A double-blind placebo-controlled randomized trial on the effect of hyosine n-butyl bromide for improving duration of labor in term pregnancies.

AIM: To compare the effectiveness of intramuscular hyocine n-butyl bromide (HBB) with placebo for shortening the duration of the first stage of labor in term pregnancies. METHODS: A double blind placebo-controlled randomized trial of parturients who presented at term in the active phase of labor was conducted. They were randomly (1:1 ratio) given intramuscular injection of either 40 mg (2 mL) of HBB or 2 mL of water for injection as a placebo. The primary outcome measures were the duration of first and second stages of labor. Subgroup analysis of primigravid and multigravid women were also performed for various outcomes. We did intention-to-treat analysis. RESULTS: Sixty-two women were randomized to each group and none were lost to follow-up. Baseline characteristics were similar between the HBB and placebo groups. The mean duration of first stage of labor was noted to be significantly shorter in the HBB group for both the primigravidas (246.6 ± 21.9 vs 391.8 ± 56.6 min for control; P < 0.001) and for multigravidas (205.9 ± 17.8 vs 323.8 ± 16.0 min for control;P < 0.001).There was also significantly shorter duration of second stage of labor in the HBB group (primigravida: P = 0.013; multigravida: P = 0.016). The duration of third stage of labor, mode of delivery and maternal and/or neonatal outcomes for both classes of parturients were not significantly different. CONCLUSION: HBB is effective in reducing the first and second stages of labor without adverse maternal or neonatal outcome. HBB does not significantly influence the duration of third stage of labor including mode of delivery. More evidence is needed to further explore the potential useful role of HBB in the active phase of labor.

Palliative interventions for controlling vaginal bleeding in advanced cervical cancer.

BACKGROUND: This is an updated version of the original Cochrane review published in Issue 5, 2015.Cervical cancer is the fourth most common cancer among women worldwide, with estimated 569,847 new diagnoses and 311,365 deaths per year. However, incidence and stage at diagnosis vary greatly between geographic areas and are largely dependent on the availability of a robust population screening programme. For example, in Nigeria, advanced-stage disease at presentation is common (86% to 89.3% of new cases), whereas in the UK, only 21.9% of women present with International Federation of Gynaecology and Obstetrics (FIGO) stage II+ disease. Women with advanced cancer of the cervix often need palliation for distressing symptoms, such as vaginal bleeding. Vaginal bleeding can be life threatening in advanced disease, with an incidence ranging from 0.7% to 100%. Bleeding is the immediate cause of death in 6% of women with cervical cancer and its management often poses a challenge.Thus, vaginal bleeding remains a common consequence of advanced cervical cancer. Currently, there is no systematic review that addresses palliative interventions for controlling vaginal bleeding caused by advanced cervical cancer. A systematic evaluation of the available palliative interventions is needed to inform decision-making. OBJECTIVES: To evaluate the efficacy and safety of tranexamic acid, vaginal packing (with or without formalin-soaked packs), interventional radiology or other interventions compared with radiotherapy for palliative treatment of vaginal bleeding in women with advanced cervical cancer. SEARCH METHODS: The search for the original review was run in 23 March 2015, and subsequent searches for this update were run 21 March 2018. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 3) in the Cochrane Library; MEDLINE via Ovid to March week 2, 2018; and Embase via Ovid to March week 12, 2018. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles, and contacted experts in the field. We handsearched citation lists of relevant studies. SELECTION CRITERIA: We searched for randomised and non-randomised comparative studies that evaluated the efficacy and safety of tranexamic acid, vaginal packing (with or without formalin-soaked packs), interventional radiology or other interventions compared with radiotherapy techniques for palliative treatment of vaginal bleeding in women with advanced cervical cancer (with or without metastasis), irrespective of publication status, year of publication or language in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no studies for inclusion and, therefore, we analysed no data. MAIN RESULTS: The search strategy identified 1522 unique references of which we excluded 1330 on the basis of title and abstract. We retrieved the remaining 22 articles in full, but none satisfied the inclusion criteria. We identified only observational data from single-arm studies of women treated with formalin-soaked packs, interventional radiology or radiotherapy techniques for palliative control of vaginal bleeding in women with cervical cancer. AUTHORS' CONCLUSIONS: Since the last version of this review we found no new studies. There is no evidence from controlled trials to support or refute the use of any of the proposed interventions compared with radiotherapy. Therefore, the choice of intervention will be based on local resources. Radiotherapy techniques for managing vaginal bleeding are not readily available in resource-poor settings, where advanced cases of cervical cancer are predominant. Thus, this systematic review identified the need for a randomised controlled trial assessing the benefits and risks of palliative treatments for vaginal bleeding in women with advanced cervical cancer.

Palliative interventions for controlling vaginal bleeding in advanced cervical cancer.

BACKGROUND: Cervical cancer is the second most common cancer among women worldwide, with around 500,000 new diagnoses and 273,000 deaths per year. However, incidence and stage at diagnosis vary greatly between geographic areas and are largely dependent on the availability of a robust population screening programme. For example, in Nigeria, advanced-stage disease at presentation is common (86% to 89.3% of new cases), whereas in the UK, only 21.9% of women present with International Federation of Gynaecology and Obstetrics (FIGO) stage II+ disease. Women with advanced cancer of the cervix often need palliation for distressing symptoms, such as vaginal bleeding. Vaginal bleeding can be life threatening in advanced disease, with an incidence ranging from 0.7% to 100%. Bleeding is the immediate cause of death in 6% of women with cervical cancer and its management often poses a challenge.Thus, vaginal bleeding remains a common consequence of advanced cervical cancer. Currently, there is no systematic review that addresses palliative interventions for controlling vaginal bleeding caused by advanced cervical cancer. A systematic evaluation of the available palliative interventions is needed, to inform decision-making. OBJECTIVES: To evaluate the efficacy and safety of tranexamic acid, vaginal packing (with or without formalin-soaked packs), interventional radiology or other interventions compared with radiotherapy for palliative treatment of vaginal bleeding in women with advanced cervical cancer. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 2, 2015; the Cochrane Gynaecological Cancer Group Trials Register; MEDLINE from 1980 to March week 3, 2015 and EMBASE from 1980 to February week 12, 2015. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles and contacted experts in the field. We handsearched citation lists of relevant studies. SELECTION CRITERIA: We searched for randomised and non-randomised comparative studies that evaluated the efficacy and safety of tranexamic acid, vaginal packing (with or without formalin-soaked packs), interventional radiology or other interventions compared with radiotherapy techniques for palliative treatment of vaginal bleeding in women with advanced cervical cancer (with or without metastasis), irrespective of publication status, year of publication or language in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no studies were identified for inclusion and, therefore, we analysed no data. MAIN RESULTS: The search strategy identified 1335 unique references of which 1160 were excluded on the basis of title and abstract. We retrieved the remaining 22 articles in full, but none satisfied the inclusion criteria. We identified only observational data from single-arm studies of women treated with formalin-soaked packs, interventional radiology or radiotherapy techniques for palliative control of vaginal bleeding in women with cervical cancer. AUTHORS' CONCLUSIONS: There is no evidence from controlled trials to support or refute the use of any of the proposed interventions compared with radiotherapy. Therefore, the choice of intervention will be based on local resources. Radiotherapy techniques for managing vaginal bleeding are not readily available in resource-poor settings, where advanced cases of cervical cancer are predominant. Thus, this systematic review identified the need for a randomised controlled trial assessing the benefits and risks of palliative treatments for vaginal bleeding in women with advanced cervical cancer.

Harmful Cultural Practices and Reproductive Health in Nigeria

Background: Harmful cultural practices affecting reproductive health abound in Nigeria especially in the Niger Delta region. Method: A review of the literature using internet search engines such as PUBMED; AJOL; GOOGLE was undertaken. Results: A wide range of harmful cultural practices affecting reproductive health were found and were reviewed. They include female circumcision; abdominal massage; widowhood rite; fire and heat treatment; patronage of traditional birth attendants; early forced marriages; permission from men before obtaining medical treatment; insertion of toxic herbs and preference for the male child. The various reasons for their practice; implications to reproductive health of women and ways of reduction and eradication are discussed. Conclusion: Harmful cultural practices affecting pregnant women and reproductive life is often deep rooted in culture and tradition of the people. Therefore continuous health education and behavioural modification of the people is required. Changing the people's perception of their beliefs and myth may be fundamental in breaking theses harmful cultural chain. There is also a place for legislation by the government with appropriate and enabling laws put in place to check these harmful practices. Governments should openly condemn all forms of violence against women. The girl child and women in our society need to be empowered financially and educationally as an empowered woman would know her rights. Women should also form self help groups with the sole aim to combat this scourge

Intestinal obstruction due to bilateral ovarian cystic teratoma in a pregnant woman: report of a case.

UNLABELLED: Teratoma is the most common ovarian tumour associated with pregnancy. The complications in pregnancy include torsion, rupture and malignant transformation mimicking ovarian carcinoma. Its association with intestinal obstruction is uncommon. CASE: A 35 year old gravida 5 para 4 woman with 18 week gestation was referred to our hospital with a 2 week history of abdominal pain, abdominal distension and vomiting. Initial physical examination and ultrasound scan showed bilateral ovarian masses and intrauterine singleton viable pregnancy. At surgery the right mass was observed to be adherent to a part of the small intestine. The masses were excised and confirmed grossly and histologically as benign cystic teratoma. She was well and discharged nine days post operatively. The pregnancy was managed conservatively and she was delivered of a normal male baby at term by spontaneous vertex delivery. Although intestinal obstruction due to benign cystic teratoma in pregnancy is uncommon, abrupt surgical intervention and conservative management is important for favourable outcome.

Forgotten intrauterine device contributing to infertility.

The aim of the study is to show that long standing forgotten intrauterine device contributes to infertility, reporting three cases presented at Central Hospital Warri, Nigeria, a government tertiary health center. Three cases of forgotten intrauterine contraceptive device (IUCD) contributing to infertility were seen. Two were inserted for contraceptive reasons while one was inserted while being managed for uterine synechae. Health care providers should ensure proper documentation of all procedures carried out, adequate counseling which should include taking an informed consent and also ensuring both short and long term follow up of their clients. Also all patients being evaluated for infertility and clients with past history of intrauterine device must have a speculum examination and ultrasound scan carried out.

Hypertension in pregnancy: pattern; anaesthetic care and outcome in a hospital in the Niger-Delta Region of Nigeria

This study set out to determine the pattern; seasonal presentation and the challenges encountered by anesthesiologists in the care of patients with hypertension in pregnancy at caesarean section in a centre short of anaesthetic manpower without an intensive care unit. Method A retrospective assessment of anaesthetic records of patients presenting in theatre for caesarean section was done with particular reference to mode of anaesthesia; complication including fetal and maternal outcome in the immediate perioperative period from 2004 to 2008 Results Hypertensive disease in pregnancy constituted 13.1of caesarean section cases; with peaks of presentation commonly between February and June. The months of September and October also experience lower and less frequent peak incidents in tandem with periods of peak rainfalls in the Niger- Delta. This corroborates studies done in other parts of the world including northern and eastern Nigeria. The incidence in The Niger-Delta was remarkably higher than other parts of Nigeria and other rain forest zones. Of these; 50were eclamptics; 45had pre-eclamspia while other hypertensive diseases constituted the balance of 5. 60.6of these patients had General anaesthesia -relaxant technique; 18.1had intravenous ketamine (plus hypotensive adjuvant) ; 11.7spinal anaesthesia while others had epidural; combined-spinal epidural (CSE) and local infiltration with sedation. Four intraoperative maternal deaths were experienced; while fetal mortality was 8.6Conclusion : The higher incidence of pre-eclampsia/ eclampsia in the Niger-Delta compared to other parts of the rain forest and the world makes it an issue of significant public health concern in this region. Health education; accessibility to skilled health care services and ease of transportation in this region would reduce the morbidity and mortality associated with this disease

Solitary anterior abdominal wall leiomyoma in a 31-year-old multipara woman: a case report.

BACKGROUND: Anterior abdominal wall fibroid are uncommon and could be a cause of pain and discomfort. Very few cases have been reported in the literature but none in our region. CASE PRESENTATION: We present an uncommon case of a 31 year old para 2+2 trader from the Itsekiri tribe of the Niger Delta region of Nigeria who presented with a one year history of a periumbilcal mass, had surgical removal of the mass and histology revealed leiomyoma. CONCLUSION: Abdominal wall fibroid is a good differential diagnosis to be considered in any woman of reproductive age with an anterior abdominal mass and previous uterine surgery, including laparoscopic surgeries.

Ipsilateral ectopic pregnancy occurring in the stump of a previous ectopic site: a case report.

BACKGROUND: Ectopic pregnancy continues to be a significant cause of maternal morbidity, mortality and reproductive failure in Nigeria. Ipsilateral ectopic pregnancy occurs rarely and may be difficult to diagnose in low resource settings where there are no diagnostic tools. Few cases have been reported in the literature but none in our region. CASE PRESENTATION: We present an unusual case of a 22 year old female undergraduate, from the Urhobo tribe in the Niger Delta region of Nigeria who had a recurrent left ectopic pregnancy at the stump of a previous cornual resection done five years earlier. She had a left salpingo-oophorectomy done and did well postoperatively. CONCLUSION: Ectopic pregnancy could pose a diagnostic dilemma where diagnostic facilities are not available. Every woman with a previous ectopic pregnancy would be at high risk for recurrence and that would be the condition to be ruled out if a pregnant woman presented at early gestation with abdominal pain.

Female genital mutilation: knowledge, attitude and practice among nurses.

BACKGROUND: Female genital mutilation (FGM) and cutting is a subject of global interest, with many countries of the world still practicing it despite efforts by the WHO and other agencies to discourage the practice. The highest known prevalence is in Africa. OBJECTIVES: To determine the knowledge, attitude and practice of FGM among nurses in the ancient metropolis of Benin in a Nigerian state where FGM is illegal. RESULTS: One-hundred-ninety-three nurses in the study hospital were recruited in the study out of which 182 (94.3%) appropriately filled and returned the questionnaires. The average age of respondents was 37 years, and the average duration of postgraduation experience was 14.5 years. Most respondents are of Bini (36.8%) and Esan (34.1%) ethnic origin. All respondents identified at least one form of FGM, but only 12 respondents (6.6%) could correctly identify the four types of FGM. The harmful effects of FGM identified by the majority of respondents include hemorrhage, difficult labor/childbirth, genital tears, infections and scar/keloid formation. Forty-four (24.2%) of respondents were of the opinion that some forms of FGM are harmless. Eighty nurses admitted to having undergone FGM, for a prevalence of 44%. Five respondents (2.8%) view FGM as a good practice and will encourage the practice. Twelve respondents (6.6%) routinely perform FGM out of which seven (58.3%) viewed FGM as a bad practice. Nurses performing FGM routinely were those who had spent >20 years (59%) and 11-20 years (41%) in the profession. Another 26 (14.3%) had performed FGM before, though not on a routine basis. Of this latter group, 15 will perform FGM in the future when faced with certain circumstances. Reasons for FGM practice were mainly cultural. Eight of the respondents would have their daughters circumcised. CONCLUSION: Nurses perceive FGM in Benin as cultural. Almost half have had FGM themselves, and a small percentage recommend it to their daughters. Discouraging FGM practice will require culturally sensitive education of the healthcare providers and the population at large on the ill effects of FGM, including the risk to health and violations of human rights.

Antenatal care: a comparison of demographic and obstetric characteristics of early and late attenders in the Niger Delta, Nigeria.

BACKGROUND: The utilization of modern antenatal care is poor in most parts of Nigeria and studies indicate that the majority of those who present for antenatal care do so late. MATERIAL/METHODS: This was a retrospective study involving 303 consecutively booked pregnant women over a 6-month period (March 1 to August 31, 2004) in a suburban tertiary hospital practice. The objectives were to determine the incidence of late booking for antenatal care and to compare the demographic and obstetric characteristics of women who booked late with those who booked early for antenatal care. The Fisher's exact test, odds ratio, and the 95% confidence interval were used for statistical analysis. RESULTS: Most (79.9%) of the women booked late for antenatal care. It was found that age, parity, level of education, social class, previous fetal loss, and previous obstetric complications did not differ significantly between women who booked early and those who booked late. CONCLUSIONS: The majority of the study population booked late for antenatal care. Socio-demographic and obstetric factors do not appear to be responsible for late utilization of antenatal care in the Niger Delta, Nigeria. Further studies are needed to explore the contribution of cultural factors to late presentation for antenatal care. Community-based health education programs on the importance of early presentation for antenatal care need to be put in place to address the anomaly of late utilization of antenatal care in Nigerian women.