Tropical Journal of Obstetrics and Gynaecology

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

Fri, 30 Aug 2024 00:00:00 -0600

third of preterm births. It is associated with increased risk of maternal and perinatal morbidity and mortality. OBJECTIVES: To evaluate the prevalence, clinical characteristics as well as feto- maternal outcomes of PPROM at the University of Medical Sciences Teaching Hospital (UNIMEDTH) Complex, Ondo. METHODS: A retrospective review of women with PPROM from January 2013 to December 2017 was carried out. Data were retrieved from hospital, labour room and Neonatal intensive care unit records. Data was analyzed by descriptive statistics using Statistical Package for Social Sciences (SSPS), Windows version 23, Computer Software. RESULTS: There were 13,425 births, of which 352 women had PPROM giving a prevalence of 2.6%. The mean age of the women was 30.02 ± 5.26 years. A total of 68.5% of subjects were not registered for care in our facility. The mean gestational age at delivery was 32.12 ± 2.41 weeks. Caesarean section was the mode of delivery in 32.7% of patients while 17.3% had chorioamnionitis, and 9.4 % developed puerperal sepsis. Live births accounted for 95.1% of total while 83% and 4.9% of latter had low birth weight and birth asphyxia, respectively. Neonatal unit admission was necessary in 72% of the live births and perinatal mortality was 10.4%. One maternal mortality was recorded. CONCLUSION: The prevalence of PPROM at the UNIMEDTH Ondo is 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.

Trend and Methods of Contraceptives Usage at Federal Teaching Hospital, Gombe, North East Nigeria; A Five Years Review

Fri, 30 Aug 2024 00:00:00 -0600

ABSTRACT

BACKGROUND:

Contraception has played a key role in fertility decline and reduction in maternal mortality, especially in countries with high contraceptive prevalence. Despite the high fertility rate of 5.7 children per woman in Nigeria, our contraceptive prevalence rate is low at 15%.

OBJECTIVE:

This study aimed to determine the pattern of contraceptive usage and socio-demographic characteristics of the users of family planning services in Federal Teaching Hospital, Gombe from 1^st January 2017 to 31^st December 2021.

STUDY DESIGN AND SETTING: This was a 5-year retrospective study.

MATERIALS AND METHODS:

The records of the clients that attended the family planning clinic and patients who had Tubal ligation from 1st January 2017 to 31^st December 2020 were analysed. The variables taken into consideration included age, parity, marital status, educational status, number of living children and the methods of contraception used. These were analysed using Epi Info 2019 version 7.2.2.16

RESULT: A total of 4713 new clients attended the Family Planning Clinic of FTHG, Gombe within the period of review. There was a steady rise in the number of new clients accepting a method of contraception over the period from 302 (6.41%) in 2017 to 1948 (41.33%) in 2021. The commonest method of contraception was sub-dermal implant (2417; 51.28%), followed by Intrauterine device (1404; 29.8%), while the lowest was bilateral tubal ligation (29; 0.62%).

CONCLUSION: The acceptance rate of different the methods of contraception in our hospital are increasing rapidly and majority prefer long acting reversible contraceptives.

Prevalence And Determinants of Undernutrition Among Pregnant Women in Selected Public Hospitals in Ibadan, Nigeria.

Fri, 30 Aug 2024 00:00:00 -0600

Abstract

Background: Undernutrition is one of the greatest public health challenges affecting pregnant women in Africa with associated adverse pregnancy outcomes. This study aims to determine the prevalence and identify the associated factors for undernutrition among pregnant women accessing antenatal care in selected public hospital facilities in Ibadan. Methodology: A cross-sectional facility-based study was conducted among 1,162 randomly selected pregnant women who attended antenatal clinics in selected public hospitals in Ibadan , Nigeria. A structured questionnaire was used to collect the data. Left mid-upper arm circumference measurement was used to assess the nutritional status of the pregnant women by using an adult non-elastic mid-upper arm circumference tape at the mid-point between the tip of the shoulder and the tip of the elbow. Individual minimum dietary diversity for women(MDDW) was determined using the Food and Nutrition Technical Assistance III project. STATA was used for analysis. Result: The overall prevalence of undernutrition was 20.0% and a low minimum dietary diversity score was observed in 25.2%. Undernutrition status varies across the level of health care; primary health care(PHC) had the highest (30.8% and 26.8%), secondary health care facility was (14.1%), and tertiary health care; (18.7% and 9.9 %). Mothers aged 25 years and above, Marital status of being married, and Parity of para 1-5 had lower odds of being undernourished. However, there was no significant association between MDDW and the nutritional status of the respondents. Conclusion: This study revealed a relatively high prevalence of undernutrition. Healthcare providers across the three levels of healthcare should make nutritional assessment and counselling an active part of the routine antenatal care.

Psychosocial Burden of Obstetric Fistula Among Women in South-South Nigeria

Fri, 30 Aug 2024 00:00:00 -0600

Background: Obstetric fistula, a medical and psychosocial problem, is a source of misery for women in low- and middle-income countries. This study was aimed at identifying the psychosocial impact of obstetric fistula among women in Cross River State of Nigeria.

Methodology: It was a descriptive cross-sectional study carried out among women seeking treatment for obstetric fistula in 3 hospitals in Cross River State, Nigeria. A combined purposive, proportionate and consecutive sampling technique was used to select 210 participants. Ethical approval was obtained. An interviewer-administered questionnaire was used to obtain information on the demographics, obstetric characteristics and psychosexual problems experienced by the women. Data was analyzed with SPSS version 20. Chi-square was used to compare categorical variables. A P-value of less than 0.05 was considered significant.

Results: The mean age of the women was 33.7+16.6 years. The commonest psychosocial problem encountered by the participants was depression which was experienced by 175 (83.3%) women. Other problems included social discrimination in 151 (71.9%) women, sleep disturbance in 143 women (68.1%), loss of libido in 138 women (65.7%), loss of job/means of livelihood in 86 women (41.0%), extreme poverty (34.3%), ostracism in 54 women (25.4%) and divorce/marital separation in 27 women (12.9%).

Conclusion: Obstetric fistula has enormous psychosocial burden on the women affected, the commonest problem being depression. Beyond urinary continence, the goals of treatment should include social rehabilitation, re-integration, psychotherapy and mental well-being. A collaborative approach is recommended to achieve these.

Association of Serum Neutrophil Gelatinase Associated Lipocalin with Preeclampsia and its severity.

Fri, 30 Aug 2024 00:00:00 -0600

Background: Hypertensive disorders in pregnancy are among the leading causes of maternal and neonatal morbidity and mortality worldwide particularly in developing countries. The pathogenesis of hypertensive disorders in pregnancy involves complex mechanisms including incomplete invasion and remodeling of the maternal spiral arteries, cytokines, and generalized endothelial dysfunction. Neutrophil gelatinase-associated lipocalin (NGAL) is an acute phase protein which appeared to be a biomaker for acute kidney injury. It has been found to be upregulated in pathological conditions following endothelial cell injury and it is also released from the maternal-fetal interface. However, its role and relationships in preeclampsia has not been fully evaluated especially in our environment. Therefore, the aim of this study was to determine the association between Serum Neutrophil gelatinase-associated lipocalin and preeclampsia and its severity.

Methods: This was a cross-sectional study of fifty-eight (58) women with preeclampsia recruited as the study group while same number of normotensive pregnant women, served as the control. Serum NGAL levels in both groups were determined using ELISA. Data was analyzed using SPSS IBM version 26.0. Appropriate tests were used to compare continuous and categorical variables in normotensive and preeclamptic women.

Results: The mean age of normotensive and preeclamptic patients were 28.17±5.57 and 27.98±6.34 (p= 0.573). Mean Serum NGAL Level in normotensive (77.36±40.15ng/ml) was significantly lower than the mean serum NGAL level (120.66±40.26ng/ml) among preeclamptic women (p<0.001). There is difference in the serum NGAL between mild preeclampsia (118.48±31.52ng/ml) and severe preeclampsia (122.43±46.60ng/ml) but was not statistically significant (p=0.714).

Conclusion: There is an association between serum NGAL levels and preeclampsia but not with severity of preeclampsia in the studied population.

Essential- (Cobalt, Chromium, Molybdenium and Nickel) And Non-Essential- (Aluminium, Beryllium and Boron) Heavy Metals in Patients with Breast- or Cervical- Cancer.

Arinola Ganiyu Olatunbosun, Jimoh Mutiu Alani, Edem Fabian Victory — Fri, 30 Aug 2024 00:00:00 -0600

Background: There are 23 heavy metals with wide environmental distribution and known to induce multiple organ damage even at low levels of exposure. Despite high degree of toxicity and public health significance of heavy metals, their toxicity depends on dose, route, host age, gender or organ type. However, nickel, chromium, cobalt, beryllium, molybdenum, boron and aluminium are less studied in cancers. Objectives: To determine plasma concentrations of essential (cobalt, chromium, molybdenum and nickel) and non-essential (aluminium, beryllium and boron) heavy metals in Nigerian females with breast- or cervical- cancer. Method: This study was undertaken to determine plasma cobalt, chromium, molybdenum, nickel, aluminium, beryllium, nickel and boron in 30 breast cancer patients and 30 cervical cancer patients attending University Teaching Hospital, Ibadan, Nigeria; and 30 healthy female control using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Descriptive statistics was done, with statistical significance set at p≤ 0.05. Results: The mean plasma cobalt, chromium, molybdenum, nickel, aluminium, beryllium, nickel and boron were not significantly increased in cervical cancer patients or significantly decreased in breast cancer patients compared with healthy female control. However, the mean plasma cobalt, chromium, molybdenum, nickel, aluminium, beryllium and boron were significantly increased in cervical cancer patients compared with breast cancer patients. When stage 2 cervical cancer patients was compared with stage 2 of breast cancer, the mean plasma cobalt, chromium, molybdenum, nickel, aluminium, beryllium and boron were significantly increased in cervical cancer patients compared with stage 2 breast cancer patients. Conclusion: This study revealed that concentrations of heavy metals vary with cancer types. Therefore, differential nutritional supports and chelation therapy for the management of cancer patients will be needed for different cancers.

Awareness, Knowledge and Acceptability of Human Papilloma Virus Vaccination Among Women Attending Antenatal Clinics in Zaria, Northwestern Nigeria.

Fri, 30 Aug 2024 00:00:00 -0600

Background: Cervical cancer remains a major cause of mortality in Sub-Saharan Africa despite being a preventable disease. Human papilloma Virus vaccine is an effective primary preventive strategy for cervical cancer prevention. Nigeria has rolled out HPV vaccine at grassroot level. Thus, there is need to assess the level of awareness and acceptance of the vaccine. Objectives: The study assessed awareness and acceptability of Human Papilloma Virus vaccination among women attending antenatal clinics in Zaria. Factors that influence such were explored. Materials and Methods: It was cross sectional descriptive study. Sample size was 435. It was conducted between December 2022 and July 2023 among women attending antenatal care Primary, Secondary and Tertiary health care facilities in Zaria Metropolis. Data was obtained using both quantitative and qualitative approach. Results: The mean age of respondents was 27.9 (± 6.1) years, 48% engaged in trade with only 2.5% working in health and allied profession. Only 67 (15.4%;) were aware of HPV vaccine; of which, only 3 (4.5 %) respondents had good knowledge. More were willing to vaccinate their female than their male children (86.6% versus 71.6%), however the difference was not statistically significant. Women with higher educational level were more willing to pay or travel to vaccinate their children (p =0.003 and 0.05 respectively). Lack of adequate information about the vaccine and safety concerns were major barriers to acceptability. Conclusion: Awareness of HPV vaccine is low, and knowledge is poor among the respondents. Acceptance was high among respondents that were aware of the vaccine.

Prevalence of, and Risk Factors for Dysmenorrhea among Female Medical Students at the University of Ibadan, Nigeria

Fri, 30 Aug 2024 00:00:00 -0600

Aim: This study investigates the prevalence and factors associated with dysmenorrhea among medical students at the University of Ibadan, Nigeria. Materials and Methods: A cross-sectional study was conducted among female medical students that were regularly menstruating. A structured questionnaire validated by expert independent observers was used for data collection. Information collected included socio-demographic characteristics, pattern of menstruation including dysmenorrhea, and related reproductive health explanatory variables. The association between dysmenorrhea and selected explanatory variables status was assessed with the chi-square test. Poisson regression with robust variance was used to examine the significant factors that affect the prevalence of dysmenorrhea. Results: In total, 171 female medical students participated. Majority 163 (96.45%) of participants reported have had lower abdomen pain during menstruation. There was a statistically significant difference in the average monthly allowance between participants with and without a history of dysmenorrhea (p<.001). A higher percentage of participants 99 (61.88%) with a history of dysmenorrhea stated that a family member had experienced cyclical pain. Participants who were unsatisfied with their relationship with their parents had 1.04 (95% CI 1.01 - 1.08) times more likely to experience dysmenorrhea than participants who felt satisfied with their parents. Conclusion: There is a high prevalence of dysmenorrhea amongst medical students with those having an increased average monthly allowance and feeling satisfied with their parents at a decreased risk.

Impact of the COVID-19 Pandemic on Obstetrics and Gynaecology Residency Training in Nigeria

Safiyya Faruk Usman, Korede Durojaiye, Dauda Katagum — Fri, 30 Aug 2024 00:00:00 -0600

Context: The bid to curtail the COVID-19 pandemic has led to the reduction of several Obstetric and Gynaecological services with possible impairment in training. Hence, the objective of this study was to assess the impact of the COVID-19 pandemic on Obstetrics and Gynaecology residency training program in Nigeria.

Methods and Materials: This was a cross-sectional study. An online invitation to participate in the study as well as the study link was sent to Obstetrics and Gynaecology residents in 42 training institutions in Nigeria via residents’ WhatsApp groups and emails. The study questionnaire was completed anonymously by consenting residents. Univariable logistic regression analyses were used to evaluate the impact of the COVID-19 pandemic on residents’ clinical services and teaching activities as well as on the psychological wellbeing of the residents.

Results: Two hundred and twenty-one residents completed the survey. Sixty-seven percent of the residents were aged between 31-40 years while eighty-five percent of the residents were training in COVID-19 reference hospitals. Fifty-nine percent and 66.9% of the residents reported significant reduction in general clinical practice and teaching activities respectively during the COVID-19 pandemic. Logistic regression analysis showed that the level of general reduction in clinical practice and the degree of mood impairment were not significantly associated with the residents’ characteristics.

Conclusion: The COVID-19 pandemic has considerably reduced clinical and academic training exposure of Obstetrics and Gynaecology residents in Nigeria.

Keywords: Covid-19 Pandemic, Obstetrics, Gynaecology, Residency training, Nigeria

An Evaluation of The Success Rate and Pregnancy Outcome of Tocolysis for Preterm Contractions at Lagos University Teaching Hospital: A 5-Year Review

Fri, 30 Aug 2024 00:00:00 -0600

Context:

Preterm contraction and resultant preterm delivery is a major contributor to perinatal morbidity and mortality. This necessitates decision to tocolyse when there is no significant cervical change, to prolong pregnancy and enhance fetal maturity. Several tocolytic agents are available and sometimes there may be a need to switch tocolytic agents when one is considered not to be as effective as expected.

Aims:

To determine prevalence of preterm contractions at Lagos University Teaching Hospital (LUTH) and the success rate of various tocolytic agents used in the last five years.

Settings and Design:

A cross sectional study.

Methods and Material:

Data was collected from case notes of all patients managed for preterm contractions at the health facility and analyzed using SPSS version 25.0. Chi square test was used to test for association between categorical variables.

Results:

Prevalence of preterm contractions during study period was 68.1 per 1,000 obstetric admissions. Uterine inhibition was successfully achieved in 81.7% of cases following tocolysis. Tocolytic agents used during study period were oral Salbutamol, oral Nifedipine, parenteral Magnesium Sulphate and Atosiban. Atosiban was found to be most effective and Magnesium Sulphate least effective (p < 0.001). Atosiban was also found to be safest in terms of side effects compared to other tocolytic agents used (p = 0.002).

Conclusions:

The high success rate of tocolysis for preterm contractions as found in this study is encouraging. Oxytocin receptor antagonist such as Atosiban is the most the effective and safest tocolytic agent and its use needs to be encouraged where it is readily available.

Key-words: Preterm contractions, tocolysis, uterine inhibition, effectiveness, safety, side effects.

Key Messages: The use of Atosiban should be encouraged where it is readily available as it effective and safe in preterm contractions.

Pattern and Outcome of Gynaecological Malignancies at a Tertiary Hospital in the Federal Capital Territory (FCT), Nigeria.

Fri, 30 Aug 2024 00:00:00 -0600

BACKGROUND: Gynaecological cancers in Nigeria are associated with high morbidity and mortality due to poverty, late presentation and limited treatment facilities. There is a need to evaluate the trend and outcome of the disease in the Nigeria’s Federal Capital Territory. AIM: To evaluate the trends in gynaecological cancer, stage at diagnosis, treatment and outcome of patients diagnosed at Federal Medical Centre Abuja. MATERIALS AND METHODS: A 5-year retrospective study of all histological diagnosed gynaecological cancer managed at Federal Medical Centre Abuja from 13^h May 2018 to 12^th May 2023. Their case notes were retrieved and relevant information extracted. Data was collected using an Epi Info^TM version 7.2.2.6 and results presented as frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. RESULTS: Out of the 8,425 gynaecological cases managed within the study period, 58 of them were gynaecological cancers, giving a prevalence of 0.69%. Their overall mean age was 50.96 12.6 years. Cervical cancer was the commonest with a prevalence of 39.66%, followed by ovarian (27.59%), endometrial (25.86%), choriocarcinoma (5.17%) and vulva (1.72%). Majority presented in early stage 1 disease (39.66 %), followed by stage 3 (27.59%), then stages 2 (24.14%) and 4 (8.62%). Majority (32.76%) received surgery/chemotherapy, 31.03% referred for chemoradiation alone, The overall 5-year outcome revealed that 43 (74.14%) were alive and 15 (25.86%) were dead. Ovarian cancer contributed 37.50% to the mortality followed by endometrial cancer (33.33%) and cervical cancer (17.39%). CONCLUSIONS: The prevalence of gynaecological cancers has been on the rise in our facility, with cervical cancer being the commonest. Most were of early stage disease with high survival rate. The mortality recorded were mostly from advanced disease and delay in commencement of radiotherapy, necessitating government intervention.

Sigmoid Colonovaginoplasty – Case Series at the National Obstetric Fistula Center Katsina

Gideon Musa, Auwal Sani — Fri, 30 Aug 2024 00:00:00 -0600

Mullerian duct abnormalities are rare and the exact incidence is unknown, patients may present with absence of the uterus, fallopian tubes, cervix and upper two third of the vagina, ovaries are usually present and functional. We treated 3 patients from 2020 to 2023, the average age was 23 years both presented with primary Amenorrhea, with well-developed secondary sexual characteristics, no cyclical abdominal pain or features of hyperandrogenism, and on examination they had normal external genitalia with short vagina or only a dimple. Radiological findings showed features of MRKH (present ovaries, absent or hypoplastic uterus, fallopian tubes and cervix). No renal abnormalities. A definitive repair with creation of a neovagina using the sigmoid colon segment was performed in a single stage which offers a promising and safe alternative for patients with MRKH.

Keyword: Mullerian duct anomalies, Mayer Rokitanski, Kuster-Hauser Syndrome (MRKH), Neovagina.

Role of Anthihelminthics in Prevention of Anemia in Pregnancy

Qudus O. Lawal, Haliru Kadiri, Friday Oarhe — Fri, 30 Aug 2024 00:00:00 -0600

N/A

Advancing Medical Education in Nigeria… The Ajabor Legacy

Ehigha Enabudoso, Alero Ogbebor, Mutairu Ezimokhai, Eli Sukarime, Eugene Okpere — Fri, 30 Aug 2024 00:00:00 -0600

ABSTRACT

Prof. Linus Ajabor, one of the renowned pathfinders of the Medical Profession in Nigeria, left indelible footprints in the medical profession especially in the field of Obstetrics and Gynaecology. He was an astute clinician, an excellent teacher and a disciplined administrator, qualities which earned him many positions and awards. Of all his many good qualities and skills, he was most outstanding as a teacher and a mentor. These qualities caused him to influence the careers of many doctors and earned him many mentees who in turn decided to honour him while alive with a lecture series called “FRONTIERS IN MEDICAL EDUCATION”.

This article reviewed all the published and presented lectures in this series given at the Annual General Meetings and Scientific Conferences of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) from 2015-2023 in the order of medical training. It begins with the undergraduate to internship and ultimately to various aspects of the postgraduate training, to portray the diversity yet inclusivity of medicine, all of which Prof Ajabor actively contributed and partook in. It highlights the state of medical education and proposes models to improve medical education in Nigeria based on the research and recommendations of the presenters.