Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHODS: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO). RESULTS: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH. CONCLUSIONS: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. FUNDING: The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Attitudes towards abortion law reforms in Nigeria and factors influencing its social acceptance among female undergraduates in a Nigerian university.

BACKGROUND: Unsafe abortion is one of the causes of maternal morbidity and mortality globally and it is still a burden in Nigeria. Restriction laws have been blamed for the recurrent vulnerability of women including female adolescents to unsafe abortions. METHODS: A cross-sectional, semi-structured, self-administered questionnaire was administered to 407 first year female undergraduates in the three female halls of residence of the University of Ibadan, Nigeria in February 2012 to determine their attitudes to abortion laws and the social acceptance of abortion laws in Nigeria. RESULTS: A vast majority (96.1%) knew what an abortion was and barely half were aware of the grounds in which it may be legal. Only 84 (20.6%) of the respondents knew that there were 2 abortion laws in operation in Nigeria. One hundred and thirteen (27.8%) wanted the current abortion law to be reformed and thirteen (3.2%) admitted that they had had an abortion in the past. More than half of them, 212 (52.1%) would support an abortion if pregnancy followed rape/ incest and 201(49.4%) if there was fetal abnormality. Religious reasons influenced the social opinions on abortion laws in most of the students (73%). CONCLUSION: The study showed some awareness towards abortion law reforms and we advocate that sexually active young individuals should be encouraged to adopt effective dual protection against unwanted pregnancy and STIs. Efforts should also be made at imparting reproductive health education to youths, especially girls.

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting.

OBJECTIVES: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. MATERIALS AND METHODS: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 µg or 50 µg of vaginal misoprostol for pre-labour cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1 st to May 31 st 2006. A total of 128 patients were randomized; 65 patients received 25 µg and 63 patients received 50 µg of vaginal misoprostol. RESULTS: Significantly higher number of patients in the 50 µg group progressed to active labour as compared with the 25 µg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 µg as compared with 50 µg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 µg group delivering vaginally within 24 hours as compared with the 25 µg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not statistically different in the two groups (754 ± 362 minutes and 885 ± 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 µg group. CONCLUSION: Twenty-five microgram of misoprostol appears to be as effective as 50 µg for pre-induction cervical ripening and labour induction. Though 50 µg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more labour complications as compared with 25 µg of misoprostol.

FACTORS ASSOCIATED WITH SEXUAL DYSFUNCTION AMONG FEMALE PATIENTS IN A NIGERIAN AMBULATORY PRIMARY CARE SETTING.

BACKGROUND: Sexual dysfunction is a common but under-reported problem of public health importance among female adults in Nigeria. Empirical evidence on sexual dysfunction among female Nigerians is scarce. OBJECTIVE: To determine the prevalence and risk factors associated with sexual dysfunction among female patients presenting at the General Outpatient Clinic (GOPC), University College Hospital (UCH), Ibadan, Nigeria. METHODOS: This was a cross-sectional study of 480 married female patients who presented consecutively at the GOPC, UCH, Ibadan, Nigeria. The 28-item Sexual Function Questionnaire (SFQ-28) was used to determine sexual dysfunction. Information on their sociodemographic characteristics, obstetric and gynecological history were obtained. Bivariate and multivariate analyses were carried out and alpha was set at 0.05. RESULTS: Point prevalence of sexual dysfunction was 80.0%. The most common sexual dysfunction was problems with sexual desire (99.4%), while the least common was problems with arousal cognition (5.8%). There was a significant association between the prevalence of sexual dysfunction and age, years of relationship, number of children alive, parity, level of education, age at coitarche and family dysfunction. Age (OR=0.893; 95% CI=0.821-0.972, p=0.008), parity (OR=3.093; 95% CI=1.174- 8.151, p=0.022), having family dysfunction (OR=2.096; 95% CI= 1.129-3.891, p=0.019) and having ≥10 years of formal education (OR=4.808; 95% CI= 2.604-8.928, p<0.0001) were found to be the predictors of sexual dysfunction. CONCLUSION: Sexual dysfunction among female married adults in our setting was high. We propose that modifiable factors such as socio-demographic and gynaecological variables should be evaluated during the consultation of female patients at first contact.

Male participation in pregnancy and delivery in Nigeria: a survey of antenatal attendees.

This was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic - paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompany their wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable.

Prevalence of malaria at booking among antenatal clients in a secondary health care facility in Ibadan, Nigeria.

The prevalence of malaria parasitemia at booking was studied in 1,848 pregnant women in a secondary hospital in Ibadan, Nigeria. Main outcome variables were patent parasitemia and fever. 8.4% hadpatent malaria parasitaemia. Most clients (89%) with parasitemia were asymptomatic. Febrile subjects booked at an earlier gestational age [22.7 versus 24.2 weeks] than afebrile patients (p = 0.0052). Anemia was more prevalent among patients with patent parasitemia than those without (58.1% versus 22.6%, p < 0.0001). Malaria parasitaemia was higher among nulliparous women than other parity groups (p < 0.0001). Symptomatic malaria was associated with early booking for antenatal care and malaria parasitemia was a significant determinant of anemia. The prevalence of malaria parasitaemia in this study is much lower than in previous reports.

Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review.

Fourteen cases of abdominal pregnancy managed at the University College Hospital, Ibadan, Nigeria, over a ten-year period (January 1994 to December 2003) were reviewed. The incidence ratio of abdominal pregnancy was one in 654 deliveries. It accounted for 4.3% of ectopic pregnancies. Age range was 20 to 43 years; 63.4% of the patients were unemployed and 50% were nullipara. Pre-operative diagnosis was possible only in half of the cases. Only two patients with advanced pregnancies and live fetuses (14.3%) were allowed to have conservative management while the others had immediate laparotomy. Live birth rate was 7.1%, but overall fetal survival rate was 0%. Fetal malformations were common, with talipes equinovarus and jaw abnormalities occurring in 49.2% and 14.3% respectively. Twelve patients (85.7%) who had complete removal of the placenta, though lost more blood, had better outcome than those with placenta left in-situ. The case fatality rate was 7.1%.

Blood loss at fibroids surgery: myomectomy versus total abdominal hysterectomy.

Two hundred and fifty patients with uterine fibroids were reviewed to compare operative outcomes and blood loss.

Total ovulating period: any contribution to ovarian carcinogenesis?

The etiology of ovarian cancer has many postulates including that of incessant ovulation. Women of high parity especially those that breastfeed in addition are supposed to be protected. Ovarian cancer patients in the developing world are of higher parity than their Caucasian counterparts. Our study compared the length of reproductive career (LRC), the physiological ovulation free period (PFP) and the total ovulating period (TOP) amongst histologically proven ovarian cancer patients and age - matched controls. This is a questionnaire survey of 21 ovarian cancer patients managed by us between 1st December 1998 and 31st July 2002 and 42 gynaecological patients not known to have ovarian cancer. The mean age among the patients was 45.7+16.9 years while among the controls it was 45.4 +/- 16.1 years. The mean parity of the patients was 3.6 +/- 2.2 compared to 3.4 +/- 2.9 in the controls. The patients had a mean LRC of 23.8 +/- 11.2 years while in the controls it was 25.7+10.8 years. The mean PFP of the patients was 7.4 +/- 5.6 years and for the controls 7.1 +/- 6.5 years. The patients had a mean TOP of 15.8 +/- 8.8 years while this was 18.6 +/- 8.1 years for the controls. None of these differences was statistically significant. Our study revealed no statistically significant differences in the total ovulating periods between ovarian cancer patients and age-matched controls. Further studies will be necessary.

Comparison of changes in pre-induction cervical factors' scores following ripening with transcervical foley catheter and intravaginal misoprostol.

The study compares the changes in the cervical factors in pre-induction cervical ripening with both transcervical Foley catheter and Intravaginal Misoprostol. This was a randomised prospective study of pregnant women, with singleton gestations who presented for antenatal care and delivery at a tertiary health institution in the South-western Nigeria between 1st March 2003 and 31st March 2004. One hundred and two (102) patients received 50microg intravaginal Misoprostol and Ninety-six (96) received size 16F Transcervical Foley catheters. Both groups were similar at the baseline. Misoprostol group showed greater improvement in the final cervical length score, with 38.4% and 58.6% scoring 2 and 3 respectively, in contrast with the Foley catheter group where 77.7% had final score of 1, with only 16% scoring 2 and none scored 3 (P = 0.00). Ninety-one percent of the patients in the misoprostol group achieved the maximum cervical consistency score of 2, contrasting with the 31.9% in the Foley Catheter group (P = 0.00). 64.9% of the patients in the Foley catheter group did not achieve appreciable change in cervical consistency. Our findings indicate that intravaginal misoprostol was more effective in improving the scores of cervical length and consistency, while transcervical Foley catheter was better at improving the cervical os dilatation score at pre-induction cervical ripening. The clinical implication is that, patients for pre-induction cervical ripening can be selected for either of these ripening agents based on which cervical factors require improvement in scores

Serum albumin, creatinine, uric acid and hypertensive disorders of pregnancy.

BACKGROUND: Pre-eclampsia is a form of hypertensive disorder of pregnancy. It is a common cause of both maternal and perinatal morbidity and mortality in both developed and developing countries. OBJECTIVE: To evaluate the possibility of early prediction of hypertensive disorders of pregnancy using single estimation of serum protein, creatinine and uric in serum samples of healthy primigravidae with singleton pregnancy. SETTING: University College Hospital, Ibadan. SUBJECTS: Fifty nine normortensive primigravidae. METHODS: Fifty nine healthy normotensive primigravidae with singleton pregnancy who booked for antenal care and delivered at the University College Hospital, Ibadan had single estimations of their serum albumin, creatinine and uric acid levels at booking before the 20th week of pregnancy. The women were followed up longitudinally throughout pregnancy. RESULTS: Pre-eclampsia occurred in five of the patients (21.7%), two had pregnancy induced hypertension only (8.7%) while 16 remained normotensive (69.6%). The difference in the mean serum concentration of uric acid (0.162 +/- 0.02 mmol/L) and creatinine (93.70 +/- 10.08 micromol/L) respectively were not statistically significant (p>0.05). However, the difference in the mean serum albumin levels (4.06 +/- 0.06 versus 3.71 +/- 0.33 gm/dl) was significantly higher in the pre-eclampsia group (p<0.05). The predictive performance of these tests was generally low whether alone or in combination. CONCLUSION: Single estimation of serum uric acid and creatinine levels early in pregnancy are of little value in the prediction of pre-eclampsia. A large study is recommended to properly define the value of serum albumin levels in pregnancy in the prediction of pre-eclampsia in the light of the findings of this study.

Maternal haematocrit and pregnancy outcome in Nigerian women.

Anaemia is the most common medical disorder in pregnancy and a direct or indirect cause of maternal and perinatal mortality; therefore antenatal care should be concerned with early detection and management. The incidence of anaemia in 735 normal singleton pregnant patients at booking in the University College Hospital, UCH, Ibadan, between the 1st of June 2000 and 31 of May 2001 was 15%. Six hundred and thirty-three of the patients (86.1%) presented for delivery at this centre. Five hundred and sixty seven (89.6%) of the patients were not anaemic when seen in labour, reducing the incidence of anaemia to 10.4%. Forty-two (6.6%) and 24 (3.8%) patients had mild and moderate anaemia respectively. No patient had severe anaemia. Of those presenting in labour, 195 (30.8%) were primigravid, while 417 (65.9%) and 21 (3.3%) were multiparous and grandmultiparous respectively. Five hundred and twenty-eight (83.4%) were aged between 21 and 35 years. The mean gestational age at booking was 21.3 weeks and at delivery was 38.7 weeks. Spontaneous vertex delivery was achieved in 76.3% with 96.7% having live births. The perinatal mortality rate was 33 per 1,000 births. Stillbirths occurred more in the moderately anaemic patients. The higher the packed cell volume in labour, the greater the birth weight, better the Apgar scores but the more the blood loss at delivery. The babies of the patients with a normal packed cell volume had better Apgar scores at one minute, which was statistically significant (p value < 0.05), but the mildly anaemic patients had babies with better Apgar scores at 5 minutes. This was however not statistically significant. There was no maternal death.

Uterine rupture: UCH, Ibadan experience.

OBJECTIVES: To determine the incidence, predisposing factors, maternal and fetal outcome of uterine rupture patients at the University College Hospital (U. C. H.), Ibadan. MATERIALS AND METHODS: A 5-year retropective study of patients with uterine rupture in U. C. H., Ibadan between January 1996 - December, 2000 was done. RESULTS: Thirty five cases of uterine rupture out of a total delivery of 4531 were recorded over the 5-year period. An incidence of 7.75/1000 deliveries or 0.72% was obtained and the yearly trend showss it's on the increase. 85.7% of the patients were unbooked. Common modes of presentation were bleeding per vaginam and abdominal pain. Spontaneous cause of rupture predominates. The interval between diagnosis and surgery was greater than 7 hours in 75% of cases. Uterine repair with or without tubal ligation was commonly employed. Case fatality rate was high at 17.9%. Perinatal mortality was 92.5%. Other maternal morbidities include anaemia, puerperal and wound sepsis, vesico-vaginal fistula and prolonged hospital stay. CONCLUSION: All the indice at the present time are higher than they were 10 years ago. The incidence is still high and is on the increase. Attributable reasons include type I, II, III delays in health care service utilization associated with poor socioeconomic status of patients and lack of essential drugs and compatible blood in the hospitals.

Pattern of semen analysis of male partners of infertile couples at the University College Hospital, Ibadan.

OBJECTIVES: To evaluate the seminal patterns of the male partners of the infertile couples, towards identifying the possible contribution of the male factors to overall infertility problem in our environment. METHODOLOGY: The study is a descriptive analysis of the seminal patterns of the partners of the infertile couples, who presented at the Fertility Research Unit (a WHO collaborating centre) of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, between 1st January 1990 and 31st December, 1999. RESULTS: Result of the seminal analysis of 824 male partners of infertile couples were retrieved for the study, of which 598 (73%) were referred for secondary infertility. Overall, 225 (27.3%) of these subjects had abnormal semen analyses, with Asthenozoospermia being the most common (27.8%) of the disorders observed. Fifty-four (6.7%) subjects of the study population had Azoospermia. The most common multiple factors abnormality in the study population was Astheno/Oligozoospermia (25.5%), while three factors defect--Oligo/Astheno/Teratozoospermia was noticed in 106 (13.1%) of the subjects. CONCLUSION: Abnormal semen quality remains a significant contribution to overall infertility in our environment and Asthenozoospermia is the most common seminal quality abnormality.

Forceps delivery at the University College Hospital, Ibadan, Nigeria.

UNLABELLED: The incidence of forceps delivery has reduced in Nigeria and in the world in general. Some Obstetricians have not been trained in its use and lack the skill. OBJECTIVE: To determine the outcome of forceps delivery at this centre. METHODOLOGY: A retrospective analysis of all forceps delivery done at this centre between the 1st of January 1997 and 31st December 2001, a 5-year period was done. RESULTS: The incidence of forceps delivery was 1.57% or 16 per 1000 births and they were all low cavity deliveries. Most of the patients (68.5%) were booked at this centre. The mean age was 28.21 +/- 4.79 years and most (64.4%) were nulliparious. The mean gestational age at delivery was 38.7 +/- 3.0 weeks. The most common indications were prolonged second stage of labour (58.9%), maternal distress (43.8%) and fetal distress (15.1%). There were multiple indications in some patients. The mean birth weight was 3.03 +/- 0.69 kgs and 90.4% were live births. The main maternal complications were maternal injuries (8.1%), primary post partum haemorrhage (5.5%), anaemia (5.5%) and retained products of conception (4.1%). Maternal deaths occurred in 2 eclamptics and birth asphyxia in 6.9% of babies. The perinatal mortality rate was 54.8 per 1000 births. There were no fetal injuries. CONCLUSION: Obstetrics forceps delivery is on the decline in Nigeria. It is an art that can safely and quickly deliver the fetus. It could be offered in the place of a caesarean section in some instances with a good outcome to both the mother and fetus in skilled hands. Obstetricians should be trained to use it more frequently.

Ogilvie's syndrome (colonic pseudo-obstruction) occurring in an 18-year-old Nigerian female.

Ogilvie's syndrome which is colonic obstruction without an identifiable distal mechanical cause is reported in an 18 year old female Nigerian. A high index of awareness is required to diagnose this condition.

A review of hypertensive disorders of pregnancy.

The detection and clinical management of hypertension in pregnant women are complicated by the concern for fetal development and survival as well as for the health of the mother. Preeclampsia describes a common syndrome that occurs in the second half of pregnancy and often manifesting with hypertension and proteinuria. It occurs in up to 10% of all pregnancies. The factors that initiate preeclampsia are unknown and still a subject of intense clinical research by both Obstetricians and Physicians. The blue print for the development of preeclampsia is probably laid down early in pregnancy, and delivery of the fetus and placenta remains the only effective treatment. Severaclinical, biophysical and biochemical tests have been reported in the world literature to predict the development of preeclampsia. Also, numerous reports have described the predictive value of every possible substance that can be measured in maternal blood or urine. However, the presence of microalbuminuria is an important clinical finding in pregnant women. Indeed, urinary albumin excretion when used as a single test has shown that albumin excretion was higher at booking in those that later developed hypertensive disorders of pregnancy than those that did not have the condition. It had a higher sensitivity and poor predictive value. In conclusion, the factors that are responsible for hypertensive disorders of pregnancy remain unknown and treatment is still difficult. The search for an ideal predictive test or tests should therefore be a continuous exercise.

Perception and satisfaction with quality of antenatal care services among pregnant women at the university college hospital, ibadan, Nigeria.

BACKGROUND: Antenatal care is an important health service which detects and sometimes reduces the risk of complications among pregnant women. The quality of care is likely to influence effective utilization and compliance with interventions. OBJECTIVES: This study evaluated clients' perception of antenatal care quality at the University College Hospital (UCH), Ibadan and determined levels of client satisfaction. METHODS: Women presenting for antenatal care at the study centre were interviewed in a cross-sectional design using a structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of quality of amenities, waiting time and level of satisfaction. Data analysis was done using frequency tables, Chi-square cross tabulations and logistic regression. The p-value was set at P<0.05. RESULTS: There were 239 participants; 74% percent of the women were aged 25-34 years; majority of the respondents (86%) had tertiary education while 49.4% were skilled workers or professionals. In 57.7% of women, the gestational age was between 13 and 27 weeks while 66.1% were Para 1-4. Amenities and water supply were regarded as unsatisfactory in 60.7% and 61.9% respectively. The clinic services were regarded as good in 81.1% of respondents; the only significant association with patient satisfaction was the desire to register in the same facility in the next pregnancy. CONCLUSION: There is a high overall level of satisfaction with antenatal services among pregnant women in UCH. Policy makers and health providers should however address improvement of amenities, reduction of waiting time and ensure that health interventions are available for all clients.

An appraisal of retained placentae in ibadan: a five year review.

OBJECTIVES: To determine the frequency of retained placenta at the University College Hospital Ibadan (UCH). and to describe the socio-demographic characteristics of the patients and examine the risk factors predisposing to retained placenta. METHODS: This is a descriptive study covering a period of 5 years from January 1(st) 2002 to December 31(st) 2006. During the study period, 4980 deliveries took place at the University College Hospital, Ibadan and 106 cases of retained placenta were managed making the incidence 2.13 per cent of all births. RESULTS: During the five year period, there were 106 patients with retained placenta; of these, 90 (84.9%) case notes were available for analysis. The mean age was 29.37 ± 4.99 years. First and second Para accounted for 52 per cent of the patients. Majority of the patient were unbooked for antenatal care in UCH with booked patients accounting for 27.8 per cent of the cases. The mean gestational age at delivery was 34.29 ± 6.02. Three patients presented to the hospital in shock of which 2 died on account of severe haemorrhagic shock. Fifty-eight patients (64.8%) presented with anaemia (packed cell volume less than 30 per cent) and 35 patients (38.8%) had blood transfusion ranging between 1-4 pints. 1 patient required hysterectomy on account of morbidly adherent placenta. Eleven patients (12.2%) had placenta retention in the past, 28 patients (31%) had a previous dilatation and curettage, 14 patients (15.5%) had previous caesarean sections and 47 patients (41.3%) had no known predisposing factors. CONCLUSION: Retained placenta still remains a potentially life threatening condition in the tropics due to the associated haemorrhage, and other complications related to its removal. The incidence and severity may be decreased by health education, women empowerment and the provision of facilities for essential obstetric services by high skilled health care providers in ensuring a properly conducted delivery with active management of the third stage of labour.