Subserous uterine fibroid presenting atypically with features of pseudo‑meig’s syndrome

To describe an atypical presentation of subserous uterine fibroid. We report a case of pseudo‑Meig’s syndrome from subserous uterine fibroid in a 31‑year‑old para 0+0 woman who had myomectomy, appendectomy, and bilateral wedge resection of both ovaries. Histopathological examination confirmed uterine leiomyoma, appendicitis, and normal ovaries. Pseudo‑Meig’s syndrome is a condition which describes the association of any ovarian tumour (other than ovarian fibroma) or any other pelvic tumor such as leiomyoma with ascites and pleural effusion. Very few studies have reported the association of this entity with leiomyoma. It becomes highly important to identify this condition as it is a curable condition mimicking malignancy and can avoid unnecessary interventions. Subserous fibroid presenting with pseudo‑Meig’s syndrome is a rarely reported entity, especially in Nigeria, which can mimic malignant condition; hence, it is important to consider it as a differential in patients within the reproductive age presenting with ascites.Keywords: Atypical presentation; pseudo‑Meig’s syndrome; subserous uterine fibroi

Comparison of first parturition outcome between mothers aged 15-19 and 20-24 years

Context: Comparative data on pregnancy, labour and delivery outcomes of nulliparae aged 15-19 and 20-24 years are limited.Objectives: To compare the pregnancy, labour and delivery outcomes of nulliparae aged 15-19 and 20-24 years.Study Design, Settings and Subjects: A retrospective comparative study conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Nulliparae aged 15-19 years (study group) and 20-24 years (control group) were compared with respect to height, haematocrit levels at booking and 48 hours after delivery, mode of delivery, birth weight, and antenatal, intrapartum and postpartum complications.Results: The study group booked with significantly lower haematocrit (p<0.002) and had a significant drop in the haematocrit level after delivery (p<0.001) than the control group. There were no significant differences between the two groups with respect to maternal height, birth weight, mode of delivery and Apgar scores at one and five minutes. The frequency of prolonged labour from cephalo-pelvic disproportion was similar between the study and control groups.Conclusion: There were not much differences in the obstetric performance of the two groups presumably because the bulk of the study group were aged 18 and 19 years when the pelvis had attained maximum growth as in the control group

Teachers’ Record Keeping as Related to Teachers Job Performance in Cross River State Secondary Schools, Nigeria

This research investigated the influence of principal’s inspection of teachers’ record keeping strategy on teachers’ job performance in Cross River State, Nigeria. Subjects involved six hundred and sixty (660) teachers and three thousand, three hundred senior secondary school students which were randomly selected from two hundred and thirty two (232) secondary schools in Cross River State. Data was collected with Principals’ Instructional Supervisory Strategies Questionnaire (PISSQ) and Teachers’ Job Performance Scale Questionnaire (TJPSQ). The result of analysis utilizing one-way analysis of variance (ANOVA) indicated that principal’s inspection of record keeping strategy significantly influenced teachers’ job performance. It is recommended that regular supervision which must include teachers’ record keeping strategy be regularly organized by government to enhance teachers’ job performance

Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis Infections among Pregnant Women Booked for Antenatal Care at Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Sexually transmitted infections (STIs) among pregnant women are an important health issue in Nigeria, but its prevalence inLokoja is not known. Objective: The objective of this study is to establish the seroprevalence of the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis infections among pregnant women booked for the antenatal clinic in Kogi State Specialist Hospital, Lokoja, Nigeria, and determine risk factors associated with the infections. Methods: We prospectively screened three hundred pregnant women booked for antenatal care between January 1, 2016, and December 31, 2016, for HIV, HBV, and syphilis. Their demographic data, risk factors, and results of the screening tests were analyzed using the SPSS version 20 and presented in simple charts, tables, and percentages. Results: Thirty nine (13%) out of the 300 pregnant women tested seropositive for either HIV (28, 9.3%), HBV (10, 3.3%), or syphilis (one, 0.3%). The most common identifiable risk factor for these infections was multiple sexual partners which accounted for 38.4%. Conclusions: The seroprevalence of STIs in this study was 13% and the most common risk factor for the infections was multiple sexualpartners. Therefore, effective preventive strategies for HIV, HBV, and syphilis are advocated. Keywords: Hepatitis B virus, human immunodeficiency virus, Nigeria, pregnancy, screening, seroprevalence, syphili

Vaginal Candida infection in pregnancy and its implications for fetal well-being

Vaginal Candida infection is one of the most common genital tract infections reported in pregnant women. This study was designed to determine the prevalence of vaginal Candida infection and pattern of Candida species isolates in the genital tract of pregnant women during antenatal period and in early labour; and the associated fetal outcome. The study was conducted at the antenatal clinic and labor ward of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria. High vaginal swabs were collected from 408 pregnant women at the antenatal clinic and repeated in early labour. The samples were processed to isolate Candida species. Data were analysed using Statistical Package for Social Science (SPSS) windows version 21.0 (IBM Corp., Armonk, NY, USA). Prevalence of Candida infection was significantly higher in early labour (46%) than during antenatal period (38%) (P=0.02). Candida albicans was the predominant isolate, followed by Candida glabrata and Candida tropicalis. Candida infection was associated with increased likelihood of low birth weight babies (AOR 2.8, CI: 1.1-6.8; P= 0.03). However there was no statistically significant effect of Candida infection on the likelihood of preterm delivery (AOR 1.4, CI: 0.7-2.6; P= 0.35). Routine screening and prompt treatment of women at risk of delivering low birth weight babies is advocated. Keywords: Candida; Pregnancy; Preterm birth; Prevalence   L'infection vaginale à Candida est l'une des infections des voies génitales les plus courantes signalées chez les femmes enceintes. Cette étude a été conçue pour déterminer la prévalence de l'infection vaginale à Candida et le profil des isolats d'espèces de Candida dans le tractus génital des femmes enceintes pendant la période prénatale et au début du travail; et l'issue foetale associée. L'étude a été menée à la clinique prénatale et au service d'accouchement de l'hôpital universitaire Olabisi Onabanjo de Sagamu, dans l'État d'Ogun, au Nigéria. Des écouvillons vaginaux élevés ont été prélevés sur 408 femmes enceintes à la clinique prénatale et répétés au début du travail. Les échantillons ont été traités pour isoler les espèces de Candida. Les données ont été analysées à l'aide de la version 21.0 de Windows Package for Social Science (SPSS) (IBM Corp., Armonk, NY, USA). La prévalence de l'infection à Candida était significativement plus élevée au début du travail (46%) qu'au cours de la période prénatale (38%) (P = 0,02). Candida albicans était l'isolat prédominant, suivi de Candida glabrata et Candida tropicalis. L'infection à Candida était associée à une probabilité accrue de bébés de faible poids à la naissance (AOR 2,8, IC: 1,1-6,8; P = 0,03). Cependant, il n'y avait aucun effet statistiquement significatif de l'infection à Candida sur la probabilité d'accouchement prématuré (AOR 1,4, IC: 0,7-2,6; P = 0,35). Le dépistage systématique et le traitement rapide des femmes à risque d'accoucher de bébés de faible poids à la naissance sont recommandés. Mots-clés: Candidose; Grossesse; Naissance prématurée; Prévalenc

Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome

Background: To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design: A prospective longitudinal study. Setting and Population: Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods: Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures: Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results: Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis.At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period(P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions: Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Keywords: Bacterial vaginosis, foetal outcome, Lactobacillus, pregnancy, vaginal microflora. Funding: This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with referencenumber OOU/IBR/010

"Near-miss" obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study

AIM: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre. METHODS: Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care. RESULTS: There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5%) and maternal death (88.6%) were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100,000 deliveries. The overall maternal death to near-miss ratio was 1: 4.8 and this remained relatively constant over the 3-year period. CONCLUSION: The quality of care received by critically ill obstetric patients in this centre is suboptimal with no evident changes between 2002 and 2004. Reduction of the present maternal mortality ratio may best be achieved by developing evidence-based protocols and improving the resources for managing severe morbidities due to hypertension and haemorrhage especially in critically ill unbooked patients. Tertiary care hospitals in Nigeria could also benefit from evaluation of their standard of obstetric care by including near-miss investigations in their maternal death enquiries

Clinico-Pathological Discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Jaume Ordi and colleagues examine the discrepancies between clinical diagnoses of causes of maternal deaths and pathological findings by necropsy in Mozambique

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution