Trends in the Management of Miscarriages with the Implementation of the Volunteer Obstetrician Scheme in Selected Primary Health Care Centres in Maiduguri, Northeastern Nigeria.

BACKGROUND: Post-abortion care (PAC) is a crucial component of emergency obstetric care, and many of the primary health care centres (PHC) in the internally displaced person (IDP) camps and host communities in Maiduguri lack it. Improved access to high-quality PACs is essential for meeting the reproductive health needs of the IDPs and reducing the maternal morbidity and mortality that can result from miscarriages. OBJECTIVE: To determine the trend in managing miscarriages in the IDP camps and host communities in Maiduguri and the impact of the volunteer obstetrician scheme (VOS) on PAC. METHODOLOGY: We conducted a longitudinal study in selected PHCs serving IDP camps and host communities in Maiduguri. The study spanned five (5) years, and we compared the management of miscarriages and PAC services one year before the VOS project, two years during the project and two years after the project. During the two-year VOS project, staff manning the PHCs had supportive supervision with hands-on training on PAC. Chi-square for trend and odd ratio with a 95% confidence interval was used as appropriate to compare the trend in PAC services provided during the study period. RESULTS: One thousand eight hundred and eight (1808) women presented with miscarriages, and 1562 (86.4%) required uterine evacuation. Medical evacuation with oral misoprostol was offered to 974 (62.4%), and manual vacuum aspiration (MVA) was used in 422 (27.0%) of the women who needed uterine evacuation. There was a statistically significant rise in the use of medical evacuation throughout the study period (52.2% before VOS, and 71.4% by the second year of VOS) with ꭓ2=41.64 and P<0.001. In comparison, the use of MVA fell from 38.6% in 2015 to 27.7% in 2019 (ꭓ2=34.74 and P<0.001). Similar rising trends were also observed in postabortion family planning acceptance (ꭓ2=22.27, P<0.001). CONCLUSION: The Volunteer Obstetrician Scheme project appears to have improved PAC services, especially medical evacuation and family planning uptake in the PHCs in IDP camps and host communities in Maiduguri, Borno State, Nigeria. We recommend task shifting of PAC services and periodic supportive supervision to ensure the quality of care.

CONTEXTE: Les soins après avortement (PAC) sont une composante cruciale des soins obstétricaux d'urgence, et de nombreux centres de soins de santé primaires (PHC) dans les camps de personnes déplacées internes (PDI) et les communautés d'accueil à Maiduguri en sont dépourvus. Un accès amélioré à des PAC de haute qualité est essentiel pour répondre aux besoins de santé reproductive des PDI et réduire la morbidité et la mortalité maternelles qui peuvent résulter des fausses couches. OBJECTIF: Déterminer la tendance dans la gestion des fausses couches dans les camps de PDI et les communautés d'accueil à Maiduguri et l'impact du Programme de bénévoles obstétriciens (VOS) sur la PAC. MÉTHODOLOGIE: Nous avons mené une étude longitudinale dans des PHC sélectionnés desservant des camps de PDI et des communautés d'accueil à Maiduguri. L'étude a duré cinq (5) ans, et nous avons comparé la gestion des fausses couches et les services de PAC un an avant le projet VOS, deux ans pendant le projet et deux ans après le projet. Pendant les deux ans du projet VOS, le personnel des PHC a bénéficié d'une supervision avec formation pratique sur la PAC. Le chi carré pour la tendance et le rapport de cotes avec un intervalle de confiance de 95% ont été utilisés, le cas échéant, pour comparer la tendance des services de PAC fournis pendant la période de l'étude. RÉSULTATS: Mille huit cent huit (1808) femmes ont présenté des fausses couches, et 1562 (86,4%) ont nécessité une évacuation utérine. Une évacuation médicale avec du misoprostol oral a été proposée à 974 (62,4%), et l'aspiration manuelle sous vide (AMV) a été utilisée chez 422 (27,0%) des femmes ayant besoin d'une évacuation utérine. On a observé une augmentation statistiquement significative de l'utilisation de l'évacuation médicale tout au long de la période de l'étude (52,2% avant le VOS et 71,4% la deuxième année du VOS) avec ꭓ2=41,64 et P<0,001. En revanche, l'utilisation de l'AMV est passée de 38,6% en 2015 à 27,7% en 2019 (ꭓ2=34,74 et P<0,001). Des tendances similaires à la hausse ont également été observées dans l'acceptation de la planification familiale après avortement (ꭓ2=22,27, P<0,001). CONCLUSION: Le projet de Programme de bénévoles obstétriciens semble avoir amélioré les services de PAC, en particulier l'évacuation médicale et l'acceptation de la planification familiale dans les PHC des camps de PDI et des communautés d'accueil à Maiduguri, dans l'État de Borno, au Nigéria. Nous recommandons de déléguer les services de PAC et une supervision de soutien périodique pour garantir la qualité des soins. MOTS-CLÉS: Communauté d'accueil, Camps de PDI, Aspiration manuelle sous vide, Évacuation médicale, Misoprostol, Soins après avortement.

FACTORS AFFECTING RESEARCH ENGAGEMENT AMONG CLINICIANS IN AZARE, BAUCHI STATE, NIGERIA.

Introduction/Background: Medical research is a key element in the advancement of medicine and patient care improvement. However, there is evidence that developing regions like Nigeria have comparatively low research output. Clinicians' attitudes, practices, and barriers toward research are key causal factors of the low research productivity. Objectives: This study explored the research practice, attitude, and barriers towards research engagement among Clinicians at Federal Medical Centre, Azare, Bauchi state. Methodology: This was a quantitative cross-sectional study conducted at Federal Medical Centre, Azare, Bauchi state. Data on sociodemographic characteristics, research practices, attitudes, and barriers toward research engagement was obtained using a pretested, self-administered questionnaire. Data was collated and analyzed using IBM Statistical Package for Social Sciences software (SPSS) version 21. Result: A total of 101 clinicians participated in this study of which 14.9%, 31.7%, and 29.7% were Consultants, Registrars and Medical Officers respectively. Only 20.8% of the respondents have presented at a scientific conference previously, while 18.8% of the respondents have a published paper in a scientific journal. Although clinicians showed a positive attitude towards research (Mean: 4.39, SD ± 0.61), lack of research funding, facilities, mentorship, and demanding clinical services are major deterrents to clinicians' engagement in research. Conclusion: Clinicians have poor research practice despite their positive attitude towards research engagement. Appropriate interventions should be implemented for effective research engagement to augment research output.

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

Awareness and perception of human papilloma virus vaccine among healthcare professionals in Nigeria.

Human papilloma virus (HPV) is a necessary cause of cervical cancer and cervical cancer is largely a vaccine-preventable disease. The aim of the study was to document the knowledge of healthcare professionals of the HPV vaccine and its acceptability. It was a cross-sectional study in three of the six geo-political zones of Nigeria, carried out between June 2010 and January 2011. The 602 adult Nigerian respondents were made up of 147 (24.4%) males and 455 (75.6%) females aged 20-57 years, with a mean of 34.3 ± 7.9 years; most were under 40 years (70.1%) and married (n = 394; 65.5%). In total, 548 (91%) were aware of HPV; 83.4% knew HPV as an STI; 78.2% knew HPV can cause cervical cancer but only 265 (44.0%) were aware of the HPV vaccine. Among the healthcare professionals studied, nurses were the least aware of the existence of the HPV vaccine (χ(2) = 1.54, p = 0.001). A total of 489 (81.0%) would approve HPV vaccine for their teenage daughters. The men were more likely to accept the vaccination of their daughters than the women (χ(2) = 14.76, p = 0.002). The unmarried were more favourably disposed to vaccination of teenagers than the married (χ(2) = 27.37, p = 0.001). Safety concerns were the commonest reasons expressed by the 7% who were reluctant to accept the vaccination of their teenage daughters. In conclusion, healthcare providers are the custodians of health in a community, yet have low knowledge of a vaccine that can prevent the commonest cancer in women in sub-Saharan Africa.

Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North-Eastern Nigeria.

OBJECTIVE: This study determined the prevalence and socio-demographic characteristics of bacterial vaginosis (BV) among pregnant women with abnormal vaginal discharge. STUDY DESIGN: Descriptive cross-sectional study. SETTING: University of Maiduguri Teaching Hospital. MATERIALS AND METHODS: Vaginal swab samples and data on epidemiological risk factors were collected from 400 consecutive pregnant women with complaints of abnormal vaginal discharge. The data was analyzed using the SPSS 16.0 statistical software. Association between variables was compared by using the Chi-square (χ2 ) and Fisher's exact tests while P < 0.05 was considered significant at 95.0% confidence level. RESULT: The prevalence of BV among pregnant women with abnormal vaginal discharge was 17.3%. Age 20-24 years, multigravidity, lack of western education and unemployment were associated with increased prevalence of BV. Yellowish, watery vaginal discharge (P = 0.001) was associated with BV. Dysuria, dyspareunia and lower abdominal tenderness were associated with BV (P = 0.001). Fifty three (77%) of patients had BV during the second trimester compared to 6 (9%) who had it in the 1 st trimester of pregnancy (P = 0.012). CONCLUSION: The high prevalence of BV in this study may necessitate adequate screening of pregnant women with abnormal vaginal discharge in order to give appropriate treatment and avoid complications associated with it.

Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri.

BACKGROUND: Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. OBJECTIVES: To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. METHODS: High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software. RESULTS: The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P < 0.001). The prevalence of C. albicans was 41%. The frequencies of Vulval itching, Dyspareunia and vulval excoriation among those with candidiasis were 151 (50.3%), 14 (56.0%) and 75 (75.0%) respectively (P < 0.001). CONCLUSION: The prevalence of abnormal vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice.

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Determinants of utilization of papanicolaou smear among outpatient clinic attendees in north-eastern Nigeria.

BACKGROUND: The utilization of cervical cancer screening services is very poor in developing countries. OBJECTIVE: The study was aimed at establishing the determinants of the awareness of cervical cancer, Papanicolaou smear and its utilization among outpatient clinic attendees in north-eastern Nigeria. METHODOLOGY: Cross sectional study among outpatient clinic attendees in two tertiary institutions in north-eastern Nigeria. RESULTS: A total of 235 women of reproductive age were interviewed during the study period. Sixty two (62%) were aware of cervical cancer, while 44.3% were aware of screening with Pap smear. However, overall, only 11.5% had ever been screened for cervical cancer before our study. More than half (54%) of the respondents did not state any reason for not doing the test. Compared with women who were not screened, screened women were aged 30 years and above with a mean age of 29.7 +/- 7.6 years (p = 0.021), better educated (p = 0.046), multiparous and employed outside home (p = 0.000). Determinants of awareness of cervical cancer and Pap smear were higher level of education (O.R. 7.80, 95% CI: 7.2-9.4; O.R. 5.12, 95%; CI: 5.0-6.4) and being civil servants (O.R. 2.01, 95% CI: 2.5-3.0; O.R. 3.23, 95%; CI: 2.9-4.7) respectively, while utilization of Pap smear depended on the age (O.R. 3.25, 95%; CI: 2.7-4.0) and higher educational status (O.R. 2.87, 95%; CI: 2.9-3.2). CONCLUSION: The utilization of Pap smear among women studied is very low. But the reasons advanced for poor utilization are modifiable. Efforts at addressing these reasons might improve the take up rate of cervical cancer screening in North-eastern Nigeria.

Oral health practices among pregnant women in North Eastern Nigeria.

OBJECTIVE: The objective of this study was to document oral health practices of pregnant women in two tertiary institutions in North-eastern Nigeria. MATERIALS AND METHODS: This was a cross-sectional study of pregnant women seen at the antenatal clinics of the University of Maiduguri Teaching Hospital and Federal Medical Centre Yola from May 1, 2009 to July 1, 2009. RESULTS: A total of 294 women were interviewed. They were aged 15-46 with a mean of 27.42 ± 5.97 years. The parity ranged from 1 to 9 with a mean of 2.23 ± 1.65. Twelve (4.1%) women gave a history of symptomatic oral lesion in index pregnancy. Forty-four (15%) had had previous encounter with a dentist, while the highest frequency of oral care was twice a day in 164 (55.8%) of respondents. The majority, 264 (89.9%), used toothbrush/toothpaste as a form of oral care while 2 (0.7%) used charcoal. Women of low parity tended to have better oral care than those of high parity (P = 0.002). Women who are employed had better oral care than housewives (x2 = 27.749, P = 0.001). There was no significant relationship between oral complaints and trimester of pregnancy (x2 = 4.271, P = 0.118). CONCLUSION: Oral healthcare among the respondents was encouraging but involvement of the dental surgeon in preventive oral care in pregnancy is rather dismal.

Outcome of twin deliveries at the University of Maiduguri Teaching Hospital: a 5-year review.

OBJECTIVES: The objectives of the study were to determine the outcome of twin births at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in terms of morbidity and mortality and to recommend possible measures to curtail or reduce some of the preventable complications. MATERIALS AND METHODS: This is a 5-year retrospective study, from January 2000 to December 2004, of twin births at the UMTH. RESULTS: There were 196 twin deliveries in 8431 total deliveries, with a twin incidence of 2.3%. Dizygotic twins accounted for 63.4%. The increasing maternal age and positive family history of multiple pregnancies were associated with the increasing twinning rate. The main complications encountered were preterm labor, pregnancy-induced hypertension, and cord prolapse. The perinatal mortality rate of 107.5/1000 births was higher than that observed for singleton pregnancies in the same institution. Similarly, there was a higher Cesarian section rate of 24.7% compared to singletons within the same period. There were significantly higher perinatal mortality rates among the preterm (P = 0.000002) and low-birth-weight (P = 0.000004) fetuses. CONCLUSION: Considering that fetal prematurity and low birth weight, sequelae to preterm labor, are the commonest causes of perinatal death in this study, efforts should be geared during the antenatal period toward the prevention of a premature birth.

Pregnancy outcome among grand multiparous women at the University of Maiduguri Teaching Hospital: a case control study.

Grand multiparity has been described as an independent risk factor for a variety of obstetric complications, especially in developing countries with inadequate health facilities. This case control study compares the pregnancy outcomes of grand multiparas with that of multiparas at the University of Maiduguri Teaching Hospital over a period of 1 year. The labour ward records and patients' case notes were used to extract information. Multivariate analysis created a model of the adverse factors that were independently associated with grand multiparity after control for confounding effects of age and other variables. During the period of study, there were 1,865 deliveries, out of which 350 were grandmultiparas, a rate of 18.8%. Out of the 350 grandmultiparas, 91 were excluded, leaving 259 (74%) patients which were used for the study. The multivariate analysis shows that compared with the multiparas, the grand multiparas were more likely to be uneducated, have abruptio placentae, precipitate labour and stillbirth but were less likely to have prolonged labour, episiotomy, placenta praevia, require operative deliveries or be anaemic at booking. Grandmultiparity was found to be associated with adverse pregnancy outcome. This finding has implications for practitioners caring for these women in our environment.

Morbidity of total abdominal hysterectomy at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.

BACKGROUND: 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.

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

Prevalence, risk factors and effects of placental malaria in the UMTH, Maiduguri, North-eastern, Nigeria: a cross-sectional study.

SUMMARY: Most of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period.

Hydatidiform mole as seen in a university teaching hospital: a 10-year review.

SUMMARY: Hydatidiform mole (HM), is a known cause of early pregnancy wastage and has the risk of malignant potential. This is a retrospective study of 71 patients who were managed for hydatidiform mole at the University of Maiduguri Teaching Hospital, (UMTH) Maiduguri over a 10-year period, from January 1996 to December 2005, inclusive. The objective of the study was to determine the incidence, risk factors, clinical presentations and histological types of HM. Case records of 71 histologically confirmed HM were studied. Their sociodemographic characteristics, clinical presentations and histology reports were obtained and analysed. The institutional incidence of molar pregnancy was 3.8/1,000 deliveries. Histological findings showed partial mole in 51 (71.8%) cases and complete mole in 20 (28.2%) cases. The peak age-specific incidence rate was 17.5 years. The leading presenting clinical feature was abnormal vaginal bleeding seen in 100%. No case of invasive mole was found. Maternal complications included severe haemorrhage requiring blood transfusion (30.0%) and infections (15.5%). There was no maternal death. In conclusion, the incidence of partial hydatidiform mole was found to be higher than that of complete variety in our environment and the identified risk factors were young age, low parity and previous history of HM.

Prevalence of utero-tubal infertility.

SUMMARY: Tubal factor infertility is the commonest cause of infertility seen in gynaecological clinics in Nigeria. This, to a large extent, is a preventable cause of infertility. The objective of the study was to determine the prevalence of utero-tubal factors in the causation of infertility. This is a prospective descriptive study of infertile women seen at the gynaecological clinic of the Federal Medical Centre Gombe from June 1999 to May 2002. A total of 229 infertile women were studied. The prevalence of primary and secondary infertility was 37.1% and 62.9%, respectively. Tubal factor was the cause in 67.2% and cervical factors contributed to 19.2%. The women were aged 17-44, with a mean of 28.6 +/- 5 years. There were four (1.7%) teenagers and eight (3.5%) women were aged 40 years or above. The majority, 55% (126), were in their third decade, with those aged 20-34 years constituting 86% (197) of patients. The high prevalence of tubal factor infertility in our environment is unacceptable. Primary prevention of reproductive tract infections and syndromic management of STD will go a long way in reducing the high prevalence of tubal factor infertility.

Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse.

CONTEXT: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. OBJECTIVES: To determine the incidence of umbilical cord prolapse, predisposing factors, and fetal outcome. STUDY DESIGN, SETTING AND SUBJECTS: A 20 year retrospective study of all women who presented with umbilical cord prolapse at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. RESULTS: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part (65.2%), spontaneous rupture of membrances (62.1%) and grandmultiparous women (57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1 +/- 21.7 minutes and 28/33 (84.9%) of babies delivered within 60 minute had normal Apgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made. The perinatal mortality was 27.3%. CONCLUSION: umbilical cord prolapse is a brisk obstetric emergency with high perinatal morbidity and mortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre team to reduce the decision-delivery interval would improve the perinatal outcome.

Outcome of tubal macrosurgery in Gombe, North-eastern Nigeria.

Tubal factor infertility is the commonest cause of female infertility in developing countries. The option of management is either tubal surgery or in-vitro fertilisation and embryo transfer (IVF-ET). This study aims to determine the outcome of tubal macrosurgery in Gombe, North-eastern Nigeria. It was a 6-year retrospective review of tubal macrosurgeries performed between January 2001 and December 2006. Of the 92 women who underwent tubal surgery, during the 1-year follow-up, seven (7.6%) became pregnant: five (5.4%) had full-term pregnancies and two (2.2%) had a spontaneous abortion. The majority (64, 69.6%) were aged between 25 and 34 years. The mean age and parity were 29.41 +/- 4.36 and 0.57 +/- 0.80, respectively. Most (48, 52.2%) of the patients presented within 4 years and three (3.3%) presented more than 19 years later. Secondary infertility (58, 63%) was the commonest cause; mild tubal disease occurred in 21 (22.8%) patients. Salpingostomy was performed in 29 (31.5%); salpingolysis in 19 (20.7%) and multiple procedures in 33 (35.9%). The low pregnancy rate seen in this study is unlikely to improve significantly even with good case selection as long as tubal macrosurgery is the modality of treatment. Establishment of affordable in vitro fertilisation (IVF) centres is the key to solving the problem of tubal factor infertility in our environment.

Caesarean delivery at the Federal Medical Centre Gombe: a 3-year experience.

BACKGROUND: Caesarean delivery carries a higher morbidity and mortality than vaginal delivery. This first audit of caesarean delivery in our centre will be compared with previous studies around the world. Our objective is to document the indications and outcome of caesarean delivery. METHOD: This was a retrospective study of patients who had caesarean delivery in Federal Medical Centre Gombe, from January 2001 to December 2003. The biosocial characteristics, indication for surgery, booking status, number and type of caesarean deliveries, type of uterine incision, complications, and cadre of surgeon and duration of hospital stay were obtained for each patient. RESULTS: 264 caesarean deliveries were performed, 250 cases made the criteria for inclusion. There were 2,172 total deliveries during the study period giving a caesarean delivery rate of 12.2%. The majority, 181 (72.4%) of the patients had emergency caesarean delivery while 69 (27.6%) had elective caesarean delivery. The commonest indication for caesarean delivery was cephalopelvic disproportion (20.8%), followed by preeclampsia/eclampsia (18.8%) and ante partum haemorrhage (14.4%). Others were fetal distress (8.8%), and previous caesarean delivery (7.2%). Majority of the patients, 104 (41.6%) were booked with the Federal Medical Centre Gombe, 88 (35.2%) booked elsewhere and 58 (23.2%) were unbooked. Twenty one (8.4%) had complications of which wound infection 11 (5.2%) was the commonest morbidity encountered. There were two maternal deaths and twenty one perinatal deaths giving a maternal and perinatal mortality rates of 800/100,000 and 82/1000 respectively. CONCLUSION: The indications for caesarean delivery in our study are comparable to findings from other parts of the world. The high emergency caesarean delivery rate among those booked elsewhere is a cause for concern. Health education could reduce the number of emergency caesarean deliveries. Consequently this might reduce the high infectious morbidity associated with the procedure in this study.