Chlamydia trachomatis seropositivity among women with tubal factor infertility and fertile controls: a comparative study.

Introduction: Chlamydia trachomatis is the most reported bacterial sexually transmitted infection and if not properly treated may lead to tubal blockage. Tubal factor infertility is the most common form of infertility in Nigeria. This study was designed to determine the usefulness of chlamydia antibody testing in diagnosis of tubal factor infertility. Methods: this was a comparative cross-sectional study conducted in Olabisi Onabanjo University Teaching Hospital Sagamu. One hundred and forty-seven women with tubal blockage on hysterosalpingography and confirmed with laparoscopy, and pregnant control were recruited using convenience sampling method. Information obtained and chlamydia assay results were entered into a computer and analyzed using SPSS version 21. Chi-square was used to determine association between categorical variables. Logistic regression analysis was used to determine the risk factors associated with chlamydia infection. Results: ninety-four (63.9%) of the women with tubal factor infertility were positive for chlamydia IgG antibodies while 37(25.2%) women in the control group had positive results for IgG antibody. This was statistically significant (P=0.001). Analysis using multivariate logistic regression shows early age of coitarche, presence of multiple sexual partners and previous sexually transmitted infection were significantly associated with chlamydia infection (P=0.001). Conclusion: there was a strong association between chlamydia seropositivity and tubal blockage. Early age at coitarche, previous sexually transmitted infection and multiple sexual partners are significant risk factors for chlamydial infection. Chlamydia trachomatis antibody testing could be used as marker for tubal blockage when evaluating infertile patient.

Depot-medroxyprogesterone acetate: Lipid profile changes and associated cardiovascular risks among acceptors in Sagamu, South West Nigeria.

Depot-medroxyprogesterone acetate (DMPA) is a highly effective long acting reversible contraceptive. Alterations in lipid profile have been associated with use of DMPA, however there is considerable debate about how profound these effects are. Hence the aim of this study is to determine the effect of DMPA on lipid profile and the associated cardiovascular risks. This was a prospective longitudinal study conducted at the family planning clinic of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State. Sixty eight new acceptors of DMPA who had their blood samples collected for lipid profile assays at initiation of DMPA, and then at 3 months and 6 months. Data were analyzed using SPSS version 24. After 3 months of DMPA use, there was statistically significant increase in serum Total Cholesterol (TC) concentration (P=0.022), serum Low Density Lipoprotein (LDL) concentration (P=0.033), non significant increase in serum Triglyceride (TG) concentration (P=0.150) and non-significant decrease in serum Higher Density Lipoprotein (HDL) concentration (P=0.076). However, after 6 months of DMPA use, there was statistically significant increase in serum TC concentration (P=0.002), serum LDL concentration (P=0.003), serum TG concentration (P=0.001) and significant decrease in serum HDL concentration (P=0.001). DMPA use is associated with increased serum TC, TG, LDL, and reduction in HDL after 6 months of use. These changes in lipid profile may increase the risk of cardiovascular diseases.

Prevalence and predictors of squamous intraepithelial lesions in human immunodeficiency virus positive women in Sagamu, southwest Nigeria.

Background: Cervical cancer is still a public health problem in many developing countries, like Nigeria. HIV infection makes HPV infections last longer, progress to squamous intraepithelial lesion of the cervix, and eventually lead to invasive cervical cancer. Objective: Find out how often squamous intraepithelial lesions (SIL) happen and what causes them in HIV-positive women in Sagamu, southwest Nigeria. Methods: A cross-sectional study was done with 165 women with HIV and 165 women without HIV. Pap smears were done on all of the people in the study. The data was looked at with IBM-SPSS Windows v. 23. Results: Both groups were about the same age and had the same number of children (P=0.194 and P=0.388, respectively). The participants' average age (SD) was 36.8 (5.6), and the median number of children they had was 3. HIV-positive women were much more likely to have an abnormal cytology smear (24.8%) than HIV-negative women (7.3%) (2 = 18.904, P 0.001). There wasn't a link between having HIV and the severity of cervical lesions (2 = 3.66, P = 0.162). A CD4 cell count of less than 350 cells/mm3was found to be a strong predictor of an abnormal cervical cytological smear in HIV-positive women (AOR: 25.5; CI: 8.8-73.5; P 0.001). Conclusion: In Sagamu, Nigeria, the number of HIV-positive women with SIL of the cervix was much higher than the number of HIVnegative women with SIL of the cervix. HIV-positive women, especially those with a low number of CD4 cells, need cervical smear tests more often. This will make sure that pre-invasive lesions are found and treated as soon as possible.

Breastfeeding Practices among Mothers in Southwest Nigeria.

BACKGROUND: This study was conducted to determine the breastfeeding practices among parous antenatal attendees in two teaching hospitals in Southwest Nigeria. METHODS: A cross-sectional study was carried out on 340 parous antenatal clinic attendees in two teaching hospitals in Ogun State, Nigeria. A structured questionnaire was used to obtain data on breastfeeding practices. Data were analyzed using Statistical Package for Social Sciences (SPSS) windows version 21.0 (IBM Corp., Armonk, NY, USA). RESULTS: Out of a total of 340 women, 319 (93.8%) breastfed their last babies. The median duration of breastfeeding was 15 months. One hundred and thirty two women (38.8%) initiated breastfeeding within 30 minutes of delivery, and 200 women (58.8%) exclusively breastfed their babies for six months. The majority of the women, 299(87.9%k) did not report any problem associated with breastfeeding. Logistic regression analysis showed that women who had no breastfeeding problems were more likely to exclusively breastfeed their infants for six months compared to those with breastfeeding problems (AOR 3.4; CI 1.6-7.1; P=0.001). Similarly, women who got breastfeeding information from mass media were more likely to practice exclusive breastfeeding for six months compared to those that got breastfeeding information from other sources (AOR42.2; CI 3.1-568.5; P=0.005). CONCLUSION: Exclusive breastfeeding is suboptimal in Ogun State, Nigeria. Provision of breastfeeding information via mass media will assist in improving breastfeeding practice. Educating mothers on the techniques that help to prevent breastfeeding complications will also be beneficial.

Abdominal Pregnancy: A Case Report of a Viable Nondysmorphic Fetus.

Abdominal pregnancy is a rare form of ectopic gestation. It accounts for about 0.4% of all cases of ectopic pregnancy, and often associated with significant morbidity and mortality. Clinical presentation varies, and diagnosis is commonly challenging. Although ultrasound is helpful in early gestation, this could be unsatisfactory at advanced gestational age. Hence, a high index of suspicion is required in the diagnosis. We present a case of secondary abdominal pregnancy in a 27-year-old gravida 2 para 0 + 1 at an estimated gestational age of 33 weeks and 5 days. She had ultrasound scan done at 9 weeks and 2 days confirming the diagnosis, but declined surgery to seek spiritual intervention. She subsequently presented with generalized abdominal pain and fainting attack. She had exploratory laparotomy with delivery of a live female baby with no congenital anomaly. The placenta was attached to the left infundibulopelvic ligament and was delivered wholly without remnants. She was discharged on the 8th postoperative day, and the baby was discharged after 14 days from the neonatal intensive care unit. Accurate diagnosis and prompt intervention with evaluation of placenta attachment is vital to prevent adverse consequences.

Labor Analgesia in South West Nigeria: Methods and Self-reported Effectiveness.

Context: Labor exposes many women to severe pain. Effective labor pain management is one of the prerequisites for a satisfying labor experience. Aim: The aim of this study was to assess the labor pain management practices and patients' assessment of adequacy of pain relief in two tertiary hospitals in South West Nigeria. Materials and Methods: This was a cross-sectional study involving 132 pregnant women who had a noninstrumental vaginal delivery at the obstetric units of Babcock University Teaching Hospital and Olabisi Onabanjo University Teaching Hospital, between December 2017 and May 2018. A structured questionnaire was administered to women within 24 h of delivery to record details of labor and delivery, the form of labor analgesia administered and respondents' perceived effectiveness of the analgesia. Data were analyzed using the IBM-SPSS statistics for Windows version 21.0 (IBM, Armonk, New York). Results: Sixty-six (50%) women rated labor pain to be severe. Thirty-eight women (28.8%) did not receive any pain relief during labor. Nonpharmacological pain management practices such as back massage, breathing exercises, and companionship were administered to 45(34.1%), 79(59.8%), and 45(34.1%) women, respectively. Nine women (6.8%) received intramuscular pentazocine (30 mg) for labor analgesia. There was a statistically significant association between use of back massage and severe labor pain perception (χ 2 = 4.080; P = 0.043). Self-reported effectiveness was highest among users of back massage (82.2%) and companionship (77.8%). Conclusions: There is a large unmet need for labor analgesia in South West Nigeria. Nonpharmacological pain management practices were the most frequently used methods, and most patients experienced reduction in severity of pain. There is need for improvements in obstetric analgesia services in our maternity units.

Contexte: Le travail expose de nombreuses femmes à des douleurs intenses. Une gestion efficace de la douleur du travail est l'une des conditions préalables à une expérience de travail satisfaisante. Objectif: Évaluer les pratiques de gestion de la douleur du travail et l'évaluation par les patientes de l'adéquation du soulagement de la douleur dans deux hôpitaux tertiaires du sud-ouest du Nigéria. Méthodologie: Il s'agissait d'une étude transversale portant sur 132 femmes enceintes qui ont eu un accouchement vaginal non instrumental dans les unités d'obstétrique de l'hôpital universitaire de Babcock et de l'hôpital universitaire d'Olabisi Onabanjo, entre décembre 2017 et mai 2018. Un questionnaire structuré a été administré aux femmes dans les 24 heures suivant l'accouchement pour enregistrer les détails du travail et de l'accouchement, la forme d'analgésie du travail administrée et l'efficacité perçue de l'analgésie par les répondantes. Les données ont été analysées à l'aide des statistiques IBM-SPSS pour Windows version 21.0 (IBM Corp., Armonk, NY, USA). Résultats: Soixante-six (50%) femmes ont évalué la douleur du travail comme étant sévère. Trente-huit femmes (28,8%) n'ont reçu aucun soulagement de la douleur pendant le travail. Des pratiques de gestion de la douleur non pharmacologiques telles que le massage du dos, les exercices de respiration et la compagnie ont été administrées à 45 (34,1%), 79 (59,8%) et 45 (34,1%) femmes respectivement. Neuf (9) femmes (6,8%) ont reçu de la pentazocine intramusculaire (30 mg) pour l'analgésie du travail. Il y avait une association statistiquement significative entre l'utilisation du massage du dos et la perception d'une douleur intense au travail (χ2 =4.080; P = 0.043). L'efficacité autodéclarée était la plus élevée parmi les utilisateurs de massage du dos (82,2%) et de compagnie (77,8%). Conclusions: Il existe un grand besoin non satisfait d'analgésie du travail dans le sud-ouest du Nigeria. Les pratiques de gestion de la douleur non pharmacologiques étaient les méthodes les plus fréquemment utilisées et la plupart des patients ont connu une réduction de la sévérité de la douleur. Il est nécessaire d'améliorer les services d'analgésie obstétricale dans nos maternités.

Structured Antenatal Counselling and Postpartum Contraceptive Uptake in South West Nigeria.

Background: Antenatal clinic is an opportunity to counsel women on the need for postpartum contraception. This study was designed to determine the effect of structured antenatal counselling on postpartum contraceptive uptake. Materials and Methods: A prospective intervention study was conducted in the antenatal clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu from July 15, 2018 to June 31, 2019. Two hundred antenatal attendees were randomly allocated to intervention and control groups. Women in the control group had routine antenatal counselling by the nurses/midwives, whereas those in the intervention group had well-structured antenatal contraceptive education sessions at each antenatal visit. A data capture sheet was used to obtain relevant information at presentation in labor and completed 6 months postpartum through phone conversation. Results: The overall contraceptive acceptor prevalence was 35.5%. Majority of the contraceptive acceptors (42.3%) opted for intrauterine contraceptive devices. The contraceptive prevalence among the intervention group was 45% when compared with 26% among the controls. This was statistically significant (χ 2 =7.883, P = 0.005). However, after multivariate logistic regression analysis, the intervention (structured antenatal counselling) was not found to be a significant determinant of postpartum contraceptive uptake [adjusted odds ratio (AOR) 1.0; confidence interval (CI) 0.4-2.2; P = 0.941). Previous history of contraceptive usage, attending six or more antenatal visits, and Islamic religion were significant determinants of postpartum contraceptive uptake [(AOR 34.3; CI 7.1-164.6; P < 0.001) (AOR 8.0; CI 2.9-22.3; P < 0.001) (AOR 8.3; CI 3.3-10.0; P < 0.001), respectively]. Conclusion: Incorporation of structured antenatal contraceptives counselling was not significantly better than routine antenatal care in its effect on postpartum contraceptive uptake. There is need for deliberate efforts to encourage women to attend antenatal clinics in which contraceptive information would be provided during routine visits.

Contexte: La clinique prénatale est l'occasion de conseiller les femmes sur la nécessité d'une contraception postpartum. Cette étude a été conçue pour déterminer l'effet d'un conseil prénatal structuré sur l'adoption de la contraception post-partum. Méthodes: Une étude d'intervention prospective menée dans la clinique prénatale de l'hôpital universitaire Olabisi Onabanjo, Sagamu du 15 juillet 2018 au 31 juin 2019. Deux cents patientes prénatales ont été réparties au hasard dans les groupes d'intervention et de contrôle. Les femmes du groupe témoin ont bénéficié de conseils prénatals de routine dispensés par les infirmières/sages-femmes, tandis que celles du groupe d'intervention ont bénéficié de séances d'éducation prénatale bien structurées sur la contraception à chaque visite prénatale. Une feuille de saisie de données a été utilisée pour obtenir des informations pertinentes lors de la présentation pendant le travail et a été complétée 6 mois après l'accouchement par conversation téléphonique. Résultats: La prévalence globale des accepteurs contraceptifs était de 35,5%. La majorité des utilisatrices de contraceptifs (42,3%) ont opté pour des dispositifs contraceptifs intra-utérins. La prévalence contraceptive parmi le groupe d'intervention était de 45% contre 26% parmi le groupe témoin. Ceci était statistiquement significatif (χ2 = 7.883, P = 0.005). Cependant, après une analyse de régression logistique multivariée, l'intervention (conseil prénatal structuré) ne s'est pas avérée être un déterminant significatif de l'adoption de la contraception post-partum (AOR 1,0; IC 0,4-2,2; P = 0,941). Les antécédents d'utilisation de contraceptifs, la participation à six visites prénatales ou plus et la religion islamique étaient des déterminants significatifs de l'utilisation de la contraception post-partum [(AOR 34,3; IC 7,1 ­ 164,6; P < 0,001), (AOR 8,0; IC 2,9 - 22,3; P < 0,001), (AOR 8,3; IC 3,3-10,0; P < 0,001) respectivement]. Conclusion: L'intégration de conseils structurés sur les contraceptifs prénatals n'était pas significativement meilleure que les soins prénatals de routine dans son effet sur l'adoption de contraception post-partum. Des efforts délibérés sont nécessaires pour encourager les femmes à se rendre dans les cliniques prénatales où des informations sur la contraception seraient fournies lors des visites de routine.

Prevalence of Group B Streptococcus Colonisation and Antimicrobial Susceptibility Pattern among Pregnant Women Attending a Tertiary Health Facility in Ogun State, Southwest Nigeria.

Background: Genital colonisation by group B Streptococcus (GBS) in pregnant women in their third trimester has been shown to be a known risk factor for morbidity and mortality among newborns. Aim: The aim of the study was to determine the prevalence of GBS colonisation among pregnant women in Abeokuta, its associated sociodemographic factors, and the neonatal outcome among exposed babies. Design: Longitudinal cohort study. Setting: Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State. Methodology: One hundred sixty pregnant women presenting for routine antenatal care between 35 and 41 weeks were recruited consecutively. Swabs were taken from the vagina and then the rectum using a single swab. The samples were processed at the hospital's Medical Microbiology Laboratory using standard microbiological methods. Babies whose mothers were positive had their bodies swabbed and the samples sent for GBS isolates. They were also screened for early-onset neonatal sepsis with C-reactive protein. Results: Prevalence of GBS vaginal colonisation was 4.3%. There was no significant association between GBS colonisation status and age, level of education, or occupation; however, women of parity ≤1 had significantly higher prevalence of GBS colonisation than those of parity ≥2. There was no incidence of GBS infection observed in the babies. The GBS isolates were 100% sensitive to cefuroxime and 83.3% resistant to ampicillin. Conclusion: The prevalence of GBS is low in our environment. The organisms were highly sensitive to cefuroxime, erythromycin, and ceftriaxone. Routine screening of all pregnant women may be unnecessary. However, women at risk of GBS who present in labour without a recent GBS screening should be offered intrapartum prophylactic cefuroxime.

Contexte: La colonisation génitale par le streptocoque du groupe B (SGB) chez les femmes enceintes au cours de leur troisième trimestre s'est avérée être un facteur de risque connu de morbidité et de mortalité chez les nouveau-nés. Objectif: Déterminer la prévalence de la colonisation par le SGB chez les femmes enceintes à Abeokuta, ses facteurs sociodémographiques associés et l'issue néonatale chez les bébés exposés. Conception: Étude de cohorte longitudinale. Cadre: Département d'obstétrique et de gynécologie, Centre médical fédéral, Abeokuta, État d'Ogun. Méthodologie: Cent soixante femmes enceintes se présentant pour des soins prénatals de routine entre 35 et 41 semaines ont été recrutées consécutivement. Des écouvillons ont été prélevés du vagin puis du rectum à l'aide d'un seul écouvillon. Les échantillons ont été traités au laboratoire de microbiologie médicale de l'hôpital à l'aide de méthodes microbiologiques standard. Les bébés dont les mères étaient positives ont eu leur corps écouvillonné et les échantillons envoyés pour les isolats de SGB. Ils ont également été dépistés pour une septicémie néonatale d'apparition précoce avec la protéine C-réactive. Résultats: La prévalence de la colonisation vaginale par SGB était de 4,3%. Il n'y avait pas d'association significative entre le statut de colonisation par SGB et l'âge, le niveau d'éducation ou la profession; cependant, les femmes de parité ≤1 avaient une prévalence significativement plus élevée de colonisation par le SGB que celles de parité ≥2. Aucune incidence d'infection à SGB n'a été observée chez les bébés. Les isolats de SGB étaient 100% sensibles au céfuroxime et 83,3% résistants à l'ampicilline. Conclusion: La prévalence du SGB est faible dans notre environnement. Les organismes étaient très sensibles à la céfuroxime, à l'érythromycine et à la ceftriaxone. Le dépistage systématique de toutes les femmes enceintes peut être inutile. Cependant, les femmes à risque de SGB qui se présentent pendant le travail sans dépistage récent du SGB devraient se voir proposer du céfuroxime prophylactique intrapartum.

Labour pain perception: experiences of Nigerian mothers.

INTRODUCTION: Labour pain perception is influenced by a variety of factors; hence women experience and cope with labour pain differently. This study was designed to assess labour pain perception among parturient. METHODS: A cross-sectional study involving 132 pregnant women who had vaginal delivery at two tertiary hospitals in south west Nigeria. A structured questionnaire was administered to women within 24 hours of delivery to record details of labour and delivery. Labour pain perception was assessed using the Visual Analogue Score (VAS). Data analysis were done using IBM-SPSS Statistics for Windows version 21.0 (IBM Corp., Armonk, NY, USA). RESULTS: The mean age of the parturients was 30.6±4.8 years. The mean pain perception of the parturients as assessed by VAS was 7.0 with range of 1.2-10.0. Sixty-six (50%) parturients rated labour pain to be severe (VAS > 7.1). Majority of the respondents 114(86.4%) desired some form of pain relief. The Body Mass Index (BMI) of respondents and birth weight of their babies had statistically significant association with pain perception (p = 0.010; p = 0.038 respectively). Factors associated with increased odds of having severe pain perception include unbooked status, secondary level education, BMI < 30, and gestational age ≥ 37 weeks. CONCLUSION: Women in south west Nigeria perceived labour pain as severe and many desired pain relief during labour. Occupation, BMI, gestational age and baby's birth weight were significant mediating variables in women's experience of labour pain. Modern methods of labour analgesia should be offered to parturients who express desire for it. This will lead to improvements women's childbirth experience.