Types of ovarian tumours seen in Benin-City, Nigeria.

There were 243 histologically proven ovarian tumours seen at the University of Benin Teaching Hospital, Benin-City, from 1973 to 1987. Out of these 198 (81%) were benign, with dermoid cyst (31%) being the commonest benign ovarian tumour. Granulosa cell tumours was the commonest malignant ovarian tumour seen (20% of malignant cases).

The contribution of previous induced abortion to tubal ectopic pregnancy.

Data from a one year prospective study of thirty-one tubal ectopic pregnancies and ninety-three matched controls is presented. Compared with the controls, a history of induced abortion, was not only statistically significantly more frequent amongst the subjects (P less than 001) but was the Penultimate cyesis in 41.9% of ectopic cases as against 3.2% of the controls (P less than 001). Non-physicians provided 51.6% and 3.3% of induced abortions in the study and control groups respectively. Complications occurred in 51.6% of study population and 6.5% of controls. It is concluded that induced abortions created the predispotion to tubal implantation in the study population and therefore a reduction in the incidence of illegally induced abortion in the community can reduce the incidence of ectopic tubal gestation and tubal infertility.

PIP: Data from a 1-year prospective study of 31 tubal ectopic pregnancies and 93 matches controls is presented. Compared with the controls, a history of induced abortion was not only statistically significantly more frequent among the subjects (.001) but was the penultimate cyesis in 41.9% of ectopic cases as compared with 3.2% of the control (p,.001). Nonphysicians provided 51.6% and 3.3% of the induced abortions in the study and control groups, respectively. Complications occurred in 51.6% of the study population and 6.5% of the controls. It is concluded that induced abortions created the predisposition toward tubal implantation among the study population and therefore a reduction in the incidence of illegally induced abortion in the community can reduce the incidence of ectopic tubal pregnancy and tubal infertility. (author's)

Outcome of cesarean section in twin pregnancy.

In an 8-year period (January 1978 to December, 1985), the 17,379 deliveries at the University of Benin Teaching Hospital (UBTH) consisted of 2089 cesarean sections (12.0%), 56 of which were associated with twin pregnancy. The main indications for cesarean section on the twin pregnancies were antepartum hemorrhage (placenta previa), malpresentation, cervical dystocia and previous cesarean section. The maternal mortality rate was 2% for all twin mothers delivered by cesarean section. There was no statistical difference in perinatal mortality rates (PMR) for all twin deliveries, vaginal twin deliveries and deliveries by cesareans section which were 111,113 and 100 per 1000 births, respectively. In the case of a retained second twin, however, recorded PMR was significantly higher (133 per 1000 births). Consideration of more liberal recourse to cesarean section in all cases of twins may reduce these unacceptably high perinatal death rates in twin pregnancy.

Abortion-related morbidity and mortality in Benin City, Nigeria: 1973-1985.

In a 13-year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the three major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by-product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, as well as integration of planned parenthood at primary health care level into the health care delivery system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidised by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.

PIP: In a 13-year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the 3 major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by-product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidized by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.

Maternal mortality at the University of Benin Teaching Hospital Benin City, Nigeria.

PIP: A study of 165 maternal deaths at the University of Benin Teaching Hospital, Benin City over a 13-year period (from April 1, 1973 to December 31, 1985) is presented. All patients' case files were recovered from the central records library and each case file was carefully analyzed. With a total delivery of 29,324, the maternal mortality rate, inclusive of death from abortion, was 563/100,000 deliveries. There was a general increase in maternal mortality rate with age and this became alarming from 35 years. There was an equally high mortality rate among teenagers, mainly accounted for by illegally induced abortion. Indeed, abortion accounted for 72% of teenage mortality. A statistically significant association between maternal deaths and parity (p, 0.001) was observed. The most important causes of death were hemorrhage with a total of 26 out of 42 deaths, sepsis, and abortion. Other important causes were hypertensive disorders such as eclampsia, liver and respiratory disease, anemia, trophoblastic diseases, caesarean sections, and acute renal failure. Additional causes of maternal deaths include tetanus, sickle-cell disease, anesthetic death, drug reactions, pulmonary embolism, acute pyogenic meningitis, typhoid disease, urinary bladder tumor, acute lymphoblastic leukemia, and carcinoma of the breast thyroid. Factors identified with these deaths included such health services factors as deficient medical treatment of obstetric complications, lack of adequate personnel at primary and secondary health care levels, lack of access to maternal health services, and consequently, lack of prenatal care. Extreme reproductive age, grandmultiparity, and unwanted pregnancies, especially among teenagers, also contributed to maternal deaths. Overhaul of the maternal health care services at national level to include organization of such programs as provision of adequate blood transfusion facilities, prompt treatment of infections, early referrals of patients at risk to secondary and tertiary health centers, intensified family planning programs, and liberalization of abortion laws are recommended in order to reduce the unacceptably high maternal mortality.^ieng

Preventable factors in abortion-related maternal mortality in Africa: focus on abortion deaths in Benin City, Nigeria.

In a 13-year review of maternal deaths of the University of Benin Teaching Hospital, Benin City, abortion was one of the 3 major causes of death, accounting for 37 (22.4) out of 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage and inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis, (including tetanus) hemorrhage, and trauma to vital organs, complication directly attributable to faulty techniques by unskilled abortion providers, by- product of the present restrictive abortion laws. Total overhaul of maternal child health services and family health education system, as well as integration of planned parenthood at primary health care level into the health care delivery system, are suggested. Contraceptive practice should be made available to all categories of women at risk and the cost subsidized by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notable, in the African continent, is overdue.

Acceptance of contraceptive practice by grandmultiparae in Benin City, Nigeria.

Five hundred sixty grandmultiparous women were interviewed as to their contraceptive awareness, desirability and use in the three major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was high level of awareness of contraceptive availability and usefulness (65%), but low level of practice (27.1%). The main causes of the low practice level included opposition from husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. We believe that with more concerted effort at family planning counseling, the community will be rid of the hazards and menace of grandmultiparity.

PIP: 560 grandmultiparous women were interviewed as the their contraceptive awareness, desirability and use in the 3 major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was a high level of awareness of contraceptive availability and usefulness (65%), but a low level of practice (27.1%). The main causes of the low practice level included opposition from the husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. A more concerted effort at family planning counseling will rid the community of the hazards of grandmultiparity. Questionnaire interviews were used to conduct the study. All the interviews were conducted by medical personnel. 201 subjects were interviewed in late pregnancy, 40 intrapartum and 319 in the early puerperium. Societal pressure to have male children was found to be a hurdle for contraceptive use. Male opposition to contraception, particulary among men in the lower socioeconomic groups, is a problem that needs to be addressed by policy makers. There is an urgent need for a national policy on family planning. As an incentive, there should be mass availability of all types of contraceptive devices free of charge to users or at least highly subsidized. Education influences that age at marriage and 1st childbirth and increases acceptance of contraceptive practice.

Outcome of induced labor in 931 term pregnancies.

An analysis of 931 consecutive inductions of labor over an eight-year period is presented. The success rate was 90.4%. Spontaneous vaginal delivery was achieved in 83.5% of cases and the induction-delivery interval was less than 12 hours in 82.6% of cases. The preinduction state of the cervix most significantly influenced the outcome of labor, followed by maternal age and parity. Provided induction of labor was by synchronous use of forewater amniotomy and oxytocin titration, labor outcome was regularly predictable two hours after induction using the concept of latent period of labor and the cervical dilatation at eight hours from the induction. When the latent period was two hours or less, 64.2% of the patients delivered within eight hours, and vaginal delivery was achieved in all women in whom the cervical dilatation was 8 cm or more at eight hours from the induction of labor. The maternal complication rate was 12.1%, the early neonatal morbidity was 11.6%, and the stillbirth rate was 2.3%.

The challenges of vaginal atresia and stenosis: Nigerian experience.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.