Clinical correlates of women requesting labour epidural analgesia in a tertiary hospital in Nigeria.

OBJECTIVES: To evaluate the clinical correlates of women who received pain relief in labour with lumbar epidural analgesia and also investigate the labour outcome. MATERIALS AND METHODS: A hospital -based case-control study conducted in a tertiary care facility in Nigeria. The clinical characteristics and delivery outcome of women who had epidural analgesia in labour were compared to those without. RESULTS: The utilisation rate of labour epidural analgesia during the study period was 13/1000 women. Tertiary education was significantly higher among women who had epidural analgesia in labour (22.7% vs 3.4%, p=0.0009). There were no statistically significant differences between women who had labour epidural analgesia and the controls in terms of labour and delivery by caesarean section. The second stage of labour was prolonged in women who received epidural for pain relief in labour (p=0.005). The neonatal indices (Mean birth weight or Apgar score<7 in first minute) were similar. CONCLUSION: This study suggests that labour epidural analgesia is not associated with increased caesarean section and adverse foetal outcome. This is of value in increasing the acceptance of this service by pregnant women in Nigeria.

Physical after effects and clients satisfaction following colposcopy and cervical biopsy in a Nigerian population.

BACKGROUND: Although Nigeria has a high prevalence of cervical cancer, screening services including colposcopy and directed cervical biopsy are not widely available. OBJECTIVES: A prospective study among 111 women who had colposcopy and cervical biopsy following an abnormal Pap smear result at the University of Benin Teaching Hospital in Nigeria. It explored physical after effects experienced and satisfaction of clients after the procedure. RESULTS: The mean age of the population was 49.5±8.7 years (range, 30 - 64 years) and majority (64.9%) had tertiary education. Overall, 69 women (62.2%) reported physical effects following the procedure. Common physical effects experienced included spotting blood per vaginam (65.2%), pain (34.8%) and vaginal discharge (17.4%). Spontaneous resolution of symptoms occurred within 48 hours in 90.9% of those who reported physical effects. Clients who experienced physical after effects were significantly older (p=0.002) and had tertiary education (p=0.019). Majority of the women (94.6%) were satisfied with the screening services and more than 97% were willing to accept a repeat procedure. CONCLUSIONS: Although majority of the clients who had colposcopy and cervical biopsy reported they experienced physical side effects, more than 97% were willing to have a repeat procedure. This information can assist colposcopic service providers in counseling clients.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria.

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p=0.024) and unmarried women (p=0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

HIV-AIDS related maternal mortality in Benin City, Nigeria.

OBJECTIVE: To determine the causes and characteristics of maternal deaths in HIV-infected women. DESIGN: A retrospective study of maternal deaths in a cohort of HIV-infected women. SETTING: A facility-based maternal death review using case records and mortality summaries. METHODS: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4-year period. Causes and circumstances surrounding each maternal death were identified. RESULT: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancy-related sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. CONCLUSION: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.

Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population.

Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.

Influence of maternal height on mode of delivery in Nigerian women.

AIMS AND OBJECTIVES: To determine the influence of maternal height on the mode of delivery even when matched for maternal characteristics. The study is a prospective cohort study comparing the mode of delivery in 57 short stature women (d"150 cm) with age and parity-matched, taller control women (n = 57). MATERIALS AND METHODS: A total of 114 parturients were studied, 57 of whom had a height of 150 cm or lower and constituted the study group, while the other 57 taller women were matched with respect to parity (i.e. belonging to same parity group of either nulliparity, para 1-3, para 4+) and maternal age group (i.e. <20, 20-34, 35+ years) to the shorter women and constituted the control group. Patients were also matched by gestational age (28-37 weeks, 38-42 weeks, 42+ weeks) and birth weight (<2500g, 2500-3999g, 4000+) groupings. RESULTS: Caesarean section rate in the short women was higher (42.1%) than in taller women (21.1%), P= 0.016, as was the incidence of cephalopelvic disproportion (35.5% versus 10.3% respectively, P = 0.010). Nevertheless, neonatal outcome remains good; the 5-min Apgar score <7 was 21.1% versus 15.8% respectively, P =0.469, while the stillbirth rate was 10.5% versus 7.0), P = 0.508. CONCLUSION: Short stature is independently associated with an increased risk of intrapartum caesarean section in Nigerian women and advocate early recourse to caesarean section to avoid undue delay.

Induction of labour: determinants and implications of failure to keep an initial appointment in a developing country.

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the 'spousal factor' (23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.