Spontaneous splenic rupture in pregnancy: a case report

Spontaneous splenic rupture in pregnancy is a rare condition, associated with very high maternal mortality rate and fetal wastage. It is frequently misdiagnosed at presentation. We report a case of a 33-year-old, gravida 2, para 1 lady at 29 weeks' gestation with spontaneous splenic rupture, which was initially diagnosed as hypovolaemic shock due to ruptured uterus. Spontaneous splenic rupture as a cause of shock and abdominal pain should be considered whenever uterine rupture is suspected in the second half of pregnancy.Keywords: Spontaneous, spleen, rupture, pregnancy, twin

Could Periodontitis Affect Time to Conception?

Background: Chronic periodontitis is gaining increasing prominence as a potential influnce on systemic health. Time to conception has been recently investigated in relation to chronic periodontitis among Caucasians. The authors set out to replicate the study among Nigerian pregnant women. Aim: The etiology of many medical conditions have been linked with the state of the oral health and one of such is the time to conception (TTC)among women. This study was aimed to assess the effect of periodontitis on TTC.Subjects and Methods: A cross.sectional study in a hospital setting involving 58 fertility clinic attendees and 70 pregnant controls using the simplified oral hygiene index, community periodontal index (CPI) and matrix metalloproteinase.8 immunoassay. Statistical analysis used included Spearmanfs rank order correlation statistic, Z.statistic and logistic regression.Results: Good oral hygiene correlated with shorter TTC (<1 year) than fair oral hygiene, but not statistically significant. The odds of increased conception were higher with CPI (odds ratio [OR]: 0.482, 95% confidence interval [CI]: 0.259.0.895, P = 0.02), periodontitis risk (OR 0.157, 95% CI 0.041.0.600, P < 0.01) and age (OR 0.842, 95% CI 0.756.0.938, P < 0.01). Conclusion: Chronic periodontitis was positively associated with increased TTC in the present study. The authors are recommending that women in child bearing age should be encouraged to have regular preventive dental check.ups in order to maintain good oral and periodontal health.Keywords: Fertility, Oral hygiene, Periodontitis, Time to conceptio

The effect of a supplementary ('Gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial.

Guided by Fuzzy Trace Theory, this study examined the impact of a 'Gist-based' leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants' numerical ability. Adults aged 45-59 years from four UK general practices were randomly assigned to receive standard information ('The Facts', n = 2,216) versus standard information plus 'The Gist' leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The 'Gist + Facts' group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest 'The Gist' leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected

Knowledge and Practice of Contraception among Pregnant Women Attending The Antenatal Clinic in Lagos University Teaching Hospital

BACKGROUND: Preconception, prenatal and postnatal care forms a continuum. Family planning is one of the important aspects of the spectrum. Contraceptive options are available but the uptake has been poor. Ante natal clinic attendees represent a major target population for well designed /appropriate post partum contraceptive counseling and care.OBJECTIVES: The study examined the socio-demographic data of antenatal clinic attendees at the Lagos University Teaching Hospital (LUTH), their knowledge about contraceptive methods, previous contraceptive practice and anticipated pattern of post partum contraceptive uptake.METHOD:A Semi-structured questionnaire was administered to 151 pregnant women attending the antenatal clinic in LUTH to collect data on their socio-demographic characteristics, knowledge of family planning methods, pre-pregnancy contraceptive use and their anticipated post-partum contraceptive choices.RESULTS: The mean age of the women was 29.9 years and the mean Parity was 1.1.  Majority (90.7%) of the women were married. Ten women (6.6%) felt that they had poor knowledge about contraception while the rest had fair to excellent knowledge. The prevalence of contraceptive use before current pregnancy was 57.6% and the male condom was the method used in 56 cases (64.4%). Their major (54%) source of contraceptive commodity was the chemist/ pharmacy. Sixty (69%) women stopped using contraceptive because they wanted to get pregnant. Sixty-eight (45.0%) women planned to use contraceptives after delivery and the male condom (55.9%) was the most preferred method of post-partum contraception. There is no statistical association between age, religion, parity and educational attainment and desire for post-partum contraception.CONCLUSION: Antenatal women in LUTH appeared quite knowledgeable about contraception but majority had no plan for contraceptive use post delivery. Information dissemination about benefits of child spacing and provision of incentives for easy uptake of post partum contraception would help to correct this imbalance.KEY WORDS: Antenatal Clinic, contraceptive, Family planning, Postpartum, Lagos, Nigeria

Trends in Maternal Mortality at the Lagos University Teaching Hospital, Lagos, Nigeria.

Background: Recent reports suggest that the burden of maternal mortality remains heavy in Sub-Saharan Africa; and that the fifth millennium development goal might not be achieved. As the target date 2015 draws near, we carried out a review of maternal mortality in a Teaching Hospital unit to assess the current situation.Objectives: To determine the Maternal Mortality Ratio (MMR), the clinical causes of maternal deaths and the numerical and etiological trends in maternal mortality at the Lagos University Teaching Hospital (LUTH).Method: The records of births and maternal deaths at LUTH over a five year period were reviewed. The data collected was analyzed to determine the maternal mortality ratio, the socio-biological factors associated with maternal death and the clinical causes. Comparisons are made with findings from previous studies done in LUTH and elsewhere.Results: The maternal mortality ratio was 2096 per 100000 live births. The mortality ratio has more than doubled over a period of 3 decades. Unbooked patients accounted for 7.1% of deliveries but contributed 88.1% of the maternal deaths.Majority (59.0%) of the deaths occurred within 24 hours of admission. The main clinical causes of death included sepsis (17.9%), hypertensive diseases (17.9%), abortion (11.2%), HIV/ AIDS infection (11.2%)), haemorrhage (9.0%) and medical disorders (18.7%).Conclusion: The maternal mortality ratio remains high in our unit in line with some other reports from Nigeria but in contrast to the trends in other developed and developing countries. Unless urgent action is taken, the 5th millennium development goal may not be achieved.Key words: Maternal mortality, maternal death,sepsis,hypertensive  diseases, HIV/AIDS, haemorrhage, abortio