Factors Influencing The Use Of Episiotomy During Vaginal Delivery In South Eastern Nigeria

Background: Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries. Objective: To determine the prevalence of episiotomy at Aba in South Eastern Nigeria, examine factors influencing the performance of episiotomy and document complications associated with the procedure. Design: A hospital based retrospective study. Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria, from January 2001 to December 2005. Subjects: Four thousand, one hundred and seventy two mothers who delivered vaginally within the study period. Results: There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). When controlled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay. Conclusion: The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy. East African Medical Journla Vol. 85 (5) 2008: pp. 240-24

Rupture of the uterus in a primigravida: A case report

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Delayed interval delivery in twin pregnancy without cerclage: Case Report

This report describes a patient-counselling approach and non-surgical management of a dichorionic, diamniotic twin pregnancy where the delivery of the second twin followed the delivery of the first by 59 days. An initial ultrasound scan at twenty and a half weeks gestational age suggested cervical dilatation with protruding amniotic membrane of a dead first twin, and a viable second twin. She aborted the dead fetus at 21 weeks’ gestation and delivered a healthy female infant weighing 1300g at twenty nine and a half weeks gestation. After the loss of the first foetus, delayed delivery in multiple pregnancies can be successful in selected cases as exemplified by the case presentation. In well prepared perinatal centers, with physically and psychologically balanced patients who are well informed about the risks and benefits of the procedure, delayed interval delivery in twin pregnancy without cerclage may be a reasonable strategy

Contraceptive choices of women in rural southeastern Nigeria

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Pregnancy outcome in booked and unbooked mothers in Southeastern Nigeria

Background: In order for individual health institutions in Nigeria to contribute towards the achievement of the Millennium Development Goals (MDG) with regards to maternal health, there is need for research on the local causes of and factors influencing adverse maternal outcomes. This would enable care providers and policy makers appreciate the burden of the problem and know where to focus as they distribute resources.Objectives: To compare the socio-demographical characteristics, obstetrical complications and foetal outcome in booked verses unbooked mothers who delivered at this hospital.Design: A hospital based retrospective study.Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria.Subjects: Three thousand, seven hundred and thirty four mothers who delivered in the hospital between 1st January 2005 and 31st December 2007.Results: Unbooked mothers constituted 17.0% of the 3734 deliveries in the studied period. Compared to booked mothers, unbooked mothers were younger in age (28.2 ± 5.80 vs. 29.3 ± 6.04; p < 0.001) and had a lower educational status (

Knowledge of genital herpes infection among antenatal clinic attendees in South-Eastern Nigeria

Background: Herpes simplex virus (HSV) is a major cause of genital ulcer disease worldwide and a significant factor for increased risk of acquisition and transmission of the Human Immune Deficiency Virus (HIV). The determination of the level of knowledge of genital herpes is necessary for the design and implementation of its specific preventive strategies as well as the reduction of the contribution of genital herpes to HIV transmission.Objective: To determine antenatal women’s knowledge on genital herpes infection. Design: A cross sectional descriptive study.Setting: Antenatal clinic of Abia State University Teaching, Hospital, Aba, Nigeria. Subjects: Three hundred and fifty consecutive and consenting antenatal clinic attendees of Abia State University Teaching Hospital (ABSUTH), Aba, South Eastern, Nigeria. Results: Seventy nine respondents (22.6%) had ever heard of genital herpes whilst sixty two (17.7%) had ever had recurrent blisters around their genitals. Two hundred and sixteen respondents (61.7%) reported having had cold sores or blisters around thelips or mouth following an episode of fever. Seventy four (21.1 %) of the respondents knew that the virus that causes cold sores or blisters can be sexually transmitted. Higher educational levels attained and occupations other than being a housewife or farmer were associated with a greater awareness of genital herpes (

Risk Factors for Hepatitis B Virus Infection during Pregnancy in South Eastern Nigeria

Objective: To determine the seroprevalence of hepatitis B surface antigen (HBsAg) and possible risk factors in pregnant women.Design: A cross –sectional serological survey of women attending antenatal clinics.Setting: Five antenatal clinics in Aba, South Eastern Nigeria.Subjects: Eight hundred and ten consecutive and consenting antenatal clinic attendees over the period 15 June- 15 November 2010.Main Outcome measures: For each pregnant woman, the medical and sociodemographic data were documented. Hepatitis B surface antigen seropositivity determined.Results: Twenty two (2.7%) of the 810 subjects were found to be HBsAg seropositive and asymptomatic. Maternal age, parity, educational level attained, marital status, history of blood transfusion, intravenous drug use, tattooing, jaundice in the past and Human Immunodeficiency Virus seropositivity did not show any association with HBsAg sseropositivity.Conclusion: HBsAg seropositive women in the study were asymptomatic and showed no association with the medical and sociodemographic characteristics examined. These findings affirm the recommendation for universal HBsAg screening in pregnancy and imply that screening on the basis of the presence of risk factors alone may be insufficient

Mutations and Binding Sites of Human Transcription Factors

Mutations in any genome may lead to phenotype characteristics that determine ability of an individual to cope with adaptation to environmental challenges. In studies of human biology, among the most interesting ones are phenotype characteristics that determine responses to drug treatments, response to infections, or predisposition to specific inherited diseases. Most of the research in this field has been focused on the studies of mutation effects on the final gene products, peptides, and their alterations. Considerably less attention was given to the mutations that may affect regulatory mechanism(s) of gene expression, although these may also affect the phenotype characteristics. In this study we make a pilot analysis of mutations observed in the regulatory regions of 24,667 human RefSeq genes. Our study reveals that out of eight studied mutation types, “insertions” are the only one that in a statistically significant manner alters predicted transcription factor binding sites (TFBSs). We also find that 25 families of TFBSs have been altered by mutations in a statistically significant manner in the promoter regions we considered. Moreover, we find that the related transcription factors are, for example, prominent in processes related to intracellular signaling; cell fate; morphogenesis of organs and epithelium; development of urogenital system, epithelium, and tube; neuron fate commitment. Our study highlights the significance of studying mutations within the genes regulatory regions and opens way for further detailed investigations on this topic, particularly on the downstream affected pathways

Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

BACKGROUND –: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality with a known genetic contribution. We tested the performance of a genetic risk score (GRS) for its ability to predict VTE in three cohorts of patients with cardiometabolic disease. METHODS –: We included patients from the FOURIER, PEGASUS-TIMI 54, and SAVOR-TIMI 53 trials (history of atherosclerosis, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE GRS based on 297 SNPs with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared to available clinical risk factors (age, obesity, smoking, history of heart failure, diabetes) and common monogenic mutations. RESULTS –: A total of 29,663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles (p-trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI 1.23–2.89, p=0.004) and 2.70-fold (95% CI 1.81–4.06, p<0.0001) higher risk of VTE compared to patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the GRS was associated with a 47% (95% CI 29–68) increased risk of VTE (p<0.0001). CONCLUSIONS –: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia