Outcome of twin deliveries at the University of Maiduguri Teaching Hospital: A 5-year review

Objectives: The objectives of the study were to determine the outcome of twin births at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in terms of morbidity and mortality and to recommend possible measures to curtail or reduce some of the preventable complications.Materials and Methods: This is a 5-year retrospective study, from January 2000 to December 2004, of twin births at the UMTH.Results: There were 196 twin deliveries in 8431 total deliveries, with a twin incidence of 2.3%. Dizygotic twins accounted for 63.4%. The increasing maternal age and positive family history of multiple pregnancies were associated with the increasing twinning rate. The main complications encountered were preterm labor, pregnancy-induced hypertension, and cord prolapse. The perinatal mortality rate of 107.5/1000 births was higher than that observed for singleton pregnancies in the same institution. Similarly, there was a higher Cesarian section rate of 24.7% compared to singletons within the same period. There were significantly higher perinatal mortality rates among the preterm (P = 0.000002) and low-birthweight (P = 0.000004) fetuses.Conclusion: Considering that fetal prematurity and low birth weight, sequelae to preterm labor, are the commonest causes of perinatal death in this study, efforts should be geared during the antenatal period toward the prevention of a premature birth

Survey on the use of misoprostol for induction of labour among Obstetricians in the west African sub region

Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complicationsObjective: To determine the use of Misoprostol for induction of labour among the Obstetricians in the West African sub region.Methodology and settings: During the October 2007 pre examination workshop of the West African College of Surgeons (FWACS), Faculty of Obstetrics and Gynaecology 42 examiners responded through structuredquestionnaires on the use of misoprostol for induction of labour (IOL) in their institutions of practice. Results: About 91 % admit using misoprostol for IOL with only half (50%) having written protocols for labour induction with misoprostol. Almost all (93%) prefer the vaginal route for the administration of misoprostol andabout 74% do not use misoprostol for those with Caesarean section scar compared to only 19% who do. Misoprostol is used for cervical ripening and control of post partum haemorrhage among 24.4% and 50% of theObstetricians respectively. The commonest complications encountered were Fetal distress, uterine rupture and uterine hyper tonus among 54.8%, 52.4% and 45.2% of the respondents.Conclusions: Misoprostol use was high with yet serious complication occurring among those using it for IOL. Despite the manufacturers and other regulatory agents warning against its use in pregnancy because of serious maternal and fetal complications, misoprostol use for IOL is widespread. A regulated use of this drug especially in pregnancy is advocated

Indications and complications of hysterectomy in maiduguri, Northeastern Nigeria

This study intends to determine the indications and complications of hysterectomy in a typical teaching hospital in tropical Africa and then to make appropriate recommendations. Setting, Materials and Methods: The records of 180 out of 240 patients who had hysterectomy over a ten year period (January 1989-December 1998) at the University of Maiduguri Teaching Hospital formed the basis of the study. Details of their mode of clinical presentation, indications for surgery and postoperative course and complications were extracted from their records and analysed. The SPSS statistical software package was used for the analysis of the data. Results:The mean age of the patients was 48.5 + 7.4 years with a range of 24 - 60 years and 66.6 % aged 40 years and above. The mean parity among the patients was 4.3 + 3.7 with a range of 0 - 13. Thirty six (20%) were nulliparous. The indications for hysterectomy are uterine fibroids 114 (63.3%), utero vaginal prolapse 19(10.6%) and ovarian tumours 16 (8.9%). Dysfunctional uterine bleeding accounted for 2(1.1%) cases. There were 2 cases of ruptured uterus. One patient (0.6%) had endometrial cancer, while 2(1.1%) had atypical endometrial hyperplasia. Total abdominal hysterectomy, either alone or in combination with bilateral/ unilateral oophorectomy and omentectomy, accounted for 160 (88.9%) cases. There was one case of subtotal hysterectomy from ruptured uterus following prolonged obstructed labour. Vaginal hysterectomy accounted for 19(10.6%) cases. The leading complications in this series are anaemia 34 (10.9%), abdominal wound dehiscence 20(11.1%), wound sepsis 14 (7.8%), febrile morbidity and post hysterectomy symptoms 12(6.7%). All cases of complete wound dehiscence occurred in association with abdominal hysterectomy. The type of incision and the level of experience of the surgeon (consultant and registrar) did not significantly affect the incidence of complications in this study. Conclusion: Uterine fibroids, uterovaginal prolapse and ovarian tumours are the leading indications for hysterectomy in our environment. Anaemia, abdominal wound dehiscence, sepsis and febrile morbidity are the commonest complications. Vaginal hysterectomy is associated with low treatment costs, shorter hospital stay and less morbidity when compared with abdominal hysterectomy. Therefore, whenever possible, vaginal hysterectomy should be done in preference to abdominal hysterectomy.&nbsp

Oral health practices among pregnant women in North Eastern Nigeria

Objective: The objective of this study was to document oral health practices of pregnant women in two tertiary institutions in North-eastern Nigeria.Materials and Methods: This was a cross-sectional study of pregnant women seen at the antenatal clinics of the University of Maiduguri Teaching Hospital and Federal Medical Centre Yola from May 1, 2009 to July 1, 2009.Results: A total of 294 women were interviewed. They were aged 15-46 with a mean of 27.42 ± 5.97 years. The parity ranged from 1 to 9 with a mean of 2.23 ± 1.65. Twelve (4.1%) women gave a history of symptomatic oral lesion in index pregnancy. Forty-four (15%) had had previous encounter with a dentist, while the highest frequency of oral care was twice a day in 164 (55.8%) of respondents. The majority, 264 (89.9%), used toothbrush/toothpaste as a form of oral care while 2 (0.7%) used charcoal. Women of low parity tended to have better oral care than those of high parity (P = 0.002). Women who are employed had better oral care than housewives (x2 = 27.749, P = 0.001). There was no significant relationship between oral complaints and trimester of pregnancy (x2 = 4.271, P = 0.118).Conclusion: Oral healthcare among the respondents was encouraging but involvement of the dental surgeon in preventive oral care in pregnancy is rather dismal

Prevalence of Vaginal Candidiasis among Pregnant Women with Abnormal Vaginal Discharge in Maiduguri

BACKGROUND: Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. OBJECTIVES: To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women.METHODS: High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software.RESULTS: The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P<0.001). The prevalence of C. albicans was 41%. The frequencies of Vulval itching, Dyspareunia and vulval excoriation among those with candidiasis were 151 (50.3%), 14 (56.0%) and 75 (75.0%) respectively (P<0.001). CONCLUSION: The prevalence of abnormal vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment. Erratum Note: Ibrahim SM, Mohammed B, Yahaya M, Audu BM, Ibrahim HA on the article ”Prevalence of VaginalCandidiasis among Pregnant Women with Abnormal Vaginal Discharge in Maiduguri” on Page Nig. J. Med2013. 138-142. Should read: Ibrahim SM, Bukar M, Mohammed Y, Audu BM, Ibrahim HM

Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North‑Eastern Nigeria

Objective: This study determined the prevalence and socio‑demographic characteristics of bacterial vaginosis (BV) among pregnant women with abnormal vaginal discharge.Study Design: Descriptive cross‑sectional study.Setting: University of Maiduguri Teaching Hospital.Materials and Methods: Vaginal swab samples and data on epidemiological risk factors were collected from 400 consecutive pregnant women with complaints of abnormal vaginal discharge. The data was analyzed using the SPSS 16.0 statistical software. Association between variables was compared by using the Chi‑square (χ2) and Fisher’s exact tests while P < 0.05 was considered significant at 95.0% confidence level.Result: The prevalence of BV among pregnant women with abnormal vaginal discharge was 17.3%. Age 20‑24 years, multigravidity, lack of western education and unemployment were associated with increased prevalence of BV. Yellowish, watery vaginal discharge (P = 0.001) was associated with BV. Dysuria, dyspareunia and lower abdominal tenderness were associated with BV (P = 0.001). Fifty three (77%) of patients had BV during the second trimester compared to 6 (9%) who had it in the 1st trimester of pregnancy (P = 0.012).Conclusion: The high prevalence of BV in this study may necessitate adequate screening of pregnant women with abnormal vaginal discharge in order to give appropriate treatment and avoid complications associated with it.Key words: Bacterial vaginosis, pregnancy, vaginal discharg

Distributions of anthropometric measurements of new born babies among various ethnic groups in Maiduguri, Nigeria: a prospective study.

Weight and other newborn anthropometric measurements at birth are considered as the most important indicators of a newborn's chances of survival, growth, long-term health and psychosocial development. Objective: To determine the mean birth weight, birth length and head circumferences of new born babies among the various ethnic groups in Maiduguri. Method: A descriptive cohort study involving 854 pregnant women with their live singleton babies was carried out in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH) and the State Specialist Hospital (SSH), Maiduguri, over a 6-months period, between 2 February 2009 and 29 July 2009. Mothers' socio-demographic and obstetrics performances, baby's birth weights, birth lengths and head circumferences were obtained and recorded and data analyzed using SPSS version 16. Statistical significance was computed by t-test and Chi-square. A P value <0.05 was considered significant. Results: A total of 854 mothers together with their 854 live singleton babies were studied. There were 460 (53.9%) male and 394 (46.1%) female babies. Among these babies, 144 were low birth weight, 660 had normal birth weight while high birth weight was seen in 50 babies. The mean birth weight of all babies delivered in the study population was 3030.47±631g, with mean birth length of 47.8±3.1cm, and the mean head circumference was 34.2±2. All the parameters studied were significantly lower in those that were of LBW compared to babies that were not of LBW, and the mean difference was statistically significant (P value 0.000). Conclusion: All the anthropometric measurements were highest in Igbo newborns while Hausa/Fulani had the lowest among the various ethnic group studied in Maiduguri. Improving the socio-economic status especially of the disadvantage ethnic group and further community based research is recommended.&nbsp

Effect of Light Intensities on Growth Performance of Tetrapleura tetraptera Seedlings Schum. (Thonn.)

The study assessed the effect of varying light intensities and optimum percentage of sunlight favourable for raising Tetrapleura tetraptera seedlings. The light intensity was measured through photometer. The experiment was subjected to a control without wire mesh(T1) and three other treatments (T2, T3 and T4) covered with different layers of black wire mesh with 99.5%, 75%, 49.8% and 25% light intensities respectively. Each of the treatments was replicated six times in a completely randomized design. The plant height, leaf production and stem diameter were all monitored for 12 weeks. Analysis of Variance (ANOVA) was employed and the means separated using Least Significant Difference (LSD). The results showed that the significance effect (P = \u3b10.05) was only observed in the seedlings height of Tetrapleuratetrapteraseedlings. However, the mean values obtained for all the parameters considered revealed the treatment 1(i.e. 99.8% wire mesh) was observed to be the best performing treatment. For the plant height, mean value ranged between 13.09 cm and 16.8 cm, a range from 0.22cm to 0.28mm was recorded for stem girth while the mean values between 22 and 27 were obtained for number of leaves among the treatments. It may be concluded from the study, that light intensity of 100% i.e without interference should be used for the growth and development as well as production of Tetrapleura tetraptera seedlings in the nursery

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria

Objective : To determine the trend and indications for the use of caesarean delivery in our environment. Method : A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results : During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion : Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate