Knowledge Levels and Predictors of Venous Thromboembolism among Pregnant Women in Nigeria: A Cross-Sectional Survey for the 'Move for Flow' Programme.

BACKGROUND: Pregnancy is a significant risk factor for Venous Thromboembolism (VTE) which results in high maternal and perinatal morbidity and mortality rates. Awareness creation is one of the preventable strategies of VTE. To this effect, we designed the 'Move for Flow' program aimed at maternal health education on VTE, its symptoms and preventive strategies. For the best implementation of this program, the current knowledge level of the relevant population is of great interest in guiding the program design and implementation. AIM: To assess the knowledge levels of VTE among Nigerian pregnant women. METHODOLOGY: In this cross-sectional survey, 1000 pregnant women residing in Enugu, Nigeria, completed a structured questionnaire which assessed their knowledge of VTE, its risk factors and prevention strategies. Quantitatively, their knowledge levels were categorized as no, poor, average and good knowledge. RESULTS: The majority of the respondents did not know about pregnancy-related deep vein thrombosis (DVT) (80.8%) and pulmonary embolism (PE) (88.9). Predictors of DVT knowledge levels include husbands' level of education (at most secondary education) (AOR = 4.2; 95%CI = 2.554-6.816; p = <0.001) and maternal age (AOR = 0.9; 95% CI = 0.930-0.999; p = 0.044) while predictors of PE knowledge level include husbands' level of education (at most secondary education) (AOR = 2.1; 95%CI = 1.005-4.436; p = 0.048) and maternal occupation (professionals) (AOR = 0.4; 95% CI = 0.219- 0.794; p = 0.008). CONCLUSION: Pregnant women are unaware of pregnancy-related VTE in Enugu, Nigeria. Immediate designing and implementation of the 'Move for Flow' program are recommended to improve maternal knowledge levels of VTE.

CONTEXTE: La grossesse est un facteur de risque important pour la thromboembolie veineuse (TEV), qui entraîne des taux élevés de morbidité et de mortalité maternelles et périnatales. La sensibilisation est l'une des stratégies de prévention de la TEV. À cet effet, nous avons conçu le programme "Move for Flow", qui vise à éduquer les mères sur la TEV, ses symptômes et les stratégies de prévention.Pour une mise en œuvre optimale de ce programme, le niveau de connaissance actuel de la population concernée est d'un grand intérêt pour guider la conception et la mise en œuvre du programme. OBJECTIF: Évaluer le niveau de connaissance de la TEV chez les femmes enceintes nigérianes. MÉTHODOLOGIE: Dans cette enquête transversale, 1000 femmesenceintes résidant à Enugu, au Nigeria, ont rempli un questionnaire structuré qui évaluait leurs connaissances sur la TEV, ses facteurs de risque et les stratégies de prévention. D'un point de vue quantitatif, leurs connaissances ont été classées en trois catégories : pas de connaissance, faible connaissance, connaissance moyenne et bonne connaissance. RÉSULTATS: La majorité des personnes interrogées ne connaissaient pas la thrombose veineuse profonde (TVP) (80,8 %) et l'embolie pulmonaire (EP) liées à la grossesse (88,9 %). Les facteurs prédictifs des niveaux de connaissance de la TVP comprennent le niveau d'éducation du mari (au plus l'éducation secondaire) (AOR=4,2 ; 95% CI =2,554-6,816 ; p= <0,001) et l'âge de la mère (AOR=0,9 ; 95% CI=0,930-0,999 ; p=0. 044) tandis que les prédicteurs du niveau de connaissance de l'EP incluent le niveau d'éducation du mari (auplus l'éducation secondaire) (AOR=2.1 ; 95%CI=1.005-4.436 ; p=0.048) et la profession de la mère (professionnels) (AOR=0.4 ; 95% CI=0.219-0.794 ; p=0.008). CONCLUSION: Les femmes enceintes ne sont pas conscientes de la TEV liée à la grossesse à Enugu, au Nigeria. La conception et la mise en œuvre immédiates du programme " Move for Flow " sont recommandées pour améliorer les connaissances maternelles sur la. Mots clés: Grossesse, Thromboembolie veineuse, Thrombose veineuse profonde, Embolie pulmonaire, Nigeria.

Contributions of von Willebrand factor to clinical severity of sickle cell disease: a systematic review and metanalysis.

AIM: To evaluate the contributions of VWF to the clinical manifestation and severity of SCD. DESIGN: A systematic review of peer-reviewed articles published in English. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS: The data sources for the review included MEDLINE, PubMed, CINAHL, and Academic Search Complete. Articles that applied a quantitative approach to the investigation of the relationship of vWF with clinical manifestations and severity indices were included. The risk of bias assessment was carried out with a mixed-method appraisal tool. We computed I 2 to estimate the degree of heterogeneity. RESULT: There was a significantly higher level of VWF in SCD than in the control (d = 2.7, Z = 4.865, P < 0.001, I 2 = 96.41%). Significant positive correlations were obtained for the relationship of VWF with vasoocclusive crisis (r= 0.277, Z= 5.077, P < 0.001, 1 2 =15.62), rate of hemolysis (r=0.441; Z= 4.440, I 2 = <1%), extracellular haemoglobin (r=-0.397, Z=-4.155, I 2 =<1%) and CRP (r = 0.331, Z = 4.566, P < 0.001, I 2 < 1%).The VWF is important in determining the clinical severity of sickle cell disease, which constitutes a putative therapeutic target. More work is required to understand the causal direction underlying the association between VWF levels and the clinical severity of sickle cell disease and the potential role that VWF plays in the clinical manifestations of sickle cell disease. PROTOCOL REGISTRATION: The protocol was registered with PROSPERO (CRD42021262625).

Clinical Audit of Low Dose Prophylaxis Programme for Nigerian Children with Haemophilia.

INTRODUCTION: The evidence of benefits for prophylaxis especially low dose prophylaxis is incontestable yet most children in developing countries as Nigeria do not have access to this treatment protocol. AIM: The aim was to audit the low dose prophylaxis treatment in Nigerian children with haemophilia. METHODOLOGY: A multicentre clinical audit of five haemophilia treatment centres; University of Nigeria Teaching Hospital Enugu, Lagos University Teaching Hospital, National Hospital Abuja, University of Port Harcourt Teaching Hospital Port Harcourt, and Federal Teaching Hospital Gombe. Eighteen children with mild-severe haemophilia were enrolled into low-dose prophylaxis treatment programme. The reduction of joint bleeding, improvement of joint function and Quality of Life (QoL) during prophylaxis were analysed. RESULTS: In total 18 children - 17males and 1 female (median age 8 years) were enrolled. The median duration of observation was 7 months (range 3-15months). Seven of the children were on primary prophylaxis (41%) while 10 of the children (59%) were on secondary prophylaxis. The number of joint bleeds decreased from a total of 162 (individual range 5-20, mean 10.3) to 42 (range 0-7, mean 3.0) during the observation period with an overall reduction of 74%. Joint function improved in 94.1% of disease joints, while only 5.6% reported no improvement (due to poor compliance). School attendance improved in all subjects, sports participation and daily activity improved moderately. CONCLUSION: Low dose prophylaxis was beneficial in reduction of joint bleeds, improvement of joint function and improvement of QoL of Children with haemophilia in Nigeria.

INTRODUCTION: Les preuves des avantages de la prophylaxie en particulier la prophylaxie à faible dose est incontestable cependant en pays en développement comme le Nigeria n'ont pas accès à ce protocole de traitement. OBJECTIF: L'objectif était de vérifier le traitement prophylactique à faible dose chez les enfants nigérians atteints d'hémophilie. MÉTHODOLOGIE: Un audit clinique multicentrique de cinq centres de traitement de l'hémophilie ; L'hopital universitaire de Nigéria, Enugu Hôpital universitaire de Lagos, Hôpital national d'Abuja, l'hôpital universitaire de Port Harcourt et l'hôpital universitaire fédéral de Gombe. Dix-huit enfants atteints d'hémophilie légèresévère ont été inscrits au programme de traitement prophylactique à faible dose. La réduction des saignements articulaires, l'amélioration de la fonction articulaire et de la qualité de vie (Qo) ont été analysées. RÉSULTATS: Au total, 18 enfants - 17 garçons et 1 fille (âge médian: 8 ans) ont été recrutés. La durée médiane d'observation était de 7 mois (de 3 à 15 mois). Sept des enfants étaient sous prophylaxie primaire (41 %) et 10 enfants (59 %) étaient sous prophylaxie secondaire. Le nombre de saignements articulaires a diminué, passant d'un total de162 (fourchette individuelle 5-20, moyenne 10,3) à 42 (fourchette 0-7, moyenne 3,0), pendant la période d'observation, soit une réduction globale de 74 %. La fonction articulaire s'est améliorée dans 94,1 % des articulations malades, tandis que seulement 5,6 % n'ont signalé aucune amélioration (en raison d'une mauvaise observance). n'ont signalé aucune amélioration (en raison d'une mauvaise observance). La fréquentation scolaire s'est améliorée dans toutes les matières, la pratique du sport et l'activité quotidienne s'est améliorée modérément. CONCLUSION: La prophylaxie à faible dose s'est avérée bénéfique dans la reduction des saignements articulaires, l'amélioration de la fonction articulaire et l'amélioration de la qualité de vie des enfants atteints d'hémophilie au Nigeria. MOTS-CLÉS: Prophylaxie à faible dose, Nigeria, Hémophilie, qualité de vie, concentré de facteur VIIII.

Sero-prevalence of Hepatitis B virus infection: A cross-sectional study of a large population of health care workers in Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD). AIMS: As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030. METHOD: This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire. RESULTS: A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study. CONCLUSION: The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

ABO blood group as a biomarker of preeclampsia among antenatal clinic attendees in Nigeria.

BACKGROUND: The clinical application of the ABO blood group is not limited to transfusion medicine but extends to other aspects of medicine. Its impact on preeclampsia is controversial. AIM: To determine the association of ABO blood group type with preeclampsia. SUBJECTS AND METHODS: This was a cross-sectional analytical study of 66 women with preeclampsia and 81 apparently healthy women controls carried out in a tertiary health institution. The case and control groups were consecutively recruited during antenatal clinic visits and matched for age, parity, and gestational age. Data on demographics and the ABO blood group of the two groups of individuals were obtained. The analysis was both descriptive and inferential using the statistical package for social sciences (SPSS) version 21 (Chicago Il, USA). A P value of <0.05 was considered statistically significant. RESULTS: The mean age of the participants was 30.6 (4.9), 95% CI: 27.76-33.95. The majority of the women were ≤40 years (98.5%) and multigravidae constituted 81.8%. Forty-six (69.7%) women with preeclampsia had blood group O and 20 (30.3%) had a non-O blood group. Forty-nine (60.5%) of the controls had blood group O and 32 (39.5%) had a non-O blood group. The observed difference was not statistically significant (OR 1.50; 95% CI: 0.75-3.0; P = 0.26). The odds ratio for developing preeclampsia was 0.83 (95% CI: 0.37-1.91; P = 0.67) for the primigravidae. The non-O blood groups were more likely to present with symptoms than the O group (P < 0.01). Twenty-six (39.4%) women with preeclampsia had a mild disease while 40 (60.6%) had severe disease. CONCLUSION: Women with non-O blood groups are not at increased risk of developing preeclampsia but are more likely to be symptomatic than the O group.

Cancer prevention, the need to preserve the integrity of the genome at all cost.

INTRODUCTION: The entire genetic information carried by an organism makes up its genome. Genes have a diverse number of functions. They code different proteins for normal proliferation of cells. However, changes in the base sequence of genes affect their protein by-products which act as messengers for normal cellular functions such as proliferation and repairs. Salient processes for maintaining the integrity of the genome are hinged on intricate mechanisms put in place for the evolution to tackle genomic stresses. AIM: To discuss how cells sense and repair damage to their deoxyribonucleic acid (DNA) as well as to highlight how defects in the genes involved in DNA repair contribute to cancer development. Methodology: Online searches on the following databases such as Google Scholar, PubMed, Biomed Central, and SciELO were done. Attempt was made to review articles with keywords such as cancer, cell cycle, tumor suppressor genes, and DNA repair. RESULTS: The cell cycle, tumor suppression genes, DNA repair mechanism, as well as their contribution to cancer development, were discussed and reviewed. CONCLUSION: Knowledge on how cells detect and repair DNA damage through an array of mechanisms should allay our anxiety as regards cancer development. More studies on DNA damage detection and repair processes are important toward a holistic approach to cancer treatment.

Molecular characterization of exon 28 of von Willebrand's factor gene in Nigerian population.

BACKGROUND: Polymorphisms in von Willebrand factor (VWF) gene are an important contributor to the expression of VWF gene and differences in ethnic distribution of these single nucleotide polymorphisms (SNPs) exists. AIMS: Our objective was to molecularly characterize the exon 28 of the VWF gene in the three major ethnic groups of Nigeria. SUBJECTS AND METHODS: We recruited 90 subjects, 45 had a history of bleeding. Questions included those used in the Zimmerman Program for the Molecular and Clinical Biology of von Willebrand disease (VWD), and the bleeding scores were calculated using the Molecular and Clinical Markers for the Diagnosis and Management of type 1 VWD scoring system. Full blood count, coagulation profile, VWF:antigen level and VWF:collagen-binding activities were carried out. Data were analyzed using GraphPad Prism (5.03). GraphPad Software, Inc USA. The BigDye terminator chemistry was used to determine the nucleotide sequences of VWF gene (exon 28). RESULTS: Eight SNPs were identified, rs 216310 (T1547), rs 1800385 (V1565L), rs1800384 (A1515), rs1800383 (D1472H), rs 1800386 (Y1584C), rs 216311 (T1381A), rs 216312 (intronic) and rs 1800381 (P1337). CONCLUSION: The SNPs rs 216311, rs 1800383 and rs 1800386 associated significantly with bleeding in study subjects. rs1800386 occurred in all with bleeding history, no ethnic variations were noted.

Prevalence and predictors of placental malaria in human immunodeficiency virus-positive women in Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV)-infected pregnant women have alterations in cellular and humoral immunity that increase the risks to placental malaria infection. AIM: This study aimed at determining the prevalence and predictors of placental malaria among HIV-positive women in Nigeria. MATERIALS AND METHODS: It was a longitudinal cohort study of pregnant women receiving antenatal care at a tertiary hospital in Nigeria. Peripheral blood sample for packed cell volume estimation and placental blood sample for malaria parasite estimation were collected from each participant at a presentation in labor and upon delivery, respectively. RESULTS: The Prevalence of placenta malaria (68.6%) and anemia (66.7%) in HIV-positive women were significantly higher than the prevalence of placental malaria (35.3%) and anemia (44.1%) in HIV-negative control (P < 0.001 and P = 0.001 respectively). The employment status was the only sociodemographic factor significantly associated with the development of placental malaria in HIV-positive women (odds ratio: 21.60; 95% confidence interval: 7.1-66.2; P< 0.001). CONCLUSION: The prevalence of placental malaria is very high among HIV-positive women in Nigeria. Scaling up free distribution of insecticide treated nets in the short term and employment opportunities of HIV-positive women, in the long run, may reduce the prevalence of placental malaria in our population.

Understanding the RECORDS 3 Trial and its impact on anticiagulation practice in resource poor countries.

Venous thromboembolism is a significant cause of mortality and morbidity in patients following major orthopaedic surgeries. The RECORDS 3 trial revolutionised anticoagulation practice especially in patients with total knee arthroplasty and challenging the strong hold of warfarin and heparin in anticoagulation practice. With all these novel agents shifting the paradigm in anticoagulation management, Cost, in accessibility and lack of awareness of the availability of the agents amongst clinicians and surgeons alike are some factors militating against the use of these agents in patients in resource poor countries.

Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria.

BACKGROUND: Female sexual dysfunction is a common, condition that significantly reduces the quality-of-life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings. AIM: The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria, Enugu Campus, Enugu State, Nigeria. SUBJECTS AND METHODS: This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0, Chicago, IL, USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors, and the total FSFI scores dichotomized as normal and reduced sexual function. In addition, multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all, calculations, P < 0.05 was considered as statistically significant at 95% confidence interval (CI). RESULTS: The prevalence of female sexual dysfunction (FSFI score ≤ 26.50) was 53.3%. The highest prevalence occurred in the 41-50 years age group (73.3%; 66/90), married and living together 56.4% (123/218) and had postsecondary education (56.1%; 137/244). Only age significantly predicted female sexual function (P = 0.007; 95% CI; 0.691-0.943). Marital status, religion, ethnic group, and educational qualification had no significant effect (P < 0.05). The total FSFI significantly increase as desire increases (P = 0.002; 95% CI = 0.817-3.573). CONCLUSION: Female sexual dysfunction is common in the university environment, with the highest prevalence occurring in 41-50 years age group.

Benefit incidence analysis of free insecticide treated nets distribution in urban and rural communities of Enugu state, South East Nigeria.

BACKGROUND: Malaria is a leading cause of mortality as well as a barrier to economic and social development in developing countries. The use of insecticide-treated nets (ITNs) for malaria vector control is effective in controlling malaria attacks in pregnant women and under-5 children. The Nigerian government, in its bid to achieve the Millennium Development Goal (MDG) 4 and 5 distributes free ITNs to pregnant mothers and under-five children in the Roll Back Malaria programme (RBM). AIM: This study compared the benefit incidence analysis of this government program between urban and rural areas. MATERIALS AND METHODS: Pretested, semi-structured questionnaires were administered to 150 pregnant women and also 150 mothers of under-5 children, who were randomly selected from each of the two communities (rural and urban) from a local government area (LGA) in Enugu state, Nigeria. The study was conducted within the rainy season periods (March-August) of 2008. The information obtained included some socio-economic variables, accessibility, usage and benefits of usage of ITNs. Data entry and analyses were done using the Statistical Package for Social Sciences (SPSS) version 15.0(Chicago IL, USA). Student's t-test and Chi-square were used for comparison where appropriate. Significant values were taken as P value. Value of less than 0.05 was considered significant. RESULTS: The respondents' mean monthly expenditures on food utilities and anti-malarials in the rural area and urban areas were N266.1 (74.02), range (143.3-395) and N473 (90) range (380-495.7) respectively (P < 0.001). Within each socio-economic stratum (SES), the average monthly expenditure in the urban community was higher than that of the rural community except for least poor SES (P < 0.05). For the urban community, 106 (71.6%) respondents used ITNs as against 99 (66.9%) in the rural community [P = 0.778, OR = 1.3 (95% CI: 0.76, 2.05)]. Also, ITNs were always accessible to 112 (75.7%) and 54 (36.5%) respondents in the urban and rural communities respectively [P < 0.001, OR = 5.4 (95% CI: 3.28, 8.96)]. In the urban community, 130 (87.7%) respondents expressed some benefit from ITNs as against 123 (83.1%) respondents from the rural community [P = 0.258, OR = 1.5 (95% CI: 0.76, 2.28)]. CONCLUSION: Most pregnant women and mothers of under-five children in the rural study area belong to the poorest socio-economic classes and they spend less on anti-malarial treatment. Majority of the free ITN's beneficiaries in both urban and rural study areas have used and benefitted from them.

The effect of free distribution of insecticide-treated nets on asymptomatic Plasmodium parasitemia in pregnant and nursing mothers in a rural Nigerian community.

INTRODUCTION: Malaria is a major public health problem in Nigeria, with adverse outcomes on the poor, pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs). AIMS AND OBJECTIVE: This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria. MATERIALS AND METHODS: This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact, then every 2 months to check for malaria parasites using standard methods. RESULT: There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs. CONCLUSION: We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies.

Copper and selenium status of healthy pregnant women in Enugu, southeastern Nigeria.

BACKGROUND: Copper and selenium are important trace elements in man. They function as antioxidants and play roles in oxido-reductase reactions. Several imported multivitamin preparations are given to our women during pregnancy and lactation to correct possible deficiencies. OBJECTIVE: The aim of the study is to determine the serum level of these micronutrients (selenium and copper) in a cross section of pregnant women in Enugu, southeastern Nigeria. MATERIALS AND METHODS: A cross section of 130 healthy pregnant women at different trimesters of pregnancy and 30 non-pregnant controls were selected from two health facilities in Enugu, southeastern Nigeria. Serum from the samples collected was assayed for copper and selenium using atomic absorption spectrophotometer. RESULTS: The mean copper level increased (P = 0.018), while the selenium level decreased (P < 0.0001) as pregnancy advanced. CONCLUSION: High copper levels indicate that supplementation should not be undertaken during normal pregnancy. Dietary intake should be modified to ensure optimal selenium levels during pregnancy.

Malaria parasitaemia among pregnant women in a rural community of eastern Nigeria; need for combined measures.

Malaria in pregnancy is a major contributor to adverse maternal and perinatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia in pregnancy in both immune and non-immune individuals and is aggravated by poor socioeconomic circumstances. The aim of this study is to assess the prevalence of asymptomatic malaria parasitaemia among pregnant women in a rural setting. 272 pregnant women, aged between 18 and 40 years in some remote rural areas of Ebonyi State, Nigeria were recruited between January 2007 and March 2008.Their blood samples were collected and examined for malaria parasite, haemoglobin and packed cell volume using standard methods. Our results showed 59.9% prevalence of parasitaemia with the highest prevalence occurring in the first trimester [84.1%]. Among the positive cases, mild parasitaemia was recorded in 47.2% moderate parasitaemia in 37.4% while severe parasitaemia was recorded in 15.3% of cases. These differences were statistically significant [P<0.016]. Furthermore the distribution of malaria densities in different gravidity groups showed an inverse relationship, 45.4% in primigravidae, [31.9%] in secundigravidae and [10.4%] among people with more than five pregnancies. These findings were statistically significant [P<0.0001]. The prevalence of anaemia in pregnancy in this study was 62.4%. Apart from the use of nets, drugs and vector control, the prevention of malaria in pregnancy in very poor socioeconomic settings should make provision for nutritional support.

The influence of parity on the gestational age at booking among pregnant women in Enugu, South East Nigeria.

Antenatal care utilization is influenced by several factors. Due to our peculiar socioeconomic and cultural circumstances, gestational age at booking may be affected by certain variables. The aim of this study was to determine the influence of parity and other socio demographic factors on gestational age at booking amongst pregnant women in Enugu, South Eastern Nigeria. This is a prospective multicenter survey of randomly selected 928 pregnant women attending antenatal care for the first time in three hospitals in Enugu between January 1, 2006 to December 31, 2007. The average age was 30.22 +/- 5.2 years. The average age of the primigravidae at booking was 29.16 +/- 5.6 years.The average gestational age at booking for all the pregnant women studied was 26.12 +/- 7.6 weeks. Parity significantly [P < 0.05] influenced the gestational age at booking. Parity age for primagravidae group was 24.0 +/-7.9 weeks. Parity age for multigravidae was 27.16 +/- 7.5 weeks while for grandmultiparous women it was 26.12 +/- 7.6 weeks. Occupation did not have significant influence on gestational age at booking. It is concluded that parity significantly influenced the gestational age at booking in Enugu.

Placenta percreta: a review of literature.

BACKGROUND: Placenta percreta is a very rare but serious complication of pregnancy. Diagnosis is difficult. Uterine perforation and invasion into adjacent organs makes life threatening haemmorrhage inevitable. Management is usually based on intraoperative findings from case reports. METHOD: Literature on clinical decisions, diagnostic and treatment modalities were critically reviewed using PUBMED and MEDLINE computerized search. Additional Information was also obtained by cross referencing, texts and journals in the medical library of University of Nigeria. RESULTS: Most of the literature was from developed countries with very little report from our environment. There was lack of comprehensive management plan in most textbooks. CONCLUSION: Rare complications are usually very difficult to manage due to lack of experience. It is thus important to identify the patients at risk, attempt to make antenatal diagnosis and involve experienced obstetricians in management.

Intraoperative uterine packing with mops: an effective, but under utilized method of controlling post partum haemorrhage-experience from South Eastern Nigeria.

BACKGROUND: Uterine packing is a simple noninvasive technique for controlling postpartum haemorrhage. However, its effectiveness has been underestimated and the procedure underutilized leading to lack of experience and expertise especially in the intraoperative usage of mops. The aim of the study was to re-evaluate the significance of intraoperative uterine packing in controlling post partum haemorrhage and preserving menstrual and reproductive functions. METHOD: Twenty cases of intraoperative uterine packing with mops performed by the authors over a three-year period (December 2000-December 2003) at three different hospitals were reviewed. Mops were removed after 24 hours. RESULTS: The mean age of the patients was 28.9 +/- 5.6 years, and the mean parity 3.1 +/- 1.8. The mean estimated blood loss was 1500 + 461.1 millilitres and the mean number of units of blood transfused was 1.45 + 1.2. The commonest indication for surgery was placenta praevia (55%). None needed further treatment. CONCLUSION: In carefully selected cases, intraoperative uterine packing is a simple and effective life saving option in our local environment with peculiar beliefs, lack of equipment and expertise.