Risk factors for retained placenta in southwestern Nigeria.

INTRODUCTION: This study aimed to determine the incidence of, and identify independent risk factors to retained placenta in Ile-Ife, southwestern Nigeria. METHODS: This was a prospective case-control study involving 120 women with retained placenta after vaginal birth at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, southwestern Nigeria over a period of seven years. Two consecutive normal deliveries after each retained placenta served as controls. Following a bivariate analysis, a multivariate logistic regression model was constructed in order to define independent risk factors for retained placenta while controlling for confounding variables. RESULTS: During the study period, there were 120 cases of retained placenta, and the total number of deliveries was 6,160, making the incidence 1.9 percent. Independent risk factors associated with retained placenta include non-use of antenatal care (odds-ratio [OR] 22.71, 95 percent confidence interval [CI] 10.5-49.12, p-value is less than 0.000), previous retained placenta (OR 15.22, 95 percent CI 3.30-70.19, p-value is less than 0.000), previous caesarean section (OR 12.00, 95 percent CI 2.05-70.19, p-value is less than 0.006), maternal age 35 years or more (OR 7.10, 95 percent CI 1.5-32.40, p-values is less than 0.012), grand multiparity (OR 6.63, 95 percent CI 1.88-23.40, p-value is less than 0.003), previous dilatation and curettage (OR 4.44, 95 percent CI 1.69-11.63, p-value is less than 0.002), preterm delivery (OR 3.12, 95 percent CI 1.12-8.68, p-value is less than 0.029) and placenta weight less than 501 g (OR 2.91, 95 percent CI 1.34-6.32, p-value is less than 0.007). CONCLUSION: Women with identifiable risk factors should be targeted for the prevention of retained placenta. There is a need for the training of birth attendants in the proper conduct of delivery and third stage of labour to prevent placenta retention and postpartum haemorrhage.

Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour.

Induction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score < or =4) were randomised prospectively to receive either 50 mug intravaginal misoprostol every 6 h for a maximum of two doses, or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 +/- 0.2 and 4.0 +/- 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 +/- 2.4 vs 11.9 +/- 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores < 7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.

Sexual behaviour of secondary school adolescents in Ilesa, Nigeria: implications for the spread of STIs including HIV/AIDS.

This research examined the sexual behaviour and perception of the risk of HIV/AIDS and other sexually transmitted infections (STIs) among adolescents in Nigerian secondary schools. Quantitative data was collected from 450 senior secondary school 1 and 2 students who were selected from 5 of the 22 co-educational secondary schools in Ilesa using a multistage sampling technique. In addition qualitative data was collected by focus group discussion (FGD) with 8 groups (4 for each of the sexes) of ten randomly selected respondents from 4 other secondary schools. Sixty three per cent had had sexual intercourse. There was no statistically significant (p>0.05) difference between the genders [females (52.3%) males (77.8%)], although males appeared to be more sexually active. The median age at first intercourse was 12 years with a range of 6-19 years. Many of the respondents had multiple sexual partners. There is poor perception of the risk of sexually transmitted infections (STIs) including that of human immune deficiency virus (HIV). It was concluded that there is a high risk of the spread of STIs, including HIV/AIDS in the study population. In view of the high prevalence of sexual intercourse and the reproductive health problems associated with STI, HIV/AIDS, it is recommended that a structured family life education (FLE) curriculum should be instituted for all schools starting at an early age.

Orofacial injuries in eclamptic Nigerians.

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.

Orofacial Injuries in Eclamptic Nigerians

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue; gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore; additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative

Analysis of perinatal mortality in a Nigerian teaching hospital.

A 5-year retrospective analysis of perinatal mortality was carried out at Wesley Guild Hospital, Ilesa Nigeria between January 1996 and December 2000. The perinatal mortality rate during the study period was 77.03 per 1000 total births. There was a steady increase in rate over the study period. The most common cause of perinatal death was asphyxia (55.2%), immaturity (23.1%), and macerated stillbirth (18.3%). The high incidence of unbooked patients, multiple pregnancies and low birth weight babies are the main reasons for the high perinatal mortality rates in our environment. Education of the public on danger signs of prolonged labour and regular retraining of health personnel on intrapartum care in addition to upgrading neonatal facilities are important measures necessary to reduce the currently high perinatal mortality rate in Nigeria.

Female genital mutilation and the unborn female child in southwest Nigeria.

Female genital mutilation, despite efforts to abolish it, is still widely practised in Nigeria. The risk of female genital mutilation to a female child in southwest Nigeria was investigated by interviewing 430 consecutive pregnant women attending the antenatal clinic of Wesley Guild Hospital Ilesa, Nigeria between July 2001 to October 2001. The results show that 60% of the pregnant women studied had a type of genital mutilation. The decision to mutilate a female child is taken before she is born. Seventy-four (17.2%) of the women and 146 (34%) of their husbands would circumcise their female child. The decision to circumcise a female child is made between the husband and wife but the final decision comes mainly from the husband. Because the majority of the women (58.4%) were yet to decide whether or not to circumcise their female children, they could sway the decision either way before the husband makes up his mind. Therefore, every effort should be taken to involve men in the struggle to eradicate this unwholesome practice.

Road traffic accidents in pregnancy in Southwest Nigeria: a 21-year review.

A 21-year (1980-2000) retrospective review of 84 pregnant women involved in road traffic accidents in Southwest Nigeria was conducted. Case notes of these 84 pregnant women treated at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, were studied. Pregnant women formed 0.3% of all individuals involved in accidents during the study period compared to 7% reported in developed countries. The fetal death rate of 3.6% and maternal death rate of 2.4% in this study were lower than the fetal death rates of 57% and maternal death rate of 8-16% reported in developed countries. There was no obvious injury in 23.8%, while in 76.2% there were serious maternal injuries ranging from limb fractures, pelvic bone fracture, quadriplegia, uterine rupture, abruption placenta, lacerations, etc. Fetal tachycardia was observed in 11.9%. Despite these injuries, the majority (80.9%) achieved spontaneous vaginal deliveries; 16.7% were lost to follow-up, while 2.4% had an emergency caesarean section for reasons unrelated to the accidents. Preventive measures such as proper screening of drivers before issuing driving licences, separation of vehicular and pedestrian traffic, installation and enforcement of the use of seat belts, restrictions of alcohol ingestion while driving, use of a crash helmet by cyclists would drastically reduce the incidence of these accidents.

Brought-in maternal deaths in south-west Nigeria.

Not all pregnant women who decide to seek care at a medical facility in Nigeria arrive in time to be treated. Some die while trying to get there. Data on such deaths are, however, scarce. In this study, conducted over a 5-year period (1995-99), when any pregnant woman was brought in dead into the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, the relatives were interviewed immediately to discover the immediate and remote causes. Reasons given for late presentation include: inability to obtain transportation in time (41.7%), inability of the health-care staff to detect an obstetric emergency early enough and refer to an appropriate centre (33.3%), inability of the referring hospital to perform an emergency caesarean section (33.3%), fear of caesarean section (25%), unwillingness of drivers to travel by night (25%) and no money to pay for hospital costs (16.7%). Causes of death include eclampsia, ruptured uterus, severe postpartum haemorrhage, severe antepartum haemorrhage, sickle cell anaemia with crises and road traffic accidents. Prevention of 'brought-in' maternal deaths requires social transformation, overhauling the health-care delivery services and improving the socio-economic status of the population.

Sexuality among pregnant women in South West Nigeria.

The sexual activity of 500 pregnant women in Ilesa, Nigeria was investigated in a prospective study carried out at the antenatal clinic of the Wesley Guild Hospital, Ilesa between December 1999 and September 2000. While the sexual desire in pregnancy of most of the women (60%) remains the same as in the non-pregnant state, coital frequency was reduced in majority of them (64%). The reasons given by the respondents for reduced sexual activity include nausea and vomiting of early pregnancy (30%), fear of miscarriage (12%), fear of harming the fetus (12%), physical awkwardness (20%), lack of interest (10%), discomfort (6%), fear of membrane rupture (8%), fear of infection (8%) and fatigue (10%). Coital frequency, however, remained the same in 32% and increased in 4% of the women. The reasons for this include: "it helps to keep the husband around" (3%), maintain marital harmony (20%), satisfying (16%) and will facilitate labour in late pregnancy (6%). The findings from this study suggest a mixed-feeling effect with a tilt towards a positive attitude to sexuality in pregnancy. The health professional should favour the complete enjoyment of sexual activity during pregnancy.