Effects of early oral feeding versus delayed feeding on gastrointestinal function of post-caesarean section women in a tertiary hospital in Enugu, Nigeria: A randomized controlled trial.

BACKGROUND: Initiation of oral intake after caesarean delivery influences return of bowel function, ambulation of patients, and time to recover from surgery. AIMS: To assess the effect of early versus delayed initiation of oral feeding after caesarean delivery on gastrointestinal function, pace of recovery, and maternal satisfaction at University of Nigeria Teaching Hospital (UNTH), Enugu. SETTINGS AND DESIGN: This was a randomized controlled study of women who had caesarean delivery from December 2012 to September 2013 at the Department of Obstetrics and Gynaecology UNTH, Enugu, Nigeria. In all, 282 participants were randomized equally into early and delayed oral feeding groups. Oral intake was commenced at 8 h post operation for those in early feeding group and at 48 h post operation for those in delayed feeding group. The primary outcome measure was the time interval from the end of surgery to the return of bowel sound. SUBJECTS AND METHODS: Analysis was by intention-to-treat. SPSS version 16 was used for data entry and analysis was done using cross tabulation and Fisher's exact test for categorical data and independent sample T-test for continuous data. P value of < 0.05 was regarded as statistically significant. RESULTS: Apart from gastrointestinal complications, there was significant difference between early and delayed feeding groups with respect to all the outcome variables: return of bowel sound (17.8 ± 4.3 h vs 35.2 ± 9.4 h; P < 0.001), return to regular diet 48.9 ± 5.2 h vs 85.5 ± 7.0 h; P < 0.001), postoperative time interval to ambulation (20.3 ± 7.0 h vs 30.9 ± 9.6 h; P < 0.001), and maternal satisfaction as estimated with visual analog scale (86.4 ± 10.4 mm vs 40.0 ± 25.9 mm; P < 0.001). CONCLUSION: Early initiation of oral feeding after caesarean delivery is safe and may be associated with earlier return of bowel functions, earlier ambulation, shorter postoperative time interval to become eligible for discharge, and high maternal satisfaction.

Patterns of gestational weight gain and its association with birthweight in Nigeria.

BACKGROUND: Despite the increasing global importance of gestational weight gain (GWG) and its impact on birthweight, little is known about the patterns of GWG in African populations. OBJECTIVES: To determine the pattern of GWG and its association with birthweight in Nigeria. METHODS: It was a longitudinal study of 200 pregnant women receiving antenatal care at two tertiary hospitals in Enugu, south eastern Nigeria. The women were consecutively recruited at <14 weeks gestation and their body mass indexes recorded upon recruitment. Thereafter, weight measurements were taken at each visit until 38-39 weeks. RESULTS: Mean total GWG was 10.7 ± 3.4 kg, while mean birthweight was 3.3 ± 0.6 kg. GWG in second trimester had positive correlation with birthweight (r = 0.164, P = 0.02). Obese women gained above the recommended limits by the "institute of medicine" while underweight women gained below the limits. Excessive total GWG was associated with higher risk of macrosomia [8/21 (38.1%) vs. 7/179; RR: 9.74; 95% CI: 3.9-24.2; P < 0.001] while inadequate total GWG was associated with higher risk of low birth weight [7/72 (9.7%) vs. 3/128 (2.3%; RR: 4.15; 95% CI: 1.1-15.4; P = 0.03]. Maternal age of <35 years, high social class, nulliparity, and regular antenatal care were associated with normal GWG while maternal age <35 years and regular antenatal care were associated with normal birthweight (P < 0.05). CONCLUSIONS: Women should be counseled on the factors that influence GWG and birthweight. Interventions to assist women achieve appropriate GWG may need to include components related to improved dietary intake for the underweight and increased physical activity for the obese.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: a case for dedicated early pregnancy services.

CONTEXT: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. AIMS: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. SETTINGS AND DESIGN: A cross-sectional survey of Nigerian Gynecologists attending the 46 th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. MATERIALS AND METHODS: This was a questionnaire-based study. STATISTICAL ANALYSIS: Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). RESULTS: A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. CONCLUSIONS: Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population.

CONTEXT: Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon. OBJECTIVE: The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting. SETTING AND DESIGN: A prospective cohort study carried out at two major tertiary maternity centers in Enugu. MATERIALS AND METHODS: Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries. STATISTICAL ANALYSIS USED: Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence. RESULTS: A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was significantly commoner in women with one previous cesarean compared with those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5). CONCLUSION: Women who have one previous C-section face a markedly increased risk of repeat caesarean sections and feto-maternal complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.

Prevalence, presentation and management of polycystic ovary syndrome in Enugu, south east Nigeria.

BACKGROUND: Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age yet, its prevalence and management has not been documented in our area. OBJECTIVE: To determine the prevalence, presentation and management of polycystic ovary syndrome among women in Enugu, south east Nigerian. METHOD: A prospective descriptive study of women with polycystic ovaries seen in two major Infertility Clinics in Enugu, South East Nigeria over a 2 year period. RESULT: A total of 342 women presented with infertility in the centres within the two year period, out of whom 62 had PCOS. PCOS occurred in 18.1% of women in the infertility clinics of the two institutions. The common modes of presentation were: inability to conceive (infertility) in 52 (83.9%), oligomenorrhoea in 45 (72.6%), obesity in 32 (51.6%), LH/FSH ratio > 2 in 28 (45.2%), hyperprolactinaemia in 26 (41.9%) and hirsuitism in 19 (30.6%) women. Ovulation induction was carried out in 42 of the 50 women with anovulatory infertility only. For those 42 women, the mean number of induced cycles was 2.6 = 1.7 (range: 1-6) with 33 (78.6%) of the women being able to do only 3 induced cycles or less. The ovulation induction agents used were clomiphene citrate and human menopausal gonadotrophin either singly or in combination with tamoxifen or bromocryptine. Adjunctive treatments offered consisted of weight reduction in 20 (40.0%) women, metformin in 11 (22.0%) women and dexamethasone in 10 (20.0%) women. CONCLUSION: PCOS is fairly common occurring in approximately one in six infertile Nigerian women. Infertility, oligomenorrhoea, obesity, LH/FSH ratio > 2, hyperprolactinaemia and hirsutism are the commonest presenting features. On individualized management, about two-fifths of them conceive either spontaneously or following ovulation induction, despite poor compliance to recommended drug regimen.

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.

Anaemia in pregnancy: a public health problem in Enugu, southeast Nigeria.

The aim of the study was to determine the prevalence of anaemia in pregnancy at booking and to determine factors associated with its occurrence in order to proffer solutions. This was a 12-month cross-sectional study of pregnant women attending the antenatal clinic for the first time (booking visit) at ESUTTH, Enugu, Nigeria from 1 April 2009 to 31 March 2010. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration and HIV status of the women were determined and the results were analysed. The prevalence rate of anaemia in pregnancy was 64.1%. Based on severity, 94.6%, 4.3%, 1.1% of them had mild, moderate and severe anaemia. The mean age of the anaemic women was significantly lower than that of the non-anaemic women (p = 0.0001). Those that had no formal education and those that booked for antenatal care in the 3rd trimester had a significantly higher prevalence of anaemia. HIV-positive pregnant women had a significantly higher prevalence of anaemia than HIV-negative pregnant women (p = 0.0072, odds ratio 2.37). It was concluded that the prevalence of anaemia in pregnancy from the study is unacceptably high. To achieve Millennium Development Goals 4 and 5, efforts must be geared towards its prevention to ensure a healthy baby and mother.

Perception and care-seekling behaviour for post partum morbidity among mothers in Enugu south east, Nigeria.

BACKGROUND: Postpartum Care is necessary to monitor and ensure return to normal of some physiological changes that occurred during pregnancy and delivery, and any abnormalities detected should be treated. The aim of this study is to describe the perception of and care seeking behaviour for maternal morbidity following childbirth among mothers in Enugu, Nigeria and determine if they depend on the socio-demographic characteristics ofmothers. METHODS: A cross-sectional survey of women who had recent deliveries was done. Quantitative and qualitative methods of data collection were used. Data analysis was by descriptive and inferential statistics at 95% level of confidence and manual content analysis. RESULTS: Three hundred and seventy-one respondents who had, at least, one self-reported morbidity following childbirth were studied. Only approximately 43.1% perceived their symptoms as abnormal and 39.5% sought medical attention for their symptoms. Inaccurate perception was influenced by the severity of symptoms as well as cultural beliefs on what constitutes abnormal symptoms following childbirth. Correct perception of morbidity was dependent on maternal age (p = 0.002) and educational status (p = 0.004) whereas positive care seeking behaviour was dependent on area of residence (p = 0.03). A greater proportion of mothers aged 30 years or below had accurate perception compared to older mothers (p = 0.02). A greater proportion of rural dwellers sought medical attention for their symptoms compared to urban dwellers. CONCLUSION: Inaccurate perception of, and poor care seeking behaviour for postpartum morbidity were common among a sample of women with recent deliveries in Enugu due largely to cultural beliefs about morbidity following childbirth. Correct perception and positive care seeking behaviour were not enhanced by older age, greater educational attainment of mothers or residence in urban areas.

Sexual practices of HIV-positive individuals: The need for continued intervention in developing countries.

SUMMARY: This questionnaire survey explored the sexual practices and problems of 184 HIV-positive individuals in two tertiary health institutions in south-east Nigeria over a 6 month period. It showed that many (56.5%) HIV-positive individuals continue to be sexually active and almost half (47.6%) of them do not know the sero-status of their partners. About 60% (n = 62) of sexually active respondents use condoms with 27.9% using them consistently, 31.7% inconsistently, while 40.4% engage in unprotected intercourse. Condom use was more among the male than the female respondents (p < 0.05) and the married or divorced couples than the unmarried (p > 0.05). Diagnosis of HIV resulted in increased abstinence (37.3%) due to loss of interest in sex and/or loss of partner. Almost half (49%) of the respondents had sexually related problems in the form of lack of sexual desire (82.4%), erectile dysfunction (25.5%) and ejaculatory problems (5.9%). These problems are more in the first 6 months of HIV diagnosis and are probably psychological. There is a need for continued discussion on safe sexual practices with HIV-positive individuals during the course of routine clinical consultation.

Waiting time to conception among the Igbo women of Enugu, Nigeria.

The objective of this study was to determine the waiting time to conception among a sample of pregnant Igbo women resident in an urban area of South-east Nigeria. This was a cross-sectional questionnaire study of antenatal clinic attendees at four major health institutions within Enugu, South-eastern Nigeria. The time to conception showed a pattern closer to that of the USA than that of the UK and is consistent with high fertility previously recorded in the Igbo population. We conclude that the data will be useful in counselling women who present with difficulty in conception.

Knowledge, attitude and practice of private medical practitioners towards abortion and post abortion care in Enugu, South-eastern Nigeria.

The objective of this study was to determine the knowledge, attitude and practice of private medical practitioners in Enugu, South-eastern Nigeria, on abortion and post-abortion care. It was a cross-sectional study of private medical practitioners in the study area using self-administered structured questionnaires. The results showed that 32.3% of the doctors terminate unwanted pregnancies when requested to do so. The majority of them (51.6%) use D&C in combination with manual vacuum aspiration for the termination of pregnancies in the first trimester. A total of 61 (63.5%) respondents offered various types of post-abortal care (PAC) services, while 42 (43.8%) of them screened women with abortion complications for sexually transmitted infections. For the doctors who do not terminate unwanted pregnancies, their main reasons were religious and moral considerations rather than obedience to the Nigerian abortion laws. We conclude that the majority of private medical practitioners in Enugu, South-eastern Nigeria, do not terminate unwanted pregnancies because of their religious beliefs.

Maternal mortality in a transitional hospital in Enugu, south east Nigeria.

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100,000 live births as a specialist hospital, with a decline to 625/100,000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies

The Impact of Intervention on Sexual Practices of HIV Positive Individuals in Southeast Nigeria.

Objective. To describe the impact of repeating behavioral educational intervention on sexual practices of HIV positive individuals. Method. A prospective cohort study of HIV positive individual was conducted in southeast Nigeria from June 2007 to May 2008. Information on sexual practices was collected at initial visit; education was given and its impact was evaluated afterwards. Results. Knowledge about risk of unprotected intercourse increased by 41%, condom use by 27% (P < .001) and consistent condom use by 55% (P < .001). The significant predictors of consistent condom use include male gender, multiple sexual partner, as well as good knowledge of HIV transmission, higher educational status and being married. Non use of condom at postintervention survey were characterized by female gender (n = 4), monogamous relationship (n = 10), little or no education (n = 10), and unmarried (n = 7) respondents. Conclusion. Repeated behavioral education intervention improves consistent condom use among HIV positive individuals and will help curb the spread of HIV/AIDS.

Trends in the twinning rate in Enugu, Nigeria.

Nigeria has the highest twinning rate in the world. Increasing twinning rates have been reported from various parts of the world as a result of assisted reproductive technologies. In order to determine whether Nigeria is part of this epidemic, the current study assessed the trends in twinning rates as seen at the University of Nigeria Teaching Hospital, Enugu, South-east Nigeria. It was a retrospective analysis of twin deliveries in the hospital over a 21-year period (1985-2005). No significant change was observed in the twinning rate within the study period. It was concluded that Nigeria is not yet part of the epidemic of multiple births affecting other parts of the world.

Voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options at the University of Nigeria Teaching Hospital.

This study assessed voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options among the pregnant women seen in a tertiary care centre in Enugu, South-east Nigeria, with the aim of identifying gaps (if any) in the prevention of mother-to-child transmission (PMTCT) implementation in the hospital. It was a prospective study of all antenatal clinic attendees and those who delivered at the University of Nigeria Teaching Hospital, Enugu, within a 7-month period (1 March to 30 September 2005). During the 7-month period, 635 pregnant women accessed the PMTCT services in the hospital. With respect to VCT, 25 (3.9%) of the antenatal clinic attendees had only group counselling, while 610 (96.1%) others had both group and individual pre-test counselling. A total of 87 (13.7%) of the 635 women tested were HIV positive. Some 426 (67.1%) women had post-test counselling carried out. Twenty (23.0%) of the 87 HIV-positive women had their infection diagnosed prior to the current pregnancy, while 67 (77.0%) had the disease diagnosed during the index pregnancy. Eight (9.2%) of them had previously had anti-retroviral therapy with nevirapine. Twelve (13.8%) of the women were on antiretroviral therapy in the index pregnancy - two on highly active antiretroviral therapy (HAART) and 10 on nevirapine. A total of 41 (47.1%) of the 87 HIV-positive women had delivered as at 30 September 2005. Ten of them had antiretrovirals administered to them during the antenatal period. The remaining 31 had antiretrovirals administered to them on arrival at the labour ward for delivery. Of the 41 women who delivered, 39 had intra-partum nevirapine, while the 2 women on HAART took their usual daily dosage. Regarding mode of delivery, one-third of the women had a caesarean section and two-thirds had vaginal delivery. Ten (24.4%) of the 41 women had episiotomy, while seven of the remaining 31 women who did not receive episiotomy sustained varying degrees of perineal tear. There was no maternal death. All the 41 live born babies received nevirapine syrup at birth. A total of 86 (98.9%) out of the 87 HIV-positive women had infant feeding counselling. All chose exclusive breast-milk substitutes for their babies. There was one twin delivery, giving a total of 42 babies delivered. One of the babies was a stillbirth. The rest survived the neonatal period. It was concluded that the VCT uptake at the University of Nigeria Teaching Hospital, Enugu, is high. The majority of the women and their babies received peripartum nevirapine and at delivery all the women chose to do exclusive formula-feeding. The main gaps identified by the study were that most of the women delivered vaginally and there were delays in obtaining HIV test results. It remains to be seen how these variables will affect the vertical transmission rate.

Attitude to sperm donation among medical students in Enugu, South-eastern Nigeria.

This study investigated the knowledge, attitude and practices of a sample of Nigerian medical students towards sperm donation. It was a self-administered semi-structured questionnaire survey of fifth and final year medical students of the College of Medicine, University of Nigeria, Enugu campus, South-eastern Nigeria. Out of 205 eligible medical students in both classes, 180 (87.8%) responded. There were 99 male and 81 female respondents. Their ages ranged from 20 to 30 years with a mean of 24.0 +/- 2.0 years. All the participants were Christians. A total of 177 (98.3%) of the respondents were aware of the practice of sperm donation for the treatment of infertility, while three students had never heard of it. A total of 15 (15.2%) of the male respondents reported their willingness to donate their sperm for infertile couples. The main motivation for wanting to donate sperm was a desire to help infertile couples. A total of 24 (30%) of the female respondents were willing to accept donor semen should the need arise. The leading factors which discouraged the male respondents from donating semen were that the practice was either against their religious belief (41.7%) or in their opinion, was morally wrong (22.6%). Some 10.7% were afraid of a possible adverse effect on future fertility, while 9.5% were afraid of being screened for sexually transmitted infections; 20 (35%) of the female respondents would not accept donor semen because of the psychological and emotional effects of having to bring up a child that is not their husband's; 13 (23%) said it was against their religious faith, while 10 (18%) believed that adopting a child was better than accepting donor semen. Eight (14%) were afraid of contracting HIV infection through donor semen, while six (11%) declined because they would not want the paternity of their child to be questioned later. With respect to the participants' views on identity disclosure, 35 (90%) of the 39 respondents willing to donate or accept sperm objected to their identities being disclosed to the recipient couples or the donor, while four (10%) did not mind. It was concluded that, despite the high level of awareness of sperm donation among medical students in Enugu, the majority of them were unfavourably disposed to it and none had ever practiced it. Public enlightenment through the mass media and correction of false notions about infertility treatment will go a long way in addressing this problem.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital(UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Pain perception among parturients in Enugu, South-eastern Nigeria.

In order to evaluate pain perception among parturients in Enugu, South-east Nigeria, a cross-sectional questionnaire study of parturients who delivered vaginally in four health institutions in Enugu from 2 December 2005 to 21 January 2006 was administered. Data analysis was by means of percentages, means +/- SD, correlation coefficients, t-tests, chi2-tests, one-way ANOVA and other inferential statistics using the statistical package SPSS for MS Windows at the 95% confidence level. A total of 250 questionnaires were distributed, out of which 181 were correctly filled and returned for a response rate of 72.4%. On a scale of 0 to 10, with 0 representing no pain and 10 representing maximal pain, the mean intensity of pain recorded by the respondents was 7.7 +/- 2.8. A total of 40 (22.1%) parturients received some pain relieving drug during their labour while 141 (77.9%) did not. Of the 40 women who received intra-partum analgesia, three women received pethidine, 17 (42.5%) received pentazocine, while 20 (50%) did not know the analgesic they received. Of the 141 respondents who did not receive intra-partum analgesia, 79 (56.0%) would have liked to have receive analgesia, while 62 (44.0%) would not. Of the 92 women who had their backs rubbed by companions during labour, 67 (72.8%) reported that this practice was helpful in relieving their labour pains, while 25 (27.2%) did not find it helpful. Of the 141 women who had a companion, 103 (73.0%) reported that this was helpful in relieving labour pains, while 38 (27.0%) reported no benefit. Antenatal care, place of residence, ethnicity, religion, marital status, occupational level, receiving intra-partum analgesia, type of analgesia received, having a companion during labour or receiving lectures on labour pains during the antenatal period had no significant impact on pain perception by the respondents (p > 0.05 for each of these variables). There was no significant correlation between pain scores and the respondents' ages and gestational age at delivery (p > 0.05). However, there was a significant positive correlation between the parturients' pain scores and their educational levels (r = 0.18, p = 0.018) and a significant negative correlation between pain scores and parity (r = -0.23, p = 0.009), with primigravidae having the highest perceived mean pain score compared with multiparas and grandmultiparas (7.5 +/- 2.3 vs 6.6 +/- 2.5 vs 6.3 +/- 2.1, p = 0.048). Additionally, those parturients who had their backs rubbed by a companion had a significantly higher mean perceived pain score than their counterparts whose backs were not rubbed (8.4 +/- 2.4 vs 6.8 +/- 2.9, p = 0.000). Parturients whose labours were either induced or augmented had a significantly higher perceived mean pain score than those who had spontaneous labour (8.9 +/- 2.5 vs 7.1 +/- 2.8, p = 0.001). It was concluded that parturients in Enugu, Eastern Nigeria, perceive labour as a very painful process with only a minority of them receiving any form of intra-partum analgesia. There is thus a large unmet need for pain relief among the parturients. Obstetric analgesia as is currently practiced in developed countries is long overdue in Nigeria.