Pregnant women's knowledge and attitude to mother to child transmission of human immuno-deficiency virus in a rural community in Northwest Nigeria.

BACKGROUND: The high seroprevalence of HIV in Nigeria contributing to a huge burden of paediatric infection and with wide disparities in the various zones of the country needs to be addressed. The main strategy involves the prevention of mother to child transmission (MTCT) of HIV which remains the cornerstone of preventing the next generation from acquiring HIV. OBJECTIVES: To ascertain the knowledge and attitude of pregnant women in Northwest Nigeria to HIV and MTCT despite the low literacy level in the rural community. METHODS: This was a cross sectional study in which 450 pregnant women attending the booking clinic of a tertiary institution were recruited and interviewed using an interviewer administered semi-structured pre-tested questionnaires. The questionnaire assessed the pregnant women's knowledge related to HIV, MTCT of HIV, its prevention and respondents' attitude towards it. RESULTS: Of the 450 respondents, majority (96.2%) were aware of HIV. Most of them (78%) had adequate knowledge of MTCT of HIV. About half of the respondents knew that MTCT of HIV could be prevented by not breastfeeding, few agreed with taking of antiretroviral during pregnancy (28%) and giving new born antiretroviral (20.2%) as ways of preventing MTCT. CONCLUSION: The respondents in this study had a high level of awareness of HIV/AIDS, a good general knowledge of MTCT and attitude towards PMTCT but a below average knowledge of specific interventions on prevention of MTCT of HIV.

Grand multiparity: obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria.

OBJECTIVE: The objective was to review the obstetric performance of booked grand multiparae. DESIGN AND SETTING: A 5-year prospective observational study of cases between January 1, 2002, and December 31, 2006, was conducted in Aminu Kano Teaching Hospital, a tertiary institution, in Kano, Nigeria. MATERIALS AND METHODS: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery), who delivered in our labor ward, were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. OUTCOME MEASURES: These were obstetric factors of maternal age and parity, antepartum hemorrhage, fetal malpresentations, and multiple pregnancy. Medical complications were gestational diabetes, hypertension, anemia, and heart disease. Pregnancy outcomes measured were gestational age at delivery, birth weight, mode of delivery, postpartum hemorrhage, and maternal and perinatal mortality. RESULTS: The age range of the grand multiparae was between 22 and 43 years, with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15, with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55, CI = 6.72-23.91), hypertension (OR = 3.07, CI = 2.07-4.59), heart disease (OR = 2.01, CI = 0.70-6.08), anemia (OR = 3.16, CI = 1.42-7.24), antepartum hemorrhage (OR = 2.18, CI = 1.22-3.92), fetal malpresentations (OR = 3.04, CI = 2.38-3.88), cephalopelvic disproportion (OR = 2.09, CI = 1.33-3.29), and fetal macrosomia (OR = 2.27, CI = 1.72-3.00) among the grand multiparae compared with multiparae. CONCLUSION: The effects of these complications were minimized by good antenatal care.

Sub-clinical hypothyroidism in infertile Nigerian women with hyperprolactinaemia.

Studies on the impact of subclinical hypothyroidism in infertility are scarce and this seeks to determine the proportion of infertile Nigerian women with hyperprolactinaemia that had subclinical hypothyroidism. Serum prolactin and thyroid stimulating hormone were determined using ELECSYS 1010 auto analyzer. Two hundred infertile women were evaluated and 67(33.7%) had hyperprolactinaemia. Subclinical hypothyroidism was observed in 14.9% of women with hyperprolactinaemia, 4.5% and 10.5% of women with primary and secondary infertility, while hyperprolactinaemia was observed in 29.9% and 70.1% in primary and secondary infertility respectively. Mean levels of thyroid stimulating hormone and prolactin were higher in secondary infertility than primary infertility. Subclinical hypothyroidism and hyperprolactinaemia were higher in secondary infertility than primary infertility. The ratio of proportions between hypothyroidism and hyperprolactinaemia was 1:7.

Obstetric outcome of teenage pregnancy in Kano, North-Western Nigeria.

BACKGROUND: teenage pregnancies are regarded as high risk, because they often occur outside marriage. There is the need to evaluate the outcome of teenage pregnancies in a predominantly Islamic society like Kano where most occur within marriage, and timely prenatal care is usually available to most of them. OBJECTIVE: to review the obstetric outcome of teenage primigravida in Aminu Kano Teaching Hospital, Kano, Nigeria. METHODS: a retrospective case-control study of 500 booked teenage primigravidae, who delivered in our labour ward from January 2002 to December 2005 (study group) was performed. Their obstetric outcome was compared with that of an equal number of booked primigravidae aged 20-34 years, who met the recruitment criteria and delivered immediately after a selected teenage mother (control group). The study variables of interest were the demographic characteristics of the women in the two groups, antenatal/intrapartum complications and neonatal outcome. RESULTS: there were no significant differences in the mean birth weight, mean gestational age at delivery, mean height and perinatal mortality between the two groups, but mean maternal weight and body mass index (BMI) were higher among the older women. The teenage mothers had increased incidence of preterm labour and low birth weight infants (P < 0.05). The incidence of caesarean section and instrumental deliveries were lower among the teenage mothers. CONCLUSION: the results of this study show that teenage mothers who receive good family and community support, timely quality antenatal care and deliver in the hospital, should expect similar obstetric outcome to that of their older peers.

Spontaneous pre-labour rupture of membranes at term: immediate versus delayed induction of labour.

BACKGROUND: Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery. OBJECTIVE: To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term. METHODS: A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate. RESULTS: Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups. CONCLUSION: Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term.

Value of partogram in vaginal birth after caesarean section.

A prospective partographic study of labour in 102 women with one previous lower uterine segment caesarean section in the Aminu Kano Teaching Hospital, Kano, Nigeria, was carried out to assess the predictive value of partogram on the outcome of labour in vaginal birth after caesarean section (VBACS). The outcomes measured were the duration of labour, cervical dilatation rate (CDR), and average cervical dilatation rate (ACDR). The data obtained were analysed using Z-test and tests of validity. A successful vaginal delivery rate of 72.5% was achieved. The cervical dilatation rate, average cervical dilatation rate and the alert line were found to be significant predictors of the outcome of labour in VBACS. These findings have important implications in establishing policies for monitoring labour in VBACS.

Rupture of the gravid uterus following a road traffic accident.

A case of rupture of the uterus at 34 weeks of pregnancy due to a road traffic accident is presented. Emergency laparotomy and total abdominal hysterectomy were done with good maternal outcome. This is a rare cause of rupture of the uterus in this population.