Obstetric hysterectomy: fifteen years' experience in a Nigerian tertiary centre.

The aim of this study was to determine the incidence, indications, associations and complications of obstetric hysterectomy in our centre with a view to suggesting ways of improving outcome. This is a descriptive study of patients who had obstetric hysterectomy in the University of Benin Teaching Hospital from January 1986 to December 2000. Data obtained from hospital records were analysed using appropriate computer statistical software for graphs and chi(2) test. In the period under study there were 20 344 deliveries. There were 46 obstetric hysterectomies, resulting in an incidence of 0.226%. Incidence increased with increasing maternal age from 0.10% at 20 years to 0.706% at 40 years and above. Incidence also increased with parity from 0.028% at para 0 to 1.298% for grandmultiparous women. The indications for the procedure were ruptured uterus 14/40 (35.0%), atonic postpartum haemorrhage 13/40 (32.5%) and placenta praevia 9/40 (22.5%); 12/40 (30.0%) of patients had previous caesarean sections. Subtotal hysterectomy had been undertaken in 43.5% of cases. There was a maternal mortality rate of 12.5%. Mortality was associated with torrential continuing haemorrhage and septicaemia. Urinary tract injury occurred in 7.50% of patients. Injury to the urinary tract was associated with previous caesarean section and total hysterectomy. Obstetric hysterectomy can have grave consequences. Availability of blood products, intensive monitors and limitation of family size is advised.

Exploring the causes of and risk factors for maternal deaths in a rural Nigerian referral hospital.

A 10-year (1990-9) review of all maternal deaths at Mater Misericordiae Hospital is presented. A total of 104 deaths occurred out of 13,391 deliveries (MMR 777/100,000). Haemorrhage, sepsis and Hypertensive diseases in pregnancy were the leading causes of death. Age below 15, Nulliparity, Grandmultiparity, low socio-economic class, lack of formal education and being unbooked were also significant risk factors. Delay in accessing health facility was also an identified contributing factor. Public enlightenment to encourage utilisation of antenatal facilities, prompt referral of complicated cases and adequate equipping of the referral hospital is suggested.

Outcome of prolonged pregnancy revisited in a Nigerian tertiary centre.

The study was conducted to evaluate whether routine induction of labour at 41-42 weeks of gestation has an increased risk for operative delivery, maternal or fetal complication compared with spontaneously initiated labour of similar gestation. A case-control study design was used; main outcome measures were caesarean section rate, instrumental delivery and fetal outcome. There was no significant difference in caesarean section rates 36(18.0%) in the induction group, compared with 28(13.8%) in parturient spontaneously initiating labour [P=0.24 odds ratio 95% CI 1.37 (0.78:2.43)]. Instrumental interventions were comparable in the two groups (5.5% and 4.0%). A subgroup analysis of nulliparous women was also not statistically different. Other than higher rates of admission into the neonatal unit in the induction group, fetal outcomes were similar. In conclusion, a routine induction of labour for prolonged pregnancy is safe, having no significant increase in caesarean section or fetal complications. The policy is advocated especially in developing countries, in view of the uncertainty of further prolongation of pregnancy beyond 42 completed weeks.

Sexual behaviour and contraceptive use among secondary school adolescents in Benin City, Nigeria.

This study was designed to examine sexual behaviour and contraceptive use among in-school adolescents in Benin City, Nigeria. A random sample of 431 females and 440 males aged 14-21 years from secondary schools in Benin City, Nigeria, were interviewed using a structured pretested questionnaire. The results show that 23% of the females and 40% of males had initiated sexual intercourse. Among those who had done so, the median age at first sexual debut was 16.8 years for girls and 15.4 years for boys. Only 22.2% of females and 23.9% of males used contraception at first sexual intercourse. Use of contraception among sexually active adolescents at last sexual debut declined to 18.6% for females and 22.2% for males. Forty-two per cent of sexually active adolescents engaged in high-risk sexual behaviour. In conclusion, the low prevalence of effective contraceptive use and time-related decline in usage indicate a need for greater emphasis on sex education aimed at adolescents in Nigeria.

Anaesthesia related complications following caesarean delivery necessitating intensive care unit admissions in a tertiary centre.

To determine the anaesthesia-related complications after caesarean section in a tertiary hospital, the hospital records of parturients admitted to the Intensive Care Unit (ICU) after caesarean section were studied. In a ten-year period, 2,686 women were delivered by caesarean section at the University of Benin Teaching Hospital, Benin City. Two thousand one hundred and two (78.3%) had emergency caesarean section while 584 (21.7%) had elective caesarean section. Of these, 2597 (96.7%) had general anaesthesia (GA) and 89 (3.3%) regional anaesthesia (RA). Within this period, 30 paturients (1.1%) were admitted to the ICU; one was after elective caesarean and 29 (96.7%) were after emergency caesarean section. Fifteen patients were admitted for anaesthesia-related complications, of which all were after caesarean section done under GA. The incidence of a major anaesthetic complication resulting in ICU admission was 15 in 2597 GA while it was zero in 89 RA (p < 0.01). Total maternal deaths in the ICU admissions were 11(36.7%); anaesthesia being directly the cause of death in 3 (27.3%) while non-anaesthetic factors accounted for 8 (72.7%) deaths. Emergency caesarean section and GA, were risk factors for anaesthesia-related morbidities after caesarean section. Preventable deaths due to poor laboratory support services and inadequate anaesthetic materials accounted for the anaesthesia-related mortalities.

Elevated serum glucose levels following ketamine intravenous anaesthesia: a report of 2 cases.

Ketamine is widely used as a sole anaesthetic agent in Nigeria, although data on its use and the associated side effects are generally lacking. This paper presents two cases of elevated blood glucose levels during caesarean deliveries under intravenous ketamine anaesthesia. Literature on complications of ketamine use is reviewed and the need for caution in the use of this drug as a single anaesthetic agent is emphasised.

Episiotomy in Nigeria.

OBJECTIVE: To review the incidence and complications associated with episiotomy and perineal tears at the University of Benin Teaching Hospital, Benin City, Nigeria. METHOD: A retrospective review of all vaginal births conducted in the hospital between January 1997 and December 1998 was undertaken. Vaginal births (1345) were reviewed. RESULT: The prevalence of episiotomy in the hospital during the period was 46.6%. Over 90% of primigravid parturients had episiotomy. The incidence of episiotomy decreased with increasing parity, while the incidence of spontaneous vaginal tears increased with parity. As compared with perineal tears, episiotomy was associated with a statistically significant increased risk of wound breakdowns requiring secondary resuturing. When controlled for parity, breech births, forceps and vacuum delivery were more likely to lead to episiotomy, compared to spontaneous vertex delivery occurring at term. CONCLUSION: A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy, the prevention of spontaneous perineal tears and the care of episiotomy wounds in this institution.