Grandmultiparity: outcome of delivery in a tertiary hospital in southern Nigeria.

BACKGROUND: Grandmultiparity is traditionally associated with increased risk of complications during pregnancy and delivery. Reports from developed countries where obstetric facilities are excellent and the standard ofperinatal care is high indicate that currently, obstetric complications among grandmultipara are now independently associated with progressive maternal age. In Nigeria and other developing nations however, grandmultiparity still contributes a significant proportion of the obstetric population. The aim of this study is to evaluate the outcome of delivery of grandmultiparous patients at the University of Uyo Teaching Hospital. METHODS: The case records of all grandmultiparous patients who delivered at the University of Uyo Teaching Hospital, Uyo over a six-year period were studied. RESULTS: Grandmultiparous women constituted 6.4% of the parturients who delivered in the hospital during the study period. Their ages ranged from 20-45 years with majority (71.5%) being 30-39 years. Majority (77.9%) were para 5 and 6 and 326 (80.1%) of the patients booked and received antenatal care in the hospital. Majority of the booked patients (79.8%) initiated antenatal care after 32 weeks of gestation while all the unbooked patients 68 (16.7%) and the antenatal clinic defaulters 8 (2.0%) were brought from unorthodox health facilities when they developed obstetric complications. Two hundred and forty three patients (59.7%) had spontaneous vaginal delivery, 15 (3.7%) of the patients had laparotomy for ruptured uterus and out of these ten of them (66.7%) had a subtotal abdominal hysterectomy while five (33.4%) had uterine repair and bilateral tubal ligation. The perinatal mortality rate was 128/1000 births. There were three maternal deaths, two from eclampsia while one followed postpartum haemorrhage resulting in a maternal mortality rate of 7.4/1000. CONCLUSION: The prevalence of grandmultiparity in our centre is relatively low. It is, however, associated with high perinatal and maternal morbidity and mortality. We advocate widespread community enlightenment on the importance of limitation of family size and number of child births. There is need for community based studies in our environment accessing the knowledge and attitude of women with high parity towards contraception.

Depot medroxyprogesterone injectable contraception at the University of Uyo Teaching Hospital, Uyo.

BACKGROUND: Depot medroxyprogesterone acetate is the most studied injectable contraceptive and also one of the most effective methods of contraception currently available. It is reversible, its use is independent of intercourse, and can be provided by trained non-medical staff making it particularly suitable for use in developing countries. The aim of this study is to determine the socio-demographic characteristics of its acceptors, the timing of use and complications at the University of Uyo Teaching Hospital, Uyo. MATERIALS AND METHODS: The record cards of all clients who accepted medroxyprogesterone acetate injectable contraception over a nine-year period were studied. RESULTS: There were 1065 new contraceptive acceptors out of which 166 (15.1%) accepted depot medroxyprogesterone acetate. The modal age group of the clients was 30-34 years (35.0%). Majority of clients were grandmultiparous (63.9%), married (82.0%), and 50.6% had primary level education. Majority of the clients (84.2%) derived their sources of information on contraception from clinic personnel and friends/relatives. All the clients received their injections within seven days of menstruation. The most common side effects were amenorrhea (12.0%) and spotting of blood per vaginam (10.8%). CONCLUSION: Depot medroxyprogesterone acetate is a safe form of contraception, which was mostly accepted by grandmultiparous women and those in their thirties. The involvement of the print and electronic media in the propagation of accurate information about depot medroxprogesterone acetate to members of the community and the introduction of post-abortal and puerperal administrations of depot medroxyprogesterone acetate and its new formulation; depo sub-Q provera in all our hospitals are advocated.

A Five-year review of uterine fibroids at the University of Uyo Teaching Hospital, Nigeria

Background: Uterine fibroids are benign tumours that arise from myometrial smooth muscle cells. They are the most common tumours found in humans and are particularly common in Negros. We determined the prevalence modes of presentation and treatment modalities of uterine fibroid at the University of Uyo Teaching Hospital; Uyo; Nigeria. Methods: The case notes of all patients with uterine fibroids over a 4-year period were studied. Results: Uterine fibroids accounted for 7.1of gynaecological admissions and 21.2of major gynaecological surgeries. The patients' age ranged from 21 to 55 years with modal age group being 31-40 years (38.8). Majority of the patients were of low parity (75.4). The most common presenting complaints were abdominal swelling (25.5) and infertility (21.4). Myomectomy was the most common surgical procedure performed (77.6) and the most common post operative omplications were anaemia (21.4) and pyrexia (18.4). Conclusion: Uterine fibroids are common in our environment. The patients are predominantly of low parity and myomectomy is the most common surgical procedure performed

Reasons for gynaecological consultations in children in Calabar, South Eastern Nigeria.

Childhood gynaecological disorders as seen in the University of Calabar Teaching hospital (UCTH), Calabar, Nigeria, over a 10-year period were studied. The aim was to establish the incidence and pattern of presentation of these disorders. Childhood gynaecological disorders constituted 3.1% of gynaecological admissions in UCTH. Vaginal laceration following rape was the most common disorder accounting for 54.8% of the cases. This was most common in the 8 to 11-year age group (52.2%). Vaginal bleeding was the most common presenting symptom (63.1%) and repair of vaginal laceration the most common procedure performed (54.8%).

Hysterectomies amongst teenagers in Calabar, Nigeria.

A 10-year retrospective study of hysterectomies performed on teenagers in Calabar was carried out.