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.

Genital prolapse in Port Harcourt, Nigeria.

BACKGROUND: Damage to the genitourinary supports from repeated pregnancies and labour is the most important predisposing aetiological factor in genital prolapse, a chronic gynaecological disorder that causes distressing morbidity (stress urinary incontinence, micturitional difficulties and problems of defecation). OBJECTIVE: To determine the pattern of presentation and management of genital prolapse at the University of Port Harcourt Teaching Hospital, and compare with experience elsewhere. METHODS: Retrospective review of all cases of genital prolapse admitted and operated upon during the period January 1990 to December 1999. Data collected and analyzed by simple percentages included sociodemographic characteristics, aspects of clinical presentation, management modality and outcome. RESULTS: Genital prolapse (118 cases) accounted for 37.5 per 1,000 gynaecological admissions during the study period. Seventy percent of the study subjects were above age 45 years, while seventy-three percent were grandmultiparous. Thirty percent were of reproductive age. The commonest symptom was "something coming down the vagina" (95% of the study subjects). Only 4% had stress incontinence. Second degree prolapse was the commonest finding on presentation (68.6%) while vaginal hysterectomy with pelvic floor repair was the main operative procedure (undertaken in 73.7% of the subjects). Postoperative deaths occurred in two patients, both diabetics (case fatality ratio 1:59) from septicaemia and intestinal obstruction respectively following vaginal hysterectomy. Postoperative morbidity following vaginal hysterectomy was also higher than that following Manchester Repair. CONCLUSION: This study's results are similar to previous findings in Nigeria and other developing countries. Measures to reduce grandmultiparity, difficult deliveries and postoperative morbidity and mortality are advocated.

Prevalence of D(u) phenotype amongst rhesus negative females in Port Harcourt, Nigeria.

The prevalence of D(u) phenotype was investigated among rhesus negative women of childbearing age (15-45 years) in Port Harcourt, Nigeria, over a period of 17 months. A total of 1,108 women were randomly sampled, out of which 1,003 (90.5%) were rhesus positive and 105 (9.5%) rhesus negative. Only one (0.95%) of the Rh-negative women was D(u) positive while 104 (99.05%) were D(u) negative (true thesus negatives). The results show that the incidence of D(u) phenotype in Nigeria may not be uniform--it is high among the Yorubas (7.5%) and rare among the Ijaws and Efik-Ibibios of the south-east. The results also suggest that D(u) testing may not be indicated in all individuals initially typed as rhesus negative while being strongly indicated only in areas of high prevalence. More studies are required in other parts of Nigeria to provide data that may facilitate the adoption of a comprehensive nationwide policy on appropriate management of rhesus negative women in the country. This will include the D(u) testing of all rhesus negative mothers in areas of high D(u) phenotype prevalence before the prophylactic administration of anti-human immunoglobulin (Rhogam).