Postmaturity and fetal macrosomia in Jos, Nigeria

Background: One of the risk factors of post term pregnancy is fetal macrosomia. The excessively large infant presents a recurring and potentially serious obstetric problem.Methods: This was a retrospective study of all consecutive births in the maternity unit, Jos University Teaching Hospital, Jos, Nigeria, between January 1998 and December 2001. The case records of all mothers of babies born with weight of 4000g and above were retrieved and data collated and analyzed for total deliveries, maternal and fetal characteristics, complications and outcome of pregnancy. Results: Macrosomic infants (4000g and above) were 286 cases representing 2.9% of all deliveries. Ten (3.5%) of the infants with macrosomia were preterm, 90.9% were term, and 5.6% were post-term. The mean age and parity of the mothers with pregnancies at term was 29.2 years, and 3.2 respectively. The post term mothers had a mean age and parity of 32.7 years and 3.8 respectively. Maternal morbidity included increased caesarean delivery, and vaginal trauma (episiotomies, tears and bruises) in both groups. Caesarean section was the mode of delivery in 31.3% of post term and 27.6% term infants, while the indication for caesarean section was cephalopelvic disproportion in 80% and 87.3% for post term and term infants respectively. Fetal complications were birth asphyxia and stillbirth. There were no gross fetal abnormalities recorded in the series. Still birth rate was 8.1% and 12.5% in term and post term infants respectively.Conclusion: Post term pregnancies account for macrosomic babies in our facility, posing an increased risk to the mother and fetus. Early diagnosis, intrapartum fetal monitoring and recourse to operative delivery may improve the fetal outcome of these infants.Keywords: fetal macrosomia, maternal morbidity, fetal complicationsRésumé Introduction: L\'un des facteurs de risque de la postmaturité de la grossesse est la macrosomie foetale. Un enfant qui est excessivement grand provoque un problème obstétrique qui est récurrent et potentiellement grave.Méthodes: Il s\'agit d\'une étude rétrospective de toutes des naissances consécutives dans le service d\'obstétrique, centre hospitalier universitaire de Jos, Jos, Nigéria, entre janvier 1998 et décembre 2001. Les dossiers médicaux de toutes les mères des enfants nés avec 4000g poids et de plus ont été tirés et les données rassemblées et analysées pour accouchement total, des caractéristiques materneles et foetales, complications et le résultat de la grossesse.Résultats: Enfants macrosomiques (4000g et lus) étaient 286 soit 2,9% de tous accouchements. Dix soit 3,5% des enfants avec macrosomie étaient préterme, 90,9% étaient terme. Et 5,6% étaient post terme. L\'âge moyen et la parité des mères avec des grossesses à terme étaient 29,2 ans, et 3,2 respectivement. Des mères post termes avaient un âge moyen et une parité de 32,7 ans et 3,8 respectivement. Morbidité maternelle comprend augmentation d\'accouchement césarien, et traumatisme vaginal. (Épisiotomies, déchirures et des blessures légères) dans les deux groupes. La césarienne était la méthode d\'accouchement en 31.3% des post termes et 27,6% des enfants à terme, tandis que l\'indication pour la césarienne était céphatopelvien dispropotionel en 80% et 87,3% pour des enfants post termes et à terme respectivement. Complications foetales étaient la naissance asphyxie et mort à la naissance. Il n\'y avait aucune abnormalité foetale grave notée dans la série. Taux de mort à terme et enfants nés à post terme respectivement.Conclusion: Grossesses post termes constituent des bébées macrosomique dans notre centre. Ceci provoque une augmentation de risque pour des mères et foetus. Un diagnostique précoce, surveillance d\'intrapatum foetal et recours au accouchement à travers l\'intervention chirurgicale pourrait améliorer le résultat foetal chez ces enfants.Mots clés: Macrosomie fœtale, morbidité maternelle, complications foetalesAnnals of African Medicine Vol. 4(2) 2005: 72–7

Experience with norplant at a Nigerian Teaching Hospital

Objectives: To determine the acceptance of Norplant implants while it was in use and share our experience with other Norplant providers.Design: Retrospective descriptive study.Setting: The family planning clinic of the Jos University Teaching Hospital, Jos, Nigeria.Results: During the 21-year period, January 1985 to December 2005, a total of eighteen thousand, two hundred and ninety one (18,291) new clients accepted various modern contraceptive methods in the family planning clinic of Jos University Teaching Hospital, Nigeria. Norplant was accepted by 1,333 clients (4.9%) as against the intrauterinedevices (IUDs) 25.4%, and Oral Contraceptive Pills (OCP) 22.9%. Female sterilisation was a contraceptive method of choice in 21.2%, the injectables in 13.9%, and the male condom in 9.3%. Failure rate was 0.37% and continuity rate was high among users. The Norplant contraceptive implant was accepted by women of mean age of 29.6 years and women of all parity. The acceptance pattern demonstrated a multi-nodalpattern from the time of introduction in 1985 to December 2005 when supply came to an abrupt stop. The greatest barriers to Norplant use were non- availability and high cost of the commodity.Conclusion: Norplant implants provided contraceptive protection with high reliability, safety, independence from user compliance, rapid return of pre-existing fertility after removal, good tolerability, and relatively simple and quick insertion and removal. The capsules will definitely be used as a reference for similar contraceptive products in the contraceptive market

A Ten - Year Review of Gynaecological Malignancies in Jos University Teaching Hospital, Jos, Nigeria (1990-1999)

A restrospective study of gynaecological malignant tumours was undertaken between January 1990 - December 1999 inclusive. It consisted of all gynecological specimens sent to histopathology laboratory in 10% formalin-saline solution. Those diagnosed as malignant tumours were retrieved from our records. A total of 2,673 malignant tumours were recorded out of which 386 were of gynaecological malignant tumours.Cancer of the cervix accounted for77.0% which were seen in advanced stages, followed by ovarian 11.0%, endometrial 6.5% and vulval cancers 4.1%. Cervical cancer was the predominant gynaecological cancer in this hospital. This high incidence may be attributed to a lack of awareness of the nature of the disease which may be responsible for the late presentation in the hospital. The number of cases of other gynaecological malignancies like ovarian and endometrial cancers have continued to rise in our hospital, and like cancer of the cervix, patients presented late. Sahel Med. J. Vol.6(2) 2003: 49-5

Norplant® acceptors in Jos, Nigeria

Background: The Norplant contraceptive implant has since been an accepted long-term steroidal method of contraception in Jos. It is now competing favorably with the older methods in our center. Method: A retrospective study was carried out to review the trend and characteristics of the acceptors of this relatively new contraceptive method in Jos. Results: During the 26 months period of study, May 2002 to July 2004, a total of 3,793 women accepted modern contraceptive methods within the period of study. Two hundred and sixty (260) had Norplant insertion after due counseling, constituting 6.8% of all contraceptive methods in the center. All clients were married. Their age ranged from 18-48 years with a mean of 33.05 ± 5.33 years. The women were of parity 0-8 and a mean of 3.57 ± 1.58. They were also of weight ranging from 32-95 kg with a mean of 65.78 ± 11.74. Two hundred and forty eight 95.4% of them were literate. Eighty five percent (222) of the clients had used other methods of contraception before switching over to the Norplant implants. Ten percent of the women were continuing with the Norplant after previous usage, and continuation rate was 99.2%. The commonest source of information about the method was from health workers at family planning clinics in Jos. Conclusion: Norplant contraceptive method was used by about 7% of all clients accepting modern contraceptive methods. The women accepting the method were of lower age and parity compared with that of other methods. Majority of the clients switched from other methods to Norplant. Keywords: norplant, acceptors, contraceptive, Jos–Nigeria Annals of African Medicine Vol. 5 (1) 2006: 20–2

HIV - Positive Women In Labour Room In Jos, Nigeria

Background : Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are commonly encountered by health practitioners in Nigeria. Unfortunately, the HIV positive status does not limit the fertility of a woman. Healthy looking women, infected with HIV are not uncommon in the antenatal clinic and the labour room. Objective: The objective of this study was to determine trend of HIV-positive pregnant women presenting in the labour room. To determine how many staff were infected. Proffer suggestions on how to minimize the spread if found to be rising in pregnant mothers in labour. Also, to draw the attention of attending physicians, midwives and hospital authorities to the need for urgent protection from infection with the viruses. Methods: This retrospective study was conducted from January 1998 to December 2003. The information was obtained from 159 patient records of the labour room of the Jos University Teaching Hospital, Jos, Nigeria. The HIV status was already confirmed antenatally. Record of HIV-positive patients were retrieved and analyzed. The record of staff at risk was also determined. Results: During the period under review, January 1998 to December 2003, 15,282 deliveries took place and 159 HIV-positive women were admitted into the maternity unit of the Jos University Teaching Hospital for labour and delivery. The study showed that from 2 cases reported in 1998, the proportion of patients with HIV had been on the increase. The incidence has risen astronomically from 0.1% to the present figure of 1.9%, or 32 per 1,673 deliveries in 2003. The age range of the patients was from 18 to 36 years with a mean of 26.4 years. All patients were married. Conclusion: The number of HIV positive patients seen and managed for labour and delivery is rapidly increasing. Labour rooms need to be better equipped with preventive measures in order to protect the lives of the personnel performing their obligatory responsibilities in this all-important part of a hospital. Key words: - Human Immunodefiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), labour room, Nevirapine, Jos-Nigeria. Highland Medical Research Journal Vol.2(2) 2004: 47-5

HIV Status Discordance: Associated Factors Among HIV Positive Pregnant Women in Lagos, Southwest Nigeria

AbstractThe HIV negative partner in a HIV serodiscordant relationship is at high risk of becoming HIV infected. The annual risk of HIV infection for a partner of a person with HIV is about 10%, with higher annual transmission rates of 20–25% per year reported in Rwanda and Zambia. Although there is considerable variation across countries, recent studies in southern and east Africa countries with mature epidemics reported that up to two-thirds of infected persons in stable relationship are discordant. HIV serodiscordance is thus a recognized priority for HIV prevention intervention. In Nigeria only few studies have studied the burden of serodiscordance, making planning difficult. In this study HIV serodiscordance rate and associated factors among pregnant women were assessed in a large PMTCT clinic in Lagos Nigeria over a 9 years period. Information on HIV status disclosure, partners HIV status (confirmed by HIV test results), sociodemographic characteristics and reproductive information were obtained from the women after enrollment and entered into the case file. In the study, relevant information was managed with SPSS for windows version 19.0. The variables independently associated with HIV status discordance were determined in both univariate and multivariate analysis. P values and Odd ratio with their confidence intervals were calculated. Out of the 4435 women enrolled during the study period, 3712 (83.7%) had disclosed their status to their partner. Partner’s HIV status among the women with confirmed HIV status was negative in 2065 (66.8%) women, thus a discordant rate of 66.8%. HIV status disclosure rate was 83.7%; with significantly higher disclosure rate in concordant couple (83.3%) compared to 76.8% among women in serodiscordant relationship (p=0.00; OR: 1.5; 95% CI: 1.25-1.82). Discordant HIV status in a female positive relationship was found to be associated with history of at least two termination of pregnancy (OR: 3.05; 95% CI: 2.91-3.89) and five or more total life time sexual partnership (OR: 2.3; 95% CI: 1.27-3.21). The perception that men are the index cases is not supported by evidence from this study. We recommend the tracking of both men and women as index cases in other to reduce HIV transmission within stable relationship. Social marketing aimed at reducing concurrency should focus on both male and females, if we must reduce new HIV infection within stable relationships.Keywords: HIV/AIDS, HIV status, Discordance, Pregnant, NigeriaRésuméLe partenaire séronégatif dans une relation sérodiscordantes du VIH est à haut risque de devenir infecté par le VIH. Le risque annuel d'infection par le VIH d'un partenaire d'une personne avec le VIH est d'environ 10%, avec des taux plus élevés de transmission annuels de 20-25% par an comme rapporté au Rwanda et en Zambie. Bien qu'il existe des variations considérables entre les pays, des études récentes dans les pays en Afrique australe et orientale avec des épidémies matures rapporté que jusqu'à deux tiers des personnes infectées en relation stable sont discordantes. La sérodifférence est donc une priorité reconnue pour l'intervention de prévention du VIH. Au Nigeria, peu d'études ont étudié la charge de sérodifférence, ce qui rend la planification difficile. Dans cette étude, le taux de sérodifférence du VIH et les facteurs associés chez les femmes enceintes ont été évalués dans une grande clinique de PTME à Lagos au Nigeria au cours d’une période de 9 ans. Les informations sur la divulgation du statut du VIH, le du statut du VIH des partenaires (confirmé par les résultats des analyse pour détecter le VIH), les caractéristiques sociodémographiques et d'information en matière de reproduction ont été obtenues auprès des femmes après l'inscription et est entré dans les dossiers des femmes. Dans l'étude, l'information pertinente a été gérée avec SPSS pour Windows version 19.0. Les variables indépendamment associés à la discordance séropositivité du statut du VIH ont été déterminées à la fois dans l'analyse univariée et multivariée. Les valeurs de P et le ratio Odd avec leurs intervalles de confiance ont été calculés. Sur les 4435 femmes inscrites au cours de la période de l'étude, 3712 (83,7%) avaient révélé leur statut à leur partenaire, le statut du VIH des partenaires parmi les femmes dont le statut VIH est confirmée était négatif chez 2065 (66,8%) des femmes, donc un taux discordant de 66,8%. Le taux de la divulgation du statut du VIH était de 83,7%; avec un taux significativement plus élevé de divulgation chez les couples concordants (83,3%), par rapport à 76,8% chez les femmes en relation sérodiscordantes (p = 0,00; OR: 1,5; IC 95%: 1,25 à 1,82). Nous avons découvert que le statut du VIH dans une relation positive d’une femme a était associé à l'histoire d'au moins deux interruption de grossesse (OR: 3,05; IC 95%: 2,91 à 3,89) et cinq ou plus des partenaires sexuels de toute la vie (OR: 2,3; 95 % CI: 1.27 à 3.21). La perception que les hommes sont les cas index ne sont pas étayées par des preuves de cette étude. Nous recommandons le suivi des hommes et des femmes comme des cas index pour réduire la transmission du VIH au sein de relation stable. Le marketing social visant à réduire la concurrence devrait se concentrer sur les deux mâles et les femelles, si nous devons réduire nouvelle infection par le VIH au sein des relations stables. Mots-clés: VIH / sida, séropositivité, Discordance, enceinte, Nigeri

Indications for removal of intrauterine contraceptive devices in Jos, North-central Nigeria

Context: Intrauterine contraceptive devices (IUDs) are commonly used reversible methods of contraception. The CuT 380A is recommended for use for 10 years but common observation has shown that they are removed much earlier than the recommended duration of use. Methodology: A retrospective study of all clients presenting at the family planning clinic of Jos University Teaching Hospital, between 1st January 1999 and 31st December 2004, for removal of their IUDs. Major Outcomes/Results: The mean (± SD) age of the clients was 32.9 ± 6.9 years and mean parity was 4.0 ± 2.2. All the women were married. The CuT 380A IUD was used in 99.3% of the cases. The mean duration of IUD use was 51.5 ± 51.0 months or 4.3 years only, and the commonest indication for removal was the desire for another pregnancy, which was recorded in 170 (30.7%) of the clients. This was followed by back pain in 70 (12.6%). Husbands' disapproval of the use of the device was recorded in 0.9% of the clients. Conclusion: The duration of IUD use by clients in our centre was very short. The commonest indication for removal of the device was to restore fertility. Shorter lasting IUDs may need to be revisited if these will cost less for clients wishing to use the method only to postpone pregnancies. More effective counselling may be appropriate for alternative contraceptive methods for this category of clients instead of the IUDs currently being used. Keywords: Intrauterine contraceptive device; indications for removal; CuT 380A;Jos-Nigeria Nigerian Journal of Clinical Practice Vol. 9 (2) 2006: pp.105-10

How safe is motherhood in Nigeria?: the trend of mammal mortality in a tertiary health institution

Objective: To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria.Design: Retrospective study.Setting: Jos University Teaching Hospital, Jos, Nigeria.Subject: AN women dying in pregnancy, labour and puerperium.Main outcome measures: Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths.Results: The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention.Conclusion: The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation(WH0) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to sigdicantly reduce maternal mortality

How safe is motherhood in Nigeria?: the trend of mammal mortality in a tertiary health institution

Objective: To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria.Design: Retrospective study.Setting: Jos University Teaching Hospital, Jos, Nigeria.Subject: AN women dying in pregnancy, labour and puerperium.Main outcome measures: Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths.Results: The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention.Conclusion: The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation(WH0) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to sigdicantly reduce maternal mortality

Factors contributing to maternal mortality in North-Central Nigeria: a seventeen-year review

Maternal mortality ratio in Nigeria is one of the highest in the world. This paper reports a facility based study in north-central Nigeria to determine the magnitude, trends, causes and characteristics of maternal deaths before and after the launch of the Safe Motherhood Initiative in Nigeria, with a view to suggesting strategic interventions to reduce these deaths. The records of all deliveries and case files of all women who died during pregnancy and childbirth between January 1, 1985 and December 31, 2001, in the maternity unit of Jos University Teaching Hospital, Jos, Nigeria, were reviewed. Data collected were analysed for socio-biological variables including age, booking status, educational level, parity, ethnic group, marital status, mode of delivery, duration of hospital stay before death occurred, cause (s) of maternal deaths. There were 38,768 deliveries and 267 maternal deaths during the period under review, giving a maternal mortality ratio (MMR) of 740/100,000 total deliveries. The trend fluctuated between 450 in 1990 and 1,010/100.000 deliveries in 1994. The mean age of maternal death was 26.4 (SD 8.1) years. The greatest risk of MMR was among young teenagers (>15 years) and older women (< 40 years). Parity-specific maternal mortality ratio was highest in the grand multiparous women. Unbooked as well as illiterate women were associated with very high maternal mortality ratio. The Hausa - Fulani ethnic group contributed the largest number (44%) by tribe to maternal mortality in our study. The major direct causes of deaths were haemorrhage (34.6%), sepsis (28.3%), eclampsia (23.6%) and unsafe abortion (9.6%). The most common indirect causes of death were hepatitis (18.6%), anaesthetic death (14.6%), anaemia in pregnancy (14.6%), meningitis (12.0%), HIV/AIDS (10.6%) and acute renal failure (8.0%). Seventy- nine percent of the maternal deaths occurred within 24 hours of admission. Most of the deaths were preventable. A regional-specific programme should be planned to reduce the deplorably high maternal mortality in north-central Nigeria. African Journal of Reproductive Health Vol. 9(3) 2005: 27-4