Operative vaginal deliveries in Zaria, Nigeria

Background : Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings Study design : Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. Results : Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. Conclusion : Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed

Attitude of Nigerian women to abnormal menstrual bleeding from injectable progestogen-only contraceptive

Background: Depot Medroxyprogesterone acetate (DMPA) and Norethisterone Enanthate (Net-En) are frequently used progestogen-only injectable contraceptives in many developing countries including Nigeria. Their use is often complicated by abnormal and unpredictable menstrual bleeding patterns. This has often been a source of worry to clients and their spouses leading to method switch or discontinuation. Method: A structured questionnaire was administered on 354 clients who were on intramuscular DMPA 150mg 3-monthly or intramuscular norethisterone enanthate 200mg 2-monthly and a matched control group of 323 clients at the Reproductive Health Center of the Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Data was analyzed using Minitab statistical software. Results: Abnormal menstrual bleeding, commonly amenorrhea and irregular bleeding, were significantly associated with use of either DMPA or Net-En. Clients tolerated amenorrhea better than irregular bleeding and their preference for either DMPA or Net-En was not altered by amenorrhea. Irregular bleeding was a significant reason for method switch or discontinuation. Conclusion: Treatments that can inflict amenorrhea could be acceptable options in the management of abnormal bleeding patterns induced by progestogen-only injectable contraceptive which are in present use. Keywords: depot-medroxy progesterone acetate, norethisterone enanthate, menstrual abnormalities Annals of African Medicine Vol. 4(4) 2005: 144–14

A huge polypoid uterine myoma causing severe primary postpartum haemorrhage: A report of one case

Complications from uterine myomas in pregnancy could occur antenally, intrapartum or in the puerperium. One of such was diagnosed in a 36-year old para 2+0 who had successful gestation to term delivery in co-existence with a huge fibroid polyp and had spontaneous vaginal delivery of a life baby. She however developed severe primary postpartum haemorrhage prompting emergency postpartum digital vaginal myomectomy which was very helpful. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 220-22

Retained Copper Sleeve and haematometria, an unusual complication of Copper-T use

Retained copper sleeve of copper-T IUCD and haematometria was observed in a patient. Same was retrieved with drainage of haematometria under general anesthesia with satisfactory outcome

Cerebral malaria in pregnancy, a report of 3 cases

No Abstract. Annals of Nigerian Medicine Vol. 1(1) 2005: 30-3

The attitudes of Kenyan In-School adolescents toward sexual autonomy

This was a cross-sectional study to examine the attitudes of Kenyan in-school adolescents towards premarital sex, unwanted pregnancies/abortions and contraception. Data collection was undertaken using a structured questionnaire. Kenyan in-school adolescents have conservative attitudes toward premarital sex, disagreeing that adolescent boy and girls should be left alone to satisfy their sexual needs. The girls had the view that boys haveuncontrollable sexual appetites. With regards to unwanted pregnancies, the majority of the respondents disagreed with allowing abortions for pregnant school girls while they agreed that a pregnant school girl should be allowed to return to school. However, the majority of the girls held the view that a school boy who had impregnated a schoolgirl should be expelled from school. The attitudes of the respondents to contraception were also largely conservative. The conservative attitudes of the respondents conflicts with the findings of high levels of unsafe sex and reproductive ill- health among Kenyan adolescents. There is need to help Kenyan in-school adolescents to develop more realistic attitudes toward sexuality in order to improve their  reproductive health.(Afr J Reprod Health 2010; 14[1]:33-41)

Maternal Risks Factors and Delivery Outcome of Fetal Macrosomia in Zaria, Northern Nigeria

Although macrosomia may be associated with adverse maternal and perinatal outcome there is paucity of recent data regarding fetal macrosomia in our setting. This study was undertaken to document the prevalence and risk factors associated with fetal macrosomia and also to determine the maternal and perinatal outcome associated with the condition in Ahmadu Bello University Teaching Hospital Zaria, Nigeria. The study was a cross sectional comparative study that was carried out over a five year period (Jan 2001-Dec 2005). Case records of 207 mothersof macrosomic infants (cases) and records of 220 mothers of normal birth weight infants (control) were reviewed. Fetal characteristics such as sex, birth weight, and perinatal complications were also analyzed and comparedbetween the two groups. The prevalence of fetal macrosomia from the study was 4.2%. There was strong association between diabetes mellitus, previous history of macrosomia, gestational age of > 40 weeks, male infant sex and a body mass index at booking of > 30 with fetal macrosomia. Maternal parity was found not to be significantly associated with fetal macrosomia. Labour was significantly prolonged, and there was associated prolonged hospital stay, primary postpartum haemorrhage and genital tract laceration in women with fetal macrosomia. The incidenceof caesarean section was three times more in mothers with macrosomic infants compared to mothers with normal weighed infants. There was no maternal mortality recorded. The mean Apgar score at 1 and 5 minutes was not statistically different in the two groups. The stillbirth rate in the macrosomic infants was 4.8% compared with 2.3% among normal weighed babies. It can be concluded that macrosomia is a relatively common complication of pregnancy in our setting and is associated with maternal factors such as obesity, diabetes, previous macrosomia, prolonged pregnancy and adverse perinatal outcome. Identifying the risk factors to fetal macrosomia during antenatal period will be useful to plan appropriate delivery management to optimise good perinatal and maternal outcome

Uterine inversion complicating traditional termination of pregnancy: case report

Abortion services remain cladenstine and unsafe in most parts of Africa. This is a case of a mid-trimester abortion induced by traditional methods which resulted in uterine inversion, a previously unreported complication of induced abortion. Until abortion services are accessible and safe on the continent, morbidity and mortality from it could be beyond imagination. Keywords: Uterine Inversion; Abortion by traditional methods Obstetrics and Gynaecology Forum Vol. 15(4) 2005: 25-2