Head circumference, as predictor of cephalopelvic disproportion: A prospective analysis of cases of spontaneous vaginal delivery and caesarean section in Ekiti State, Nigeria.

Cephalopelvic disproportion (CPD) is a previously undiagnosed anatomical misfit between maternal pelvis and the fetal head. It is one of the major indications for cesarean section (CS), especially in sub-Saharan Africa. Early diagnosis, could avert events that can increase maternal and perinatal morbidity and mortality associated with this condition. This study was designed to determine the mean head circumference of the fetus in relation to CPD as an indicator for caesarean section. A total of 350 parturients who had spontaneous vaginal deliveries (group A) were compared with another 350 parturients who had cephalopelvic disproportion leading to CS (group B). The socio-demographic characteristics, delivery parameters, head circumference, fetal weight and length were recorded in a proforma and analyzed using SPSS version 21. P value was set at 0.05. The mean head circumference for the all the babies delivered in this study was 34.6 ±1.7cm. The mean head circumference of babies delivered to women with CPD via caeserean section compared to those who had vaginal delivery was significantly greater (35.15±1.5 vs 34.1±1.8, mean difference 1.9±0.1, X2,0.308 p <0.001). The cut-off for diagnosis of cephalopelvic disproportion was head circumference 34.8cm which has a specificity of about 74% and sensitivity of 88% with area under the curve being 66%. The study demonstrated that when the head circumference of a baby is 34.8cm and above, the risk of having cephalopelvic disproportion leading to a CS is high with sensitivity of 88% and specificity of about 74%.

Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review / Determinantes da indução do trabalho de parto bem sucedida em hospital-escola na Nigéria: uma revisão de 10 anos

Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.

Obstetric Outcomes in High-Order Repeat Caesarean Deliveries in Nigeria: A Single-Center Retrospective Study.

Objective: Our aim was to evaluate the trend of effect of prior caesarean delivery (CD) on obstetric outcomes; and to investigate the existence of a threshold for order of CD associated with geometrical increase in complications. Materials and methods: We performed a retrospective cohort study of 942 parturients who undergone CD between June 2012 and May 2015 in a teaching hospital in Nigeria. The participants were stratified by the order of caesarean deliveries. We used linear-to-linear association to assess presence of a trend between the order of CD and categorical variables while Jonckheere-Terpstra was used to investigate whether a trend exist between order of CD and continuous variables. We also used multivariate logistic regression to evaluate the relative risk ratio of the outcome variables for each order of CD. Results: Composite adverse maternal outcome depicted a significant increasing trend from 1st CD (5.2%) to the 5thCD (50%). The relative risk ratio for composite adverse maternal outcome increased arithmetically from 1st CD to 3rd CD: RRR2.21, 95%CI 1.2-3.98 for 2ndCD; RRR3.39, 95%CI 1.60-9.27 for 3rdCD; followed by a geometric increase between 3rdCD and 4thCD (RRR11.64, 95%CI 3.20-18.86). In contrast, composite adverse fetal outcome did not depict a significant trend. However, perinatal death increased significantly from primary CD (4.6%) to 5thCD (33.3%). Conclusion: Maternal and fetal complications of repeat CD increase with increasing order of CD; and this trend became astronomical after the third CD. Couples should be counselled that both maternal and fetal complications increase with each additional CD and advised strongly to forgo future pregnancies after the 3rd CD.

Predictors of postpartum depression among an obstetric population in South-Western Nigeria.

BACKGROUND: Perinatal maternal depression is the most common mood disturbance associated with pregnancy. It has grave consequences on both maternal health and wellbeing of offsprings, albeit usually neglected in low- and middle-income countries. OBJECTIVE: To evaluate the relationship between antenatal depression(APD) and postpartum depression(PPD) and predictors of postpartum depression among an obstetric population in South-western Nigeria. METHODS: This was a prospective longitudinal cohort study involving272 pregnant women recruited between 34 and 36 weeks of pregnancy and followed up to till 6 weeks after delivery. Edinburgh Postnatal Depression Scale (EPDS) questionnaires were administered to collect data. Data were analysed with SPSS version 23.A p-value < 0.05 was taken as statistically significant. RESULTS: The prevalences of antepartum and postpartum depression were 6.3%, (95% CI 3.4%-9.2%) and 8.8% (95% CI 5.4%-12.1%) respectively. The Spearman correlation coefficient for antepartum EPDS and postpartum EPDS scores was 0.52, p < 0.001.The predictors of postpartum depression were antepartum depression (adjusted OR 10.6, 95% CI 8.33-48.60, p < 0.001), puerperal sepsis (adjusted OR 4.33, 95% CI 3.89-8.69, p = 0.03), domestic violence (adjusted OR 3.40, 95% CI 1.94-15.67, p = 0.01) and age group 25-34 years (adjusted OR 0.11, 95% CI 0.02-0.75, p = 0.02), and household income $1671-$3330 (adjusted OR 0.10, 95% CI 0.02-0.56, p = 0.01). CONCLUSION: There was a positive association between the antenatal EPDS and postnatal EPDS scores. Screening for maternal depression should be considered in prenatal period. Further studies are necessary to explore the novel finding of predictive role of puerperal sepsis in PPD.

Preliminary report of sexual assaults at Ekiti Sexual Assault Referral Centre, Ado-Ekiti, Southwest, Nigeria (Moremi Clinic).

There has been a surge in the incidence and severity of sexual assaults globally with the insurgence of COVID-19 owing to lockdown restrictions. Ekiti Sexual Assault Referral Centre, Ado-Ekiti also known as Moremi Clinic was established in June 2020 as a multisectoral response centre to this surge. Seventy-four survivors accessed medical services from June 2020 to May 2021. Adolescents made up 54.1% while the median age was 14.5 years. Only seven survivors were seen within 24 h of the event and around a quarter had follow-up visits. A quarter of survivors reported repeat episodes of sexual assault. Complications documented were sexually transmitted infections (13.5%), depression (4.1%) and posttraumatic stress disorder (5.4%). There was a failure of contraception in 4.5% of survivors who had taken emergency contraceptive pills. For improvements in quality of care, strategies to ensure early presentation and encourage follow-up visits must be introduced.

The Predictors for Non-Adherence to Colposcopy among Women in an Underserved Community in Rural Southern Western Nigeria.

Background: Cervical cancer is the fourth most common cancer in women. It is a major public health problem in developing countries. Effective cervical cancer screening requires that women adhere to the screening program. The factors that influence adherence to colposcopy in rural areas of Nigeria are unknown. The objective of the study was to determine the factors that 0determine adherence and the sexual and reproductive factors that are associated with non-adherence of women to colposcopy. Methods: This is a cross-sectional study of a project undertaken to determine the age- specific incidence of Human Papillomavirus (HPV) infection in Irun Akoko, a rural town in Ondo state of Nigeria. A total of 492 women with abnormal results from 1420 women that were screened were recalled for colposcopy examination. Results: The non-adherence rate for colposcopy in this study was 25.8%. Women younger than 40years (p=0.0011) and those with number of living children ≤2 (p=0.04) are more likely to be non-adherent to colposcopy. Conclusion: The non-adherence rate to colposcopy was high. Younger women and those with fewer children were more likely not to adhere to colposcopy.

Adverse birth outcomes among women exposed to intimate partner violence in pregnancy in Ikere-Ekiti, South-west Nigeria: A prospective cohort study.

OBJECTIVE: Studies on birth outcomes associated with intimate partner violence in pregnancy in Nigeria are scarce. We aimed to evaluate adverse birth outcomes among women exposed to intimate partner violence in pregnancy in a Nigerian population. STUDY DESIGN: We performed a prospective cohort study involving 363 women with singleton pregnancies presenting for antenatal care between March 2019 and September 2019. Intimate partner violence was assessed with a validated self-administered questionnaire- ongoing abuse screen. We compared adverse birth outcomes between women that experienced intimate partner violence in pregnancy and those that did not. Multivariate logistic regression was used to adjust for confounders. RESULTS: Of the 363 pregnant women that completed the study, 56(15.4%) experienced intimate partner violence in pregnancy. Women who experienced intimate partner violence in pregnancy were significantly more likely to experience composite adverse birth outcome (53.6% compared with 20.2%,adjusted OR 4.72, 95% CI: 2.43-9.19, p < 0.001) preterm delivery (26.8% compared with 13.4%,adjusted OR 2.96, 95% CI: 1.34-6.50, p = 0.007), stillbirths(17.9% compared with 3.3%,adjusted OR 9.52, 95% CI: 3.96-22.90, p < 0.001) and neonatal intensive care unit admission (32.1% compared with 19.9%, adjusted OR 1.93, 95% CI: 1.19-10.60, p = 0.03). Mode of delivery and low birth weight did not differ significantly between the two groups. CONCLUSION: Intimate partner violence is associated with increased risk of preterm delivery, stillbirth and neonatal intensive care unit admission. There is a need to evaluate the effect of interventions on these adverse birth outcomes.

A Nested Case-Control Study of Serum Fasting Lipid Profiles in Pre- Eclamptic Primigravidas in Ile-Ife, Nigeria.

BACKGROUND: Pre-eclampsia contributes significantly to both maternal and perinatal morbidities and mortalities. One of the identified pathophysiologies of pre-eclampsia is the deranged serum lipid profile of which some components have been found to be elevated early in pregnancy in women destined to develop pre-eclampsia. OBJECTIVES: To compare the serum fasting lipid profiles of pre-eclamptic primigravidas with normal primigravidas at week 20, 28, and 34. METHODS: We conducted a nested case-control study at Obafemi Awolowo University, Ile-Ife between November 2016 and April 2018. A cohort of 290 primigravidas was recruited at week 20 and followed up until delivery. Serum fasting lipid profiles were quantified at weeks 20, 28 and 34 for all participants. Twenty four women that developed pre-eclampsia were compared with 48 women that had a normal pregnancy. Data were analyzed with SPSS version 22. We used a linear mixed-effect regression model with random intercept and slope. Significance was established using p<0.05. RESULTS: Serum lipid profiles showed an average weekly increase in both groups. Primigravidas that developed pre-eclampsia had a weekly increase of 0.2(SE0.14) mmol/l in serum total cholesterol more than those with normal pregnancies. (p<0.001) Serum low-density lipoprotein also showed a differential weekly increase of 0.1(SE0.05)mmol/l in primigravidas that developed pre-eclampsia over primigravidas with normal pregnancies. (p<0.001). CONCLUSION: The average weekly increase in serum total cholesterol and low-density lipoprotein was significantly higher in primigravidas that developed pre-eclampsia when compared to the control group. These findings depicted an association between serum lipid profile and pre-eclampsia among the primigravidas.

Transvaginal Retropubic Urethropexy Versus Pubovaginal Sling for Treatment of Postrepair Urinary Incontinence.

OBJECTIVES: The aim of this study was to compare the success rates of transvaginal retropubic urethropexy with fascia lata pubovaginal sling (PV sling) for treatment of postrepair urinary incontinence at a fistula center in Nigeria. METHODS: This was a retrospective review of 60 patients who had transvaginal retropubic urethropexy and 46 patients who had PV sling on account of postrepair incontinence at National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Data were retrieved from the hospital records. Success was defined as negative urinary stress test at 3 months after repair. Data were analyzed with SPSS version 20, and P value <0.05 was taken as statistically significant. χ was used to determine the association between the procedures and success rate. RESULTS: The success rate of transvaginal retropubic urethropexy versus PV sling was 53.3% versus 82.6% (χ = 9.95, P = 0.02). Complications occurred in 13.2%. CONCLUSIONS: In conclusion, the efficacy of the fascia lata PV sling was more than that of transvaginal retropubic urethropexy for postrepair urinary incontinence. Urodynamic assessments need to be incorporated into management of these women for better patient's selection for each procedure.

Comparison of weight gain between levonorgestrel and etonogestrel implants after 12 months of insertion.

OBJECTIVE: To compare weight gain between women using etonogestrel implants and those using levonorgestrel implants 12 months after insertion. METHODS: A multicenter prospective cohort study was performed on women recruited from family planning clinics between July 2016 and August 2017. The main study outcome was mean weight gain after 12 months of insertion of the implants. RESULTS: The present study included 150 women (age range 18-45 years) using levonorgestrel implants and 167 women using etonogestrel implants. The women recruited had been using implants for less than 6 months; implants had been inserted 6-12 months after their last pregnancy. Participants were followed up until 12 months after insertion through telephone conversations. Baseline parameters were obtained from the clinic records and weight was measured within 6 weeks of the 12-month anniversary of insertion of the implants. Data were analyzed with SPSS version 23. Weight gain in the levonorgestrel group was significantly higher than in the etonogestrel group (3.16 ± 4.08 vs 0.77 ± 3.76, P = 0.013; relative risk 1.69, 95% confidence interval 1.46-1.96). There were no differences in the occurrence of menstrual irregularities and client satisfaction. CONCLUSION: Women using levonorgestrel implants were more likely to gain weight compared to those using etonogestrel implants after 12 months of insertion.

Profile and outcome of patients with recurrent urogenital fistula in a fistula centre in Nigeria.

INTRODUCTION AND HYPOTHESIS: Management of a recurrent urogenital fistula is very challenging and requires experienced surgeons. The aim of this study was to describe the characteristics, success rates, and associated factors related to surgical repairs of patients with recurrent urogenital fistulas by an experienced team at a fistula centre in Nigeria. METHODS: This was a retrospective cohort study of 154 patients that had repeat urogenital fistula repairs at the National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Information was retrieved from their hospital records. Successful repair was defined by continent status at 3 months after repair. Data were analyzed with SPSS version 20 by IBM Inc., and p < 0.05 was taken as statistically significant. Chi-square test was used to determine the association between the factors and successful repair. RESULTS: The mean age was 36.27 ± 12.96 years. Obstetric fistula occurred in 92.2% of the patients. The success rates for the first, second, third, and fourth repeat repairs were 68.8%. 56.2%, 50%, and 0% respectively. Significant factors were the number of previous attempts at repair (χ2 = 20.44, p = 0.002), age group (χ2 = 16.95, p = 0.03), Waaldijk's classification (χ2 = 13.31, p = 0.04), duration of fistula (χ2 = 19.6, p = 0.03), surgeons' experience (χ2 = 7.11, p = 0.04), and place of previous attempt at repair (χ2 = 6.35, p = 0.02). There were no complications in 86.4%. CONCLUSIONS: The success rate was good. Patients who had previous failed repairs at the fistula centre had better outcomes after the repeat surgeries. Centralizing fistula care will enhance optimal outcomes. It may also boost training and research in this specialty.

Unmet need for contraception among HIV-positive women in Ile-Ife, Nigeria.

As mother-to-child transmission of HIV is difficult to predict and also hard to prevent in practice, pregnancy among women living with HIV/AIDS (WHA) needs to be taken with considerable aforethought. The prevention of unwanted pregnancy among WHA is therefore a public health issue. The aim of our study was to determine the unmet need for contraception among HIV-positive women and the associated factors. Ours was a cross-sectional study involving 425 non-pregnant WHA attending an adult HIV clinic in Nigeria. Interviewer-administered, structured questionnaires designed for the study were used to obtain data. The contraceptive uptake was 47% while the unmet need for contraception was 20%. There were significant associations between unmet need for contraception and age group ( P < 0.001), religion ( P < 0.001), ethnic group ( P < 0.001), knowledge about contraceptives ( P = 0.02), educational status ( P = 0.01) and partners' retroviral status ( P = 0.008) The unmet need for contraception was high. Advocacy programs should perhaps be focused on older women, Christians and those with little or no education.

Prevalence and risk factors for urinary incontinence in pregnancy in Ikere-Ekiti, Nigeria.

AIMS: The objective of this study was to determine the prevalence and associated risk factors for urinary incontinence (UI) among antenatal clinic attendees in a low resourced setting in Nigeria. METHODS: This study was a cross-sectional study involving pregnant women aged 18-45 years. Data was obtained from 442 pregnant women using the English version International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short form (ICIQ-UI-SF) from July 2017-September 2017. The questionnaires were self-administered. Data was analyzed with SPSS version 20. Logistic regression was also used to derive the adjusted odds ratio for risk factors of urinary incontinence among the respondents. A P-value <0.05 was taken as statistically significant. RESULTS: The prevalence of urinary incontinence in this study was 28.1%. UI prevalence among the nulliparous and multiparous women were 28.7% and 27.7% respectively. Stress urinary incontinence was the commonest (17.4%) while sexual relation was the most affected lifestyle (22.6%). Overweight (AOR 1.39, P = 0.03), obesity (AOR 1.60, P = 0.009), third trimester (AOR 2.09, P = 0.011), previous instrumental vaginal delivery (AOR 11.54, P < 0.001), Ibo tribe (AOR 3.29, P = 0.006); and Ebira tribe (AOR 8.86, P = 0.028) were associated with UI in pregnancy. CONCLUSION: Urinary incontinence affects more than a quarter of pregnant women; with substantial lifestyle changes; and sexual relation is the most affected activity. Health care providers should endeavor to enquire about symptoms of UI among pregnant women. Efficacy of interventions needs to be investigated in this population.

Follicle Stimulating Hormone and Anti-Müllerian Hormone among Fertile and Infertile Women in Ile-Ife, Nigeria: Is there A Difference?

BACKGROUND: Reduced ovarian reserve predicts poor ovarian response and poor suc- cess rates in infertile women who undergo assisted reproductive technology (ART). Ovarian reserve also decreases with age but the rate of decline varies from one woman to another. This study aims to detect differences in ovarian reserve as measured by basal serum follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) between a matched cohort of fertile and infertile regularly menstruating women, 18-45 years of age. MATERIALS AND METHODS: This case-control study involved 64 fertile and 64 subfertile women matched by age at recruitment. Peripheral blood samples were taken from the women recruited from the Gynecological and Outpatient Clinics of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Serum FSH and AMH were quantified using ELISA at the Metabolic Research Laboratory of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. RESULTS: A significant difference existed in the mean FSH of fertile (6.97 ± 3.34) and infertile (13.34 ± 5.24, P=0.013) women. We observed a significant difference in AMH between fertile (2.71 ± 1.91) and infertile (1.60 ± 2.51, P=0.029) women. There was a negative correlation between FSH and AMH in both fertile (r=-0.311, P=0.01) and infertile (r=-0.374, P=0.002) women. CONCLUSION: The difference in ovarian reserve observed in this study suggests that reduced ovarian reserve in regularly menstruating women may be associated with early ovarian ageing or subfertility.