Preoperative versus postoperative misoprostol use for prevention of blood loss during caesarean section in pregnant women at term: a multi-centre randomised controlled trial.

OBJECTIVE: Caesarean section is associated with higher blood loss than vaginal delivery. This study was performed to compare the safety and efficacy of preoperative versus postoperative rectal and sublingual misoprostol use for prevention of blood loss in women undergoing elective caesarean delivery. METHODS: Eligible patients in Southeast Nigeria were randomly classified into those that received 600 µg of preoperative rectal, postoperative rectal, preoperative sublingual, and postoperative sublingual misoprostol. All patients received 10 units of intravenous oxytocin immediately after delivery. Data were analysed with SPSS Version 23. RESULTS: Preoperative sublingual misoprostol use caused the highest postoperative packed cell volume, least change in the packed cell volume, and lowest intraoperative blood loss. Preoperative sublingual and rectal misoprostol use was associated with better haematological indices and maternal outcomes than postoperative use by these routes. However, preoperative sublingual and rectal use caused more maternal side effects than postoperative use by these routes. CONCLUSION: Preoperative sublingual misoprostol was associated with the most favourable haematological indices. Although preoperative sublingual and rectal misoprostol use caused more maternal side effects, these routes were associated with better haematological indices and maternal outcomes than postoperative sublingual and rectal misoprostol use.

Serum leptin levels and relationship with maternal weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria: a comparative cross-sectional study.

OBJECTIVE: To determine and compare the mean maternal serum leptin levels, the prevalence of high serum leptin levels and mean gestational weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria. METHODS: This cross-sectional comparative study enrolled obese and non-obese pregnant women. The serum leptin levels of the women were determined using an enzyme-linked immunosorbent assay kit. Anthropometric and sociodemographic data were obtained and compared. Mean weight gain during pregnancy was determined. RESULTS: A total of 170 pregnant women were included in the study. The mean ± SD serum leptin level (99.39 ± 50.2 ng/ml) and the prevalence of hyperleptinaemia (81 of 85 patients; 95.3%) among the obese pregnant women at term were significantly higher than those of the non-obese pregnant women (48.98 ± 30.35 ng/ml/65 of 85 patients; 76.5%). The mean percentage weight gain was significantly higher in the non-obese women compared with the obese women at term. The predictors of high maternal serum leptin level at term among the participants were the employment status and levels of education of the participants. CONCLUSION: Maternal serum leptin level, maternal weight gain and prevalence of hyperleptinaemia at term were significantly higher in the obese compared with the non-obese pregnant women.

Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu.

INTRODUCTION: Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE: To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS: This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT: The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION: Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Interpregnancy interval after a miscarriage and obstetric outcomes in the subsequent pregnancy in a low-income setting, Nigeria: A cohort study.

Objectives: The aim of this study was to determine and compare the occurrence of adverse pregnancy outcomes in a cohort of pregnant women with interpregnancy interval of < and ⩾6 months (short and normal interpregnancy interval, respectively) following a spontaneous miscarriage in their last pregnancies. Methods: This was a cohort study that involved pregnant women with a spontaneous pregnancy loss in their last pregnancies. They were recruited at a gestational age of 13-15 weeks and followed up to determine the obstetric and foetal outcomes of their pregnancies at four tertiary hospitals in Nigeria from July 2018 to September 2019. Data collected were analysed using SPSS version 26.0. A Chi-square and multivariate logistic regression analysis were done, and a p-value of less than 0.05 was assumed to be statistically significant. Results: A total of 705 participants were studied, out of which 448 (63.5%) and 257 (36.5%) of the participants had short and normal interpregnancy interval after a spontaneous miscarriage. Over 80% of the participants had first-trimester pregnancy losses and were managed with manual vacuum aspiration in 73.3% of the cases. The majority, 87.5% for the normal interpregnancy interval cohort and 86.4% for the short interpregnancy interval cohort, had live births, while 8.5% and 10.1% of the women in the normal and short interpregnancy interval cohorts, respectively, had repeat miscarriages. There was no statistical difference in the occurrence of live births and repeat miscarriages between both cohorts (p > 0.05). There was no increased risk of occurrence of adverse foetomaternal outcomes in both groups (p > 0.05). Multivariate logistic regression analysis showed that there was no statistical difference in the occurrence adverse foetomaternal outcomes between the studied cohorts (p > 0.05). Conclusion: There was no significant difference in the occurrence of adverse maternal and foetal outcomes in the cohorts of mothers with short and normal interpregnancy interval following miscarriages in their last previous pregnancies.

A 20 year retrospective study of rape pattern in Ebonyi State, South-East Nigeria.

This paper investigates patterns of rape in Ebonyi state, South-East Nigeria. This was a retrospective study in which data on rape over a twenty year period (January 1999 to December 2018) were obtained from the records of the Criminal Investigation Department, Nigerian Police Force, State Headquarters, Abakaliki and the Ebonyi State Ministry of Justice, Abakaliki. The data was analysed with the Statistical Package for Social Sciences version 20 software (SPSS Inc, Chicago, IL, USA). The Chi square test and Students' t-test test were used to analyze the categorical and continuous variables respectively. A multinomial Logistics Regression (MLR) and Pearson correlation Coefficient were used to determine the influence of the socio-demographic characteristics of the victims and perpetrators on rape of the victims. A P-value of less than 0.05 was considered statistically significant. This study showed an association between recreational drug use by the perpetrators and rape of the victims. There was a nexus among types of perpetrators, site of committed crime and social habits of the perpetrators with rape of the victims. Victims in urban residential areas were more likely to be raped based on the types of the perpetrators, site of the crime committed and social habits of the perpetrators than the victims in rural areas. Victims who were <18 years were more likely to be raped by neighbors (P = 0.01). Out of 8,286 perpetrators charged to court, it was only 2.9% of them that were convicted. Measures to stop recreational drug use will be useful in stemming the tide of increasing rape cases in the state. The relevant sections of Nigerian law on rape need to be altered to broaden its scope and help punish the perpetrators in order to serve as deterrents to others. Education and empowerment of females will help reduce rape and its associated stigma thereby enhancing the perseverance of the victims to the logical conclusion of the case.

Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria - a retrospective analysis.

BACKGROUND: To evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS). METHODS: A 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics. RESULTS: A total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20-34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p <  0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29-0.70). CONCLUSION: Second-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.

Association between time of delivery and poor perinatal outcomes -An evaluation of deliveries in a tertiary hospital, South-east Nigeria.

OBJECTIVES: Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome. METHODS: This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0. RESULTS: A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652). CONCLUSION: NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health.

Effect of treatment with single total-dose intravenous iron versus daily oral iron(III)-hydroxide polymaltose on moderate puerperal iron-deficiency anemia.

BACKGROUND: Iron-deficiency anemia is the most common nutritional cause of anemia in pregnancy and is often responsible for puerperal anemia. Puerperal anemia can impair postpartum maternal and neonatal well-being. OBJECTIVE: To determine the effect of treatment of moderate puerperal iron-deficiency anemia using a single intravenous total-dose iron dextran versus daily single dose oral iron(III)-hydroxide polymaltose. METHODOLOGY: A randomized controlled study in which postpartum women with moderate iron-deficiency anemia were randomized into treatment with either a single total-dose intravenous iron dextran or with daily single doses of oral iron(III)-hydroxide polymaltose tablets for 6 weeks. Effects on hemoglobin concentration using either method were compared at 6 weeks postpartum. Analysis was per protocol using SPSS version 17 for windows. P-values ≤0.05 were considered significant. RESULTS: Two hundred eighty-four women were recruited for the study: 142 women received single total dose intravenous infusion of iron dextran while 142 received daily oral iron(III)-hydroxide polymaltose tablets. Approximately 84.0% (237/282) completed the study and were analyzed including 81% (115/142) of those randomized to injectable iron therapy compared to 85.9% (122/142) of those randomized to oral treatment. The proportions of women who had attained hemoglobin concentration of at least 10 g/dL by the 6 weeks postpartum visit did not differ significantly between cases and controls (95.7% vs 94.3%; P=0.73). Similarly, the mean increases in hemoglobin following either therapeutic route were comparable (1.03±0.56 g/dL for intravenous iron and 0.97±0.46 g/dL for the oral group; P=0.42). CONCLUSION: Single total-dose intravenous iron for treatment of puerperal iron-deficiency anemia was as effective as daily single doses of ferric iron tablets. For puerperal patients with iron-deficiency anemia in whom compliance with and tolerability of oral iron are not certain, a single total-dose intravenous iron can be safely offered.

Obstetric morbidity and socio-cultural predictors of ruptured uterus among women in Southeast Nigeria.

This study determined the incidence, obstetric morbidity and the socio-cultural factors associated with ruptured uterus. A 6-year prospective review of ruptured uterus and an enquiry into socio-cultural barriers to specialised care was conducted. The incidence of ruptured uterus was 12 per 1000 deliveries. Occurrence was common in uneducated (78/116; 67.2%), unbooked (110/116; 94.8%) and rural women (112/116; 96.6%). The major causes were prolonged obstructed labour (104/116; 89.7%) and injudicious use of oxytocics (90/116; 77.6%). The maternal and perinatal case fatality rates were 18.1% and 96.6%, respectively. Complications resulted from haemorrhage and sepsis. Lack of birth plan (97/116; 79.3%) and unskilled birth attendance (110/116; 94.8%) were major socio-cultural risk factors. There was an association between education (p = 0.001), parity (p = 0.002), residence (<0.001), type of birth attendance (<0.001) and ruptured uterus. Women in low-income settings face threats of complications and death from uterine rupture, owing to preventable socio-cultural barriers of accessing specialised obstetric care.

Obstetric benefits of health insurance: A comparative analysis of obstetric indices and outcome of enrollees and non-enrollees in southeast Nigeria.

This study determined the obstetric benefits and compared the obstetric indices and pregnancy outcome of enrollees and non-enrollees of the national health insurance scheme (NHIS). A prospective cohort study of enrollees and non-enrollees of NHIS was conducted over 2 years. Data was analysed with Epi-info statistical software. Malaria (25.3% versus 8.0%, p value ≤0.001), anaemia (11.3% versus 3.3%, p value ≤0.0001), preterm delivery (8.0% versus 2.7% p value = 0.00001), antenatal default rate (22.7% versus 6.7%, p value = 0.0001) and maternal death (2.7% versus 0.7%, p value = 0.00001) were higher in the non-insured. Singleton low birth weight (9.3% versus 2.7%, p value = 0.00001) and new born admission (10.7% versus 4.7%, p value = 0.00001) were also more in non-enrollee, with higher perinatal deaths (6.7% versus 2.0%, p value = 0.00001). Women managed under the Nigerian NHIS scheme had better maternal and perinatal indices, therefore, effort should be scaled up to ensure universal health insurance coverage for all parturient and their newborn.

Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria.

BACKGROUND: Low serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia. OBJECTIVE: To determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria. STUDY DESIGN: A hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0. RESULTS: Two-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20). CONCLUSION: There was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery.

Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence.

BACKGROUND: Reproductive health services in the form of adolescent health and contraceptive services are fundamental in the prevention of a high incidence of teenage pregnancy. The purpose of this study was to determine the age at menarche, menstrual pattern, and awareness of and use of modern contraception among secondary school girls in Abakaliki, Nigeria. SUBJECTS AND MATERIALS: This was a cross-sectional study in which self-administered questionnaires were completed by 482 adolescent girls at two girls' secondary schools between August and September 2012. RESULTS: The mean age at menarche was 13.13±1.37 years. The mean menstrual cycle length was 27.8±3.14 days, and the mean duration of menstrual flow was 4.8±1.14 days. Thirty-seven (7.7%) respondents were ignorant of their cycle length, while 29 (6.0%) had irregular cycles. Premenstrual syndrome and dysmenorrhea were major menstrual issues, which resulted in 69 (14.3%) and 59 (12.2%) of respondents resorting to self-medication and absenteeism from school, respectively. Mothers were the main source of their daughters' adolescent education, while friends and mass media were the main source of contraceptive information. Though there was a high level (75.7%) of awareness of contraceptive information among the girls, usage (8.9%) was poor. Only eight (18.6%) of the 43 respondents who had ever used modern contraception were adherent to modern contraceptives. Students who were more than 15 years old, attained menarche at 13 years or less, and whose families were of low socioeconomic classes were more likely to be sexually active. CONCLUSION: The declining age at menarche, menstrual challenges, and poor reproductive health status of adolescent girls in this study have made menstrual issues and contraceptive adherence critical aspects of adolescent health care, especially when appropriate sources of reproductive health information were not fully harnessed. Therefore, there is an urgent need to establish adolescent-friendly clinics and include sexuality education in the curriculum of schools in this environment.

Knowledge and attitude toward interdisciplinary team working among obstetricians and gynecologists in teaching hospitals in South East Nigeria.

BACKGROUND: Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health services, thereby improving the quality of patient care. The purpose of this study was to describe knowledge of interdisciplinary team working among obstetricians and gynecologists in two teaching hospitals in South East Nigeria and to determine their attitude toward an interdisciplinary collaborative approach to patient care in these institutions. METHODS: This was a questionnaire-based cross-sectional study. Data analysis involved descriptive statistics and was carried out using Statistical Package for the Social Sciences software version 17.0 for Windows. RESULTS: In total, 116 doctors participated in the study. The mean age of the respondents was 31.9±7.0 (range 22-51) years. Approximately 74% of respondents were aware of the concept of interdisciplinary team working. Approximately 15% of respondents who were aware of the concept of interdisciplinary team working had very good knowledge of it; 52% had good knowledge and 33% had poor knowledge. Twenty-nine percent of knowledgeable respondents reported ever receiving formal teaching/training on interdisciplinary team working in the course of their professional development. About 78% of those aware of team working believed that interdisciplinary teams would be useful in obstetrics and gynecology practice in Nigeria, with 89% stating that it would be very useful. Approximately 77% of those aware of team working would support establishment and implementation of interdisciplinary teams at their centers. CONCLUSION: There was a high degree of knowledge of the concept and a positive attitude toward interdisciplinary team working among obstetricians and gynecologists in the study centers. This suggests that the attitude of physicians may not be an impediment to implementation of a collaborative interdisciplinary approach to clinical care in the study centers.

Contraceptive prevalence and preference in a cohort of south-east Nigerian women.

BACKGROUND: Rates of fertility, population growth, and maternal deaths in Nigeria are among the highest in the world, with an estimated 4% of all births being unwanted and 7% mistimed. These are caused mainly by nonuse, inappropriate choice, and difficulty in accessing contraceptive commodities. The purpose of this study was to determine the prevalence and factors influencing the choice and sources of contraceptive options among market women in Ebonyi State, Nigeria. METHODS: This was a questionnaire-based, cross-sectional, descriptive study involving 330 market women of reproductive age in Abakaliki, Ebonyi State, Nigeria. A survey was carried out to identify their knowledge, use, and sources of contraception and the factors that influence their contraceptive practices. RESULTS: Knowledge of contraception was high (275 [83.3%]), and 229 (69.4%) of the study population approved of contraceptive use. However, only 93 (28.3%) of the respondents were currently using any form of contraception. Fifty-four women (16.3%) were using modern methods. The commonly used forms of modern contraception were the barrier method (male condoms, 27 [8.2%]), the oral contraceptive pill (10 [3.0%]), injectables (8 [2.5%]), and the intrauterine contraceptive device (7 [2.0%]). The most common source of contraceptive products was patent medicine dealers (58 [51%]). The main barriers to use of contraception were desire for more children (86 [26.1%]), religious prohibition (62 [18.8%]), spousal disapproval (32 [9.7%]), and the perceived side effects of modern contraceptives (25 [7.6%]). There was a significant association for approval of contraception when the model was adjusted for religion (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18-0.84; P=0.02); educational status (OR 2.84, 95% CI 0.96-8.40; P=0.04); parity (OR 1.78, 95% CI 1.09-2.85; P=0.03); and social class (OR 2.54, 95% CI 1.26-5.11; P=0.01). CONCLUSION: There is good knowledge about contraception among Nigerian women, but use of these products is low. The main barriers to use of contraception are the desire for more children, religious prohibition, and spousal disapproval.

A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria.

BACKGROUND: The global rise in cesarean delivery rate has been a major source of public health concern. AIM: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. MATERIALS AND METHODS: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. RESULTS: Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. CONCLUSION: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction.

Successful pregnancy following myomectomy for giant uterine fibroid in an infertile woman.

BACKGROUND: Giant uterine fibroid is a rare tumor of the uterus, usually symptomatic requiring surgical intervention. Uterine fibroid is generally common among black women. CASE PRESENTATION: In this study, a case of 31 year old nullipara was reported who presented to the Gynaecology unit of Enugu State University Teaching Hospital (ESUTH), Nigeria with a history of progressive abdominal swelling of 8 years duration, six years duration of infertility and weight loss and dyspnoea on exertion. Physical examination and transabdominal ultrasound revealed a huge abdominopelvic mass. She had myomectomy. She had a histologically confirmed giant uterine fibroid that weighed 16.8 kg. She subsequently achieved a live birth. CONCLUSION: Giant uterine fibroids are relatively rare. It poses great challenges in its management. The surgical option of management should consider the fertility preservation and aspiration of couples especially in developing countries.

Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria.

BACKGROUND: Preterm birth is a high risk condition associated with significant mortality and morbidity in the perinatal, neonatal, and childhood periods, and even in adulthood. Knowledge of the epidemiology of preterm births is necessary for planning appropriate maternal and fetal care. OBJECTIVE: The objective of this study was to determine the prevalence, pattern, and perinatal mortality associated with preterm births at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria. METHODS: This was a review of prospectively collected routine delivery data involving preterm deliveries that occurred between 1 January 2009 and 31 December 2013. Data analysis involved descriptive and inferential statistics at 95% level of confidence using SPSS version 17.0 for Windows. RESULTS: There were 3,760 live births over the 5-year study period out of which 636 were preterm births, giving a prevalence rate of 16.9%. Spontaneous preterm births occurred in approximately 57% of preterm births while provider-initiated births occurred in 43%. The mean gestational age at preterm deliveries was 32.6±3.2 weeks while the mean birth weight was 2.0±0.8 kilograms. Approximately 89% of preterm births involved singleton pregnancies. Sixty-eight percent of preterm births were moderate to late preterm. The male:female ratio of preterm babies born during the period was 1.2:1. The adjusted perinatal mortality rate for preterm babies in the study center was 46.1% (236/512). The stillbirth rate for preterm babies was 22.0% (149/678) and the adjusted early neonatal death rate was 24.0% (87/363). CONCLUSION: The prevalence of preterm births and associated perinatal mortality were high which may be a reflection of suboptimal prenatal and newborn care. An urgent improvement in prenatal and newborn care is therefore needed in the study center in order to improve the capacity to prevent or abate preterm labor, and preterm premature rupture of membranes; and to reduce avoidable stillbirths. Further upgrading of personnel and facilities in the newborn special care unit is also required to minimize early neonatal deaths.

Comparison of domestic violence against women in urban versus rural areas of southeast Nigeria.

BACKGROUND: The perception and prevalence of domestic violence (DV) in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. METHODS: This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1-7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. RESULTS: A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P<0.001). In particular, the prevalence of physical violence was significantly higher among rural women than among urban women (37.2% versus 23.5%; P=0.05). In contrast, rural and urban women did not differ significantly in the proportions that had experienced psychological or sexual violence. The proportion of women who believed that DV was excusable was significantly higher among rural dwellers than among urban dwellers (58.5% versus 29.6%; P=0.03). CONCLUSION: The burden of DV against women may be higher in rural communities than in urban communities in southeast Nigeria. More rural women perceived DV as excusable; this finding suggests that factors that sustain DV could be strong in rural areas. A comprehensive program to curb DV in this area may need to significantly involve the rural areas.

Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: the Nigerian experience.

BACKGROUND: Nigeria's high perinatal mortality rate (PNMR) could be most effectively reduced by targeting factors that are associated with increased newborn deaths. Low access to skilled birth attendants (SBAs) and weak health system are recognized factors associated with high PNMR but other socio-demographic and reproductive factors could have significant influences as well. Identification of the major factors associated with high PNMR would be required in designing interventions to improve perinatal outcomes. METHODS: For this cross-sectional study, data from the Nigeria Demographic and Health Survey 2008 were used to estimate the PNMR of non-hospital births in identified socio-demographic and reproductive situations that are known to influence PNMR. The estimated PNMR were compared using logistic regression analysis. RESULTS: The PNMR was 36 per 1000 live births. North central region had the lowest PNMR while the south east region had the highest rate (odds ratio 1.59; 95% CI: 1.03, 2.45). Other correlates of high PNMR were belonging to the poorest wealth quintile (odds ratio 1.87; 95% CI: 1.30, 2.70), maternal age group 15-19 years (odds ratio 1.59; 95% CI: 1.05, 2.22), multiple birth (odds ratio 3.12; 95% CI: 2.11, 4.59), history of previous perinatal death (odds ratio 3.31; 95% CI: 2.73, 4.02), birth interval shorter than 18 months (odds ratio 1.65; 95% CI: 1.26, 2.17) and having a small birth size (odds ratio 2.56; 95% CI 1.79, 3.69). Birth attendant, place of birth, parity, maternal education and rural/urban residence had no association with PNMR. CONCLUSIONS: Reproductive factors that require midwifery skills were found to contribute most to PNMR. We recommend general strengthening of the health system, recruitment of SBAs and retraining of available birth attendants with emphasis on identification and referral of complicated cases. Family planning should be a core MCH activity to address the issues of teenage pregnancy and short pregnancy intervals.

Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria.

BACKGROUND: Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period. METHODS: This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0. RESULTS: The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45-5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval. CONCLUSION: Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes.