necessary: blood film for malarial parasite identification and count, cerebrospinal fluid (CSF) analysis and chest X-ray.Results: Of the 303 children 180 (59.4%) were males and 123 were females (40.6%). The mean age was 21.7±14.0months, 54.5% were less than 24months. ARI accounted for 44.6% (mainly tonsillitis, 61%, pneumonia, 27% and otitis media, 12%), while malaria and UTI were observed in 38.3% and 4.6% respectively. Five (35.7%) patients with UTI were males while 9 (64.3%) were females. Their combined mean age was 25.4±18.6months, 57% of these children were less than 24 months old. In 3(21.4%), UTI coexisted with malaria.Conclusions: Acute respiratory infection, malaria and UTI are the three leading causes of fever in children under 5 years.Keywords: Fever, Children, Acute respiratory infection, Malaria, UT

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

A Review of hysteroscopy in a private hospital in Jos, Nigeria

Background: Examination of the uterine cavity is an imperative gynaecology for the detection and treatment of intrauterine abnormalities. Hysteroscopy is considered to be the gold standard for this purpose Identification and subsequent treatment of intrauterine leisons may improve pregnancy rates in Invitro fertilization(IVF).Methods: Medical records of patients who had hysteroscopy between May 2016 and April 2017 at Kauna Specialist Hospital were analysed. Indications for hysteroscopy, findings and complications were noted.Results: A total of 82 hysteroscopies were performed during the period under review. The commonest indication was preparation for IVF in infertile patients (58.1%). Other indications included infertility (27.2%), menorrhagia (9.9%) and hypomenorrhoea (2.4%). Intrauterine abnormalities were detected in 59.3% Patients. Intrauterine adhesions were found in 30.9% of the patients . Endometrial polyps (13.7%), fibroids(4.9%) and irregular endometrial lining(4.9%) were also observed. A large proportion (42.7%) of patients who had recurrent IVF failure had intrauterine abnormalities.Conclusion: Hysteroscopy is an invaluable tool in the detection and treatment of intrauterine leisons. Its wider use is advocated in gynaecological practice in Nigeria.Key words: Hysteroscopy; Infertility; In Vitro fertilization, intrauterine abnormalitie