Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study

BackgroundPreventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. MethodsA prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time–motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant.ResultsThe overall mean DDI was 233.99±132.61 minutes (range 44–725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. ConclusionPerinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI

Pre-and-post-operative aversion among men whose partners had caesarean delivery in a patriarchal setting.

Objectives: The study evaluated pre and post-operative perception and aversion to caesarean delivery (CD) among men whose partners underwent the procedure.Design: A multicentre cross-sectional study.Setting: Two tertiary and two secondary health facilities.Participants: Men whose partners underwent CD at the study sites.Methods: Participants were recruited by purposive sampling, data collection was through interaction via an interviewer-administered questionnaire first immediately the decision for CD was made and thereafter on the third postoperative day. Men whose partners had vaginal delivery were excluded from the study and data management was with SPSS version 21.0 while p<0.05 was significant.Results: Awareness about CD was 84.0% mainly through the healthcare workers (42.1%) and the female partner (34.1%); 88.0% of participants recommended CD for medically-indicated reasons. The greatest influence on consent was the male partner (48.8%). The major pre-operative concerns were limitation of family size (34.7%) and fear of repeat CD (34.0%). Pre-operative perceptions of CD included being expensive (60.7%), fear of the procedure (48.0%), fear of complications (45.3%) and longer hospital stay (44.0%). Aversion to CD was 30.0% pre and 5.3% post-operation; predictors of aversion were history of previous surgery among male or female partner and awareness about CD. However, there were reductions in negative perception and aversion post-operation.Conclusion: The high negative perception and aversion to CD among male partners were reduced post-operation. Healthcare workers should address the concerns and negative perceptions about CD and prioritize patient-friendly experiences during surgical operations

Pattern of cervical dilatation among parturients in Ilorin, Nigeria

Objective : To evaluate the pattern of cervical dilatation in live singleton pregnancies with spontaneous onset of labor and to compare any differences among nulliparas (P ara 0) and multiparas (Para 651). Material and Methods : Descriptive statistics are presented for 238 consecutive labor patients with spontaneous onset, 6537 weeks gestation, live singleton pregnancy and who had spontaneous vertex delivery at the University of Ilorin Teaching Hospital, Nigeria, from May 2004 to June 2004. Pre-labor rupture of membrane and referred cases were excluded. Results : The mean cervical dilatation on presentation and duration of labor before presentation in labor ward among nulliparas were 5.40 cm and 6.66 hours; and among multiparas, 6.45 cm and 5.15 hours, respectively, the overall mean being 6.12 cm and 5.63 hours, respectively. The average time spent to achieve full cervical dilatation from time of arrival in labor ward was longer in nulliparas (4.80 hours) than in multiparas (3.60 hours) (t test not significant; P> 0.05). Overall mean total length of first stage of labor was 9.36 hours, while the total length of first stage of labor was 11.03 hours and 8.53 hours for nulliparas and multiparas, respectively (difference is significant; t test P< 0.05). Significant negative correlation existed between parity and total length of first stage of labor. Mean cervical dilatation rate in labor ward (active phase) was higher in multiparas (1.83 cm/h) than in nulliparas (1.76 cm/h), but the difference was not significant (t test P> 0.05). No significant correlation existed between rate of cervical dilatation and maternal age, gestational age and fetal size. Conclusion : It is evident from this study that higher the parity the shorter the length of first stage of labor; however, significant difference existed only in the first half of first stage of labor between nulliparas and multiparas. Mean rate of cervical dilatation was greater than the WHO-specified and Philpott\u2032s lower limit of 1 cm/h in active phase of labor.Objectif: pour \ue9valuer la motif de dilatation du col ut\ue9rin dans les grossesses singleton live avec spontan\ue9e apparition du travail et de comparer les diff\ue9rences entre les nulliparas (para 0) et multiparas (para 651). Methodes: Statistiques descriptives sont pr\ue9sent\ue9es pour 238 cas du travail cons\ue9cutifs avec apparition spontan\ue9e, 6537weeks gestation, vivre singleton grossesse et avait vertex spontan\ue9e livraison \ue0 l\u2019h\uf4pital d\u2019enseignement universitaire de Ilorin, Nig\ue9ria, de mai 2004 \ue0 juin 2004. Rupture prelabour de la membrane et cas mentionn\ue9s ont \ue9t\ue9 exclus. R\ue9sultats: le signifi e la dilatation du col ut\ue9rin sur pr\ue9sentation et la dur\ue9e du travail avant pr\ue9sentation dans le quartier du travail chez les nulliparas a \ue9t\ue9 cm 5.40 et 6.66hrs et cm 6.45 et 5.15hrs chez multiparas, alors que moyenne globale \ue9tait cm 6.12 et 5.63hrs respectivement. Le temps moyen pass\ue9 pour atteindre la dilatation compl\ue8te du col de moment de l\u2019arriv\ue9e dans le quartier du travail \ue9tait plus longtemps dans nulliparas (4.80hrs) que dans multiparas (3.60hrs), t tester non signifi cative p > 0,05. Dans l\u2019ensemble signifi e longueur totale de premi\ue8re \ue9tape du travail a \ue9t\ue9 9.36hrs, tandis que 11.03hrs et 8.53hrs pour nulliparas et multiparas respectivement (diff\ue9rence est importante, t tester p > 0,05).Corr\ue9lation n\ue9gative signifi cative existait entre parit\ue9 et la longueur totale de premi\ue8re \ue9tape du travail. Signifi e que le taux de dilatation du col ut\ue9rin dans quartier du travail (active phase) \ue9tait plus \ue9lev\ue9 dans multiparas (1,83 cm/h) que dans nulliparas (1.76 cm/h), mais la diff\ue9rence n\u2019est pas signifi cative, t tester p > 0,05. Aucune corr\ue9lation signifi cative n\u2019existait entre les taux de dilatation du col ut\ue9rin et \ue2ge maternel, \ue2ge gestationnel et taille du foetus. Conclusion: il ressort de cette \ue9tude que plue la parit\ue9, la plus courte de la longueur de premi\ue8re \ue9tape de travail, toutefois diff\ue9rence signifi cative existait uniquement dans le premier la moiti\ue9 de premi\ue8re \ue9tape du travail entre nulliparas et multiparas. Taux moyen de dilatation du col ut\ue9rin a \ue9t\ue9 sup\ue9rieure \ue0 WHO et Philpott de la plus faible limite de 1 cm/hr. phase active de travail

Non-fistulous urinary leakage among women attending a Nigerian family planning clinic

Urinary leakage is an important gynecological challenge, which has a substantial impact on quality of life. The aim of this study was to determine the prevalence and types of non-fistulous urinary leakage among women attending the family planning clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria. The study was a cross-sectional study carried out between January 3 and April 25 2009. One hundred and two women experienced urinary leakage out of 333 women interviewed, giving a prevalence rate of 30.6%. Stress incontinence was the most common urinary leakage (prevalence rate 12.0%). This is followed by urge incontinence (10.8%), urinary incontinence (4.8%), and overflow incontinence (3.0%). None of the women afflicted sought medical help. Conclusively, this study has demonstrated that non-fistulous urinary leakage is a common problem among women of reproductive age in this environment

Childhood Benign Surgical Gynaecological Disorders in Ilorin, Nigeria.

Context: Childhood benign gynaecological conditions are rare, yet their recogniton and correct management can have a huge impact on the individual's long-term reproductive health. Objective: To describe the experience with benign surgical gynaecological disorders in a tertiary health care institution. Study Design, Setting and Subjects: A descriptive analysis of 93 childhood benign gynaecological disorders that were surgically managed between 1st January 1989 and 31st December 1998 at the Maternity Hospital Wing of University of Ilorin Teaching Hospital, Ilorin, Nigeria. Result: Procedures to treat childhood benign gynaecological conditions accounted for 101 (2.6%) of the 3,919 gynaecological operations performed during the study period. The ages of the patients ranged from 8 months to 16 years. The three leading disorders were clitoridal cyst 26(28.0%), labial adhesion 21 (22.6%) and urethral mucosal prolapse 20 (21.5%). Others include vaginal laceration from rape 9 (9.7%), imperforate hymen 7 (7.5%), Bartholin abscess 5 (5.4%) and ovarian cysts 5 (5.4%). Conclusion: This study showed that childhood benign surgical gynaecological disorders are uncommon in our environment. Female circumcision was implicated as the aetiological factor in most of the patients suffering from the three commonest disorders. Discouraging female circumcision has the potential to significantly reduce the prevalence of paediatric gynaecological problems in Nigeria. Key Words: Paediatric Gynaecology, Congenital, Genital Tract [Trop J Obstet Gynaecol, 2003, 20: 37-39

Knowledge and Previous Contraceptive Use by Pregnant Teenagers in Ilorin, Nigeria

Context: Teenage pregnancy is a major health and social problem the world over and its incidence is on the increase. One important contributory factor to the increase is non-use of contraception. Objective: To determine knowledge of and previous contraceptive use by pregnant teenagers in Ilorin, Nigeria. Subjects and Methods: Between 1st January and 30th June, 1999, 326 consecutive pregnant teenagers that booked for antenatal care at University of Ilorin Teaching Hospital, Ilorin, Nigeria were interviewed with the aid of a pre-tested questionnaire administered by resident doctors. Information obtained included demographic characteristics, knowledge of and previous use of contraception. Results: Respondents displayed a high level of contraceptive knowledge, as 277 (91.7%) were aware of it. The condom and the combined oral pill were the two contraceptive methods most commonly known, by 254 (85.5%) and 225 (78.8%) of the respondents respectively. Only 53 (16.3%) had previously used any contraceptive method. The combined oral pill was the commonest method ever used by the respondents 29 (54.7%). Friends were the most common source of information about contraception in 135 (45.5%). None of the respondents used any contraceptive method prior to or during their first sexual experience. Fear of side effects was the commonest reason for non-use of contraception. Conclusion: Pregnant teenagers are quite knowledgeable about contraceptive method but are poor users. Family life education, including contraception should be provided for teenagers and incorporated into the curricula of schools and colleges. Clinics where comprehensive reproductive health services are provided for teenagers should also be established. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 73-77

Epidemiology of Vesico-Vaginal Fistula at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Context: Vesico-vaginal fistula (VVF) is a major public health problem in Nigeria. Objective: To describe the causes and patterns of presentation of vesico-vaginal fistula in a tertiary hospital in Central Nigeria. Subjects and Methodology: Records of all patients with VVF seen over a 10-year period (1st January, 1988 to 31st December, 1997) at the University of Ilorin Teaching Hospital were reviewed. The patients' social and demographic data, aetiological factors, anatomical types and complications of VVF were analysed. Results: There were 44 cases of VVF during the period. Obstetric VVF accounted for 37 (84.1%) of the cases. Most of the patients were illiterate 39 (88.6%), and of low social class 37 (84.1%). Most had poorly supervised deliveries; 33 (89.2%). The age of the patients ranged between 15 and 73 years with a mean age of 29.4 years. The highest frequency was in the 15-19 years age bracket (25%) and 43.2% were primiparous women. Prolonged obstructed labour (65.9%) was the commonest cause of VVF in the patients. Other causes include advanced cervical cancer 6 (13.6%), ruptured uterus 3 (6.8%), caesarean section 3 (6.8%), forceps delivery 1 (2.3%), caesarean hysterectomy 1 (2.3%) and total abdominal hysterectomy 1 (2.3%). Twelve (27.3%) patients were separated/divorced from their husbands. Of the 33 VVF patients that had VVF repair, 29(87.9%) were successful; 27 (81.8%) at the first attempt and 2 (6.1%) at the second attempt. Conclusion: Urinary fistulae are still a major health problem for women in this locality and prolonged obstructed labour is the major cause. Key Words: Vesico-Vaginal Fistula, Obstructed Labour, Urinary Incontinence [Trop J Obstet Gynaecol, 2002, 19: 101-103

Spousal participation during pregnancy and delivery in Ilorin, Nigeria

Background: The potential benefits of the active involvement of men in antenatal and intrapartum events remain largely unexplored in low-resource countries despite the reported benefits from highincome areas.Aim: To evaluate male partners' attitudes and experience on their level of involvement during pregnancy, labour and delivery.Methods: A cross-sectional study conducted at four health facilities in North Central Nigeria from 1st February to 30th July 2017. Participants were male partners of women who were pregnant during the study period; recruitment was after informed consent, data management was with SPSS (version 21.0); p <0.05 was significant.Results: The male partners were aged 23 to 60 years (mean 35.96±6.76), 173 (69.2%) accompanied the partner to antenatal clinic and 150(60.0%) to ultrasound scan examination. The commonest hindrance to men's antenatal participation was commuter marriage (29; 37.7%); 171(68.4%) participants supported the presence of the man at delivery while 32(40.5%) opined that men may disturb the health provider during delivery. Also, 137(54.8%) men have requested to be present at delivery previously while 46(33.6%) were obliged;  among those obliged, 25(54.3%) described the experience as satisfactory while 28(60.9%) intend to be present at future deliveries. In all, 212(84.8%) suggested antepartum education classes for male partners, 202(80.8%) intend to attend such classes while 143(57.2%) suggested health facility restructuring to facilitate men's participation.Conclusion: Men are increasingly desirous of active participation at antenatal and intrapartum events; increasing male partner education, male-friendly facility infrastructures and health providers' cooperation will encourage them to fulfil these roles.Keywords: Male partner support, Maternal Health, Male participation, Men at Delivery, Spousal support

Violence against women: A comparative study of the pattern and experience before and during pregnancy among antenatal clinic attendees at University of Ilorin Teaching Hospital, Nigeria

Background: While violence against women is increasing globally, its prevention and evaluation in pregnancy has not receiving  adequate attention.Aim: To evaluate the occurrence and pattern of violence against women before and during index pregnancy.Methods: A prospective, comparative study comprising 200 antenatal clinic attendees categorized into two groups of 100 each was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Group I consisted of women who had suffered violence  previously while those in group II did not have such experience. Participants were recruited at the antenatal clinic and informed consent obtained. Participants were screened using a modified version of Abuse Assessment Screen from Centre for Disease Control; the data was analyzed using SPSS version 20.0 and p<0.05 was significant.Result: There was similarity in the age (p0.688), marital status (p0.605), level of education (p0.914) and gestational age at booking (p0.490) among the two groups. Alcohol consumption was significantly higher (21 vs. 10; p0.045) among partners of victims of violence (group I). Physical violence decreased from 47% before to 22% during index pregnancy while sexual violence reduced from 53% vs. 50%. A total of 68 cases of psychological violence (68%) occurred during pregnancy. The partner was responsible in 78.7% of physical and 84.7% of sexual violence cases before pregnancy as well as 91.0% of physical, 100.0% of sexual and 78.0% of psychological violence which occurred during index pregnancy.Conclusion: Violence against women (especially psychological violence) is heightened during pregnancy. Routine screening for violence during pregnancy is justified because it is associated with poor maternal/fetal outcomes while its prevalence is higher than other conditions routinely screened for in pregnancy

Pattern of cervical dilatation among parturients in Ilorin, Nigeria

Objective : To evaluate the pattern of cervical dilatation in live singleton pregnancies with spontaneous onset of labor and to compare any differences among nulliparas (P ara 0) and multiparas (Para ≥1). Material and Methods : Descriptive statistics are presented for 238 consecutive labor patients with spontaneous onset, ≥37 weeks gestation, live singleton pregnancy and who had spontaneous vertex delivery at the University of Ilorin Teaching Hospital, Nigeria, from May 2004 to June 2004. Pre-labor rupture of membrane and referred cases were excluded. Results : The mean cervical dilatation on presentation and duration of labor before presentation in labor ward among nulliparas were 5.40 cm and 6.66 hours; and among multiparas, 6.45 cm and 5.15 hours, respectively, the overall mean being 6.12 cm and 5.63 hours, respectively. The average time spent to achieve full cervical dilatation from time of arrival in labor ward was longer in nulliparas (4.80 hours) than in multiparas (3.60 hours) (t test not significant; P> 0.05). Overall mean total length of first stage of labor was 9.36 hours, while the total length of first stage of labor was 11.03 hours and 8.53 hours for nulliparas and multiparas, respectively (difference is significant; t test P< 0.05). Significant negative correlation existed between parity and total length of first stage of labor. Mean cervical dilatation rate in labor ward (active phase) was higher in multiparas (1.83 cm/h) than in nulliparas (1.76 cm/h), but the difference was not significant (t test P> 0.05). No significant correlation existed between rate of cervical dilatation and maternal age, gestational age and fetal size. Conclusion : It is evident from this study that higher the parity the shorter the length of first stage of labor; however, significant difference existed only in the first half of first stage of labor between nulliparas and multiparas. Mean rate of cervical dilatation was greater than the WHO-specified and Philpott′s lower limit of 1 cm/h in active phase of labor.Objectif: pour évaluer la motif de dilatation du col utérin dans les grossesses singleton live avec spontanée apparition du travail et de comparer les différences entre les nulliparas (para 0) et multiparas (para ≥1). Methodes: Statistiques descriptives sont présentées pour 238 cas du travail consécutifs avec apparition spontanée, ≥37weeks gestation, vivre singleton grossesse et avait vertex spontanée livraison à l’hôpital d’enseignement universitaire de Ilorin, Nigéria, de mai 2004 à juin 2004. Rupture prelabour de la membrane et cas mentionnés ont été exclus. Résultats: le signifi e la dilatation du col utérin sur présentation et la durée du travail avant présentation dans le quartier du travail chez les nulliparas a été cm 5.40 et 6.66hrs et cm 6.45 et 5.15hrs chez multiparas, alors que moyenne globale était cm 6.12 et 5.63hrs respectivement. Le temps moyen passé pour atteindre la dilatation complète du col de moment de l’arrivée dans le quartier du travail était plus longtemps dans nulliparas (4.80hrs) que dans multiparas (3.60hrs), t tester non signifi cative p > 0,05. Dans l’ensemble signifi e longueur totale de première étape du travail a été 9.36hrs, tandis que 11.03hrs et 8.53hrs pour nulliparas et multiparas respectivement (différence est importante, t tester p > 0,05).Corrélation négative signifi cative existait entre parité et la longueur totale de première étape du travail. Signifi e que le taux de dilatation du col utérin dans quartier du travail (active phase) était plus élevé dans multiparas (1,83 cm/h) que dans nulliparas (1.76 cm/h), mais la différence n’est pas signifi cative, t tester p > 0,05. Aucune corrélation signifi cative n’existait entre les taux de dilatation du col utérin et âge maternel, âge gestationnel et taille du foetus. Conclusion: il ressort de cette étude que plue la parité, la plus courte de la longueur de première étape de travail, toutefois différence signifi cative existait uniquement dans le premier la moitié de première étape du travail entre nulliparas et multiparas. Taux moyen de dilatation du col utérin a été supérieure à WHO et Philpott de la plus faible limite de 1 cm/hr. phase active de travail