A ten year review of female sterilization at the university of Maiduguri teaching hospital, Maiduguri, Nigeria

Background: In most developing countries like Nigeria, female sterilization is not a popular method of contraception. Objective: The objective of this study was to determine the prevalence of female sterilization and socio-demographic characteristics of women who had sterilization in our setting.Methodology: This was a retrospective study carried out between 1st January 1997 and 31 December 2006.A total of two hundred and one female sterilisation operations were performed but ten case notes were incomplete and therefore, one hundred and ninety one 191 were analyzed. Information retrieved from the case notes included the age, parity, religion, literacy, and type of bilateral tubal ligation. The data collected were analyzed using SPSS Version 16.0 statistical package and the results represented in simple tables and percentages.Results: There were 16,319 deliveries during the study period and 201women had bilateral tubal ligation (BTL), giving a prevalence of 1.2%. The mean age at BTL was 30.18, while the mean parity was 4±0.6. Women between the ages of 30-39 constituted majority of the patients. In most of the women 138 (72.3%) bilateral tubal ligation was performed during caesarean section, while few women 16 (8.4%) had the procedure at laparotomy. The rest, 37(19.4%) women opted for interval BTL. Significantly more literate women (73%) sought for interval tubal ligation compared to non literate (23%) ones. A large number of the Muslims (87.5%) had BTL at laparotomy compared to the Christians (12.5%). P=0.002.Conclusion: The prevalence of bilateral tubal ligation in this study is low. There is need to encourage the uptake of female sterilization in our environment

Role of national blood transfusion service (NBTS) in promoting emergency obstetrics care (EMOC)

Background: Obstetrics haemorrhage is one of the leading cause of maternal mortality in our settings, this was compounded by the non availability to safe blood in situation of need. Hence the prompt access and availability of blood can avert this preventable cause of maternal death. Objectives: to highlight the benefits of effective collaboration with NBTS in ensuring prompt availability of blood for emergency obstetric services requiring blood for transfusion. Material And Method: All obstetrics cases requiring blood transfusion in FMC Nguru from 1st stJanuary 2006 ­ 31 December 2011 were retrospectively reviewed. Trends and pattern of the st strequest and source of blood were looked at within the two periods (from 1 January 2006 ­ 31 st stDecember 2008 and 1 January 2009 ­ 31 December 2011). Records of 1634 obstetric patients requiring blood transfusion or received blood transfusion in the maternity units were retrieved from the medical records, maternity ward record and blood bank. Information pertaining to their age, parity, indication for the transfusion or requests and source of blood was obtained for analysis. Data was analysed using simple percentage. st st Results: Between 1 January 2006 and 31 December 2008 only 513 (56%) of the units requested st st907 units of blood were supplied, while between 1 January 2009 and 1 December 2011 1367 ( 87%) of the 1567 units of blood requested were supplied. Within the earlier study period the only available source were from willing relatives and commercial blood donors, however between 2009 and 2011 more than 2/3 (64.2%) were supplied from the north east zonal NBTS office in Maiduguri. In 2006 through 2008, donation from relatives and commercial donors accounted for 53.22% and 46.78% respectively, but in 2009 and 2011 donation from relatives and commercial donors were recorded as 23.9% and 11.6% respectively. The commonest indication for the requests were anaemia, obstetrics haemorrhage (PPH, APH) and emergency C/S. Conclusion: Ready available source of blood will significantly improve timely availability of blood in our setting. There is the need to encourage this collaboration in other regions to ensure prompt availability of blood to attend to emergencies requiring blood transfusion

The Effect Birth Interval on Fetal Outcome at the University of Maiduguri Teaching Hospital – A Cross Sectional Study.

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.

Effectiveness of Manual Vacuum Aspiration (MVA) in the Management of First Trimester Miscarriage: Experience in a Specialist Centre in North-Eastern Nigeria

Background: Safe management of abortion with an easy; simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity; gestational age at presentation; indication for MVA use; duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period; out of which 251 were MVA procedures performed for various first trimester miscarriages; accounting for 13.2of the total gynaecological admissions. Sixty one (24.3) of the patients who benefited from MVA were in the 25-29 years age group; while those in the age 20-24 and 30-34 years group constituted 21.5and 20.7respectively. Grandmultiparas (53.7) constituted the majority. The procedure was performed for 50.2of the patients at 9-11 wks of gestation. Most (88.0) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0were for check MVA after complete abortion and missed abortion. Most (67) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre

A 5-Year Review of Maternal Mortality Associated with Eclampsia in a Tertiary Institution in Northern Nigeria

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