Effect of the Foley catheter and synchronous low dose misoprostol administration on cervical ripening: a randomised controlled trial.

This randomised controlled trial was carried out over a 14-month period in a tertiary health institution in Nigeria, to determine the effectiveness of Foley catheter and synchronous low dose misoprostol for pre-labour cervical ripening. Term pregnant women with unfavourable cervices (Bishop's score < 6) requiring cervical ripening/induction of labour were assigned randomly into three groups: Group A, transcervical Foley catheter was used synchronously with low dose intravaginal misoprostol; Group B, transcervical Foley catheter alone was used and Group C, low dose intravaginal misoprostol alone was used. The time to achieve a favourable cervical status as well as vaginal delivery was significantly shorter in the synchronous group than in the control groups (p < 0.05). The synchronous use of Foley catheter and misoprostol is very effective in cervical ripening and should be considered in clinical situations where there is need to hasten vaginal delivery in the presence of an unripe cervix.

Anti-malaria prescription in pregnancy among general practitioners in Enugu state, south east Nigeria.

BACKGROUND: The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin-based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs). OBJECTIVE: To determine the pattern of anti-malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election. RESULTS: The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti-malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy-six (51.7%) practitioners prescribed IPT-SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05). CONCLUSION: The pattern of anti-malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence-based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.

Pattern and outcome of infertility in Enugu: the need to improve diagnostic facilities and approaches to management.

BACKGROUND: In Nigeria, infertility is a social for the childless couple due to the high premium placed on propagating oneself. OBJECTIVE: To determine the pattern of infertility among women attending the gynaecological clinic of university of Nigeria Teaching Hospital, Enugu and to examine the outcome of management. METHODS: A descriptive retrospective design study based on findings from the folders of infertile couples presenting at the gynaecological clinic of University of Nigeria Teaching Hospital over a five year period (2004 - 2008). The data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary, the causes, and the treatment in the years under review. The outcome of management was also evaluated. These were analyzed using SPSS 12.0.1 for window version. RESULTS: The mean age of the women was 34.1 +/- 4.9 range 21 - 46) years. The prevalence of infertility was 5.5% of all outpatient gynaecological consultations. The cause of infertility could not be determined in 39.4% of cases, female factors were identified as the sole causes in 28.7% of cases, male factors as sole causes in 11.5% of cases, and combined male/female factors in 20.4% of cases. Secondary infertility accounted for 76.8% of infertility and primary infertility 23.2%. The age of the women and the educational level did not significantly influence the type of infertility the women presented with (P > 0.05). Tubal factor was identified in majority of cases and pregnancy was recorded in only 17.0% of the women. CONCLUSION: Secondary infertility is more prevalent in Enugu with tubal factor accounting for majority of the cases with identifiable causes. The outcome of treatment of infertility is poor. There is need to improve infertility diagnostic and treatment facilities and approaches in Enugu, Nigeria.

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.

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.

Pattern of gynaecological cancers in University of Nigeria Teaching Hospital, Enugu, south eastern Nigeria.

BACKGROUND: Gynaecological cancers are among the leading causes of cancer related deaths worldwide. The objective of this study was to determine the pattern and relative frequencies of gynecological cancers as seen at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Southeastern Nigeria. METHODS: An analysis of retrospective clinical data from the ward admissions and discharge books and the operating theatre record books. RESULTS: During the 10-year period under study (2000-2009), 407 cases of gynaecological cancers were admitted into the hospital. The age range of these women was 21-80years with mean age of 54.6 +/- 14.2 years. The commonest gynaecological cancers in women less than 30 years of age were choriocarcinoma (36.1%) and ovarian cancer (33.3%). After 30 years, cervical cancer became the commonest cancer. Overall, cervical cancer was by far the commonest gynecological cancer constituting 78% of all the cases, followed by ovarian cancer (8.9%), choriocarcinoma (4.3%), endometrial cancer (4.1%), vulva cancer (4.0%) and leiomyosarcoma (0.5%). There was no case of vaginal cancer during the study period. Anaemia was the commonest sequelae, complicating 55% of the cases, followed by genital fistulae (12%), infertility (3%), renal failure (3%), and pulmonary complications (2%). CONCLUSION: Cervical cancer is by far the commonest gynaecological cancer in Enugu and there is high incidence of this cancer even in young women below the age of 30 years. The commonest gynaecological cancer in women less than 30 years is choriocarcinoma, and anaemia is the commonest sequelae of all gynaecological cancers.

A five-year survey of caesarean delivery at a Nigerian tertiary hospital.

BACKGROUND: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques, caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus, the current emphasis is to limit the rising rate of caesarean section to as much as possible. OBJECTIVE: To determine the rate of caesarean section, pregnancy out-come, major indications and complications of caesarean section. METHODS: A five year (January 1(st) 2005 to December 31(st) 2009) retrospective analysis of clinical data from the ward admissions and discharge books, patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. RESULTS: Out of the 3,554 deliveries during the study period, 980 cases were by caesarean section, giving a rate of 27.6%. Most cases 918 (93.7%) were by emergency caesarean sections, with elective procedure accounting only for 6.3% of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5%) were primigravidae, 503(51.4%) were between para one and para four, while 70 (7.1%) were grand-multipara. The rate of caesarean section was higher amongst the booked patients, 563 (57.5%) than the unbooked patients 355 (36.2%). Two previous caesarean section was the commonest indication for caesarean section 211(21.5%), followed by cephalopelvic disproportion 198 (20.2%), and foetal distress188 (19.2%). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91%) were delivered by emergency procedure. More than half of the babies 582(57.7%) had birth asphyxia and there were 39 (3.9%) perinatal deaths. All the cases of perinatal deaths and 549 (94.3%) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7%. CONCLUSION: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital.

A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary Hospital

Background: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques; caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus; the current emphasis is to limit the rising rate of caesarean section to as much as possible. Objective: To determine the rate of caesarean section; pregnancy out-come; major indications and complications of caesarean section. Methods: A five year (January 1st 2005 to December 31st 2009) retrospective analysis of clinical data from the ward admissions and discharge books; patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital; Ituku Ozalla; Enugu. Results: Out of the 3;554 deliveries during the study period; 980 cases were by caesarean section; giving a rate of 27.6. Most cases 918 (93.7) were by emergency caesarean sections; with elective procedure accounting only for 6.3of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5) were primigravidae; 503(51.4) were between para one and para four; while 70 (7.1) were grand-multipara. The rate of caesarean section was higher amongst the booked patients; 563 (57.5) than the unbooked patients 355 (36.2). Two previous caesarean section was the commonest indication for caesarean section 211(21.5); followed by cephalopelvic disproportion 198 (20.2); and foetal distress188 (19.2). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91) were delivered by emergency procedure. More than half of the babies 582(57.7) had birth asphyxia and there were 39 (3.9) perinatal deaths. All the cases of perinatal deaths and 549 (94.3) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7. Conclusion: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital

Women in southern Nigeria with change in paternity do not have increased incidence of pre-eclampsia.

This was a prospective cohort study of women in their second pregnancies aimed at determining if there was a difference in the incidence of pre-eclampsia between those with changed paternity and those without change in paternity in an entirely black African population. Women in their second pregnancies receiving antenatal care between September 2006 and August 2007 were recruited into the study between 10 and 20 weeks' gestational age and followed up until 37 weeks' gestation. The main outcome measures included incidence of pre-eclampsia in relation to change in paternity at second pregnancy, incidence of pre-eclampsia in relation to duration of sexual cohabitation among those with changed paternity and inter-pregnancy interval. There was no significant difference in the incidence of pre-eclampsia between women who had changed paternity and those without change in paternity (3.5% vs 3.1%, p=0.835). The inter-pregnancy interval was also similar in both groups. The mean duration of sexual cohabitation was similar between women who had changed paternity that developed pre-eclampsia and those that did not develop pre-eclampsia (7.9+/-1.3 vs 7.5+/-2.1 months, p=0.531). It was concluded that Southern Nigerian women with change in paternity in their second pregnancies do not have increased incidence of pre-eclampsia.

Nosocomial infection in a Nigerian rural maternity centre: a series of nine cases.

BACKGROUND: An outbreak of urinary tract infection in a rural maternity hospital near Enugu, Nigeria led to bacteriological assessment which identified Serratia marcescens as the causative organism. An epidemiological investigation was done to trace the source of this organism. OBJECTIVE: To investigate an outbreak of urinary tract infection in a rural maternity centre. DESIGN: A descriptive study. SETTING: Maternity centre in a rural community near Enugu run by local midwives assisted by auxiliary nurses trained by the midwives. SUBJECTS: Nine patients at term with symptoms of urinary tract infection. RESULTS: In all nine cases, the pigmented form of Serratia marcescens was found to be the cause of the urinary tract infection and the source of this organism was traced to the auxillary nurse who shaved the patients and the instrument she used. CONCLUSION: Since the causative organism of the outbreak of urinary infection in these women was traced to the shaving instruments used and the fingers of the auxillary nurse who shaved them, there is the need for better hygiene practices in the health centre and the use of properly trained staff to attend to pregnant and parturient women. It is recommended that the practice of shaving parturient women should be discarded.