ABSTRACT
Background: Vesico-vaginal fistula is a common problem that has public health significance. Aims: To determine the epidemiology, causes as well as the outcomes of VVF repair in the Department of Obstetrics and Gynaecology State Specialist Hospital Maiduguri, Borno State of Nigeria. Methods: A ten year (Jan 1998 to Dec 2007) retrospective review of the patients’ records, operation theatre records and Gynaecological clinic records of patients with vesico-vaginal fistula. Results: Three hundred and eighty five (385) VVF repair were done out of 2105 gynaecological operations during the study period, giving a prevalence of 18.3%. Three hundred and forty seven (347) patients records were analysed. Most (51.9%) of the fistulae occurred in women aged 15-24 years. The patients are mostly married (79%), primiparas (56.5%), uneducated (89%) and not salaried employed (99.4%). Obstetrics complication was the commonest cause of VVF. The overall success rate of repair was 59.1%. Success of repair decreases as the number of fistula or complexity of fistula increases (p<0.0001). Conclusion: Vesico-vaginal fistula is mainly caused by prolonged obstructed labour. Complexity of fistula was associated with poor surgical outcome. Interventions that will improve access to trained delivery attendant will minimise the occurrence of prolonged obstructed labour and that will go a long way to decrease the incidence of vesico-vaginal fistula.
ABSTRACT
Background: Birth spacing is a well-known and underutilized health intervention. Longer birth intervals are associated with multiple health benefits for both mother and the child. Aim: To determine the effect of birth interval on fetal outcome in our environment. Methods: A cross sectional study, conducted at the university of Maiduguri teaching hospital. The subjects were multiparous women carrying singleton pregnancy who come to deliver at the hospital Obstetrics and Gynaecology unit during the study period. A pretested questionnaire was used to obtain their sociodemographic and obstetric characteristics. The effect of birth interval on fetal outcome was determined using χ2 test. Results: During the study period, 530 women fulfilled the inclusion criteria out of which complete data was obtained in 500 women; a response rate of 94.3%. The mean age of the study population was 28.8±5.7 years and the mean birth interval was 32.3±18.1 months. The mean gestational age at delivery was 38.93±1.87 weeks and the mean birth weight was 3270±165 gram. There was significant association between short birth interval and preterm delivery (χ2 =18.45, P=0.005) as well as fifth minute Apgar score of less than 7 (χ2 =12.112, P=0.007). Conclusion: Short birth interval was significantly associated with preterm delivery and birth asphyxia.
ABSTRACT
Aim: To compare the pregnancy outcomes among nulliparae, with multiparae as the control. Study Design: Retrospective cohort study. Place and Duration of Study: University of Maiduguri Teaching Hospital over a period of one year (1st January 2007 to 31st December 2007). Methodology: This retrospective cohort study reviewed the pregnancy outcome of nulliparae over one year, using multiparae as control. The data were analysed using SPSS. The χ 2-test was used to compare the sociodemographic characteristics and pregnancy outcomes of the nulliparae and the multiparae. Multivariate logistic regression analysis was used to create a model for the factors that were independently associated with nullipara. A P-value of<0.05 was considered significant. Results: Nulliparae contributed 259 (13.7%) of the 1,865 babies delivered during the period of study. The age ranged from 15 years to 42 years with mean age of 27.1 years ±5.3 years. Nulliparous women were more likely to be of younger age less than 20 years (P<0.001), educated (P=0.01) and booked early (P=0.001) when compared with multiparae. Also nulliparous women were more likely to have pregnancy induced hypertension (P=0.001) and episiotomy at delivery (P<0.001) but less likely to have anaemia (P=0.002) when compared with multiparae. Multivariate logistic regression showed that Nulliparae were more likely to be of younger age group (OR 7.22, P<0.001) and have malaria (OR 2.22, P=0.02), malpresentation (OR 5.68, P=0.02), abruptio placentae (OR 6.41, P=0.02), preterm delivery (OR 7.04, P=0.01), episiotomy (OR 7.74, P<0.001) and pregnancy induced hypertension (OR 3.53, P=0.01) but less likely to have anaemia at booking and fetal macrosomia. Conclusion: Nulliparous women are at increased risk of certain adverse pregnancy outcome including malaria, preterm delivery and pregnancy induced hypertension. These adverse factors should be looked out for and excluded in order to improve maternal and fetal health in these women.
ABSTRACT
Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed; retrospectively. Their social demography; mode and place of delivery; time of eclampsia; and fetal outcome were extracted for analysis. Results : Eclampsia accounted for 52 (46.4) of the 112 total maternal deaths recorded within the 5-year period; with case fatality of 22.33. Age group 20; 20-29 and above 30 all had similar case fatality rate of 22.1; 23.8and 26.7; respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5of the case fatality in that category. As expected; unbooked had higher case fatality of 24.0compared to 15among booked cases; while those with no formal education also had more death (22.3case fatality) as compared to 3.3among those who had some form of formal education. Antepartum eclampsia was the cause in 50of the death; 11(21.2) of the pregnancies were not delivered before their death; while 18 (34.6) were stillbirth. Conclusion : Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery