Pregnancy outcome in nulliparous women aged 35 or older.

Our objective was to examine pregnancy outcome in women age 35 and over. We compared pregnancy delivery complications in 207 women aged 35 years and older with 219 control women aged 25 - 29 years. Data was collected retrospectively and stratified by parity. Results of statistical analysis showed that the older women differed significantly in (1) antepartum factors (previous pregnancy experience, chronic and pregnancy-induced hypertension, maternal and gestational diabetes, placenta previa) (2) intrapartum factors (malpresentations, fetal disproportions, abnormal labour, caesarean and operative vaginal delivery) (3) neonatal outcomes (birth asphyxia, prematurity, low birth weight, neonatal intensive care unit admissions). However, birth trauma and perinatal mortality did not differ between the two groups. We concluded that pregnancies in older women are prone to complications, but when managed accordingly the overall perinatal outcomes were good.

Sociodemographic factors in mental disorders associated with infertility in Nigeria.

The mental status of 37 female patients with infertility and that of 37 healthy controls was evaluated using General Health Questionnaire, Present State Examination, and clinical assessment. An interview schedule, designed to elicit information on sociodemographic, psychiatric predisposing, and obstetric factors, was also administered. A significantly higher proportion (29.7%) of the patients was found to have diagnosable psychopathology, mainly depressive episode and generalized anxiety disorder. Compared with the control group, the infertile women experienced poorer marital relationships, had a significant family history of infertility, were more negatively predisposed to child adoption. and had a greater history of surgery and induced abortion. Polygamy was found to have a close association with psychopathology in the sample of infertile women. The implications of these findings and ways of improving the mental status of the infertile woman are discussed.

Experience with 29 cases of female ventral incisional hernias in Ile-Ife, Nigeria.

Ventral incisional hernia, a major cause of postoperative morbidity after abdominal operations is reviewed in 29 adult female patients following 2042 major procedures during a 10-year period in Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. All the patients were in the reproductive age group. The overall incidence of 1.4% is low but being a hospital incidence, the authors feel that it should not be deluding. Premature deliveries were associated with pregnancy coexisting with incisional hernia. Operations for complicated obstetric conditions and wound infections, were the major predisposing factors. It is noted that a reduction of the frequency of occurrence of incisional hernia and its complications in female patients can be achieved through a combination of health education and sound surgical technique with good wound care. An elective repair of hernia is most auspicious.

Ogilvie's syndrome.

Four cases of Ogilvie's syndrome (acute colonic pseudo-obstruction) are reported. All occurred in the early puerperium following cesarean section and cesarean hysterectomy. In three of the patients, the diameter of the distended cecum was less than 9.0 cm and so management was conservative while in the fourth patient it was more than 9.0 cm, and so surgical intervention was carried out. A cecal diameter of 9.0 cm or above is an indication for surgical intervention to prevent possible colonic perforation. Other indications for surgery include established cecal perforation and failed conservative management. It is important that an early diagnosis is made and management instituted in order to prevent complications and associated high mortality.

A ten-year review of encephalocele in a teaching hospital.

A 10-year review of infants with encephalocele was carried out in a multicentered teaching hospital. Out of 23,438 infants seen within the period, only 12 cases of encephalocele were seen, giving an incidence of 0.5/1000 births. Nine (75%) of patients had occipital encephalocele, two (16.7%) occipitoparietal and one (8.3%) fronto-nasal. Two patients had spina bifida as an associated neural tube defect while ocular abnormalities were seen in another two. None had neurological defects at birth but some showed evidence of hydrocephalus and delayed milestones after surgery. Ultrasonic diagnosis was made in one case only. The etiologic, prognostic and descriptive characteristics, in addition to obstetric management of encephalocele are discussed.

Congenital absence of an ovary in a Nigerian woman.

A case of unilateral absence of the left ovary in a 45-year-old grand multiparous Nigerian woman is reported. Congenital absence of a gonad is extremely rare and it indicates a genetic or chromosomal error in the formation of the urogenital ridge.

The value of symphysio-fundal height/abdominal girth measurements in predicting fetal weight.

This paper presents the results of a study using the product of symphysio-fundal height and abdominal girth at the umbilical level measured in centimeters and the results expressed in grams to estimate fetal weight at term in utero. The estimated weight before delivery correlated well with the birth weight. This simple method can be used in areas where sophisticated methods are unavailable.

Gravid uterus in an anterior abdominal wall hernia of a Nigerian woman.

A case of a gravid uterus in an incisional hernia in the anterior abdominal wall of a 27-year-old Nigerian woman is presented. The patient developed an ulceration of the anterior abdominal wall necessitating prolonged hospitalization. She was delivered by emergency lower segment cesarean section at 35 weeks gestational age because of premature labor. The patient unfortunately died from primary postpartum hemorrhage.

The obstetric performance of sickle cell disease patients and homozygous hemoglobin C disease patients in Ile-Ife, Nigeria.

In a 9-year period (1980-1988), 46 delivered hemoglobinopathy patients were studied. There was a high incidence of complications during pregnancy. The perinatal and maternal mortalities were 13.4% and 9.2% respectively. The complications could be minimized by adequate supervision in pregnancy, labor and puerperium.

Decision-intervention interval in ruptured uteri in Ile-Ife, Nigeria.

OBJECTIVE: To determine the decision-intervention interval in ruptured uterus with a view of overhauling the management strategy thereby improving the maternal and perinatal outcome. DESIGN: Cross-sectional survey based on secondary data done between 1990-1999. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and two consecutive women who had uterine rupture. RESULTS: The decision-surgical intervention interval ranged from 30 minutes to 4.5 hours. The major reason for delay was unavailability of compatible blood (88.2%), followed by lack of electricity (4.9%), unsterile instruments (3.9%), waiting for ambulance to get senior obstetricians (2.9%), delay in arrival of anaesthetist (1.9%) and neonatologists (1.9%). The peri-natal mortality rate (PNMR) was 843 per 1000 total births and maternal mortality rate (MMR) 4902 per 100,000 births. CONCLUSION: The maternal and perinatal outcome in uterine rupture would be improved by early diagnosis and avoidance of preoperative delay through availability of essential obstetric services.

Umbilical cord prolapse: a clinical study of 60 cases seen at Obafemi Awolowo University Teaching Hospital, Ile-Ife.

The incidence of umbilical cord prolapse at Obafemi Awolowo University teaching hospital complex, Ile-Ife over a ten year period was 0.42% (one in 240 deliveries). The incidence was observed to be higher among the unbooked patients (76.7%). Analysis of the 60 cases reveals that multiparity, unengaged presenting part from cephalo-pelvic disproportion, prematurity, prelabour spontaneous rupture of membranes, breech presentation, and multiple pregnancy were the major contributory factors. The perinatal mortality (36.7%) was significantly higher than that of the hospital which was 8% (P < 0.05). The perinatal mortality rate was higher among the unbooked patients (86.4%). Caesarean section gave better results except when the cervix was fully dilated. Early resort to Caesarean section, proper and adequate antenatal care and properly supervised hospital delivery is recommended.

Uncomplicated Caesarean section: is prolonged hospital stay necessary?

BACKGROUND: Caesarean section among the Yoruba of western Nigerian is surrounded by a lot of fears, miseries, aversion, guilt and misconceptions for reasons varying from the desire by women to have a natural vaginal birth, fear of surgery, morbidity and deaths from the operation and prolonged hospital stay. OBJECTIVE: To examine issues of reduced hospital stay following Caesarean section with a view of making the operation more acceptable and proffering solution to some of the problems faced by women when Caesarean section is indicated. DESIGN: A prospective case control study. SETTING: Wesley Guild Hospital, Ilesha, Nigeria from 1st July, 1997 to 30th June, 1998. SUBJECTS: One hundred consecutive patients who had uncomplicated Caesarean section, randomised into two groups of short (three days) and prolonged (seven to eight days) hospital stay respectively. MAIN OUTCOME MEASURES: Observations of patients in both groups were made by an independent observer on day seven post-operation and the main outcomes measured included: wound infection rates, ability to maintain erect posture, mood changes, neonatal sepsis rate, immunisation rate of the neonates and average hospital bills. RESULTS: The findings revealed that wound infection rates of six per cent and ten per cent among the short and prolonged hospitalised patients respectively are not significantly different. Patients with short stay have better erect posture, lower incidence of depressive mood, lower neonatal sepsis rate, lower hospital bill and are more satisfied with early home discharge. CONCLUSION: Embracing the concept of early home discharge after Caesarean section in uncomplicated cases may remove some of the psychological upsets and economical impediments associated with the operation and make the operation more acceptable.

Ureteric injuries following pelvic operations.

BACKGROUND: Iatrogenic injuries to the ureter are hazardous complications of pelvic operations, causing severe morbidity and even mortality. OBJECTIVE: To present our 10 years experience in the management of such ureteric injuries. DESIGN: A retrospective study carried out between January 1990 and December 1999. SETTING: Two busy health institutions, namely Ife State hospital and Wesley Guild Hospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The incidence of iatrogenic injury was 0.4%. Ureteral transection was the commonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operated cases. Those diagnosed at the time of injury and treated with end-to-end anastomosis had the best results. CONCLUSION: The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries.

An endometriotic cyst of the left ovary in pregnancy--a case report.

A case of an endometriotic cyst of the left ovary in a pregnant Nigerian woman is presented. Left ovarian cystectomy was performed at the 18th week of gestation. The patient had a spontaneous vaginal delivery of a 3.54kg live male baby.

Biosocial factors affecting menarche in a mixed Nigerian population.

A prospective study of school girls in a mixed Nigerian population revealed that the mean menarcheal age was 13.98 +/- 1.30 years. The mean menarcheal age was influenced by the social class of the parents, being higher in the lower social class, there were considerable variations in the biologic measurements (height, weight and body mass index) among girls who attained menarche.

Amoebic recto-vaginal fistula--a case report and review of literature.

A case of amoebic recto-vaginal fistula is presented, with a review of literature on this rare complication of intestinal amoebiasis. A temporary defunctioning sigmoid colostomy was necessary. This in combination with oral metronidazole and tetracycline resulted in spontaneous closure of the fistulous tract. Non-traumatic recto-vaginal fistula poses a major diagnostic problem especially in the tropics where many granulomatous infections are endemic and could mimic carcinoma.

Tetanus in pregnancy in a Nigerian woman--a case report.

PIP: Tetanus infection complicating pregnancy is strongly associated with maternal mortality and perinatal morbidity. This is a case report of a 31-year-old woman who was admitted to the intensive care unit of Obafemi Awolowo hospital in Nigeria. She presented with a 1-day history of stiff neck, backache, inability to open her mouth widely, and spasms of the facial, back and limb muscles. A physical examination revealed an acutely ill patient with trismus, and a septic ulcer on her upper thigh. A diagnosis of tetanus during pregnancy was made. The patient was given diazepam 20mg and antitetanus serum (20,000 units). This was followed by 0.5ml of tetanus toxoid intramuscular. The wound was cleaned and 50ml of pus was evacuated. The patient developed fever and the pregnancy was terminated with a premature stillbirth male fetus. The risk of tetanus related to pregnancy would be greatly reduced in the event of world wide immunization against tetanus of all females during childhood, pregnancy, postpartum immunization of unbooked patients, and proper wound care in pregnant women.^ieng

Experience with 159 cases of premature rupture of fetal membranes in Ile-Ife, Nigeria.

In a 10-year period, 159 out of 16,825 total deliveries had premature rupture of fetal membranes giving an incidence of 0.94%. The condition poses a serious threat to both mother and the infant. Maternal infection increased exponentially with the latent period. The institution of an active management programme is suggested as a way of reducing the hazards associated with this condition.

Puerperal sepsis: a preventable post-partum complication.

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1%. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.

PIP: This study of 146 consecutive cases of postpartum genital tract sepsis was undertaken to determine the characteristics and outcome of patients with puerperal sepsis. Included in the study were patients with puerperal sepsis admitted into Ife State Hospital of Obafemi Awolowo University Teaching Hospital Complex in Nigeria during the period of January 1986 to December 1995. Findings revealed that 1.7% out of 8428 deliveries were diagnosed as having puerperal sepsis. The incidence was higher among unbooked patients (71.2%). Predisposing factors of puerperal sepsis include anemia in pregnancy; prolonged labor (labor lasting up to 12 hours or more); frequent vaginal examination during labor (more than 5 times); premature rupture of membranes; and nonadherence to asepsis during delivery. In addition, the mortality rate was 4.1%. Thus, antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce the seriousness of postpartum morbidity.

Ultrasonic measurement of biparietal diameter and femur in foetal age determination.

Our objective was to verify ultrasonic measurement of biparietal diameter and femur in foetal age determination in the second and third trimester of pregnancy. The prospective cross sectional study was carried out at the ultrasound department of Aberdeen Maternity Hospital Scotland. The study population consisted of 716 pregnant Scottish (Caucasian) women who were certain of their gestational ages and had their gestational ages confirmed in the first trimester by ultrasound. The findings revealed: (1) Linearity through out pregnancy using the femur length measurements while that of the biparietal diameter demonstrated poor correlation after 32 weeks of gestation. (2) The standard deviation and the correlation coefficient of the femur length measurements were 0.0042 and 0.9920 respectively while the corresponding values for biparietal diameter were 0.0045 and 0.9850 respectively. (3) The standard error for femur length estimate was 0.2251 as against 0.3009 for biparietal diameter estimate. The results suggest that femur length measurement is a more reliable index of late third trimester gestational age prediction than biparietal diameter.