Risk factors for preterm delivery in south western Nigeria.

This was a case-control study to determine the risk factors of preterm delivery among Nigerian women seen at Obafemi Awolowo University teaching hospital, Ile-Ife, Nigeria over a period of 9 months. All women delivering preterm were recruited into the study, with two consecutive term deliveries after each preterm delivery serving as controls. Information obtained from the women includes socio-demographic characteristics, past reproductive and present pregnancy history and outcome. Laboratory investigations were conducted as necessary. Bivariate analysis revealed 21 potential risk factors, however, following adjustment by multiple logistic regression only previous preterm delivery (OR 4.68, 2.24-6.31), previous second trimester spontaneous abortion (OR 4.48, 2.32-8.54), heavy and stressful occupation (OR 3.56, 1.05-6.45), premature rupture of fetal membrane (OR 3.46, 1.04-6.45), maternal medical disorders (OR 3.13, 1.56-5.16), body mass index at delivery of less than 23 (OR 3.01, 1.56-5.43), antepartum haemorrhage (OR 2.73, 1.18-6.34), maternal febrile illness (OR 2.84, 1.32-4.52), intrauterine growth retardation (OR 2.14, 0.98-2.34) and multiple pregnancy (OR 1.98, 1.02-2.68) remained as significant factors.

Retained second twin: experience from Ile-Ife, Nigeria.

BACKGROUND: Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus. OBJECTIVE: To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution. DESIGN: Retrospective review over a 12 year period from January 1988 to December 1999. SETTING: Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria. SUBJECTS: All cases of retained second twin managed during this period. MAIN OUTCOME MEASURES: Causes, sources of referral, perinatal and maternal complications. RESULTS: The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively. CONCLUSION: The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres.