Estimation of fetal weight: a comparison of clinical and sonographic methods.

Fetal weight estimation is important in the management of labour and delivery. This study aimed to compare the accuracy of the clinical and ultrasound methods of fetal weight estimation. This was a prospective study involving 110 term cephalic singleton pregnancies delivered within 24 hours of clinical fetal weight estimation using Johnson's and Dare's formulae and ultrasound estimation at a Tertiary hospital in Abakaliki, Nigeria. The data were analysed with Stata 11 software. The sonographic estimation within 10% of the actual birth weight (ABW) of 68.2% was significantly greater than the accuracy of Johnson's (23.6%), Dare's (26.4%), and the combined clinical formulae (27.1%). The clinical methods overestimated the fetal weight. Both methods showed a positive correlation with the ABW. In conclusion, the sonographic method had a better accuracy than the clinical methods. However, fetal weight overestimation by clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude fear of complications from macrosomia. Impact statement What is already known on this subject? An accurate estimation of fetal weight is important in the management of labour and delivery. However, there is limited evidence that any of the available methods of fetal weight estimation is more accurate than the others. What do the results of this study add? This study showed that the clinical methods using Johnson's and Dare's formulae had a significantly higher mean percentage and absolute mean percentage error compared to the sonographic estimation of fetal weight. The sonographic estimation within 10% of actual birth weight (ABW) of 68.2% was significantly greater than that of Johnson's and Dare's formulae with 23.6% and 26.4%, respectively. All of the methods showed a positive correlation with the ABW. What are the implications of these findings for clinical practice and/or further research? This implies that the sonographic method has a better accuracy than the clinical methods in estimating the fetal weight. However, the overestimation of fetal weight by the clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude the fear of complications from macrosomia.

Experiences with provision of post-abortion care in a university teaching hospital in south-east Nigeria: a five year review.

The objective of the study was to review the implementation of Post Abortion Care and effective linkage to other post abortion services in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. Data on PAC over a five year period (July, 2004 to June, 2009) were analyzed and a standardized questionnaire was administered to 45 direct PAC service providers. Abortion complications constituted 41.4% of all Gynaecological admissions. Maternal mortality from complications of abortion was 11.5% of all the maternal mortality at the centre. Women aged 19 years and less were 37 (7.1%) and single women were 132, constituting 25.3% of all cases. About 31% of the PAC care providers had formal training for the implementation of the PAC services. Fifteen percent of the care givers were satisfied with the linkage between PAC and the Family Planning services. There is poor integration between emergency post abortion care and other reproductive health services in the centre.

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Background: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking

Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria.

BACKGROUND AND OBJECTIVE: To document bilateral tubal ligation (BTL) rates and highlight the need to improve on the rates. MATERIALS AND METHODS: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. RESULTS: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ± 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL. CONCLUSIONS: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section.

Higher-order multiple births in Abakaliki, Southeast Nigeria.

INTRODUCTION: Higher-order multiple births have implications for perinatal and maternal morbidity and mortality. This study aimed to determine the incidence and outcomes of higher-order multiple pregnancies in a rural area in Southeast Nigeria. METHODS: The study reviewed the data on all higher-order multiple deliveries conducted in two tertiary health institutions in Abakaliki over a seven-year period from January 2000 to December 2006. RESULTS: Higher-order multiple births constituted 0.13 percent of the 16,968 deliveries at the two institutions. There were 21 triplet births and one quadruplet delivery. Mothers with higher-order multiple pregnancies had more antenatal admissions for preterm uterine contractions and had more preterm deliveries. The vaginal route was the preferred method of delivery. Stillbirth was recorded in 12.7 percent of the triplets, with 25.5 percent involving triplets I, II and III, who suffered birth asphyxia. The perinatal mortality rate was 276 per 1,000. CONCLUSION: The Igbo women of Ebonyi State, Nigeria, have a high rate of higher-order multiple births. These are attended by increased obstetric and perinatal complications. Abdominal delivery is therefore recommended in order to reduce the rate of intrapartum stillbirth and birth asphyxia among triplets.

Cervical cytology profile of infertility patients in Abakaliki, South-eastern Nigeria.

Cervical cancer is of public health importance in developing countries. High risk sexual behaviour is a risk factor. This cross-sectional study aimed at establishing the cervical cytology profile of infertile women in Abakaliki, Nigeria. It involved 200 infertility patients and 200 general gynaecological patients. They were interviewed with a structured questionnaire and screened for pre-malignant cervical changes. A total of 28 infertility patients (14.9%) and 34 general gynaecological patients (17.7%) had epithelial cell abnormalities. A total of 21 infertility patients had cytology positive for pre-malignant changes, comprising: seven with atypical squamous cells of undetermined significance (ASCUS) (3.7%); eight with a low-grade squamous intraepithelial lesion (LSIL) (4.3%); and six with a high-grade intraepithelial lesion (HSIL) (3.2%). There were 25 general gynaecological patients who had cytology positive for pre-malignant changes, comprising: eight ASCUS (4.2%); seven LSIL (3.5%); and ten HSIL (5.2%). The distribution did not attain statistical significance. Infertility did not increase the risk of development of cervical pre-malignant changes.

Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria.

BACKGROUND: Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria. METHODS: To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study. RESULTS: The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients. CONCLUSION: The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care.

Risk factors and perinatal outcome of umbilical cord prolapse in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria.

AIM: The goal of this study was to identify risk factors associated with umbilical cord prolapse and to document the perinatal outcome of cases of cord prolapse. MATERIALS AND METHODS: During the period of the study (from July 1, 2001 and June 30, 2007), forty-six cases of umbilical cord prolapse were identified from the labor ward record and analyzed retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. RESULTS: During the period of the study, 46 cases of cord prolapse were encountered out of 10,080 deliveries which was 0.46% of all deliveries. Of the 46 fetuses with umbilical cord prolapse 32.6% had a fetal weight of less than 2.5 kg compared with 15.2% for fetuses in control group (P<0.012). The umbilical cord prolapse occurred in association with breech presentation eleven times (23.9%) and transverse presentation seven times (15.2%). The occurrence of breech presentation among the control cases was 4.3% (P<0.00031), and that of transverse lie was 4.4% (P<0.02007). Among the women that had cord prolapse, 47.8% had unbooked pregnancies compared with the control group with 14.5% (P<0.0000033). Multiparity accounted for 78.3% in the cord prolapse cases and 68.1% in the controls (P=0.19). The perinatal mortality rate was 413/1000. (41.3%), compared to the perinatal mortality of 58/1000 for the control group. CONCLUSIONS: Our findings in this study has confirmed an association between increased risk of umbilical cord prolapse and abnormal fetal presentation, low birth weight and unbooked status. It is therefore suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care and this will enhance the early identification of these risk factors and an appropriate management instituted to reduce perinatal mortality.

Risk Factors and Perinatal Outcome of Umbilical Cord Prolapse in Ebonyi State University Teaching Hospital; Abakaliki; Nigeria

Aim: The goal of this study was to identify risk factors associated with umbilical cord prolapse and to document the perinatal outcome of cases of cord prolapse. Materials and Methods: During the period of the study (from July 1; 2001 and June 30; 2007); forty-six cases of umbilical cord prolapse were identified from the labor ward record and analyzed retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. Results: During the period of the study; 46 cases of cord prolapse were encountered out of 10;080 deliveries which was 0.46of all deliveries. Of the 46 fetuses with umbilical cord prolapse 32.6had a fetal weight of less than 2.5 kg compared with 15.2for fetuses in control group (P0.012). The umbilical cord prolapse occurred in association with breech presentation eleven times (23.9) and transverse presentation seven times (15.2). The occurrence of breech presentation among the control cases was 4.3(P0.00031); and that of transverse lie was 4.4(P0.02007). Among the women that had cord prolapse; 47.8had unbooked pregnancies compared with the control group with 14.5(P0.0000033). Multiparity accounted for 78.3in the cord prolapse cases and 68.1in the controls (P=0.19). The perinatal mortality rate was 413/1000. (41.3); compared to the perinatal mortality of 58/1000 for the control group. Conclusions: Our findings in this study has confirmed an association between increased risk of umbilical cord prolapse and abnormal fetal presentation; low birth weight and unbooked status. It is therefore suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care and this will enhance the early identification of these risk factors and an appropriate management instituted to reduce perinatal mortality

The incidence, pattern and management outcomes of early pregnancy losses at the Ebonyi State University Teaching Hospital, Abakaliki.

BACKGROUND: Early pregnancy losses are a source of deep emotional trauma to any woman, her family and the attttending Gynaecologist. This study evaluated the prelence, pattern and management outcomes of such losses at a tertiary Health Institution. METHODS: Data of all women who suffered early pregnancy losses between 1st January, 2002 and 31st December, 2004, were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event, their socio demographics, obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate. RESULTS: Early pregnancy losses comprised miscarriages, molar pregnancy and ectopic gestations accounted for 32.1% of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8% attended all forms of early pregnancy losses during the period. CONCLUSION: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome.

The role of unorthodox and traditional birth care in maternal mortality.

Many pregnant women see unorthodox medical providers in labour before presentation to the modern medical facilities after obstetric complications have arisen. This study evaluates the contribution of unorthodox medical facilities to the delays subsisting maternal mortality in a rural, poor and illiterate community. Data was collected prospectively on all referrals from outside the St. Vincent's hospital, over a three-year period. Seven hundred and fifty women were referred to the hospital and there were a total of thirty maternal deaths out of the 1268 live births, giving a maternal mortality ratio of 2366/100,000. Most of the referrals were patient-driven and verbal and came from traditional birth attendants (TBAs). The majority of the patients (86.7%) came in poor clinical conditions and some were moribund. The TBAs contributed most to maternal deaths. Prolongation of labour for more than 24 hours correlated positively with maternal mortality. Ruptured uterus complicating obstructed labour (34.8%) and haemorrhage (30.4%) were the leading causes of death in this series. The mortal delay suffered by pregnant women in accessing unorthodox medical attention deserves further attention in issues of maternal mortality in the underserved rural communities of Nigeria.

Avulsion of the perineal body in a single nulliparous woman following a motorcycle accident: a case report.

Miss OO was seen at the gynaecology clinic in April 2008 with history of a road traffic accident three years earlier. She was thrown off a motorcycle and fell astride a culvert, sustaining perineal injury. She was treated at a private hospital, but subsequently developed faecal incontinence and was usually soiled with faecal matter during coitus. Examination revealed loss of perineal body and reconstruction was done, with success. With increase in motorcycle accidents on our roads, many more gynaecologically-related traumas are bound to occur. Proper and timely referral will lead to improved management with reduced psychosocial trauma. Organized awareness creation programmes will reduce these accidents in the long-term.

Obstetric performance recall accuracy (OPERA) among a low literacy population in Southeast Nigeria.

CONTEXT: Accurate obstetric history is of utmost importance in prenatal care to ensure optimal maternal and fetal outcomes. AIMS AND OBJECTIVES: To determine the accuracy of recalled obstetric history among rural Igbo women of Southeast Nigeria. STUDY DESIGN: Primiparous and multiparous women, who accessed antenatal care in a rural Mission Hospital over a two-year period, had their past obstetric histories recorded in a pro forma by trained research assistants. The information so obtained was compared with the previous obstetric data documented in the patients' hospital case files to evaluate their correctness. Univariate analysis was performed for statistical evaluation using the epi info package version 3.3.2 of 2005. RESULTS: Two hundred and thirty-five antenatal clinic attendees aged between 18 and 41 years were recruited for the study. Low literacy level is prevalent in rural communities of Southeast Nigeria. The ability of the women to accurately recall past obstetric events, including major pregnancy risk factors, was considerably limited. The recall accuracy for details of the immediate past pregnancy was 43.6% and 41.3% for the penultimate pregnancy. Patient's educational attainment, but not her age or parity, had significant influence on the recall ability. CONCLUSION: The introduction of the Obstetric performance card for use in the busy antenatal clinics in low literacy rural communities of the developing countries such as Nigeria, will corroborate the information obtained from patients and greatly enhance the management and positive outcomes of the index pregnancy.

Pattern and determinants of domestic violence among prenatal clinic attendees in a referral centre, South-east Nigeria.

Gender-based violence, though deeply entrenched in some cultures and religions, has remained a neglected area in health research in South-east Nigeria. This study assessed the prevalence, pattern and background factors precipitating domestic violence in a population of prenatal clinic attendees. This was a cross-sectional questionnaire-based study. Booked antenatal women were recruited into the study after informed consent. Trained research assistants administered the questionnaires in the local dialects of the women. Analysis was by the Epi Info Statistical Software package version 3.2.2 of 2005. A total of 500 women were involved in the study that spanned 3 months. Of these, 68 were exposed to gender-based violence. Verbal abuse/insult was the commonest form of male engendered violence. Others were sexual abuse, financial deprivation, threats and physical harm. Financial and domestic issues were the major sources of disagreements. Some 17.6% sustained physical injury, while all admitted to some degree of psychological trauma. Routine assessment in a non-judgemental way of antenatal population for gender-based violence is advocated. This will determine the true prevalence and pattern of domestic violence, and form a rational basis for the formulation of interventional strategies.

Uterine fibroids in a tertiary health centre South East Nigeria.

BACKGROUND: Uterine fibroids are common benign tumours of the female reproductive tract. This study evaluated the clinical presentations and the treatment of fibroids at Ebonyi State University Teaching Hospital over the 5-year period (2001-2005). METHODS: A retrospective analysis of all cases of uterine fibroids admitted into the gynaecological ward of the Ebonyi State University Teaching Hospital (EBSUTH) over the five-year period (2001-2005). RESULTS: Uterine fibroids accounted for 13.6% of all gynaecological admissions during the period. It was found predominantly during the third and fourth decades of life in nulliparas and women of the higher socio economic class. Primary infertility (22.9%), lower abdominal mass (21. 6%), menstrual abnormalities (15.9%), lower abdominal pain (15.9%) and anaemia (11.8%) were the common clinical presentations while abdominal myomectomy was the commonest modality of treatment employed (90%). CONCLUSION: Uterine fibroid is common among gynaecological admissions in Igbo women of Southeastern Nigeria. Infertility is a common presentation necessitating abdominal myomectomy in majority of the cases.

Retained placenta aspect of clinical management in a tertiary health institution in Nigeria.

BACKGROUND: Retained placenta is a significant cause of postpartum haemorrhage, maternal morbidity and occasionally mortality. This study assessed the clinical presentation, management and outcomes of retained placenta at the Ebonyi State University teaching Hospital. METHOD: Analysis of records relating to retained placenta managed in the hospital over a three year period (August 2003 to July 2006. RESULTS: The incidence of retained placenta was 0.22% (1 in 456 vaginal deliveries). Eleven (32.4%) patients were admitted with retained placenta following home delivery. Two (5.6%) delivery in a peripheral hospital, 6 (17.7%) delivered in a. Health center and 2 (5.9%) delivered in a maternity home. Preterm deliveries accounted for 17.7% of the cases. Eighteen parturient were admitted in shock. One patient had hysterectomy for adherent placenta. CONCLUSION: Improved peripatum services, education on the dangers of unsupervised home deliveries, women empowernment and prompt referral for emergency obstetrics care will reduce the associated mortality and morbidity.

Sociocultural impediments to male factor infertility evaluation in rural South-east Nigeria.

This study evaluated the rate and factors influencing male uptake of infertility investigations. Infertility constituted 11.2% of all new gynaecological consultations in the centre during the study period. A total of 61 (70.1%) males consented to seminal fluid studies without much hesitation, 12.4% after much persuasion, while the remainder (17.5%) refused. Obliging doctor's recommendation was the primary motivation for those who willingly had seminal fluid studies while the claim to be healthy and not being responsible for infertility were the commonest barriers for reluctance or refusal to be investigated. Fears of exposure of semen so obtained to witchcraft and rituals were also contributory. Gynaecologists working in rural South-east Nigeria should through systematic public enlightenment dispel misconceptions of necessary medical intervention.

Patterns of menopausal symptoms and adaptive ability in a rural population in South-east Nigeria.

We set out to assess menopausal symptoms and the adaptability to them in a Nigerian population. This was a cross-sectional survey using a self-administered questionnaire and supplemented with focus group discussion carried out on a rural postmenopausal population in South-east Nigeria. Data were analysed using the epi Info version 3.3.2. Data from 186 were analysed. The mean age of women at the time of interview was 49.6+/-6.3 years. Mean and median ages at menopause were 45.47+/-5.5 years and 47 years, respectively. The major symptoms at menopause were: hot flushes 36 (58.1%), sweating 25 (40.3%), urinary frequency 24 (38.7%), vaginal dryness, discomfort or discharge 22 (35.5%), lack of concentration 17 (27.4%) and irritability 15 (24.2%). Widowhood and the empty nest syndrome but not educational attainment imparted negatively on the ability of the women to cope with the menopausal symptoms. Menopausal symptoms are a health concern to the Christian population in South-east Nigeria. Doctors working in this environment should utilise the opportunity of clinical consultation to raise and discuss these symptoms with postmenopausal women.

Advocating the new WHO antenatal care model in a free maternity care setting in a developing country.

In a free maternity care setting the number of antenatal clients can be overwhelming for the obstetric staff. Using the World Health Organization (WHO) classifying form, most of the women can be triaged for the basic component of the new WHO antenatal care model. Our aim was to evaluate the risk status of pregnant women in a tertiary health institution providing free maternity care in Nigeria. We interviewed 1022 randomly selected clients using the WHO classifying form at our booking clinic over a 12-month period. The analysis was performed using the epi info statistical program. Seven hundred and sixty-five clients (74.9%) were found eligible for the basic component of the new antenatal care model. The associated risk in pregnancy increased with increasing parity. The basic component of the new WHO antenatal care model can safely be implemented in centres such as ours.