Achieving continuous improvement in routine questioning about domestic violence with an embedded advocacy service.

Domestic violence (DV) is a common but underreported cause of morbidity in pregnant women. A retrospective review of maternity notes of 103 women who delivered October-November 2007, followed by prospective review of records after feedback intervention of 168 pregnant women who had nuchal a scan in February 2008 was undertaken. The aim was to determine: (1) the proportion of women who were asked abuse questions at any time during pregnancy and postnatally; (2) the prevalence of disclosed domestic violence; (3) the sociodemographic predictors of a pregnant woman being asked about DV; (4) if feedback is associated with improved routine questioning. Routine enquiry about DV in pregnancy significantly increased from 53% in 2007 to 66% in 2008 (p < 0.05). Current DV was disclosed by 3.6% of women in both surveys. Domestic violence is common in pregnancy. After implementation of training and an embedded DV advocacy service, routine enquiry demonstrated significant increase over time.

Leucocyte phagocytosis and circulating immune complexes in mothers after child birth.

Leucocyte phagocytosis and level of circulating immune complexes (CICs) were measured in pregnant women at the three trimesters of pregnancy and in mothers 24-48 hours after child birth to evaluate the influence of pregnancy on leucocyte functions. The mothers were divided into gestation groups depending on the ages of their pregnancies as 1st trimester, 2nd trimester and 3rd trimester. The result shows that total white blood cell count (WBC), lymphocytes (B- and T-lymphocytes) and circulating immune complexes were high in pregnant women (independent of gestational ages) and mothers 24-48 hrs after child birth compared with non-pregnant controls. In contrast, mean percentage migration index (% M.I.), percentage candidacidal index (% C. I) and H2O2 production were reduced in pregnant women and mothers after child birth compared with non-pregnant controls. When test groups (pregnant women and mothers after child birth) were compared, women after child birth had least mean % C.I and %M.I while pregnant women at 1st trimester had highest mean %C. I., %M. I. and highest level of H2O2 production. Within the gestational groups, pregnant women at 3rd trimester had higher %M. I. compared with those in 2nd trimester while those in 2nd trimester had lower %M. I., %C. I. and H2O2 production compared with women at 1st trimester. Our finding shows that cell mediated immune responses vary between trimesters therefore susceptibility of pregnant women to different pathogens may vary with gestation.

Impact of maximal cervical dilatation at primary caesarean delivery on mode of delivery in the following pregnancy.

The maximum cervical dilatation achieved by parturients who went through labour prior to their primary caesarean births were related to the mode of delivery in the subsequent birth to ascertain if there is a link between the two. The success rates of vaginal births after primary Caesarean sections (VBAC) for arrest and non-arrest disorders were also compared using information derived from the birth records of the hospital. The success rate for VBAC was significantly high in subjects whose primary caesarean sections were for non-arrest disorders compared to those who had arrest disorders (73.3% versus 55.6%; x2 = 5.25, p = 0.02). The maximum cervical dilatation reached before primary caesarean section did not significantly affect the success rate of VBAC in the subsequent delivery (x2 [trend] = 0.78, p = 0.68). Patients who had primary caesarean section for arrest disorder require full evaluation before being allowed to attempt vaginal birth in a subsequent pregnancy but the maximum cervical dilatation reached before primary caesarean section need not be factored into a decision for VBAC.

Sixty-one day twin to twin birth interval in a low technology setting.

Multiple pregnancy, whether spontaneous or from artificial reproductive techniques, is regarded as high risk. Limiting the twin-twin birth interval to within 30 minutes has been widely practised. However, conservative management of the retained live, immature second twin may be worthwhile. We report a case lasting sixty-one days in a low technology setting.

Childhood sexuality and child sexual abuse in southwest Nigeria.

There is paucity of information and research on childhood sexuality and child sexual abuse in Nigeria. This low level of information may not be unconnected with the fact that generally discussions on sexual matters still remain a taboo in our culture. It is almost abominable to discuss sex with children. There is need for a radical departure from this position in view of the fact that at least 5% of the respondents in this study admitted having had sex between 6 and 10 years of age and 81 respondents (2.1%) were sexually abused in childhood. The urgent need for more research and a multidisciplinary problem resolution approach to childhood sexuality and child sexual abuse is stressed.