Primary Caeserean Section In Grandmultiparae At Mater Misericordiae Hosptial Afikpo: A 5 Year Retrospective Study

To identify the common indications and the outcome of primary caesarian section in grandmultiparae at Mater Misericordiae Hospital Afikpo. The case notes of 69 grandmultiparae who had primary caesarean section at Mater MisericordiaeHospitalAfikpo between January 1999 toDecember 2003 inclusively.The information obtained included age, parity, occupation, height, educational status, booking status, indication for caesarean section, operative and post-operative complications, types of anaesthesia, types of uterine incision, mean blood loss, associated pelvic findings and foetal outcome. Eighty nine percent (89%) of 69 primary caesarean sections were done emergency procedure. The commonest indications for a caesarean section were dystocia (76.8%), antepartum haemorrhage (17.4%), essential hypertension (10.1%) Puerperal pyrexia (24.6%), haemorrhage (7.2%)wound dehiscence (4.3%) and anaemia (2.9%), were the commonest intra- and post operative complications encountered. The perinatal mortality ratewas 153/1000.Therewere twomaternal deaths (29 per 1000). Health education of the population coupled with better utilization of comprehensive maternity care and family planning facilities are advocated. Keywords: Caesarean Section, Grand multiparae. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 368-37

Antenatal Care Booking Pattern at a Tertiary Hospital in South- Eastern Nigeria

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Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Unbooked Status: A Predictor of Adverse Perinatal Outcome in HIV Positive Women at a Tertiary Hospital in the South Eastern Nigeria

Background: The scourge of HIV infection in developing countries has continued to rise at an alarming rate. This has serious health, economic and social consequences on the society. Aims and Objectives: The study was conducted to determine the effect of non-attendance of antenatal care on perinatal outcome of HIV positive pregnant women at the Imo State University Teaching Hospital (IMSUTH), Orlu. Methods: A retrospective analysis of the case records of women (both booked and unbooked) who tested positive to Human Immune-deficiency Virus and the perinatal outcome at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1 May 2005 to 30 April 2010 was made. The biosocial, obstetric and perinatal outcome data were extracted and analysed. Result: The maternal HIV positive sero-prevalence at delivery was 6.9%. The highest sero prevalence rate of 42.4% occurred in the age group of 31-35years. Sixty-three (68.5%) of the women were para 1-4. Unbooked status significantly contributed to perinatal morbidity and mortality: 13 (92.9%) of the low birth weights, 15 (71. 4%) of the still birth/IUFD, 4 (80.0%) of the birth asphyxia and 9 (81.8%) of the preterm babies. None of the women was symptomatic on presentation. Conclusion: The high maternal HIV positive seroprevalence with its associated poor perinatal outcome seen more in unbooked women in this study calls for interventions that would reduce maternal morbidity and improve perinatal outcome. The interventions that include intermittent preventive therapy for malaria, good nutrition and antiretroviral therapy must receive serious attention, which can be provided by early booking and adequate antenatal care services. Key Words: Maternal HIV, unbooked status, perinatal outcome, Orlu

Human Immuno-Defiency Virus Antibody Seroprevalence among Pregnant Women at Booking at a Univesity Teaching Hospital in South-Eastern Nigeria

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Complications associated with intrauterine contraceptive devices at the Imo State University Teaching Hospital, Orlu, Nigeria

Background: Intrauterine contraceptive device (IUCD) is one of the reversible methods of contraception. Its use has increased steadily worldwide. However, some women reject it based on presumed  complications associated with its use.Aim: To determine the complications reported by women, action taken on the complications and other associated factors in Orlu, Nigeria.Method: This is a cross-sectional study of 130 women who had IUCD insertions at the family planning clinics of Imo State University Teaching Hospital as well as its urban and rural practice centres (namely Anara Health Centre and Ogbaku Comprehensive Health Centre) both in Orlu Senatorial district between May 2008 and August 2008. Structured questionnaires were administered to consecutive women on follow-up visits at the Family Planning Clinics who are on IUCD. Information regarding age, parity, complications, reported action taken after the complication, clients' awareness of the availability of intrauterine device and duration of IUCD use were included in the questionnaires.Result: A total of 130 users were available for study. Heavy menstruation was reported by 50 (35.2%) women which was the commonest in this study; 65 (50%) did not do anything about whatever complication reported. The age range was 21-45years with a peak age group of 26-30 years. Majority of the clients 85 (65.4%) knew about IUCD from the hospital. More than half (46.2%) of the patients had between 2-5 children. The distribution of the duration of IUCD use showed that most of the clients had the IUCD for one year and less.Conclusions: IUCD is well accepted among users who still consider the benefit of reversible contraception more than the reported complication.Keywords: IUCD, Complications, Orlu Senatorial district

Wound Infection following Caesarean Section in a University Teaching Hospital in South-East Nigeria

Background: Caesarean section is a common operation in obstetric practice, but there is a general aversion to caesarean section amongst Nigerian women due to a myriad of reasons amongst which are its associated morbidity and mortality. Surgical site infection following caesarean section is both a major cause of prolonged hospital stay and the wide spread aversion to caesarean delivery in our environment.Objective: To determine the risk factors for surgical site infection following caesarean section as well as the relative contribution of each of the risk factors at the Anambra State University Teaching Hospital, (ANSUTH) Awka.Methodology: A retrospective case controlled study of patients delivered by caesarean section in Amaku General Hospital now ANSUTH from January 1st, 2000 to December 31st, 2011. The cases were the patients whose caesarean sections were complicated by surgical site infections, while those without surgical site wound infection served as controls. The hospital records were compared.Results: Five hundred and nine patients with complete records were analyzed. Fifty-six (56) patients (11%) had complicating wound infection. Statistically significant risk factors for infection were: body mass index >25 (p=0.003), prolonged rupture of membranes (p=0.0003), prolonged operation time (p=0.0011), anaemia (p=0.0009) and blood transfusion (p<0.0001), multiple vaginal examinations during labour (p<0.0001) and long duration of labour prior to caesarean section (p<0.0001).Conclusion: To make caesarean section more acceptable to women in our environment, efforts should be concentrated on strategies to prevent the risk factors.Keywords: Awka, caesarean section, infectio

Preliminary outcome of the management of eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia.Aim: This study aims at determining the prevalence and management outcome of  eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7% of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p<0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p<0.05). Twenty-eight (93.3%) of the eclampsia occurred antepartum. Twenty-eight (93.3%) had severe hypertension on presentation. Twenty nine (95.8%) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital.  Twenty-six (86.7%) of the patients had emergency Caesarean section was carried out, mostly for unfavourable cervix. The perinatal mortality was 6.7% while maternal mortality was 3.3%. Complications included acute renal failure, aspiration pneumonitis and abruptio placentae.Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking, antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment. Keywords: Eclampsia, Prevalence, Morbidity, Mortality, Orl

The influence of contraceptive use on genital human papilloma virus infection

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Prevalence of Anaemia Among Human Immunodeficiency Virus (HIV) Positive Pregnant Women at Booking in Orlu, South-Eastern Nigeria

Background: Anaemia is the most commonly encountered haematological abnormality in human immunodeficiency virus (HIV) positive patients with estimates climbing as high as 95% depending on clinical settings. The twin effects of HIV infection and anaemia in pregnancy is associated with adverse maternal and perinatal outcomes.Objective: To determine the prevalence of anaemia among HIV positive pregnant women at booking at Orlu, South-East Nigeria.Methods: A retrospective analysis of the case records of women who were screened for Human Immunedeficiency Virus and anaemia at the Imo State University Teaching Hospital from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, marital status, haemoglobin concentration and retroviral status were collected and analyzed using SPSS version 13.Results: Nine hundred and twenty one pregnant women were screened at booking within the study period. The age range of the women was  8-39years with a mean age of 28.22 ± 5.04years. One hundred and six (11.5%) of the women tested and were confirmed positive to HIV 1 & 2 antibodies. Anaemia was significantly higher among HIV positive pregnant women than in HIV negative pregnant women (75.5% vs 57.9%; P=0.001). Seventy seven point three percent (75/97) of women ≤ 20 years were anaemic. This was shown to be significant (P=0. 000). Three hundred and thirty three (69.2%) of the women that had only secondary education were significantly (P=0.000} more anaemic than those that had postsecondary education.Conclusion: There was a high prevalence of anaemia among HIV positive pregnant women at booking at the Imo State University Teaching Hospital (IMSUTH, Orlu. Anaemia was also more significant in younger age (≤20years} and lesser educated women (only secondary.school}Key Words: Anaemia, HIV, Pregnancy, Booking, Orl