Falls among pregnant women in Enugu, Southeast Nigeria.

BACKGROUND: Falls during pregnancy are major public health issues and a common cause of maternal injury during pregnancy. There is paucity of data on prevalence and risk factors of falls during pregnancy in African population including Nigeria. OBJECTIVE: To determine the prevalence and risk factors associated with falls during pregnancy in Enugu, Nigeria. MATERIALS AND METHODS: This was a cross-sectional study of 332 consecutive pregnant women presenting in labor for delivery at the University of Nigeria Teaching Hospital Enugu, Nigeria between 1(st) May and 31(st) December, 2012. RESULTS: The mean age of the women was 32.2 ± 2.7 (range: 20-42) years. One hundred and eight women (32.5%) reported falling at least once during the index pregnancy. Women aged ≤ 30 years had twofold risk of falling during pregnancy than women aged > 30 years [41.1% (69/168) vs. 23.8% (39/164); odds ratio (OR): 2.23; 95% confidence interval (CI): 1.39-3.58; P < 0.001)]. Similarly, women ≥ 160 cm in height had significantly higher risk of falling during pregnancy than women < 160 cm in height [43.5% (70/161) vs. 22.2% (38/171); OR: 0.37; 95% CI: 0.23-0.60; P < 0.0001)]. Furthermore, primigravidae had almost threefold risk of falling during pregnancy than multigravidae [45.3% (63/139) vs. 23.3% (45/193); OR: 2.73; 95% CI: 1.70-4.37; P < 0.0001)]. CONCLUSION: Falls during pregnancy is common in Enugu, Nigeria. It is, therefore, recommended that women should be counseled during pregnancy on this public health problem and the above-identified risk factors emphasized in order to reduce the prevalence and morbidity.

Non-immune hydrops fetalis.

BACKGROUND: Non-immune hydrops fetalis (NIHF) is a rare fetal condition with a very high mortality in spite of advances in prenatal diagnostic techniques, early detection, and individualized management. Despite advancement in fetal therapy and rapidly developing new knowledge about the aetiology and prenatal diagnosis, its management has remained controversial. METHODS: This is a descriptive review ofNIHF. RESULTS: NIHF is a rare fetal condition that presents in an extremely acute manner with almost 90% mortality. Fetal cardiac anomalies are the most common cause and chromosome anomalies are the second-most-common cause. The worst prognosis was related to prematurity, severe hydrops, anaemia, cardiac malformations, chromosomal disorders and congenital infections. Fetal interventions includeboth medical and surgical modalities. CONCLUSION: NIHF is a rare condition with high prenatal mortality. The exact pathophysiology is still poorly understood. It is important to detect NIHF early, diagnose the underlying cause and institute appropriate treatment. There is need for autopsy of all fetuses or neonates who die from NIHF.

A survey of women's knowledge and perception of hormone replacement therapy (hrt) in Enugu, South East Nigeria.

BACKGROUND: As a result of alteration in the physiological, biochemical and psychological environment of a woman due to menopause, there may be need for hormone replacement therapy (HRT). This concept is new in our poor resource setting, thus the knowledge and perception of HRT will be invaluable to appropriate adjustment to menopausal period. OBJECTIVE: The objective of this study was to determine the knowledge and perception of hormone replacement therapy among women in Enugu South-East Nigeria. METHOD: This was a cross sectional survey of gynaecology clinic attendees at the university of Nigeria Teaching Hospital (UNTH), Enugu. These women were randomly selected. Data were analyzed using SPSS software. The primary method used was cross tabulation. RESULT: The knowledge and perception of HR among women of South East Nigeria is poor and related to the level of education. One hundred and sixty eight women (38.9%) had knowledge of HRT and only 48 (11.1%) had taken it in the past. Currently none was using HRT despite experiencing menopausal symptoms. Majority of women were ignorant of HRT and took climacteric symptoms as part of aging process. CONCLUSION: The knowledge and perception of HRT is poor and limited. Public enlightenment would help to improve awareness of climacteric symptoms. Women at high risk for menopausal diseases should be advised on HRT.

Caesarean hysterectomy.

BACKGROUND: Caesarean hysterectomy is an obstetric emergency procedure performed to save maternal life in uncontrollable haemorrhage and few elective indications. It could be a planned procedure but more often it is an emergency operation. OBJECTIVE: To ensure adequate exposure and mastery of this emergency procedure by residents in training in Obstetrics and Gynaecology in Nigeria. METHODS: Review of the pertinent literature, selected references, and internet services through Medline search on caesarean hysterectomy. RESULTS: The incidence for emergency caesarean hysterectomy is 0.01-0.05%. The maternal death rate associated with caesarean hysterectomy from all causes is 0.7% compared to 0.05% for all caesarean sections. Porro's operation was a subtotal amputation but opinion now favours a total hysterectomy where practicable. Inexperienced surgeons may encounter identification of the lower margin of the cervix as limiting factor, for fully effaced and dilated cervix. Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind. CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery by the residents and a must for all obstetricians in their practice.

An overview of menopause associated vasomotor symptoms and options available in its management.

BACKGROUND: Vasomotor Symptoms are the most common and distressing menopausal complaint, for which women seek advice from their physician. OBJECTIVE: To review menopausal associated vasomotor symptoms and options available in its management. METHODS: Pertinent literature on menopause associated vasomotor symptoms, selected references, textbooks, journals and internet services using the PubMed and Medline databases were included in this review. RESULTS: Hot flushes are the most common and distressing symptom, for which women seek advice from their physician. It occurs in more than 75% of postmenopausal women. Management of hot flushes is problematic because the most recognized effective option oestrogen, is often contraindicated. This has resulted in extensive research exploring different therapeutic options for treatment of hot flushes. Currently, various safe and efficacious nonhormonal options exist but further research is still needed to improve on the treatment of hot flushes. CONCLUSION: The management of the most common and distressing vasomotor symptoms associated with menopause (hot flushes) is controversial. Regardless of the management strategy adopted, treatment options should be periodically reassessed as menopause-related vasomotor symptoms will abate with time even without any intervention in majority of postmenopausal women.

Trends and determinants of episiotomy at the University of Nigeria Teaching Hospital (Unth), Enugu, Nigeria.

BACKGROUND: Episiotomy is the most commonly performed obstetric procedure. The indications and efficacy are poorly established and its practice has remained controversial. OBJECTIVE: To determine the rate and the determinants of episiotomy in the parturients at the UNTH, Enugu. METHODS: A five year retrospective review of episiotomy at UNTH Enugu between 1st January, 2000 and 31st December, 2004. RESULTS: Out of 3032 vaginal deliveries, 1201 women had episiotomy during vaginal delivery, giving a rate of 39.6%. The rate fluctuated between 38.7% in 2000 to 32.7% in 2004. The risk of receiving episiotomy is significantly higher among primigravidae than multigravidae [OR = 10.92, (95% CI = 8.98,13.28)]. Similarly, macrosomia (birth weight > 4 kg) significantly increases the risk of episiotomy [OR = 0.096, (95% CI = 0.06, 0.15)]. Women who had instrumental or destructive vaginal delivery are significantly more likely to receive episiotomy than those who had spontaneous vaginal delivery [OR = 0.13 (95% CI = 0.07, 0.26)]. The postpartum blood loss is significantly higher among women that received episiotomy than those who did not [t = 42.161, P > 0.0001]. CONCLUSIONS: The rate of episiotomy in UNTH, Enugu is high. Primigravidity, macrosomia and instrumental deliveries are factors associated with increased risk of episiotomy. Knowledge of these risk factors will guide in predicting episiotomy among paturients in labour ward.

Coinfection with hepatitis B and C viruses among HIV positive pregnant women in Enugu south east, Nigeria.

BACKGROUND: Hepatitis B and C viruses coinfection in HIV positive pregnant women is a common public health problem and recognized worldwide. The consequences of this problem in our poor resource setting with the risk of mother to child transmission is obvious with increased morbidity and mortality in our environment. OBJECTIVE: To determine the prevalence of coinfection patterns of HBV and HCV among HIV positive pregnant women in Enugu Nigeria. METHODS: A retrospective survey conducted on 401 Nigeria HIV positive pregnant women seen at Prevention of Mother To Child Transmission (PMTCT) clinic at the UNTH Enugu Nigeria over a 3 year period between 1st January 2007 and 31st December 2009. RESULTS: The prevalence of hepatitis B and C viruses coinfection among HIV positive pregnant women in Enugu is 6.5%. HIV/HBV coinfection was commoner than HIV/HCV coinfection. There was no significant association between hepatitis B and C viruses coinfection and the age, ethnic group, marital or educational status of the women (P > 0.05). CONCLUSION: There is high prevalence of hepatitis B and C coinfection among HIV positive pregnant women in Enugu. This high burden of these hepatotropie virus coinfection calls for continued need to screen for these infections and vaccinate the affected babies for hepatitis B and/or C where appropriate.

Endometriosis.

BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies. METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review. RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood. CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.

Trends of myomectomy at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria.

BACKGROUND: Uterine fibroid is the commonest female genital tumour occurring within the reproductive age group, and abdominal myomectomy is the most offered surgical treatment in our environment. There is need to audit this practice in our centre so as to observe the practice pattern and outcome of myomectomies in Enugu, Nigeria. OBJECTIVE: To audit myomectomies, the practice pattern and outcome at the University of Nigeria Teaching Hospital Enugu-Nigeria. METHODS: A 5-year retrospective study of myomectomies performed in UNTH Enugu between January 1, 2004 and December 31, 2008. Data relating to socio-demographic characteristics, indication for surgery, intraoperative haemostatic measures, estimated blood loss, use of drain, duration of hospital stay and complications were abstracted and analyzed. RESULT: A total of 122 abdominal myomectomies were performed and 70.5% of the patients were aged 30-39 years and 80% were nullipara. Lower abdominal swelling and discomfort were the commonest presentation and indication for the surgery. Tourniquet was used for haemostasis in 57.4% while postoperative drain was inserted in 52.6%. 24.6% received blood transfusion and the average duration of hospital stay was 8.6 days. Complications were mild, with pyrexia as the commonest complication (28.7%). There was no mortality. CONCLUSION: Though myomectomy is safe and tolerated in our centre, a consensus practice pattern through a prospective study is required to further improve outcome.

Survey of Women's Opinions on Female Genital Mutilation (FGM) in Southeast Nigeria: Study of Patients Attending Antenatal Clinic

Background: Female genital mutilation is known to exist especially in many third world countries including Nigeria with many women being victims of this harmful practice and its complications. The practice is rife in Southeast Nigeria and efforts have been made to discourage it. Objective: To determine women's views on aspects of female genital mutilation and the prevalence among the study population. Method: Women attending the antenatal clinics of two university teaching hospitals in Southeast Nigeria were interviewed by means of structured pre-tested interviewer- administered questionnaires. The data obtained were analysed using SPSS version 10.0 and the results expressed in descriptive statistics as percentages. Results: The prevalence of FGM was 42.1. However; only 14.3of the respondents circumcised their own daughters or showed willingness to circumcise their daughters indicating considerable reduction in uptake of the practice. A larger proportion (63.7) would support legislation against FGM. Conclusion: There is a high opinion against the practice of FGM in Southeast Nigeria; with the majority of the women showing support for legislation

Obstetricians' attitudes to caesarean delivery on maternal request in Nigeria.

The study was done to determine obstetricians' attitude to and factors predicting obstetricians' acceptance of caesarean delivery on maternal request in Nigeria. Nigerian obstetricians were asked to respond to case scenarios depicting caesarean delivery on maternal request without medical indications and the reasons for their responses. The case scenarios were designed from previously published reasons for caesarean delivery on maternal request from Nigeria. Multiple logistic regressions analysis was done to determine factors predicting obstetricians' acceptance of caesarean delivery on maternal request out of respect for maternal autonomy. The majority (53.1%) of the respondents would accept caesarean delivery on maternal request out of respect for maternal autonomy. Caesarean requests backed up by social mitigating circumstances of previous childlessness and previous negative labour experience received significantly higher acceptances than requests with no back-up mitigating circumstances (p < 0.0001). A good proportion (48.8%) of Nigerian obstetricians had performed at least one caesarean on maternal request. Obstetricians' bio-professional characteristics do not influence their attitude to request caesarean delivery on maternal request. Some obstetricians expressed fear of legal consequences from caesarean delivery on maternal request.