Stillbirth Rate in a Teaching Hospital in South-Eastern Nigeria: A Silent Tragedy

Background: Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3 ;79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9 ; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

The Prevalence of Gynaecological Diseases at the Imo State University Teaching Hospital; Orlu; Nigeria

Background:Gynaecological diseases and their sequelae are common causes of hospital consultation by young girls and adult women alike worldwide. If not properly and adequately managed; these diseases can result in increased morbidity and mortality.Aim: To determine the prevalence of gynaecological diseases at the Imo State University Teaching Hospital; Orlu. Methods: A four and half-year retrospective study from June 2004 to December 2008 was undertaken. The records of all patients with gynaecological disorders seen at the gynaecological and emergency departments of Imo State University Teaching Hospital; Orlu were reviewed.Results: There were 1293 gynaecological cases seen during the period under review.The commonest gynaecological conditions seen were infertility/subfertility (33.7); uterine leiomyoma (15.4) and abortion and its complications (14.7). Cervical cancer (1.9) was the commonest gynaecological malignancy seen. Conclusion:The study showed that infertility is still the commonest reason for seeking gynaecological consultation in our environment

Preliminary Outcome of the Management of Eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia. Aim: This study aims at determining the prevalence and management outcome of eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH); Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p0.05). Twenty-eight (93.3) of the eclampsia occurred antepartum. Twenty-eight (93.3) had severe hypertension on presentation. Twenty nine (95.8) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital. Twenty-six (86.7) of the patients had emergency Caesarean section was carried out; mostly for unfavourable cervix. The perinatal mortality was 6.7while maternal mortality was 3.3. Complications included acute renal failure; aspiration pneumonitis and abruptio placentae. Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking; antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment

The Influence of Sexual Attitudes on Genital Human Papilloma Virus Infection

Background: Infection with human papilloma virus (HPV) is causally associated with cervical cancer. Many studies have tried to show some kind of association between age; marital factors; educational level and sexual behaviour with the risk of developing HPV and cervical cancer. Such socio-demographic factors may be useful in risk scoring. Aims: This study examined the association between sexual attitudes and human papilloma virus (HPV) infection of the cervix aimed at helping in the development of an effective risk scoring system for cervical cancer screening. Methods: The subjects were 450 randomly selected sexually active women attending the antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology; University of Maiduguri Teaching Hospital; Nigeria between April 1; 2001 and May 31; 2002. Pap smears of these patients were examined microscopically for evidence of HPV infection. A questionnaire assessing various sexual characteristics of the patients were administered. Results: Abnormal smears occurred in 245 (54.5) of the patients screened. Forty-eight women (10.7) had HPV associated changes constituting 19.6of all abnormal smears. Their ages ranged between 15 and 64 years; with a mean of 26.3 years. There was a statistically significant association between multiple sexual partners; coital frequency per week and the occurrence of genital HPV infection. Conclusion: Women with multiple sexual partners and frequent coitus are at increased risk of acquiring HPV infection of the cervix and should be the target in a sporadic or an organized cervical cancer screening programme without discriminating against other sexually active women

Caesarean Section Related Morbidity and Mortality at the Imo State University Teaching Hospital Orlu

Background: There is a general aversion to Caesarean section among Nigerian women. However; with increasing safety of the procedure and better enlightenment; more women are beginning to accept the procedure. To maintain this increasing acceptability; Caesarean section related morbidity and mortality must be reduced to the barest minimal levels. Aim: To determine the incidence and the complications associated with Caesarean section at the Imo State University Teaching Hospital; Orlu. Methods: A four-year descriptive study from June 2004 to May 2008 from the Obstetrics Department of Imo State University Teaching Hospital; Orlu was conducted. All pregnant women that were delivered by Caesarean section were included. Results: There were 363 (33.2) mothers who underwent Caesarean sections out of 1094 deliveries in the unit during the period under review. Postoperative complications occurred in 52 patients (14.5). The complications cut across all reproductive age groups and parity. The commonest complications encountered were wound infection (71.9); postpartum haemorrhage (63.2) and anaemia (40.4). The mortality rate was 1.2. Conclusion: The Caesarean section complication rate of 14.5is still high; even though it is less than the figures quoted for some environments. There is still the need to reduce this rate to the barest minimum for us to be able to sustain the gains of the recent past

The Use of Cervical Smear in the Diagnosis of Genital Tract Infections at a University Teaching Hospital

Background: Genital tract infections such as Gardnerella vaginalis vaginosis; trichomoniasis and candidiasis have continued to assume immense importance because of the particular unique features of their main causative organisms - Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans; and myriads of clinical and pathological changes in affected persons. Aim: To investigate the prevalence of Gardnerella vaginalis; Candida albicans and Trichomonas vaginalis in randomly selected sexually active women and the influence of some socioeconomic and demographic factors on the prevalence of these genital infections. Methods: The subjects were 450 randomly selected sexually active women attending antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital from April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of Candida albicans; Gardnerella vaginalis and Trichomonas vaginalis. A questionnaire assessing sociodemographic characteristics of the patients were administered. Results: Sixty six (66) of the 450 patients studied had specific infections giving a prevalence rate of 14.7. Candida albicans; Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans in conjunction with gardnerella vaginalis contributed 7.1; 5.1; 2.4and 1.8respectively to this overall prevalence. Age range of 15-20 years had the highest prevalence of each of the infections; but this association with age was not statistically significant (P0.05). The prevalence of each of the infections was highest among students and was lowest among housewives and business executives. These differences were statistically significant (P = 0.034). The prevalence of these genital infections increased with increasing educational level; being lowest among those with no formal and primary education and highest in the patients with post-secondary educational qualifications. This difference was statistically significant (P = 0.034; c2 for linear trend = 0.90). About 36.5) of the married women tested had evidence of genital infections compared to 41.6of the women who were not currently married; this difference was not statistically significant (P0.05). Conclusion: This study has shown that cervical cytology is of definite value in the diagnosis of some genital tract infections especially in low resource setting

Presentation and Management of Uterine Leiomyoma at Imo State University Teaching Hospital; Orlu; Nigeria

Background: Uterine myomas are benign growths primarily involving the smooth muscles of the uterus; the myometrium with varying quantities of connective tissue interspersing. It is the most common tumour of the female genital organs with more than three quarters of the tumours being asymptomatic Aim: To determine the mode of presentation; factors influencing the occurrence and the management options of uterine leiomyoma; the commonest tumour of the female pelvic organs at the Imo State University Teaching Hospital; Orlu. Methods: A descriptive study of all cases of uterine leiomyoma managed at the Department of Obstetrics and Gynaecology of the Imo State University Teaching Hospital; Orlu; from June 1; 2004 to June 30th 2007. Results: The prevalence of uterine leiomyoma at the Imo State University Teaching was 32.0. Majority of the patients (86.4) were in their 3rd and 4th decades of life. Seventy-two point one percent of the patients were nulliparous. The Commonest reasons given for late presentation were poverty (92) and aversion to surgery (86). Uterine leiomyoma affected women across all socioeconomic strata. Majority of the patients (73.5) presented with uterine mass of between 14-22 week gravid uterine size. The common modes of presentation were lower abdominal swelling (73.9); menstrual abnormalities (52.3) and infertility (26.1). The commonest site of the myomas was intramural. Treatment was essentially surgical mainly myoectomy (62.5). About 25.6of those who had myomectomy subsequently had live births. Conclusion: Uterine leiomyomas tend to grow to large sizes in our environment. Mass enlightenment campaigns; women empowerment; reduction of the cost of health care delivery in our country and routine ultrasound screening of all women of reproductive age will all help in early detection and treatment

The Choice of Contraceptives among Women in Orlu; Nigeria

Background: Remarkable progress has been recorded in the turn of the century towards the development of more efficient and safer contraceptives. Previous studies from some parts of the country showed an increase in the percentage of clients changing from one contraceptive method to another. With the advent of the HIV/AIDS pandemic at the turn of the new millennium there may still be further changes in the choice of contraceptives in different parts of the world; Nigeria inclusive. Aim: To study the choice of contraceptive usage and the factors predictive of such choices in Orlu; southern Nigeria. Design: A cross sectional study Setting: Imo state University Teaching Hospital; Orlu; Nigeria. Subjects: Clients attending the family planning clinic. Main outcome variables: contraceptive choice; reason for choice; awareness and source of awareness about contraceptives. Results: Five hundred and three clients were reviewed. Ninety one percent knew at least one method of contraception. Their ages ranged between 18 and 52 years with majority in the 33-37 years age bracket. Most of the women were housewives (46.5). Clients who had attained post secondary school education or more constituted 29.4; majority were married (84.7); in monogamous marriages (81.7) and grandmultiparous (45.9). The commonest contraceptive choice was the injectables (44.3) while nurses and midwives formed the commonest source of knowledge about contraception and referral. Conclusion: The most commonly used contraceptive method in Orlu; Nigeria is the injectables. The HIV/AIDS pandemic may likely change or affect this trend