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

Pregnancy Outcome among Nulliparous Women at the University of Maiduguri Teaching Hospital, North Eastern Nigeria: A Retrospective Cohort Study.

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.

Morbidity of total abdominal hysterectomy at the university of maiduguri teaching hospital, maiduguri, Nigeria

Total abdominal hysterectomy is a commonly performed gyneacological procedure. Although it is safe, it can still be associated with development of complication. The aim of this study was to determine morbidity associated with total abdominal hysterectomy in our environment.METHOD:All cases of total abdominal hysterectomy done over a five-year period (January 2003-December 2006) at the University of Maiduguri Teaching Hospital (UMTH) were reviewed. Information was obtained from the patients' case notes, gynaecology ward, and theatre records. The complications of the procedure were determined. Multiple logistic regression was used to find the factors that were independently associated with development of complications.RESULTS:During the study there were 101 cases of total abdominal hysterectomy out of 729 gynaecological operations, a rate of 13.8%. In majority of the cases 56 (68.3%) the indication of the hysterectomy was uterine fibroid (symptomatic). Overall 37 (45.1%) experience some form of complication out of which 26 (70.3%) was febrile morbidity Finding enlarged uterus intraoperatively {OR (95% CI) = 14.5 (1.84-114.6), p = 0.011}, blood transfusion {OR (95% CI) = 31.1(1.35-718.8), p = 0.032}and postoperative PCV < 30% {OR (95%CI) = 9.63 (1.14-81.3) p = 0.037} were found to be significantly associated with development of complication. conclusions: Total abdominal hysterectomy was associated with development of complications and enlarged uterus, increasing parity independent risk factors for development of the complication

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

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

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

The Influence of Marital Factors on Genital Human Papilloma Virus Infection

Aim: To study the association between marital factors and human papilloma virus (HPV) infection of the cervix. Method: 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 of the University of Maiduguri Teaching Hospital; Nigeria between April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of HPV infection. A questionnaire assessing various marital characteristics of the patients were administered. Result: 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 statisti-cally significant association between marital status and genital HPV infection. Conclusion: Single sexually active women 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 other sexually active women