Cesarean section on maternal request: the viewpoint of expectant women.

PURPOSE: To determine the women's perception and factors influencing willingness to have cesarean section on maternal request (CSMR) in the absence of medical or obstetric indication. METHODS: A cross-sectional questionnaire-based survey of 752 antenatal clinic attendees at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti. Pre-tested questionnaires were used to elicit information on socio-demographic and obstetric variables, awareness and perspective of CSMR and the willingness to request CS without physician's recommendation. Frequency tables were generated and univariate and multivariate logistic regression were used to determine factors that influenced CSMR using SPSS software version 16.0. RESULTS: Forty-eight (6.4 %) of the respondents reported willingness to request CS. The most common motivations for the request were fear of losing the baby during labor, delay in conception and fear of labor pains. Analysis by simple logistic regression and multiple regression showed age, parity and educational status were not significantly related to the decision for CSMR. CONCLUSION: CSMR is an evolving entity in obstetrics practice in the developing countries. Delay in conception, fear of labor pain and loss of baby during labor appear to be strong motivations.

Knowledge and Willingness to Utilize Hepatitis B Preventive Measures among Pregnant Women in Ado-Ekiti, Southwest, Nigeria.

Introduction: Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection. Objectives: This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria. Methods: This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection. Results: Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001). Conclusion: This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.

Comparison of Anxiety and Depression Among HIV-Positive and HIV-Negative Pregnant Women During COVID-19 Pandemic in Ekiti State, Southwest Nigeria.

Purpose: Coronavirus disease 2019 (COVID-19) pandemic is the significant public health crisis of the 21st century that has disrupted personal, local, and international territorial relationships. Earlier studies have shown that people with HIV were at least twice at risk of dying from COVID-19 than the general population. There are also deep concerns about the indirect impact of COVID-19 on women within the reproductive age group in Sub-Saharan Africa who were already struggling to access reproductive healthcare services. In addition, pregnant HIV-positive women have an increased rate of anxiety and depression. This study, therefore, examined depression and anxiety disorders in pregnant HIV-positive women in response to the COVID-19 pandemic. Patients and Methods: This cross-sectional study used a structured questionnaire containing sociodemographic information, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7) assessment tools. Data obtained were analyzed using Statistical Package for Social Science version 26. Results: Ninety-nine (99) representing 78% of 127 pregnant HIV-positive women enrolled in the PMTCT program were eligible for this study. This number matched 99 randomly selected pregnant HIV-negative in the study areas as controls. Major depressive disorder (MDD) and severe anxiety disorder were significantly higher among the HIV-positive group than in the HIV-negative group (PHQ-9 Mean ± SD 8.0 ± 5.4 vs 2.3 ± 2.9; p = 0.000) and (GAD-7 Mean ± SD 5.9 ± 4.6 vs 1.2 ± 2.2; p = 0.000). Conclusion: Given the high prevalence of major depressive disorder and severe anxiety disorder among pregnant HIV-positive women, mental health care should be incorporated into the prevention with positive interventions and strategies to reduce the indirect consequences of the COVID-19 pandemic.

A Review on the Etiology, Prevention, and Management of Ureteral Injuries During Obstetric and Gynecologic Surgeries.

Iatrogenic ureteral injuries are a rare but serious complication of some gynecological and obstetric procedures with both high morbidity and legal implications. The incidence varies widely depending on the type and extent of the surgeries with about 70% unrecognized intraoperatively. When recognized intraoperatively and promptly managed, the prognosis is good. Ureteral injuries recognized postoperatively come with dire consequences for the patients and are litigation prone. Due to the proximity of the lower half of the ureters to the pelvic organs, 50% of the cases of injuries to the ureter occur within the jurisdiction of gynecological and obstetric practice. A good knowledge of the etiology, predisposing factors, appropriate surgical skills, proper identification of the course and deviation of the ureters, and intraoperative recognition of inadvertent damage to the ureter and its vasculature is required by all obstetricians and gynecologists to reduce the incidence of ureteral injuries by at least 50%. This review aims to add to what is already known, particularly among obstetricians and gynecologists practicing in resource-constrained settings.

Cesarean section in relation to self-esteem and parenting among new mothers in southwestern Nigeria.

BACKGROUND: Maternal psychopathology and self-esteem during childbirth may have an effect on maternal parenting self-efficacy. OBJECTIVE: This study aimed to asses the self-esteem of newly delivered primiparous mothers who had cesarean section (CS) in relation to their parenting self-efficacy. METHODS: A total of 115 primiparous women who delivered by CS were compared with 97 matched controls who had vaginal delivery during the same period. They completed the Rosenberg self-esteem scale prior to discharge. They also completed the parent-child relationship questionnaire at six weeks postpartum, together with the Rosenberg self-esteem scale. RESULTS: The mean score on the Rosenberg self-esteem scale was significantly lower for the CS group, both prior to discharge (p = 0.006) and at six weeks (p < 0.001), than the vaginal delivery group. The mean score on the parent-child relationship questionnaire was also lower in those who had CS compared with those who had vaginal delivery (p < 0.001, OR 4.71, 95% CI 1.75-14.71). CONCLUSION: CS in Nigerian women is associated with lowered self-esteem and predicts poor parenting self-efficacy in the postnatal period. Psychological support and techniques to improve self-esteem and parenting should be incorporated into the management of women having CS.

Obstetric outcome of twin gestations in a tertiary hospital South-western Nigeria.

BACKGROUND: Twin pregnancy is considered a high risk pregnancy due to associated adverse obstetric outcomes. The objective was to determine the prevalence, complications and the obstetric outcomes of twin deliveries in EKSUTH. MATERIAL AND METHODS: A retrospective analysis of twin gestations managed at the Ekiti State University Teaching Hospital, Ado-Ekiti between January 2009 and December 2012 was done. RESULTS: The prevalence of twin deliveries was 1 in 23 deliveries (4.3%). Increasing age and parity and Yoruba ethnicity were associated with higher twinning rate. The mean gestational age at delivery was 36.6 ± 2.9 weeks and the mean birth weight was 2.47 ± 0.49 kg with first twins having higher birth weight. Spontaneous vaginal delivery was the most common mode of delivery accounting for 52.6% and 49.3% in twin 1 and twin 2, respectively, and majority (39.5%) of the twins were in cephalic-cephalic presentation. The most common indication for caesarean delivery was breech presentation in the first twin. Preterm labour was the commonest maternal complications occurring in 25.7% of cases. The perinatal mortality rate was 105 per 1000 deliveries and this was significantly associated with unbooked patients, p = 0.001. There were no maternal deaths. CONCLUSION: Preterm labour remains the commonest complication with associated high perinatal mortality.