Clinical correlates of plasma antithrombin and protein C levels in patients with pre-eclampsia and eclampsia in Sokoto, Northwest Nigeria

Background: Hypertensive disorders of pregnancy complicate 17% of pregnancies in Sokoto, Nigeria with pre-eclampsia and eclampsia accounting for 6% and 4.29% respectively. Pre-eclampsia and eclampsia stand out as major causes of poor pregnancy outcomes with eclampsia contributing 46% of adolescent maternal mortality in Sokoto. These disorders increase risk of venous thromboembolism, DIC, placental abruption, IUGR, premature delivery and recurrent pregnancy loss. The roles of antithrombin and protein C in disease severity and outcomes of pregnancies in pre-eclampsia/eclampsia are subject of recent researches albeit with conflicting findings. The aim of the study was to determine the plasma antithrombin and protein C levels of pre-eclampsia and eclampsia in Sokoto with a view to assessing any relationship with clinical severity and pregnancy outcomes.Methods: Prospective comparative study involving 31 each of pregnant women with pre-eclampsia, eclampsia and normotensive pregnancy. Plasma antithrombin and protein C levels were determined via kinetic method using S4 Nortek semi-automated coagulometer. Data analysis was performed using SPSS version 21.0.  Results: The mean plasma antithrombin and protein C levels for eclampsia, pre-eclampsia and normotensive pregnancy were (61.17±9.13 and 60.00±5.76) vs (71.24±13.15 and 71.06±6.16) vs (85.54±8.77 and 89.64±7.61) respectively; p=0.0001. Severe pre-eclampsia when compared with mild pre-eclampsia had lower antithrombin (70.21±13.58 vs 73.74±12.43; p=0.507) and protein C (70.52±6.27 vs 72.40±6.00; p=0.451) levels respectively, though without statistical significance. Pre-eclampsia with low plasma antithrombin levels had increased risk of preterm delivery when age, gravidity and booking status were factored (OR, 1.2, 95% CI 0.035 to 0.348, p=0.017).Conclusions: Lower plasma antithrombin and protein C levels were found with eclampsia and severe pre-eclampsia suggesting consumptive depletion of anticoagulants with disease progression. Women with pre-eclampsia and low plasma antithrombin levels were found to have increased odds of having preterm delivery when age, gravidity and booking status were considered

Comparison of genital microbial isolates between intrauterine contraceptive device users and nonusers in Sokoto, Nigeria

Background: In the past, the use of intrauterine contraceptive device (IUCD), in particular, Dalkon Shield was found to be associated with increased risk of pelvic infection. Recent literature illustrates that the risk of pelvic infection after insertion of an IUCD is low and that the risk peaks in the 1st month after insertion. We set out to determine the incidence of genital infection among IUCD users after the 1st and 3rd months of insertion compared to users of other contraceptive methods; to determine the risk of genital infections among IUCD users compared to users of other contraceptive methods and to determine the organisms associated with genital infection among the contraceptive users.Materials and Methods: This was a cohort study involving new clients who chose various forms of contraceptives.Results: The incidence of genital infection was 3 (8.5%) at 1 month and 4 (12.1%) at 3 months. The incidence in non‑IUCD contraceptive users was 2 (5.9%) at 1 month and 3 (8.8%) at 3 months. The relative risk was 1.44 and 1.5 at 1 and 3 months, respectively. The observed difference in the rate of infection between IUCD users and other contraceptive users was not statistically significant. Bacteria vaginosis and Trichomonas vaginalis were commonly observed in the two groups.Conclusion: The incidence of genital infection among IUCD users was relatively low compared to non‑IUCD users. IUCD s do not significantly increase the of rate genital infection.Keywords: Contraceptives; genital; infection; intrauterine contraceptive device; Nigeri

Knowledge and acceptability of prenatal diagnosis among pregnant women attending antenatal clinic in a tertiary health institution in Sokoto, Nigeria

Background: Technology and advances in research have made it possible for the fetus to become a patient whose illness can be investigated, diagnosed and treated in utero. The study was aimed at assessing the knowledge and acceptability of prenatal diagnosis among pregnant women.Methods: This was a cross-sectional study carried out between December 2016 and March, 2017. Pregnant women attending antennal care clinic at the Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH) were recruited via convenient sampling method using semi-structured interviewer questionnaire.Results: A total of 417 pregnant women were interviewed. The mean maternal age was 28.35±5 years with a range between 17 to 45 years. Up to 188 (69.10%) had at least secondary school level of education. There was an overall poor knowledge of prenatal diagnosis, as 406 (97.36%) had little to no idea. There was statistically significant association between knowledge and educational status at p value- 0.0001. Majority, 353 (87.8%) will accept prenatal diagnosis if offered. There was also statistically significant association between educational status and acceptability as well as knowledge of prenatal diagnosis at p value- 0.001 and 0.001 respectively. The noninvasive method, ultrasound was the most preferred by the majority, 332 (84.3%). Termination of pregnancy as an option of management in fetal abnormality was acceptable by up to 2/3 (63.1%) of the respondents.Conclusions: The knowledge of prenatal diagnosis among the respondents was generally poor. The identifiable factor that determined knowledge and acceptability of prenatal diagnosis was level of education

The incidence, pattern and management of sexual assault in a tertiary hospital in North-western Nigeria

Background: Sexual assault is any sexual act performed by one person on another without the person’s consent or on a victim who is incapable of giving consent. It is a violation of basic human rights, a gender-based issue and a violent crime against both the individual and the society. The objectives of the study were to determine the incidence, pattern and management of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.Methods: This was a 10 - year retrospective study. Case records of sexual assault from 1st January, 2007 to 31st December, 2016 were retrieved and relevant data extracted and analyzed using the SPSS for windows version 20.0Results: The incidence of sexual assault was 0.8%. Majority, 88 (85.4%) occurred in children and adolescents. Peno-vaginal penetration was the most common form of assault 65 (63.1%) and the assailants were known to the victims in 74 (71.9%) of the cases. Involvement of psychiatrists/psychologists in the management of the victims was poor as psychiatrists were involved in only 13 (12.6%) of the cases. Most of the victims were lost to follow up.Conclusions: Sexual assaults occurred mostly in children and adolescents in this study. Increased public awareness and preventive interventions are required especially among the at-risk age groups to enhance their safety. Training of relevant persons in the institution to offer counselling to the victims is recommended as referral for psychiatrists’ consultation was poor. It is important to institute a good tracking system to follow up the victims as most are lost to follow up.                                                               

Effect of hormonal and copper IUDs on genital microbial colonisation and clinical outcomes in North-Western Nigeria

Background: Intrauterine devices are one of the popular long term reversible contraceptive methods. Earlier forms were associated with genital infections, however more recent types such copper IUDs and hormonal types have been shown to have better safety profile. However, there is no conclusive evidence to demonstrate that hormonal IUD is less associated with genital infection when compared with copper IUDs. The objectives include determination of prevalence of genital tract infections among IUD users, to determine the type of IUD that is less associated with genital infection, and also determine clinical features seen among IUD users.Methods: We conducted a descriptive, cross sectional study of clients who were at 6 months following IUD insertion. Endocervical and high vaginal samples were taken to isolate microbes.Results: The prevalence of genital tract infection was 20% in Copper IUD users and 8.6% among LNG-IUS users. Genital infection was significantly higher among copper IUD users compared to hormonal IUD users (p=0.038, OR= 2.88). Abnormal vaginal discharge was the commonest symptoms among IUD users and formal education was associated with less risk of genital infections (p=0.048).Conclusions: Hormonal IUDs are less associated with genital tract infection compared to copper IUDs and women with formal education are less likely to have genital infection among IUD users

Perception and acceptability of bilateral tubal ligation among women attending antenatal clinic at Usmanu Danfodiyo university teaching hospital Sokoto

Background: Contraception can be defined as all temporary or permanent measures designed to prevent pregnancy. Bilateral tubal ligation is a surgical and permanent form of contraception offered to women who completed their family size or for limitation of family size due to medical condition. The practices of bilateral tubal ligation is limited in Sub-Saharan African countries, Nigeria inclusive because of great desire for a large family size, cultural and religious factors, misunderstanding and fear of the procedure. The aim of the study was to determine the perception and acceptability of bilateral tubal ligation as a form of contraception among women attending Antenatal clinic at Usmanu Danfodiyo University Teaching Hospital Sokoto.Methods: This was a cross sectional study conducted among women attending antenatal clinic between 1st of May to 31st of July, 2018. The information was obtained using a structured questionnaire to obtain the respondent’s socio-demographic characteristics, questions on perception and acceptability of bilateral tubal ligation. Data analysis was done with statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: The study revealed that 73% of the respondents were aware of bilateral tubal ligation, but only 44% of them have good perception towards it. Majority of the respondents (63.8%) reject BTL for contraception. Most of their reasons were cultural believe (33.3%), regret (31.6%), religious believe (26.6%) and fear of surgery (8.5%).Conclusions: There was poor perception and low acceptability toward bilateral tubal ligation among the study population, mostly due to cultural and religious believes, as well as fear of regret, despite awareness of BTL among majority of the respondents

Obstructed labour at Usmanu Danfodiyo university teaching hospital Sokoto: a five-year review

Background: Obstructed labour is an obstetric emergency and one of the major causes of maternal and perinatal morbidity and mortality in the developing countries, Nigeria inclusive. The aim of this study was to determine the prevalence, causes and feto-maternal outcome of cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from 1st January, 2014 to 31st December, 2018.Methods: This was a retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto over 5 years. List of cases managed during the study period was obtained and case notes were retrieved. Relevant information such as age, booking status, parity, educational status, address, causes, mode of delivery and both maternal and foetal outcomes were obtained from the case notes. Data analysis was done using statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: A total two hundred and seventy-six cases of obstructed labour were managed out of the 15,452 total deliveries during the study period. This gives an obstructed labour prevalence of 1.79%. The major cause of obstructed labour identified in this study was Cephalopelvic disproportion (74.6%) and majority of the patients were delivered by emergency lower segment caesarean section (70.6%). Up to 32.3% of the patients had no maternal complications and also 42.3% of them had live birth with no fetal complication. However, 20.2% of these patients had ruptured uterus and 37.9% of them had still birth, while 19.8% had live birth complicated by birth asphyxia.Conclusions: This study has found that obstructed labour resulted in adverse maternal and perinatal outcome. Hence, there is need to prevent obstructed labour in order to avert this consequence

Oxidative stress and outcome of antioxidant supplementation in patients with polycystic ovarian syndrome (PCOS)

Background: PCOS is a condition with significant decrease in antioxidant with an increased risk of oxidative stress. Antioxidant supplementation has been shown to improve insulin sensitivity in PCOS and may improve outcome of management of PCOS. Objectives of this study were to determine the oxidative stress level of PCOS patients, to assess the effect of antioxidant supplementation on the outcome of management of PCOS and to compare with a control group.Methods: The study was a single blind randomised control trial involving 200 patients with PCOS. The study was conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto. They were randomly divided into intervention and control groups and base line serum levels of oxidative stress marker, antioxidant enzymes, vitamins and minerals were determined. Antioxidant supplementation and placebo were given to the intervention and control groups respectively. All the patients had ovulation induction with clomiphene citrate and were followed up for 6 months. Outcome measures were clinical pregnancy or menstrual regularisation. Level of significance was <0.05.Results: There was statistical significance in the serum levels of oxidative stress marker, antioxidant enzymes, vitamins and minerals between the two groups (post intervention). Glutathione peroxidase (p = 0.001), superoxide dismutase (p = 0.0001), catalase (p= 0.0369), melondialdehyde (p= 0.007), Vitamin A, Vitamin C, Vitamin E (p = 0.0001), zinc and copper (p = 0.0001). The clinical pregnancy outcomes were 22 (22%) versus 2 (2%); live births 18 (18%) versus 2 (2%) and menstrual regularisation 48 (48%) versus 46 (46%) in the intervention and control groups respectively.Conclusions: Antioxidant supplementation in this study significantly affected pregnancy rate in patients with PCOS. Larger studies are suggested to revisit the conclusion of the Cochrane review that antioxidants supplementation had no significant role in female infertility

The profile of infertility in a teaching Hospital in North West Nigeria

Background: Infertility is a global health problem and a socially destabilizing condition for couples carrying several stigmas and a cause of marital disharmony. We determined the prevalence, causes, and clinical pattern of infertility at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This was a prospective study conducted at the Gynecological Department of UDUTH Sokoto between 1 st January, 2011 and 31 st July, 2011. All the patients that presented with infertility within the study period were recruited into the study. Relevant demographic, clinical, and laboratory/radiological data were documented using a structured questionnaire. The patients had their case folders tagged and followed up to 31 st December 2011 (6 months). Data was analyzed using SPSS version 11. Results: A total of 1,264 new gynecological cases were seen during the study period, and 198 infertile patients were evaluated. The prevalence of infertility was 15.7%. Primary infertility constituted 32.8%, while secondary infertility was 67.2%. Previous history of evidence of genital infection including lower abdominal pain (78.8%) and vaginal discharge (76.6%) were common. Female gender-related causes of infertility accounted for 42.9%; male causes accounted for 19.7%. Both partners contributed to infertility in 16.7%, while no cause was found in 20.7% of patients. Conclusion: The study shows a dominance of secondary infertility with probable genital tract infection being a major contributor. Early presentation and prompt treatments of genital tract infections may reduce the prevalence of infertility in the study population

Bilateral massive corpus leteum cysts in a human immunodeficiency virus positive singleton pregnancy at term

Corpus luteum cyst at term is a rare occurrence. It is unusual for these cysts to be bilateral. We report a case of massive bilateral corpus luteum cysts in a term singleton pregnancy. A 32-year-old gravid 2, para 1, known human immunodeficiency virus positive patient on highly active antiretroviral therapy had an elective cesarean section at term on account of a low CD4 count and ovarian cysts. At surgery, she was found to have massive bilateral ovarian cysts. Each of the cysts was about the size of a 20-week size gravid uterus, (Left side 20 cm × 23 cm×15 cm; Right side 22 cm × 24 cm ×10 cm). After the 3.4 kg male baby was delivered in a good condition, a bilateral cystectomy was performed. Subsequent histopathology confirmed the diagnosis of corpus luteum cyst of pregnancy