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.

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.

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.

A 20-year review of twin births at Mater Misericordiae Hospital, Afikpo, South Eastern Nigeria.

OBJECTIVES: To provide information on twin deliveries among Igbos in a rural/semi-urban community of South-Eastern Nigeria, and compare the twinning rate with data from the other two major tribes. METHODS: An analysis of the records of deliveries conducted over a 20-year period in a rural/semi-urban community of South-Eastern Nigeria. RESULTS: The twinning rate of the community was 1:24, and increased with increasing maternal age, and generally with birth rank. Twin births were associated with a MMR of 895/100,000, and PMR of 213/1000 maternities, figures 3.4 and 1.7 times those of the total maternal and perinatal mortalities respectively. Ninty percent of the twin mothers delivered vaginally, 2% with the aid of symphysiotomy. Caesarean section rate was 10.6%. CONCLUSION: The twinning rate within Nigeria may probably be dictated by location rather than ethnicity. The maternal and perinatal mortalities associated with twin pregnancies in this study appear higher than for singleton births.

Menstruation in rural Igbo women of south east Nigeria: attitudes, beliefs and practices.

Many cultures hold on to different beliefs and retain community-defined restrictions for menstruating women. The Igbo society of southeast Nigeria is rich in culture, myths and superstitions but, surprisingly no documentation exists on menstrual beliefs and practices among the population. This questionnaire-based cross sectional study supplemented with in-depth interviews evaluated the beliefs, myths and traditional practices associated with menstruation within rural Igbo communities. It revealed that the menstrual egress is of great significance in Igbo culture and must be disposed of carefully to avoid exposure to witchcraft and rituals. Some respondents observed self-imposed restrictions on exercises, food items, visits and sex in order to maintain physical and spiritual cleanliness, lessen discomfort and avoid embarrassment. Gynaecologists working in this region should utilize the opportunities of clinical consultations to discuss menstrual health issues with their female patients and educate them on the physiology and significance of menstruation.

Menstruation in rural igbo women of South East Nigeria : attitudes, beliefs and practices

Many cultures hold on to different beliefs and retain community-defined restrictions for menstruating women. The Igbo society of southeast Nigeria is rich in culture, myths and superstitions but, surprisingly no documentation exists on menstrual beliefs and practices among the population. This questionnaire-based cross sectional study supplemented with in-depth interviews evaluated the beliefs, myths and traditional practices associated with menstruation within rural Igbo communities. It revealed that the menstrual egress is of great significance in Igbo culture and must be disposed of carefully to avoid exposure to witchcraft and rituals. Some respondents observed self-imposed restrictions on exercises, food items, visits and sex in order to maintain physical and spiritual cleanliness, lessen discomfort and avoid embarrassment. Gynaecologists working in this region should utilize the opportunities of clinical consultations to discuss menstrual health issues with their female patients and educate them on the physiology and significance of menstruation. (Afr Reprod Health 2008; 12[1]:109-115)

Age at menarche and the menstrual pattern of Igbo Women of South-east Nigeria

This study determines the age at menarche and menstrual pattern of an Igbo population in 12 randomly selected rural communities of Ebonyi State. Information on recalled ages at menarche, menstrual flow duration and cycle length was collected using a semi structured questionnaire over three months. 1209 women of reproductive age were interviewed. The mean age at menarche was 15.0 years and this declined over the years. The mean menstrual flow duration and cycle lengths were 3.3 days and 29.7 days respectively. Only 10.2% had a menstrual cycle length of 28 days. Account should be taken of the average length of 29-30 days in the rural Igbo population when calculating the expected date of delivery and in the family planning clinics. (Afr Reprod Health 2008; 12[1]:90-95)

Congenital malformations in singleton and twin births in rural Nigeria.

BACKGROUND: The presence of a congenital malformation at birth is a cause of anxiety at an otherwise joyous occasion. Congenital malformations are a significant contributor to perinatal mortality. STUDY DESIGN: A retrospective study of external congenital abnormalities in singleton and twin births in rural eastern Nigeria over a 20 year period. RESULT: The incidence of congenital defects for all deliveries was 110.8/10,000 births. Of 1453 twins and 32206 singleton births, there were 58 and 315 congenital abnormalities, with incidence of 97.8/10,000 births and 399.2/10,000 births respectively. Twins were significantly (x(2) =115.22; p< 0.0000) more likely to have a congenital malformation than singletons (RR 4.08, 95% CI 3.10 - 5.7). The pattern of defects was similar for singleton and twin births and the leading system affected was the musculo-skeletal system, distantly followed by the central nervous system. For both groups the commonest malformation was ulnar polydactyly, followed by hydrocephaly and ankyloglossia. Surprisingly no conjoined twins were recorded and there were only 7 cases of congenital umbilical hernia, abnormalities previously considered to be very common in Nigerians and Africans respectively. CONCLUSION: Twins are about four times more likely to have congenital malformations than singletons. The overall prevalence of congenital malformations recorded is comparatively low. There is need for more detailed routine documentation of all birth defects including post-mortem report and the conduct of prospective population-based epidemiological surveys of birth defects in Nigeria.

A comparative study of marital status on the academic performance of the female medical undergraduate in a Nigerian university.

OBJECTIVE: To examine the effect of marriage, pregnancy and child bearing on the academic performance of the Nigerian female medical student. METHOD: Self administered cross sectional questionnaires were distributed to female and male medical students of Ebonyi State University, Nigeria. Academic records were examined, and data obtained analysed using the Epi info statistical software package. RESULTS: Sixteen (19.3%) of the female students were married, thirteen after admission into the Faculty. Fourteen of these had children and mean parity was 2. The married female students were older, had more resit examinations than their male and single female counterparts. The difference was statistically significant. CONCLUSION: Marriage and child bearing which play a central and prominent role in the traditional African culture, may serve as an additional burden on the Nigerian female medical student, affecting her academic performance. The specific problems associated with marriage, pregnancy and childbirth need to be recognised, addressed and reflected in a modern medical curriculum.

Quintuplet pregnancy. [case report]

A 32 year-old nigerian woman who was admitted with premature rupture of the fetal membranes in the thirty-fifth week of her quintuplet pregnancy is presented. Management is discussed

Vaginal delivery in Nigerian women after a previous cesarean section.

A total of 154 consecutive Nigerian women at term pregnancy who had undergone one previous cesarean delivery were prospectively studied during the year March 1987 to February 1988. A repeat elective cesarean section was performed in 52 (33.8%) patients. Vaginal delivery was achieved in 73 (71.6%) of the 102 subjects who were allowed into labor, and in over 90% of the comparison group. High vaginal delivery rates occurred among the women within the selection criteria irrespective of the indication for the previous cesarean section. A repeat emergency cesarean section was performed in 29 (24.5%) women. Rupture of the uterine scar occurred in 5 (4.9%) instances with the loss of 2 babies; there was no maternal loss. Excluding the high incidence of fetal asphyxia and uterine rupture which occurred among women in the study group, maternal morbidity and perinatal mortality and morbidity were similar to those of the comparison group. There was a statistically significant difference between the study and comparison group. There was a statistically significant difference between the study and comparison groups with regard to the mode of delivery. Among the study group, a significant correlation existed between the vaginal delivery rate of the patients and the indication for the primary cesarean section. There was however, no significant difference between the mean parities of the women who were delivered by cesarean section and those who delivered vaginally. Similarly, no significant difference existed in the mean birthweights of the babies delivered vaginally and those who were delivered abdominally during labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Fertility and fetal salvage among women with uterine leiomyomas in a Nigerian Teaching Hospital.

Fertility and pregnancy outcome among 141 Nigerian women with uterine leiomyomas and 270 married gynaecological subjects matched for age and parity were studied. The preoperative spontaneous abortion incidence and fetal salvage among the 68 women in the study group who had previously been pregnant were 61.8% and 78.8%, respectively. Corresponding figures among women in the comparison group were 5.3% and 95.6%. Macroscopic evidence of pelvic sepsis was found at operation in 36.2% of all the women in the study group, and in 57.7% of those who complained additionally of infertility. The overall pregnancy rate following myomectomy was 37.9%, and 9.6% in those women whose presenting complaints included infertility. The mean operation-to-conception interval in the study group was 15.7 months. The fetal salvage increased to 93.5% in the women who conceived after myomectomy, and their incidence of abortion fell markedly, to 11%. Most of the deliveries (79%) in the women after myomectomy were by cesarean section. A reappearance of uterine leiomyomas occurred in 13.7% of the women. The relatively low incidence of pelvic sepsis in this series may partly be responsible for the finding of menorrhagia, rather than abdominal pain, as the commonest complaint of the women with leiomyoma.

Observations on molar pregnancy in Enugu, Nigeria.

Forty-one molar pregnancies seen at the University Teaching Hospital Enugu, Nigeria during the 10-year period 1976-1985 are analyzed. The incidence of hydatidiform mole was 0.82 per 1000 pregnancies. The incidence of molar pregnancy was lowest among teenage women and increased markedly with advancing age over 35 years. Hyperemesis gravidarum, a relatively uncommon finding in Nigerian women during normal pregnancy was a prominent feature of molar pregnancy in the women. The incidence of postmolar gestational trophoblastic disease was 17%; choriocarcinoma occurred in 7% of the subjects. Molar pregnancy and postmolar malignant trophoblastic disease occurred much less frequently among the Igbo women of Enugu than the Yorubas of western Nigeria. Earlier and better recognition and treatment of hydatidiform mole will probably result in a decrease in the high rate of complications found during this study.

Non-Hodgkin's lymphoma of the uterus in a child.

A unique case of a 14-year-old girl with malignant lymphocytic lymphoma of the uterus clinically misdiagnosed as sarcoma botyroides is presented. Total abdominal hysterectomy was performed followed by limited chemotherapy. The patient is asymptomatic and without clinical evidence of tumor 38 months after the onset of symptoms.