Incidence of and socio-biologic risk factors for spontaneous preterm birth in HIV positive Nigerian women

BACKGROUND: Recent studies have identified HIV as a leading contributor to preterm delivery and its associated morbidity and mortality. However little or no information exists in our sub-region on this subject. Identifying the factors associated with preterm delivery in HIV positive women in our country and sub-region will not only prevent mother to child transmission of HIV virus but will also reduce the morbidity and mortality associated with prematurity and low birth weight. This study was designed to determine the incidence and risk factors for preterm delivery in HIV positive Nigerians. METHOD: The required data for this retrospective study was extracted from the data base of a cohort study of the outcome of prevention of mother to child transmission at the Nigerian Institute of Medical Research, Lagos. Only data of women that met the eligibility of spontaneous delivery after 20 weeks of gestation were included. Ethical approval was obtained from the Institution’s Ethical Review Board. RESULTS: 181 women out of the 1626 eligible for inclusion into the study had spontaneous preterm delivery (11.1%). The mean birth weight was 3.1 ± 0.4 kg, with 10.3% having LBW. Spontaneous preterm delivery was found to be significantly associated with unmarried status (cOR: 1.7;1.52-2.57), baseline CD4 count <200 cells/mm(3)(cOR: 1.8; 1.16-2.99), presence of opportunistic infection at delivery (cOR: 2.2;1.23-3.57), multiple pregnancy (cOR 10.4; 4.24 – 26.17), use of PI based triple ARV therapy (eOR 10.2; 5.52 – 18.8) in the first trimester (cOR 2.5; 1.77 – 3.52) on univariate analysis. However after multivariate analysis controlling for potential confounding variables including low birth weight, only multiple pregnancy (aOR: 8.6; CI: 6.73 – 12.9), presence of opportunistic infection at delivery (aOR: 1.9; CI: 1.1 – 5.7), and 1st trimester exposure to PI based triple therapy (aOR: 5.4; CI: 3.4 – 7.8) retained their significant association with preterm delivery. CONCLUSION: The spontaneous preterm delivery rate among our cohort was 11.1%. HIV positive women with multiple pregnancies, symptomatic HIV infection at delivery and first trimester fetal exposure to PI based triple therapy were found to be at risk of spontaneous preterm delivery. Early booking and non-use of PI based triple therapy in the first trimester will significantly reduce the risk of preterm delivery

Fetal outcome in umbilical cord prolapse in Jos, Nigeria

Background: Cord prolapse is one of the obstetric emergencies in labour, posing a life-threatening emergency for the fetus. Timely delivery at detection with a live fetus is the hallmark of good clinical management to reduce the high perinatal morbidity and mortality in the fetus. Objective: To determine the incidence of cord prolapse, predisposing factors and fetal outcome of the cases of cord prolapse managed in the Jos University Teaching Hospital (JUTH). Study Design: A review of the fetal outcome of thirty-five (35) cases of cord prolapse managed at the JUTH, Jos, Nigeria from January 1999 to December 2003. Results: There were 12,536 deliveries with 35 cases of cord prolapse, giving an incidence of 0.28%, or 1 in 358 deliveries. The highest incidence occurred in women aged 30-34 years. Cord prolapse was seen to be mainly a problem of multiparous women, 96.8%. Prematurity was the highest contributing factor 12 (30.0%), followed by twin pregnancy 9 (22.5%). About 57% of the babies were dead on presentation to the hospital, mainly from patients booked outside JUTH. One baby with severe birth asphyxia died in the early neonatal period. Perinatal mortality was 629 per 1,000 deliveries. Conclusion: The perinatal mortality in the cases of cord prolapse is still high. Most fetal deaths were from patients that booked outside the hospital, presenting with intrauterine fetal death. The un-booked patient with cord prolapse is most likely to present with an intrauterine fetal death. Keywords: cord prolapse, fetal outcome, labour Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 30-3

Attitude of Reproductive Healthcare Providers to the Post-Partum Intrauterine Device (PPIUD) in Jos, Nigeria

Context: The knowledge, attitude and practice of the post partum IUD among staff in the obstetrics and gynaecological unit of the Jos University Teaching Hospital has been in doubt all along. Clients were not forth coming for this method of contraception despite the fact that it was readily available in the facility. Objective: To assess the knowledge, attitude and practice of the post partum IUD among the clinical staff of the obstetric and gynaecological unit of the Jos University Teaching Hospital, Jos Plateau State. Method: A semi-structured self-administered questionnaire was developed and administered to a sample of randomly selected health providers working in the Obstetrics and Gynaecology department of the Jos University Teaching Hospital. Of the 200 questionnaires that were distributed, 166 were completed and returned giving a response rate of 83%. All the returned questionnaires were analyzed. Results: The highest number of responders was within the 31-40 year age-group, and 59.6% were females. About 95% had heard about intrauterine devices, 30% had had a formal training in family planning, but none of them had had training in offering PPIUD services. Up to 60% thought that the IUD could be inserted at any time within 6 weeks of delivery. Most (67.5%) of the responders were not willing to recommend the use of PPIUD to anyone for contraception. The commonest reason for not recommending the method was that the complications were more that those inserted as interval procedures, followed by high fall out rate of the IUD. The practice of the method among the respondents was absent, as none of them had actually performed the procedure. Conclusion: There is need for proper education of the health workers themselves about the PPIUD and its benefits to our women especially at the various points of contact with both the obstetric and gynaecological services. This, we believe, would positively influence the attitude and subsequent practice of the method by the majority of the respondents who were clinicians. Key Words: Knowledge, Attitude, Practice, Postpartum Intrauterine Device (PPIUD) [Trop J Obstet Gynaecol, 2004 21:91-94

Elective caesarean sections at the Jos University Teaching Hospital

Context: Elective caesarean sections have been pronounced safer for both mother and fetus compared with emergency caesarean sections. Emergency caesarean sections however have continued to constitute the lion share of caesarean sections in our facility. Objective: To determine the caesarean section rate, examine the trend of elective caesarean sections and the indications for elective caesarean sections amongst our patients. Methodology: This was a retrospective study of the clinical records of all patients that had caesarean section in Jos Nigeria from January 1985 to December 2002, an 18-year period. Data on the number and type of caesarean section, age of patients and the indication for the elective caesarean section were extracted and analyzed. Results: A total number of 41 470 deliveries were conducted within the period of study. Out of these deliveries, 6 557 were caesarean sections giving a caesarean section rate of 15.8%. Elective caesarean sections were performed in 970 (14.8%), and emergency caesarean sections in 5 587 (85.2%) of all the caesarean sections. The rate of elective caesarean section increased from 8.9% in 1985-1986 to a rate of 22.5% in the last two years of the study period. Repeat caesarean section was the commonest indication for elective caesarean sections in 51.9% of the cases, followed by bad obstetric history (BOH) in 10.8%. Conclusions: Elective caesarean section accounted for 1 out of every 6 caesarean sections in the center. The commonest single indication for the elective caesarean section was repeat caesarean section for 2 or more previous caesarean sections. Keywords: elective, emergency, caesarean section, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 39-4

Acceptability of Vasectomy in Jos, Northern Nigeria

Objective: The paper reports on the ten cases of vasectomy performed in our institution over a sixteen year period. Design: It is a retrospective study of clients\' case-notes from January 1985 to December 2000. Setting: Jos University Teaching Hospital, Plateau State, Nigeria. Results: During the 16 year period, a total of ten males volunteered to have vasectomy performed on them in contrast to 3585 females who had surgical contraception via minilaparotomy during the same period, giving an incidence of 0.28%. Their age range was 41-62 years, range of children per family of 3-14, with 3-11 children alive at the time of the procedure. They were in stable marriages and chose vasectomy because they had completed their family sizes. Compilations attributed to the procedure were minor and resolved with treatment. Conclusion: Vasectomy even though safe, simple and effective is not readily acceptable as a method of fertility control in our institution and this part of Nigeria. Key Words: vasectomy, contraception, safe, effective. [Trop J Obstet Gynaecol, 2004;21:56-57