Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is a source of health-related poor quality of life. It is, however, rarely disclosed, except when specifically enquired about by the healthcare provider. This study determined the prevalence of urinary incontinence and opportunistic screening for it in women attending a general outpatient clinic. METHODS: A total of 1,250 consenting women attending a general outpatient clinic in Ile-Ife, a semi-urban town in Southwest Nigeria, were recruited into this cross-sectional study. Confidential post-consultation interviews were performed in each patient to determine whether they had been asked about urinary incontinence and whether they felt that they ought to have been asked. The Questionnaire for Urinary Incontinence Diagnosis (QUID) was administered to determine the prevalence and pattern of urinary incontinence. Results were expressed as proportions and compared using the Chi-squared test. RESULTS: The subjects' ages ranged from 20 to 100 years (mean = 46.8 ± 17.7 years). Sixty-five women had urinary incontinence (prevalence = 5.2 %). QUID classified 30 (2.4 %), 23 (1.8 %), and 12 (1.0 %) of them as having urge, stress, and mixed incontinence respectively. None of them self-reported incontinence to their physicians. Only 9 incontinent (13.8 %) and 44 continent women (3.7 %) had opportunistic screening (p < 0.001). Fifty of the incontinent women (76.9 %) felt that their physician ought to have asked them about it. Forty-eight of them (73.8 %) did not consider incontinence a sufficient reason for presentation in hospital, but the majority (90.7 %) desired treatment. CONCLUSION: Urinary incontinence was occasionally present, but usually undisclosed by women attending the general outpatient clinic, unless when specifically asked by their physicians. Opportunistic screening is therefore recommended in this setting.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of postpartum hemorrhage in women at risk: a randomized controlled trial.

AIM: The aim of this study was to evaluate the efficacy of adjunctive rectal misoprostol compared to oxytocin infusion in the prevention of primary postpartum hemorrhage after routine active management of the third stage of labor in women with identifiable risk factors for uterine atony. MATERIAL AND METHODS: A double-blind randomized controlled trial was carried out at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 264 parturients with known risk factors for postpartum hemorrhage were randomized to receive either rectal misoprostol (600 µg; n = 132) or oxytocin infusion (20 IU in 500 mL; n = 132) after routine active management of the third stage of labor. Intrapartum blood loss was measured using a combination of the BRASSS-V calibrated drapes and differential pad weighing. Hematocrit was measured intrapartum and 24 h postpartum. RESULTS: There was no significant difference (P = 0.07) in the mean intrapartum blood loss between the misoprostol (387.28 ± 203.09 mL) and oxytocin (386.73 ± 298.51 mL) groups. There was also no difference in the requirement for additional intervention for uterine atony (P = 0.74). Postpartum hematocrit drop and blood transfusion were, however, significantly less in the misoprostol group. CONCLUSION: Rectal misoprostol is as effective as oxytocin infusion as an adjunct for prevention of postpartum hemorrhage in women with risk factors for uterine atony and is associated with a lower hematocrit drop and blood transfusion postpartum. However, shivering, pyrexia and vomiting are more frequent with misoprostol, though usually self-limited.

The effect of caesarean section on self-esteem amongst primiparous women in South-Western Nigeria: a case-control study.

OBJECTIVE: This study aims to assess the level of self-esteem of newly delivered mothers who had caesarean section (CS) and evaluate the sociodemographic and obstetrics correlates of low self-esteem in them. METHODS: Newly delivered mothers who had CS (n = 109) and who had spontaneous vaginal delivery (SVD) (n = 97) completed questionnaires on sociodemographic and obstetrics variables within 1 week of delivery. They also completed the Rosenberg self-esteem scale. RESULTS. Women with CS had statistically significant lower scores on the self-esteem scale than women with SVD (p = 0.006). Thirty (27.5%) of the CS group were classified as having low self-esteem compared with 11 (11.3%) of the SVD group (p = 004). The correlates of low self-esteem in the CS group included polygamy (odd ratio (OR) 4.99, 95% confidence interval (95% CI) 1.62-15.33) and emergency CS (OR 4.66, 95% CI 1.55-16.75). CONCLUSIONS: CS in South-Western Nigerian women is associated with lowered self-esteem in the mothers.

A randomised controlled trial of early initiation of oral feeding after cesarean section.

OBJECTIVE: To evaluate the safety and efficacy of early oral feeding after cesarean delivery. METHODS: Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24-48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding. RESULTS: The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 +/- 4.17 h versus 36.21 +/- 3.52 h (p < 0.001), passage of flatus 44.81 +/- 3.73 h versus 60.58 +/- 4.40 h (p < 0.001) and bowel movement 58.30 +/- 5.91 h versus 72.76 +/- 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 +/- 0.59 days versus 6.69 +/- 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 +/- 1.34 bottles versus 11.8 +/- 1.32 bottles (p < 0.001). CONCLUSIONS: Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome.

A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery.

OBJECTIVE: To compare immediate and 24-hour postoperative removal of urethral catheters for elective cesarean delivery. METHOD: A prospective randomized trial of 200 women admitted for elective cesarean delivery where the urethral catheter was removed 24 hours postoperatively or immediately after the procedure. Urine samples were collected preoperatively and 72 hours postoperatively for microscopy, culture, and sensitivity (MCS). Outcome measures included preoperative and 72-hour postoperative urine MCS, postoperative morbidities, and length of hospital stay. RESULTS: There were no significant differences in postoperative urinary retention (P=0.986), dysuria (P=0.188), urgency (P=0.134), fever (P=1.000), 72-hour postoperative urine MCS (P=0.489), and length of hospital stay (P=0.879) between the 2 groups. There was a non-significant lower incidence of positive urine culture 72 hours postoperatively for women in the immediate removal group compared with those who were catheterized for 24 hours (8.1% vs 11.2%; P=0.489). CONCLUSION: Immediate postoperative removal of a urethral catheter after elective cesarean delivery may be associated with a lower risk of urinary infection.