Tropical Journal of Obstetrics and Gynaecology

Management and the Prevention of Anaemia in Pregnancy: SOGON Clinical Practice Guidelines

2024-03-06T16:21:50-07:00

Anaemia during pregnancy is a significant public health concern in this country. With 40% of the population living in poverty and 63% facing multidimensional poverty as reported by the National MPI 2022, it is not surprising that women often have poor diets, making them more prone to iron and folate deficiency anaemia, which are the leading causes of anaemia during pregnancy. Other factors contributing to anaemia during pregnancy include having multiple pregnancies in quick succession, giving birth to multiple babies, pre-pregnancy menorrhagia, worm infestation, severe and prolonged hyperemesis gravidarum, among others. Anaemia during pregnancy can cause serious complications for the fetus, such as preterm birth and low birth weight. It can also affect the mother's well-being, with severe anaemia increasing the risk of death or near misses. Recent evidence also suggests that anaemia during pregnancy significantly increases the risk of postpartum haemorrhage caused by uterine atony. It's crucial for healthcare providers to be aware of the issues associated with anaemia during pregnancy and the measures for preventing and detecting high-risk pregnancies early. Healthcare providers must understand the different types of anaemia, common symptoms, and treatment options to recognize the warning signs of anaemia and avoid complications. This clinical guideline is designed for obstetricians and midwives to help manage pregnant women with anaemia appropriately. The document's layout and practical step-by-step approach to managing anaemia during pregnancy are commendable, and the team of experts who produced this high-quality document under the chairmanship of Prof Abiodun Aboyeji deserves appreciation. All members of the committee deserve commendation for a job well done. Healthcare practitioners should use this guideline to manage anaemia during pregnancy effectively, reducing complications for both mother and foetus, and ultimately reducing the burden of high maternal and perinatal mortality and morbidity related to anaemia. This is one of four clinical guidelines to be produced by the SOGON Executive under my leadership. The other three will be rolled out shortly.

Prevalence and Factors Associated with Intra-Vaginal Tobacco Powder Use among Women in The Gambia

2024-03-04T16:42:56-07:00

Background: Intra-vaginal tobacco powder, locally known as "Tabaa," is a mixture of powdered tobacco and other substances that women use vaginally for sexual enhancement and other perceived benefits. This issue elicited mixed feelings among Gambians, particularly healthcare professionals. Through a media report, the Ministry of Health warned women to stop the practice due to the potential negative consequences. Objectives: This study aimed to determine the prevalence and factors associated with intra-vaginal tobacco powder use among women in The Gambia. The findings will provide baseline information regarding the extent of intra-vaginal tobacco usage and the factors promoting them to enable the Ministry of Health and relevant stakeholders to design strategic interventions to combat the practice. Methods: A sequential exploratory mixed (qualitative-quantitative) approach was used. The research was a combination of healthcare facility-based and community-based studies, which was carried out in both rural and urban areas of The Gambia. Thirty (30) purposively selected participants were interviewed for the qualitative study, while the quantitative study recruited 400 women using a multistage sampling method. A structured questionnaire developed from the qualitative results was used to collect the quantitative data. STATA version 18 was used for the data analysis. Chi-square test and multivariate logistic regression analysis were used with a significance level of p<0.05, Adjusted Odds Ratio (aOR) and a 95% confidence interval (CI). Results:The qualitative results reveal that sexual enhancement, treating genital infections, hastening labour, lack of knowledge, long-distance marriage and polygamy were commonly cited as factors associated with intra-vaginal tobacco powder use. The main analysis in the quantitative study focused on the subset of 287 women who demonstrated awareness of intra-vaginal tobacco practices. The findings of the study revealed a lifetime prevalence of 23.7% (n=68) of intra-vaginal tobacco powder use among Gambian women, with 63.2% currently using it. Most of the women were married and within the age range of 30 to 39 years. Women aged 40 years and above (aOR = 3.20; 95% CI = 1.26–8.13; p = 0.015), from Farafenni and satellite villages (aOR = 2.20; 95% CI = 1.17-4.12; p = 0.014), had non-formal education (aOR = 2.23; 95% CI 0.64-7.79; p=0.210) and expressed perceived benefits (aOR = 16.50; 95% CI 6.10-44.50; p<0.001) have the greatest odds of using intra-vaginal tobacco powder. Conclusion: Intra-vaginal tobacco powder use is practised in the Gambia and is highest in rural areas. There is an urgent need for interventions, such as raising awareness to mitigate this practice.

Vulvar Schistosomiasis: An Important but Uncommon Diagnosis: “A Near Miss”

2024-03-04T16:36:21-07:00

Background: Vulvar schistosomias, part of the spectrum of female genital schistosomiasis (FGS), is an important tropical disease with far-reaching negative impact on female reproductive health. However, this disease is rarely diagnosed and reported in clinical setting even in endemic tropical Africa like Nigeria due to poor awareness and low index of suspicion among the physicians in the tropics. This could result in avoidable morbidities. Case report: We report a successfully managed case of vulvar schistomsomiasis that was long misdiagnosed and mismanaged by unsuspecting physicians and was nearly misdiagnosed by us. Conclusion: Female genital schistosomiasis, an important tropical disease, is rarely diagnosed in clinical setting even in the endemic regions resulting in avoidable morbidities. This case report calls attention of the physicians especially in the tropics to think outside the usual in their approach to diagnosis and management of female genital pathologies. The need for biopsy of any suspicious lesion was also underscored.

Bilateral Ureteric Injurt: Its Presentation, Management and Outcomes: A Case Report

2023-10-29T22:12:28-06:00

Background:
Iatrogenic ureteric injury is a common complication of pelvic surgery especially Gynaecological procedures. However, bilateral ureteric injury is very rare with significant morbidity and occasional mortality. Total abdominal hysterectomy is responsible for most cases in our environment especially when performed by non specialist medical professionals. While literature is sparse on the presentation, management and outcomes of this rare condition, the few ones available do not give a clear guideline.
Case summary
A 48 year old woman with 2 days history of not passing urine through the urethral catheter following abdominal hysterectomy by a general practitioner. Indication for the surgery was a symptomatic fibroid. There was associated progressive abdominal distension. Significant findings on examination was non draining 18Fr foley”s urethral catheter, lower abdominal surgical wound, significant abdominal distension with vague tenderness. Serial electrolyte, urea and creatinine showed significant progressive deterioration of the renal functions. Ultrasound showed bilateral hydroureteronephrosis with significant intraperitoneal fluid collection.
Patient had emergency exploratory laparotomy with intra operative findings of 2.5L of intraperitoneal urine collection, dilated ureters, bilateral suture ligation of distal ureters with leakage of urine around suture lines. Patient had drainage of intraperitoneal collection, bilateral ureteroneocystostomy, bilateral ureteric stenting, peritoneal lavage and was placed on continuous Bladder drainage.

Audit of Gynaecology Surgeries at the Modibbo Adama University Teaching Hospital, Yola, Adamawa State, Northeastern Nigeria

2024-01-12T01:46:52-07:00

ABSTRACT:

Background: The audit of surgeries in gynecology practice is essential for maintaining high standards of patient care, improving clinical outcomes, and fostering a culture of continuous quality improvement within the healthcare system. The study was aimed at determining the rate of all gynaecological surgeries performed, the common gynaecological surgeries and their indications within the period under review.

Materials and Methods: This was a 5-year retrospective observational study of 587 gynaecological surgeries performed between 1^st January, 2018 and 31^st December, 2022. Patients with complete relevant information in the registers were included in the audit and those with incomplete data were excluded. Data was analysed using IBM Statistical software SPSS package version 23.0 for frequencies and percentages and results were presented by simple statistical tables.

Results: A total of 10,597 patients were gynaecological attendees, out of which 587 patients had gynaecological surgeries performed, giving an institutional gynaecological surgery rate of 5.5%, within the period under review. The most common gynaecological surgery performed in MAUTH is hysterectomy (38.3%). The most common indication for the surgery is uterine fibroid (26.8%) and the route commonly used was the abdominal route (62.2%). General anaesthesia given in about (68.7%) of cases.

Conclusion: It is advisable to conduct more frequent audits of the department's provided services. This can aid in pinpointing training and service gaps, thereby enhancing the overall quality and safety of healthcare delivery. Regular audits play a pivotal role in upholding and reinforcing the governance framework by overseeing and enhancing clinical practices.

Key Words: Modibbo Adama university teaching hospital, audit, gynaecological surgery, Yola

Utilisation of Modern Contraceptives Services Among Women of Reproductive Age in a Tertiary Hospital in North-eastern Nigeria. A 6 Year Review

2023-12-27T04:00:58-07:00

ABSTRACT:

Background: Contraceptive use is one of the key factors in protecting women health and right, when generally accepted and properly utilize in any community is proven to reduces unwanted pregnancies, high parity and maternal death. Objective: To determine the prevalence and trend of modern contraceptive use and the reasons for their discontinuation among women of reproductive age accessing family planning clinic in Modibbo Adama University Teaching Hospital Yola, Adamawa state. Method: Retrospective descriptive studies of all the new contraceptive acceptors over a period of 6 years (2014-2019 inclusive) was carried out. Data obtained was analyzed using SPSS version 16.0. Results were presented in simple proportions and compare where necessary using chi square Results: In this study there were 1746 new contraceptive acceptors including Bilateral tubal ligations during the. period under review. A total of 9833 deliveries were conducted during the same period, giving rise to contraceptive prevalence of 17.8%. The commonest contraceptive method patronized was injectables 510(29.2%) followed by implantable contraceptives 486 (27.8%)) while the least contraceptive method utilized was barrier method 149(8.5%). The commonest reasons for discontinuation of method was irregular menstrual bleeding 90(29.1%) fallowed by desire for pregnancy 79(25.6%). there was strong association between age (p-v= 0.001), marital status(p-v=0.000). and parity p-v= 001 and discontinuation of contraceptive method, no significant relationship between education, religion and discontinuation of contraceptive method. Conclusion; Contraceptive acceptance in this environment is still low despite wide spread awareness campaign worldwide.

Key words: Modern contraceptives, reproductive right, utilization, reproductive age, Yola.

Histopathological Features of the Ovaries, Physical and Behavourial Patterns Following Administration of Cadmium Wister Rats

2024-02-06T04:13:47-07:00

BACKGROUND: Cadmium is an environmental pollutant, toxic to humans and animals. Cadmium toxicity affects tissues including reproductive system causing infertility. STUDY OBJECTIVE: To determine the effect of cadmium on behavior and ovaries of Wister rats. MATERIALS AND METHODS: Two groups - A and B, each of 5 Wister rats were studied at the Laboratory of Anatomy Department of Nnamdi Azikiwe University, Nnewi, Nigeria. Following acclimatization, rats in group A (control) were weighed and administered distilled water and laboratory chow while rats in group B were administered 50mg per kg of Cadmium Chloride. Both groups were fed daily, and monitored weekly (for weight and behavior over seven weeks). Following final weighing, the rats were sacrificed and the ovaries harvested and prepared for histology, carried out with photomicrography. Data analysis employed SPSS version 25, comparism of variables employed T dependent test with p <0.05 considered significant.. RESULTS: Rats in group A showed significant weight gain, 144. 407±07 vs. 167.107 ±87 (P=0.009) between initial and final measurement. They also showed normal behavioral pattern, then rats in group B showed significant weight loss, 201.405±48 vs. 163.801±78 (P=0.04) and severely abnormal behavior. Ovarian sections in group A were normal while sections in group B showed degenerated follicles, absence of secondary ovarian follicles and presence of multiple cysts. CONCLUSION: Cadmium toxicity manifested as abnormal behavior and pathological ovarian changes in rats administered cadmium chloride. Cadmium toxicity is linked to human reproduction particularly polycystic ovary syndrome, and infertility. Further studies on effect of cadmium on steroidogenesis and counter effect of some antioxidants on cadmium toxicity are recommended

Impact of Naira Scarcity and Cashless Policy on Health-Seeking Behaviour and Antenatal Care Utilisation Among Pregnant Women in Northcental Nigeria

2023-10-22T22:00:59-06:00

Introduction: Cashless policy is a macroeconomic measure aimed at repositioning the nation for economic growth, through reduction of currency notes in circulation, lowering of the inflation, money laundering and other financial related crimes. Unfortunately the implementation of this policy brought about untoward hardship to the citizens. Among the worst hit by the naira scarcity are the pregnant women, whom by the virtue of their physiological state could not endure the long queues at ATM or the banking hall to access cash. Thus, the artificial naira scarcity created could negatively affect the uptake of antenatal care services among pregnant women and contribute to unwarranted increase in maternal mortality and morbidity.

Objectives: This study sought to determine the effects of naira Scarcity on the difficulties encountered in seeking health among pregnant women attending ANC clinic, determine the effects of socioeconomic indices on the difficulties in seeking health amidst the naira scarcity and to estimate the proportion of pregnant women who had difficulties in accessing health care services consequent to naira scarcity at the Federal Medical Centre, Keffi, Nasarawa State, North- Central Nigeria.

Materials and Methods: This was a cross sectional study conducted among pregnant women attending antenatal care in Federal Medical Centre Keffi, Nasarawa state Nigeria. The study was carried out during the period of naira scarcity between 10th January 2023 and 9th march 2023. During the period, a total of 340 pregnant women were recruited using a convenient sampling method. Consecutive, consenting patients were given questionnaire and information including their sociodemographic, obstetrics, average cumulative family income, modes of transaction before the naira scarcity and during the scarcity, effect of naira scarcity on their willingness to attend ANC, difficulty in transportation and difficulty in accessing care among many others. Data were gotten and analyzed using SPSS 25. Categorical variables were presented as frequencies and percentages.

Results: A total of 340 pregnant women were recruited for this study. Women aged between 30-39 years (60.3%) ranked highest in the study with 246(72.4%) having tertiary level of education A larger number of the women in the study were unemployed 135(39.7%) while majority of the husbands of the women in the study were civil servants accounting for 195(57.4%).Most of the families in the study earned an average monthly income of >100,000 naira per month. The Point of sale (POS) was the most preferred mode of transaction accounting for 34.7% and 44.4% before and during the naira scarcity. The association between level of education and the mode of transaction during the period of the naira scarcity was significant with mobile bank app with a P = 0.0000. About 189(55.5%) women missed between 1-6 antenatal visits due to the naira scarcity but the association between the average monthly family income of respondents and the number of ante natal care missed was not statistically significant with an overall P= 0.479 .

About 266(78.2%) and 310 (91.2%) of the respondents believed that prolonged effect of the naira scarcity could lead to increased maternal mortality and morbidity

Conclusion: The cashless policy of Central Bank of Nigeria was geared towards economic recovery. The artificial naira scarcity created by the policy brought unimaginable hardship on the health seeking behavior of pregnant women such as difficulty in accessing care, missed antenatal appointments, denial of antenatal care services due to lack of cash and failure of electronic payment platforms. All the aforementioned difficulties could ultimately have a negative effect on pregnancy outcome and maternal health.

The Role of Salivary Progesterone in Predicting Women At-Risk of Preterm Delivery

2024-01-12T00:45:00-07:00

Background: Vaginal fetal fibronectin assay has been used as a gold standard biomarker for the prediction of preterm birth especially among symptomatic pregnant women with relatively good sensitivity and high specificity. However, recent evidence is emerging that salivary progesterone assay can be used to predict preterm birth. Methodology: A cohort study was used to assess the predictive values of salivary progesterone in women at-risk for preterm delivery at a tertiary hospital in Kano – Nigeria. Salivary samples were collected for progesterone level assay between 28-32weeks of gestation among 135 asymptomatic pregnant women. The study participants were followed up and the gestational age of delivery was determined and receiver operator characteristic curve was plotted to determine the predictive cut off value for salivary progesterone. Results: The mean salivary progesterone was found to be 854.24 ± 192.25pg/ml and 1599.06 ± 226.09pg/ml for those who had preterm and term deliveries respectively. There was a statistically significant difference in the mean salivary progesterone between the two groups. At a cut off value of 1253.3pg/ml, salivary progesterone was found to have a Sensitivity of 100%, Specificity of 90.8%, Positive Predictive Value of 85.7 and Negative Predictive Value of 100%. Conclusion: This study found salivary progesterone quantitative assay to be useful in predicting preterm birth among women at-risk, with high diagnostic accuracy. Therefore, it can be used as screening tool for women at risk of preterm delivery.

Key words: Salivary; Progesterone; Assay; Preterm

Domestic Violence in Antenatal Attendees atT Alex Ekwueme Federal University Teaching Hospital, Abakalike, Ebonyi State, Nigeria: Prevalence, Pattern and Determinants

2023-11-24T06:30:41-07:00

BACKGROUND

Domestic violence is a form of subjugation on women by their intimate partner. It is associated with adverse consequences particularly when it occurs during pregnancy. The aim of this study was to determine the prevalence, Pattern and determinants of domestic Violence in antenatal attendees in our facility.

METHOD

A self-administered pretested questionnaire was used for this cross sectional survey of pregnant women who attended antenatal clinic between September to December 2016 at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Data were inputted into Epi info software and analyzed. The level of significance was set at p<0.05.

RESULTS

A total of 400 questionnaires were correctly filled out of 409 questionnaires that was administered. The questionnaires were then analyzed using the Epi info. Bivariate Analysis between sociodemographic variables and presence of domestic violence was done. The mean age of participants was 28.8 years. The prevalence of domestic violence was 61%. Half of responders (50.6%) suffered emotional violence, followed by physical violence(42% ), then sexual violence(32%). The main determinants of domestic violence were early age of marriage, marital status and the socio-economic status of the partners.

CONCLUSSION

The prevalence of domestic violence was high and most of these cases were not reported. Public health enlightenment and incorporation of domestic violence management into the antenatal care models are critical and effective intervention to assist our client to have an optimal pregnancy outcome.

The Pattern of Cervical Cytology in a Tertiary Health Care Centre in Abuja - The Capital City of Nigeria

2023-10-22T22:22:59-06:00

Background: Cervical cancer is a preventable disease. Its incidence and mortality have reduced drastically in countries with well-established cervical cancer screening programmes. Objectives: To determine the pattern of cervical cytology and associated risk factors in women routinely screened at the Federal Medical Centre Abuja. Methodology: This was a cross-sectional study conducted from September 2018 to September 2019. An equal number of 270 women each were recruited from the postnatal, family-planning and gynaecological clinics giving a total of 810 women enrolled in the study. Informed consents were obtained from the participants and data on risk assessment was collected using an interviewer administered structured questionnaire. Afterwards, a cervical sample was taken from each participant’s transformation zone(liquid-based cytology), and results were reported using the Bethesda classification. The data was analysed and presented as tables of frequencies/percentages and central tendencies. The risk factors for cervical dysplasis were determined using multiple logistic regression analysis. Statistical significance was set at p-value < 0.05. Results: Overall, the prevalence of abnormal/dysplastic smears was 3.95% while 96.05% had negative smears for intraepithelial lesion or malignancy(NILM). According to the severity of dysplasia, ASCUS had prevalence of 2.96%, ASC-H 0.37%, LSIL 0.37% and HSIL 0.25%. Group specific prevalence was highest among the postnatal group (6.3%). Age was the only factor associated with increased likelihood of developing dysplasia. Conclusions: . The prevalence of cervical dysplacia is relatively low in Federal Medical Centre Abuja. Instituting routine screening of all sexually active women at every opportunity especially in postnatal clinics be encouraged as this will help in early detection of cervical dysplasia and management, thus reducing the incidence of cervical cancer.

Preterm Prelabour Rupture of Membranes at the University of Medical Sciences Teaching Hospital Complex, Ondo: A 5-Year Review.

2023-11-25T13:00:45-07:00

Preterm Prelabour rupture of membranes (PPROM) remains a major obstetric challenge. PPROM accounts for a third of preterm births. It is associated with increased risk of maternal and perinatal morbidity and mortality. We found the prevalence of PPROM at the UNIMEDTH Ondo to be 2.6%. Majority of women with PPROM were not registered for antenatal care at our facility. The high-risk nature of PPROM is evidenced by 83% of babies with low birthweight and almost 5% with birth asphyxia. Early booking for antenatal care and hospital delivery is advocated. Availability of quality neonatal intensive care services is critical in management of babies delivered.

Fertility Indicators and Prevalence of Infertility in Benue State South Senatorial District

2024-02-27T01:44:33-07:00

Background: Sub-Saharan Africa, unlike the rest of the world is yet to achieve demographic fertility transition. In Nigeria, Benue state and Benue South senatorial particular, there is a paucity of vital statistics, and hospital-based studies constitute the main source of information. Therefore, the aim of this study was to determine the indicators of fertility and the prevalence of infertility in Benue State South Senatorial District.

Aim: To determine fertility indicators and prevalence of infertility in Benue South Senatorial District.

Materials and methods: This was a community-based, descriptive cross-sectional study involving women of child bearing age. Multi-stage sampling technique was used to select eligible women from communities in Benue South Senatorial District. Ethical clearance was obtained from the Ethical Committee of the Federal University of Health Sciences, Otukpo before commencement of the study and informed consent was obtained from the study participants. A pre-designed, pre-tested Proforma was used for data collection in the selected communities. Data obtained was analysed using SPSS version 20

Results: The mean age at first pregnancy of the 226 women studied was 24 years and their average parity was 4. Level of education, body mass index (BMI), age at first pregnancy and tribe were the significant predictors of fertility in this study. Prevalence of infertility was 4%.

Conclusion: Benue South Senatorial District’s fertility indicators is similar to the national indicators.

Conclusion: Benue South Senatorial District is on course with her demographic transition.

Key words: Predictors, fertility, prevalence, infertility, Benue South