Tropical Journal of Obstetrics and Gynaecology

Knowledge Attitude and Perception on the Use of Telemedicine in Obstetric Practice among Health Workers at the Federal Medical Centre, Makurdi

2024-10-08T13:10:27-06:00

Background: Telemedicine can bridge the manpower needs to improve obstetric practice in low- and middle-income countries (LMICs). This study aims to determine the knowledge, attitude and perception of the use of telemedicine in obstetrics practice among health workers at the Federal Medical Centre (FMC), Makurdi. Method: This was a convergent parallel mixed-method design. This consist of a cross-sectional study among 210 health workers and a focused group discussion of 10 obstetricians at the FMC Makurdi. A self-administered online questionnaire (google form) and interviewer guide were used for data collection. Statistical Package for Social Sciences version 25 and NVivo version 12 were used to analyse data and presented in tables, charts and textual forms. Result: Out of the 210 respondents, 44.3% were between age 32-41years, 66.7% were female, 83.8% had tertiary education and 63.8% were Nurses. The respondents demonstrated high level of knowledge (73.3%) and utilization (88.1%) of telemedicine. A majority (>80%) of the respondents agreed that telemedicine can be used to improve obstetric practice in LMICs in areas such as E-learning, health education, prenatal care, referrals, research, increase access to obstetric care, and to improve collaborations among specialists. Information and communications technology (ICT) illiteracy, lack of awareness, high set-up cost and maintenance were the factors limiting the use of telemedicine. Conclusion: The good knowledge of telemedicine shown by the respondents can be used to improve obstetric practice and therefore reduce maternal and perinatal morbidity and mortality in LMICs. Background: Telemedicine can bridge the manpower needs to improve obstetric practice in low- and middle-income countries (LMICs). This study aims to determine the knowledge, attitude and perception of the use of telemedicine in obstetrics practice among health workers at the Federal Medical Centre (FMC), Makurdi. Method: This was a convergent parallel mixed-method design. This consist of a cross-sectional study among 210 health workers and a focused group discussion of 10 obstetricians at the FMC Makurdi. A self-administered online questionnaire (google form) and interviewer guide were used for data collection. Statistical Package for Social Sciences version 25 and NVivo version 12 were used to analyse data and presented in tables, charts and textual forms. Result: Out of the 210 respondents, 44.3% were between age 32-41years, 66.7% were female, 83.8% had tertiary education and 63.8% were Nurses. The respondents demonstrated high level of knowledge (73.3%) and utilization (88.1%) of telemedicine. A majority (>80%) of the respondents agreed that telemedicine can be used to improve obstetric practice in LMICs in areas such as E-learning, health education, prenatal care, referrals, research, increase access to obstetric care, and to improve collaborations among specialists. Information and communications technology (ICT) illiteracy, lack of awareness, high set-up cost and maintenance were the factors limiting the use of telemedicine. Conclusion: The good knowledge of telemedicine shown by the respondents can be used to improve obstetric practice and therefore reduce maternal and perinatal morbidity and mortality in LMICs.

Effect of Intramuscular Hyoscine N-Butyl Bromide on the Duration of the First stage of Labour in Nulliparous Women: A Randomized, Double-blind, Placebo-controlled Trial

2024-11-02T03:56:29-06:00

Background: Prolonged labour is common among nulliparous women and is associated with significant adverse feto-maternal outcomes. The complications associated with oxytocin-augmented labours have led to the search for other agents that can aid in shortening the duration of the first stage of labour without serious side effects. Previous studies have demonstrated that antispasmodics influence the course of labour. Aim: To evaluate the effect of intramuscular HBB on the duration of the first stage of labour in nulliparous women. Materials and Method: This was a randomized, double-blind, placebo-controlled study involving 136 nulliparous women presenting in spontaneous labour at Wuse District Hospital Abuja. They were randomized to receive either a single intramuscular 20mg of HBB or 1mL of distilled water, on diagnosis of active phase of labour. The mean durations of the three stages of labour and maternal drug side effects were compared between the two groups. Data analysis was on an intention-to-treat, using Statistical Package for Social Sciences (SPSS) version 26. The level of statistical significance was set at P< 0.05 at a confidence interval of 95%. Results: The mean duration of the first stage of labour was significantly shorter in the HBB group than in the control group (321.6 ± 20.50 min vs 381.7 ± 27.59 min, P=0.02; mean difference of 60.1 minutes). There were no statistically significant differences in the duration of the second and third stages of labour, maternal drug side effects and neonatal outcomes. Conclusion: Hyoscine butyl bromide was found to be safe and effective in shortening the duration of the first stage of labour in nulliparous women.

Key Words: Hyoscine butyl bromide, nulliparous, first stage of labour, duration of labour.

Availability and Utilization of Basic Emergency Obstetric and Newborn Care Services in Jigawa State, Northwest Nigeria

2024-07-07T06:07:38-06:00

Background: Maternal mortality reduction is a priority under goal 3 of the Sustainable Development Goals. Majority of maternal deaths occur from direct obstetric complications like post-partum hemorrhage, obstructed labor, toxemia of pregnancy and complications of abortion. Availability and utilization of Emergency Obstetric Care services have been shown to reduce suffering and deaths from obstetric complications. The study assessed the availability and utilization of Basic Emergency Obstetric and Newborn Care (BEmONC) services in Jigawa State, Northwest Nigeria. Methods: A descriptive cross-sectional study was conducted among public Primary Health Care facilities that provide delivery services in Jigawa State. A two-stage sampling technique was used to select 15 public primary health care centers. Data was collected using a structured emergency obstetric care tool developed by Averting Maternal Death and Disability andanalyzed using IBM SPSS version 25. Results: All the healthcare facilities administered parenteral Oxytocics, while 86.7% administered parenteral antibiotics and 93.3% performed neonatal resuscitation. About 53%, 74%, and 80% of the facilities performed removal of retained product, administration of parenteral anticonvulsants and manual removal of retained product respectively None of the health facilities performed assisted vaginal delivery. Only 20.3% of births took place in facilities providing BEmONC, and only 9.4% of the BEmONC needs in Jigawa State were being met. Conclusion: None of the health facilities met the criteria for fully functional BEmONC. Majority of the women with did not utilize BEmONC services and the BEmONC needs of the population were not being met.

Comparison of Short Course with Long Course Antibiotic Prophylaxis for Caesarean Section: A Randomized Controlled Study

2024-07-16T05:52:34-06:00

Comparison of Short Course with Long Course Antibiotic Prophylaxis for Caesarean Section: A Randomized Controlled Study.

ABSTRACT

Background: Antibiotic prophylaxis in caesarean section is intended to prevent post-partum infectious morbidity and mortality associated with the procedure. Judicious use of prophylactic antibiotics also reduces the incidence of adverse drug reactions and antibiotic resistance. Although there are guidelines and recommendations for the duration of antibiotic prophylaxis for caesarean section, these are often not adhered to in most healthcare facilities.

Objective: This study compares the efficacy of short-course antibiotic prophylaxis with long-course prophylaxis in caesarean section.

Methodology: This was a randomized controlled study in which 200 pregnant women undergoing elective or emergency caesarean section were enrolled into two groups of 100 women each (Group A: short course antibiotics and Group B: long course antibiotics), and monitored for 6 weeks for evidence of febrile morbidity, urinary tract infection, wound infection, and clinical endometritis. The secondary outcome measures were the cost of antibiotics and hospital care.

Results: There was no statistical difference in the incidence of wound infection (3% vs 1%, p-value 0.31, and urinary tract infection (0% vs 1%, p-value 0.32) in the short and long-course antibiotic groups respectively. The cost of antibiotics and hospital care was significantly higher in long course antibiotic group (p-value< 0.001)

Conclusion: Short-course prophylactic antibiotic prophylaxis has comparable efficacy and is more cost-effective than long-course prophylactic antibiotics in preventing post-caesarean section infectious morbidities.

Keywords: Prophylactic antibiotics, caesarean section, infectious morbidity, post-operative

Meconium-stained Amniotic Fluid in Labour: A Correlation with Mode of Delivery and Perinatal Outcome at Maitama District Hospital Abuja, Northcentral Nigeria

2024-10-07T06:18:36-06:00

Background: Meconium-stained amniotic fluid (MSAF) has been associated with adverse labour outcomes with increased perinatal morbidity and mortality.

Aim and Objectives: To determine and compare the mode of delivery and perinatal outcomes in low-risk pregnant women at term with and without meconium-stained amniotic fluid in labour.

Methods: A prospective comparative cross-sectional study involving 260 women with low-risk pregnancy at term presenting with MSAF and clear amniotic fluid (CAF) in labour at Maitama District Hospital, Abuja, between January 7^th 2021 and July 31^th 2021. The participants were divided into two groups:130 in the MSAF group and 130 in the CAF group. Outcome measures were mode of delivery, Apgar scores at 1 and 5 minutes, need for active resuscitation, special care baby unit (SCBU) admission, and perinatal mortality. Data was analysed using the Statistical Package for Social Sciences version 24 (SPSS 24, IBM). Statistical analysis was done using chi square test and student t-test with the level of statistical significance set at P<0.05 at a confidence interval of 95%. Results: Mode of delivery was not significantly influenced by presence of MSAF, although caesarean section rate was higher for deliveries in the MSAF (24.6% vs 15.4%, P=0.103). The mean Apgar scores at 1 and at 5 minutes were significantly lower in the MSAF group (P<0.001). The need for active resuscitation with oxygen supplementation and SCBU admission was significantly greater for the MSAF group (P<0.001). All three perinatal deaths (1.2%) occurred in the MSAF group. Conclusion: MSAF, especially when significant, is associated with higher operative intervention rate in form of caesarean section and instrumental vaginal delivery, lower Apgar scores, and a greater need for resuscitation and SCBU admission due to birth asphyxia and meconium aspiration. Increased intrapartum surveillance with early obstetric intervention is recommended for labours complicated by MSAF to reduce adverse perinatal outcomes.

Abnormal Oral Glucose Tolerance Test Amongst Pregnant Women in Ushafa Community: Comparison of WHO and IADPSG Criteria.

2024-10-23T13:39:24-06:00

Background: The prevalence and impact of gestational diabetes mellitus (GDM) is growing worldwide. Its management is dependent on the diagnostic criteria used and there is no consensus on screening methods and diagnostic criteria. In order to reduce adverse maternal and neonatal outcome associated with hyperglycemia including the mild forms, the International Association for Diabetes in Pregnancy Study Group (IADPSG) put forward diagnostic criteria and encourages its adoption worldwide, as against the previously used World Health Organization criteria. Methodology: This was a cross-sectional study in which 150 pregnant women were recruited. These women had a 75gram, oral glucose tolerance test (OGTT) done. The diagnosis of GDM was made in each participant using the WHO (1999) and IADPSG and then compared. Result: The prevalence of FDM in accordance with WHO 1999 and IADPSG criteria were 9.3% and 15.3%, respectively. About 6.7% of women met both criteria and 18% met either or both criteria. Using multivariable analysis, age >34 years, BMI >25kg/m² and previous history of macrosomia were significantly associated with GDM. Approximately 35% of GDM cases would have been missed if selective screening strategy was employed as against universal screening which was done. Conclusion: There is an increase in the prevalence of GDM when the IADPSG criteria is compared to the WHO 1999 criteria. Missed opportunities for diagnosis and management exist with the use of the WHO 1999 criteria and selective screening approach. There is a need for reappraisal and uniformity on the diagnostic approach and criteria to be used when managing GDM in Nigeria.

Sickle Cell Disease: Its Prevalence, Knowledge and Attitude Towards its Control Measures among Pregnant Women in a Northern Nigerian Tertiary Hospital

2024-07-18T03:41:31-06:00

Introduction: Sickle cell disease (SCD) is the most prevalent haemoglobinopathy in sub-Saharan Africa (SSA) and has been declared to be a public health burden due to its associated morbidity and mortality. Nigeria is the most endemic SCD country thus prevention of the disease remains of utmost importance. Objectives: To determine the prevalence of SCD in pregnancy; and assess knowledge and attitude of the disease and its control measures among pregnant women. Methodology: A descriptive cross-sectional study involving 210 attendees of the antenatal clinic of Ahmadu Bello University Teaching Hospital Zaria. An interviewer-administered structured questionnaire was used to obtain information about socio-demographic characteristics, knowledge of SCD and attitude towards its control measures. Pregnant women with no evidence of genotype result had venous blood sampling and their blood samples were subjected to haemoglobin electrophoresis. The data was analyzed using SPSS version 21. The chi-square test was used to test associations between variables. The level of significance was set at p<0.05. Results: The mean age of participants was 28 ± 6.3 years. Nearly half (48.6%) had tertiary education, the majority (70.5%) had a personal source of income and 23.3% were in consanguineous unions. The prevalence of SCD was 1.4% (3/210). Most (97.6%) were aware of SCD but only 53.8% had good knowledge of the disease. The majority of the participants (97.1%) were aware of premarital screening; 21% were aware of prenatal diagnosis and 68.9% of women at risk of having an affected child are willing to accept prenatal screening. Conclusion: One in every 100 pregnant women has SCD. A high level of awareness does not directly translate to good knowledge about the disease. Age and educational level were associated with knowledge of SCD. Premarital screening and prenatal diagnosis were the commonest and least known of the control measures.

Impact of Age on Semen Quality in Male Partners of Infertile Couple: A retrospective study in a tertiary Hospital in North-West Nigeria.

2024-10-08T12:45:03-06:00

Background: Spermatogenesis is known to persist well into old age. Nevertheless, advanced paternal age has been associated with significant reductions in pregnancy rates, and age-related decline in androgen secretion levels suggestive of impairment in sperm parameters. Aim: To determine association between age and semen quality in male partners of infertile couple attending fertility clinic in a tertiary Hospital in North-Western Nigeria. Method: This was a retrospective study. The laboratory semen analysis (SA) records of male partners of infertile couples seen at the fertility clinic for a 3-year period (January 2019 to December 2021) retrieved were analysed using SPSS version 23. Result: Data retrieval rate was 75.3%. The mean age of male Partners with normal & abnormal SA were 33.79±7.21 and 37.57±8.63 respectively. There were 261 (57.7%) abnormal SA. We found a negative association between age and semen quality in terms of volume, non-progressive motility (NPM), progressive motility (PM), vitality, morphology and sperm concentration (p<0.05), but no association between age, and sperm pH & immotile sperm for the normal & abnormal SA parameters combined. While with the normal & abnormal SA groups separated; only morphology had a significant negative correlation for the normal SA group. There was still significant negative correlation in NPM, PM, vitality, morphology & sperm concentration for the abnormal SA group. Conclusion: This study found that non-progressive motility, progressive motility, vitality, morphology and sperm concentration decreases significantly as age increases in men with abnormal SA, and a non-significant decrease in semen volume, pH and immotile sperm with age.

Socio-Demographic Correlates of Comorbid Anxiety and Depression Among Women Attending Antenatal Clinic in A Tertiary Health Institution in Ondo City, Southwestern Nigeria

2024-10-10T02:11:51-06:00

Abstract

Background

Pregnancy is often a joyful experience, but many women experience psychological disorders due to hormonal changes, physical discomfort, and anticipation of motherhood.

Aim

To determine the prevalence and patterns of anxiety, depression, and comorbid anxiety and depression in pregnant women attending antenatal care at UNIMEDTH Ondo.

Method

A descriptive cross-sectional design was used, employing a validated questionnaire.

Result

The study found that anxiety was prevalent in the first, second, and third trimesters, with rates of 31.1%, 47.9%, and 14.7%, respectively. The prevalence of depression was 50.3%, 46.5%, and 47.0%, while comorbid anxiety and depression had rates of 18.6%, 13.3%, and 15.5% in the first, second, and third trimesters. Respondents with a primary education or less exhibited a 3.522 times higher odds of experiencing comorbid anxiety and depression compared to those with tertiary education(OR=3.52, p=0.018). Furthermore, a noteworthy correlation was identified between comorbid anxiety and depression and average monthly income, with a 1-unit increase in income associated with higher odds of these conditions (OR=1.00, p<0.009). Respondents who preferred a male child had a 3.819 times higher likelihood of experiencing comorbid anxiety and depression, while those who preferred a female child had a 4.201 times higher likelihood of experiencing these symptoms, both statistically significant compared to those indifferent to gender (OR=3.819, p=0.018, OR= 4.201, p=0.009).

Conclusion

These findings underscore the multifaceted nature of predictors influencing comorbid anxiety and depression. Relevant stakeholder must be involve in the prevention of these disorders

Keywords; Anxiety, Depression; Comorbid, Antenatal, Nigeria

Running title; Comorbid Anxiety and Depression among antenatal women

Acute Abdomen in Pregnancy Due to Ovarian Torsion: A Case Report

2024-04-16T05:18:44-06:00

Introduction: Acute abdomen from ovarian torsion is a rare complication of pregnancy. This case report highlights the place of ovarian torsion as a cause of acute abdomen in pregnancy, management challenges, importance of early diagnosis and the need for prompt intervention.

Case presentation: A 30-year-old primiparous woman at 18 weeks of gestation presented with complaints of abdominal pain and vomiting. She was in distress with generalized abdominal tenderness and guarding. Abdominal ultrasound showed a cystic mass in the right hypochondrion. A diagnosis of acute abdomen in pregnancy was made and she had an emergency laparotomy and right salpingo-oophorectomy with findings of a twisted haemorrhagic right ovarian mass. Histology of the ovarian mass showed a matured (benign) cystic teratoma.

Conclusion: Acute abdomen in pregnancy is an obstetric emergency. Diagnosis is often unclear due to a long list of differentials. Uterine size, changes in maternal physiology and fetal considerations may pose further management challenges. Ovarian torsion should be considered early and timely surgical intervention provided for optimal maternal and fetal outcomes.

Leiomyomatosis Peritonealis Disseminata: Case Report

2024-07-20T01:31:00-06:00

ABSTRACT

Leiomyomatosis peritonealis disseminata(LPD) is a rare smooth muscle benign lesion seen mostly in premenopausal women. Pre-operative diagnosis may be challenging especially in the absence of advanced imaging techniques in low resource setting. This is a case report of a 50 year old nullipara with two previous history of open abdominal myomectomy. Histopathological evaluation of the lesion post surgery revealed smooth muscle cells of uterine leiomyoma. Conclusion: LPD is a rare disease that may mimic intra abdominal malignancies in clinical presentations.

Keywords: Case report; Leiomyomatosis peritonealis disseminata; Open abdominal myomectomy; previous myomectomy

Post-Partum Vulva Hematoma Management in a Low Resource Setting : A Case Report

2024-10-08T05:00:22-06:00

Large postpartum vulvar hematoma is a rare post-obstetric complication and its prompt recognition can help reduce the risk of maternal death. Only few cases have been reported and currently there is no standard consensus existing on the best management of vulvar hematomas. Herein, we report the successful management of a large post-obstetric vulvar hematoma through a simple incision in a low resource setting in government hospital in Isiokolo, Delta State Nigeria. We report the case of a 20-year-old booked now para I mother from rural delta state who presented with vulvar pain and rapidly expanding spontaneous vulvar hematoma in the right labium majus. On admission, the young woman had essentially normal blood work. An incision was made in the right labium majus under local anesthesia followed by surgical drainage and evacuation of clot and ligation of the bleeding points. The patients’ clinical symptoms progressively improved and their was no hemorrhagic recurrence until hospital discharge forty eight hours later. Good inspection of the vulva and perineum post-delivery remains pivotal in vulva hematoma prevention Once detected the hematoma must be immediately assessed whether or not it is localized and surrounding pelvic structures must be evaluated as these factors will determine the treatment modality. In low resource settings where hematoma is confirmed to be localized with no damage to surrounding pelvic structures and patients are hemodynamically stable a simple incision to drain the hematoma with ligation of bleeding vessels under local anesthesia can be performed to relieve the pain, prevent pressure necrosis and reduce morbidities.