The Burden of Unsafe Abortion Six Years before the COVID-19 Era in a Nigerian Tertiary Hospital: An Analytical Retrospective Study.

BACKGROUND: Unsafe abortion remains a leading cause of maternal mortality and morbidity, especially in developing countries with restrictive abortion laws. Disease containment measures during the COVID-19 pandemic have reduced access to contraception and safe abortion care, potentially increasing rates of unintended pregnancies and unsafe abortion. OBJECTIVE: To evaluate the morbidity and mortality burden of unsafe abortion before the COVID-19 pandemic. METHODS: A six-year analytical retrospective study of unsafe abortion at the Federal Medical Centre, Lokoja, Nigeria. All case records of unsafe abortion managed within the study period were retrieved, and relevant data extracted using a purpose-designed proforma. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Associations between categorical independent and outcome variables were assessed using the Chi square test at 95% confidence level. A p-value of <0.05 was considered statistically significant. RESULTS: The prevalence of unsafe abortion was 8.6 per 1,000 deliveries. More than one-half (37, 52.9%) were medical abortions using misoprostol tablets. The mean age of the women was 23.15+ 3.96 years, and most of them were single (49, 70%), with primary/ secondary education (42, 60%), and of low socioeconomic status (67, 95.7%). Nearly one-half (33, 47.1%) had either never used any modern contraceptive (9, 12.9%) or only used emergency contraception (24, 34.3%). The predominant complications of unsafe abortion included retained product of conception (69, 98.6%), haemorrhagic shock (22,31.4%), and sepsis (19, 27.1%). There were two maternal deaths, giving a case fatality rate of 2.9%. CONCLUSION: Unsafe abortion remains a significant cause of maternal mortality and morbidity in our setting. Improving access to effective modern contraceptives and liberalizing our abortion laws may reduce maternal morbidity and mortality from unsafe abortion.

CONTEXTE: L'avortement à risque reste l'une des principales causes de mortalité et de morbidité maternelles, en particulier dans les pays en développement où les lois sur l'avortement sont restrictives. Les mesures de confinement de la maladie pendant la pandémie de COVID-19 ont réduit l'accès à la contraception et aux soins d'avortement sûrs, augmentant potentiellement les taux de grossesses non désirées et d'avortements à risque. OBJECTIF: Évaluer le fardeau de morbidité et de mortalité de l'avortement à risque avant la pandémie de COVID-19. METHODES: Une étude rétrospective analytique de six ans sur l'avortement à risque au Fédéral Médical Center, Lokoja, Nigeria. Tous les dossiers de tous les cas d'avortement à risque pris en charge au cours de la période d'étude ont été récupérés et les données pertinentes extraites à l'aide d'un formulaire conçu à cet effet. Les données obtenues ont été analysées à l'aide d'IBM SPSS Statistiques pour Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Les associations entre les variables indépendantes catégorielles et les variables de résultat ont été évaluées à l'aide du test du chi carré à un niveau de confiance de 95 %. Une valeur de p <0,05 était considérée comme statistiquement significative. RESULTATS: L'prévalence des avortements à risque était de 8,6 pour 1000 accouchements. Plus de la moitié (37, 52,9%) étaient des avortements médicamenteux utilisant comprimés de misoprostol. L'âge moyen des femmes était de 23,15+ 3,96 ans, et la plupart d'entre elles étaient célibataires (49, 70%), avec une éducation primaire/secondaire (42, 60%) et de statut socio-économique bas (67, 95,7%). Près de la moitié (33, 47,1%) n'avaient jamais utilisé de contraceptif moderne (9,12,9%) ou n'avaient utilisé qu'une contraception d'urgence (24, 34,3%). Les complications prédominantes comprenaient la rétention du produit de conception (69, 98,6 %), le choc hémorragique (22, 31,4 %) et la septicémie (19, 27,1 %). Il y a eu deux décès maternels, soit un taux de létalité de 2,9 %. CONCLUSION: L'avortement à risque reste une cause importante de mortalité et de morbidité maternelles dans notre contexte. L'amélioration de l'accès à des contraceptifs modernes efficaces et la libéralisation de nos lois sur l'avortement réduiront la morbidité et la mortalité maternelles dues à l'avortement à risque. Mots-clés: Planification familiale, Avortement illégal/criminel, morbidité et mortalité maternelles, Produit de la conception retenu, Besoin non satisfait.

Pregnancy outcome in elderly primigravidae.

BACKGROUND: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes because of associated pregnancy and labor complications and, therefore, need to be evaluated. AIM: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that in younger primigravid mothers in Port Harcourt. MATERIALS AND METHODS: It was a two-year retrospective case-controlled study. The study population consisted of all primigravid mothers aged 35 years and above (elderly primigravidae) who delivered at the University of Port Harcourt Teaching Hospital (UPTH) between 1st January, 2005 and 31st December 2006, and the control group consisted of all other primigravid women less than 35 years of age. Selected maternal and perinatal sociodemographic characteristics and other outcome variables were extracted from patients' case notes. The data were entered into a personal computer and analyzed using SPSS version 11.0. The χ2 - test was used for comparison of both groups and statistical significance set at P < 0.05. RESULTS: Of the 5147 parturients who delivered during the study period, 74 (1.4%) were elderly primigravidae. They constituted 4.7% of all primigravidae. The caesarean delivery rate (58.1% vs 32.1%, P = 0.001), preterm delivery rate (10.8% vs 5.1%, P = 0.03), and fetal macrosomia rate (16.2% vs 6.6%, P = 0.002) were significantly higher in the elderly primigravidae than the younger primigravid controls. There were no significant differences in the other maternal and perinatal outcome measures. CONCLUSION: The prevalence of elderly primigravidae in our centre is 1.4%. The elderly primigravidae are at increased risk of preterm, macrosomic, and caesarean deliveries compared to their younger primigravid counterparts.

Perinatal outcome of macrosomic births in Port Harcourt.

BACKGROUND: Macrosomic babies are at increased risk of adverse perinatal outcome and therefore constitute a high risk group of neonates and the incidence appears to be rising. The objective was to determine the incidence of fetal macrosomia, and the perinatal outcome of macrosomic babies, compare with matched term, appropriate weight neonates in the booked antenatal population of the UPTH. METHODS: It was a one year prospective study of the perinatal outcome of singleton babies whose birth weights were 4000 g and above (macrosomia) delivered to booked antenatal mothers in UPTH between 1st October 2003 and 30th September 2004, comparing them with term appropriate (2500-3999 g) weight babies. The birth weight, sex, perinatal and maternal complications documented from direct observations, questioning and other information extracted from patients' case notes, were entered into a personal computer, analysed and presented as frequency tables, percentages, Chi-square X2, calculated as appropriate using Epi info version 3.4.3 statistical software. P < 0.05 was considered statistically significant. RESULTS: Fetal macrosomia occurred in 354 out of 2417 singleton term deliveries, giving an incidence of 1 in 7 deliveries or 14.65%. The birth asphyxia (7.90% vs 2.60%, p = 0.011), Neonatal admission (29.54% vs 2.85%, p = 0.001) and perinatal mortality (48/1000 vs 23/1000 births, p = 0.001), caesarean delivery (55.70% vs 18.64%, p = 0.001) rates were significantly higher in the macrosomic than the control group. CONCLUSION: There is a high incidence of fetal macrosomia in Port Harcourt with associated relatively higher adverse perinatal outcome compared to singleton term normal weight babies.

Experience with conscious sedation for oocyte retrieval in Nigeria.

Conscious sedation is the most common method of pain relief used during ultrasound-directed transvaginal follicle aspiration (UDFA) for in-vitro fertilisation/embryo transfer (IVF/ETI). It is associated with minimal risks and facilitates early discharge following UDFA. The aim of this study was to assess clients' pain experience, acceptance of conscious sedation and correlates of pain during oocyte retrieval for in vitro fertilisation (IVF) at The Bridge Clinic, Port Harcourt. It was a cross-sectional survey conducted between May 1 and October 31 2004. Pain was assessed using a 100 mm visual analog scale (VAS). Clients' pain experience and correlates were evaluated using Pearson's correlation and the student's t-test. The mean pain score was low and the duration of the procedure did not significantly affect the severity of pain felt by the client. Most (69.0%) clients would prefer the same sedation and analgesia for any subsequent procedure. Conscious sedation and analgesia are one of several methods used to relieve pain during oocyte retrieval in IVF procedures. The information in this study is of value when considering the management of pain in patients undergoing oocyte retrieval procedures.

Episiotomy and perineal trauma prevalence and obstetric risk factors in Port Harcourt, Nigeria.

BACKGROUND: Perineal trauma sustained during vaginal delivery may predispose to short and long-term complications such as postpartum haemorrhage and sexual dysfunction. Most published literature on perineal trauma and episiotomy come from developed countries and there is limited information from developing countries. The objective of this study was to determine the rate and risk factors for episiotomies and perineal trauma at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. METHODS: A retrospective review of vaginal deliveries at the UPTH between 1st January 1996 and 31st December 2000. RESULTS: The episiotomy rate in 4720 vaginal deliveries during the period of study was 39.1% in all parturients, while in primigravidae, it was 77.1%. Rates for first and second degree perineal tears in all women were 10.6 and 25% respectively. The incidence of episiotomy decreased with increasing parity while the incidence of perineal tears slightly increased with parity. Nulliparity, vaginal breech deliveries and instrumental vaginal deliveries were identified as risk factors for episiotomy. CONCLUSION: Episiotomy rate at the UPTH is high but the procedure appears to have prevented the occurrence of third degree and complete perineal tears.

Spontaneous midtrimester uterine rupture: a case report.

BACKGROUND: Spontaneous mid trimester rupture of the uterus is uncommon. AIM: To report a case of spontaneous mid trimester uterine rupture in a patient with a previous caesarean section scar. METHOD: A review of the case record of a patient managed for spontaneous mid-trimester uterine rupture and the relevant literature. RESULTS: A 30-year old unbooked gravida 6, para 1(+4) house wife with a previous caesarean section scar presented with features of an acute surgical abdomen with hypovolaemic shock at 24 weeks gestation. She had an emergency laparotomy at which she was noted to have a uterine rupture. She had a repair of the uterus and bilateral tubal ligation. Her post operative state was uneventful. CONCLUSION: There should be a high index of suspicion of uterine rupture in a gravid woman with a previous uterine scar presenting with abdominal pain and shock.

Perinatal outcome among elderly nulliparae at the University of Port Harcourt Teaching Hospital.

BACKGROUND: Maternal and perinatal health is influenced by sociodemographic factors including maternal age, parity, social class and ethnicity. Elderly nulliparity is considered traditionally, to be high risk and has not been evaluated in our centre. The objective of our study was to determine the perinatal outcome in the elderly nullipara at the University of Port Harcourt Teaching Hospital. METHODS: This was a two-year retrospective case controlled study. The study population consisted of all nulliparae aged 35 years and above who delivered in the hospital during the period and the control group consisted of all nulliparae less than 35 years of age. The chi2-test was used for comparison of both groups and statistical significance set at p values of P < or = 0.05. RESULTS: Fifty-nine (2%) of 2967 women who delivered during the period were elderly nulliparae. They accounted for 4.8% of all nulliparae. Compared to other nulliparae, there was no significant difference in the rate of preterm delivery (21.8% vs. 25.8%; p = 0.6), postterm delivery (9.1% vs. 17.3%; p = 0.2), caesarean section rate (41% vs. 32.8%; p = 0.3), low birth weight (5.2% vs. 11.6%; p = 0.2), macrosomia (10.3% vs. 5.7%; p = 0.2), still birth rate (0% vs. 3.2%), birth asphyxia (31% vs. 25.4%; p = 0.4), and sex ratios of babies. There were no congenital malformations in both groups. CONCLUSION: Elderly nulliparae are not at increased risk of adverse perinatal outcome compared to younger nulliparae in our hospital.