Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes.

Background: Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications. Aim: The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM. Materials and Methods: Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb's criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically. Results: Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM. Conclusion: Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

The outcome of complementary and alternative medicine use among pregnant women in South-East Nigeria: a multi-centre prospective study.

There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study's ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value= <.05). In conclusion, CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.Impact StatementWhat is already known on this subject? There is an increasing trend of CAM use among pregnant women in the world. Pregnancy is associated with certain conditions that predispose women to CAM use. The clinical indications for CAM use by the pregnant women are nausea and vomiting, labour pain, induction of labour, pedal oedema and waist pain.What the results of this study add? CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of the babies when compared with non-CAM users.What the implications are of these findings for clinical practice and/or further research? CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.

Acceptance of postpartum intrauterine contraceptive device among women attending antenatal care in a low-resource setting in Nigeria.

OBJECTIVE: To assess the level of awareness, acceptance, and any identifiable barriers to the use of postpartum intrauterine devices (PPIUDs) among pregnant women receiving care in a low-resource setting in Nigeria. METHODS: A pretested interviewer-administered questionnaire was used to obtain relevant data from all consenting pregnant women receiving antenatal care at Polyclinic and Uwani health center in the city of Enugu from January 1 to March 31, 2018. Data were entered and analyzed using Epi Info statistical software. P<0.05 was considered statistically significant. RESULTS: About two-thirds (65.6%) of the 620 respondents were unaware of PPIUDs. After counseling, about one-third (36.8%, n=228/620) of the respondents accepted having an immediate PPIUD, while the majority (63.2%, n=392/620) declined. The identified barriers towards accepting immediate PPIUDs were fear of side effects (57.9%), religious reasons (20.7%), and preference for other contraceptive methods. None of the respondents had ever inserted a PPIUD previously. CONCLUSION: The low level of acceptance of PPIUDs in the study appears to be a reflection of the low level of awareness of PPIUDs in the region. Efforts in creating awareness and health education to dispel the myths and misconceptions about PPIUDs are required in order to promote its uptake in the region.

Leiomyomatosis peritonealis disseminata in a Nigerian woman.

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition. A 48-year-old multiparous woman was referred because of an incidental ultrasound finding suggestive of LPD. She had a 6-year past history of use of combined oral contraceptive pills. LPD was also suspected at laparotomy and confirmed by histology. She had total abdominal hysterectomy, bilateral salpingo ophorectomy and infracolic omentectomy. Patient was being followed-up. LSD is a rare gynecological condition which can pose a diagnostic challenge. Removal of estrogen sources as was done for the patient is the mainstay of treatment. Patient follow-up is very important because of the risk of malignant transformation.

Labor support: an overlooked maternal health need in Enugu, south-eastern Nigeria.

OBJECTIVES: The current call for continuous support by women for women during labor takes for granted that women prefer to be supported by other women rather than their husbands. This study aimed at identifying the experiences and preferences of parturients as regards support in labor. METHODS: Questionnaires were administered to 395 parturients at the University of Nigeria Teaching Hospital, Enugu, south-eastern Nigeria from January to August 2006. Data analysis was both descriptive and inferential at 95% confidence level. RESULTS: None of the respondents' husband, relations or friends was allowed into the labor room. Ninety-five (24.1%) parturients did not wish to be supported in labor by their husbands. Sixty-five (68.4%) of this group preferred to be supported in labor by medical/midwifery staff only, while the remaining 30 (31.6%) would have preferred a relation. Three hundred (75.9%) parturients, if permitted, would have preferred labor support by their husbands. The preference for labor support by husband was significantly associated with maternal educational status (p=0.003), parity groups (p=0.022), and age category (p=0.037). CONCLUSIONS: Labor support by a non-medical employee of health institutions is not practiced in Enugu, south-eastern Nigeria. Most women would prefer to be supported by their husbands during labor. There is a strong desire by mothers for a policy change as regards labor support by family and friends.

Improved awareness of Pap smear may not affect its use in Nigeria: a case study of female medical practitioners in Enugu, southeastern Nigeria.

Improved awareness of Pap test by Nigerian women may not necessarily increase its use. This hypothesis was tested using female medical practitioners in Enugu state, Nigeria. They were expected to be advocates of disease screening and therefore should lead by example. All respondents were aware of the Pap smear but only 18% had used it. The mean frequency of Pap smear was 1.8+/-1.2 (range 1-5). Repeat Pap tests were observed only among respondents that had screened as routine. The majority (32%) of those who never screened for cervical cancer had no reason. There may be more to the use of Pap smear among women in Nigeria than its awareness.

An unmet cancer screening need of HIV-positive women in southeastern Nigeria.

CONTEXT: HIV infection and cervical cancer are common in Nigeria. HIV-positive women have a higher risk for cervical neoplasm; therefore, counseling and regular cervical cancer screening are recommended. After post-HIV testing counseling, HIV-positive women should be aware of the Papanicolaou (Pap) smear. OBJECTIVE: To determine the coverage of cervical cancer screening information for HIV-positive women by the post-HIV testing counseling. METHODS: Questionnaires were administered to 150 HIV-positive women and 150 HIV-negative controls after post-HIV testing counseling at the voluntary counseling and testing clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Proportions of responses were compared by using a chi-square test at a 95% confidence level. RESULTS: Thirty-three (22.0%) HIV-positive women and 57 (38%) HIV-negative women were aware of cervical cancer. The awareness of the Pap smear among HIV-positive women (4.0%) was lower than that of HIV-negative women (21.3%) (P < .001). However, this finding became insignificant after adjustment for educational status groups (P > .05). No respondent agreed to being informed of Pap smears during post-HIV testing counseling. After counseling on cervical cancer, 96.0% of the HIV-positive group and 98.7% of the HIV-negative group expressed willingness to undergo routine Pap screening. CONCLUSIONS: Cervical cancer screening information is not part of post-HIV testing counseling for women in Enugu, southeastern Nigeria.

Sterilization by minilaparotomy in south-eastern Nigeria.

The study aimed to assess the trend in acceptance and characteristics of acceptors of female sterilization between January 1999 and December 2006 at the University of Nigeria Teaching IHospital, linugu, South-Eastern Nigeria. There were a total of 20,485 new clients, with 212 (1.0%) accepting sterilization between January 1999 and December 2006. There was an initial rise in acceptance from 0.4% in 1999 to 3.0% in 2004, then a decline. 108 (50.9%) were between 35-39 years. 169 (79.7%) had more than five living children. 69 (32.5%) and 76 (35.9%) had secondary and higher education respectively. Health workers were the main source of information. Completed family size was the reason for choosing sterilization in 185 clients (87.3%). 120 (56.6%) were in occupational social class 3.106 (50.0%) did not practice any form of family planning prior to the procedure. 184 (86.8%) had interval sterilization and the rest (13.2%) postpartum. Acceptance of tubal sterilization is still low in our community.

Uterine procidentia in an African adolescent: an uncommon gynecological challenge.

BACKGROUND: Uterovaginal prolapse in adolescents is rare, hence this report. CASE: Miss O.N. was a 17-year-old Para 1(+0) A1. She had a regular menstrual cycle. She presented with complaints of mass protruding from her vagina of twenty months duration. The problem started four months after a normal delivery at a maternity home. Her mother had a similar problem after her last delivery. A diagnosis of uterine procidentia was made. The patient and her care giver consented to use of ring pessary only. SUMMARY AND CONCLUSION: Uterovaginal prolapse can occur in a black adolescent with normal menstrual cycle and in the absence of obvious musculoskeletal or neurogenic defect. The etiology could be multifactoral. Ring pessary is an effective non-surgical treatment option in the young.