Evaluation of obstetric outcomes for women in commuter versus non-commuter marriages: A comparative study.

Objectives: The study aims to determine obstetric outcomes for women in commuter marriages (CoMs) compared to women in non-CoMs, as well as the influence of living-in-companions on the obstetric outcomes. Methods: A prospective, multicentre, comparative study was conducted among antenatal clinic attendees in CoMs (160 women) and non-CoMs (160 women). Following consent, participants were recruited and monitored from antenatal booking until six weeks postpartum. The primary outcome measure was the obstetric outcomes (miscarriages, antenatal illness-associated hospital admissions, gestational ages at delivery, pregnancy-induced hypertension, gestational diabetes, and birth weights), while the secondary outcome measure was the influence of living-in-companions on the obstetric outcomes, which was measured by comparing the outcomes in women with those without living-in-companions. Data analysis was conducted using chi-square and t-tests, as applicable; a p < 0.05 was significant. Results: The commuting partners were males in the majority (n = 151; 94.4%), due to work-transfer (n = 76; 47.5%) or new employment (n = 60; 37.5%). There was a statistically significant association between CoM and delay before index pregnancy (n = 27 vs. 15; p = 0.047), higher mean gestational age at booking (22.2 ± 7.70 years vs. 19.9 ± 6.93 years; p = 0.005), higher antenatal illness-associated hospital admission (n = 39 vs. 19; p = 0.004), preterm delivery (33.8% vs. 6.9%; p = 0.001), and low birth weight (16.3% vs. 5.0%; p = 0.001). The mean gestational age at delivery (35.1 ± 2.53 years vs. 38.0 ± 2.38 years, p = 0.001) and birth weight (2445 ± 749 vs. 3146 ± 1646 g, p = 0.043) were lower and statistically significant among women in CoMs without than among those with living-in-companions. Conclusion: CoM was associated with adverse obstetric outcomes; however, living-in-companions appeared to ameliorate these adverse outcomes.

Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: a cross-sectional study.

Background: Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. Methods: A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant. Results: The overall mean DDI was 233.99±132.61 minutes (range 44-725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. Conclusion: Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.

Female adolescents and the future of female genital mutilation/cutting: a report from an endemic area.

Background: Despite collaborative efforts aimed at its eradication, Female Genital Mutilation/Cutting (FGM/C) continues in endemic areas. Objective: To evaluate the experience and preparedness of female adolescents to protect their future daughters from FGM/C. Methods: A cross-sectional survey involving adolescent secondary school girls in North Central Nigeria. Participants were secondary school students who completed the study's self-administered questionnaire after informed parental or participant's consent. Data management was with SPSS 20.0 (IBM, USA), P-value <0.05 was significant. Results: There were 2000 participants aged 13-19 years (mean 15.56±1.75), prevalence of FGM/C was 35.0%, awareness was 86.1%, mutilation was performed between infancy and eight years of age (mean 3.85±3.24 years), 644(32.2%) desire to mutilatetheir future daughters, 722(36.1%) expressed support for FGM/C and 63.1% of victims of FM/C reported adverse post-mutilation experiences. Support for FGM/C was associated with low social class (P0.0010), opinion that FGM/C has benefit (P0.001) and desire to mutilate future daughters (P0.001) while awareness of efforts to eradicate FMG/C was 813(40.7%). Conclusion: FGM/C remains prevalent with potential support for its continuation among female adolescents despite reported adverse post-mutilation experiences. The multi-pronged approach to eradicate FGM/C should prioritize re-orientation for adolescent girls, rehabilitation of mutilated girls and girl child formal education.

Pre-and-post-operative aversion among men whose partners had caesarean delivery in a patriarchal setting.

Objectives: The study evaluated pre and post-operative perception and aversion to caesarean delivery (CD) among men whose partners underwent the procedure. Design: A multicentre cross-sectional study. Setting: Two tertiary and two secondary health facilities. Participants: Men whose partners underwent CD at the study sites. Methods: Participants were recruited by purposive sampling, data collection was through interaction via an interviewer-administered questionnaire first immediately the decision for CD was made and thereafter on the third postoperative day. Men whose partners had vaginal delivery were excluded from the study and data management was with SPSS version 21.0 while p<0.05 was significant. Results: Awareness about CD was 84.0% mainly through the healthcare workers (42.1%) and the female partner (34.1%); 88.0% of participants recommended CD for medically-indicated reasons. The greatest influence on consent was the male partner (48.8%). The major pre-operative concerns were limitation of family size (34.7%) and fear of repeat CD (34.0%). Pre-operative perceptions of CD included being expensive (60.7%), fear of the procedure (48.0%), fear of complications (45.3%) and longer hospital stay (44.0%). Aversion to CD was 30.0% pre and 5.3% post-operation; predictors of aversion were history of previous surgery among male or female partner and awareness about CD. However, there were reductions in negative perception and aversion post-operation. Conclusion: The high negative perception and aversion to CD among male partners were reduced post-operation. Healthcare workers should address the concerns and negative perceptions about CD and prioritize patient-friendly experiences during surgical operations. Funding: Funding was by the researchers; no grant or external support was received for the study.

Primary umbilical endometriosis: Radical excision (omphalectomy) and laparoscopic management of associated pelvic endometriosis in a low resource tertiary hospital.

Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 - 1% of all extragenital endometriosis cases. We reviewed the data of five women with umbilical endometriosis retrospectively. The age range was 29 - 46 years, and they were all nulligravid at presentation. Common clinical presentation was umbilical pain and masses, dysmenorrhea, and primary infertility. Radical umbilical excision was performed to remove the nodule as a definitive treatment. Diagnostic laparoscopy was performed, followed by varying degrees of operative laparoscopic procedures. They all had endometriosis in the pelvis. Three out of five women operated became pregnant and had live births. Complete resolution of clinical symptoms with a reduction in umbilical and menstrual pain scores occurred. In resource-constrained settings, diagnosis, and treatment of PUE may be challenging. Clinical suspicion and appropriate case management are critical for good reproductive outcomes and quality of life.

Prevalence of asthma and respiratory symptoms during pregnancy in the middle belt of Nigeria.

Background: Information about the burden of asthma during pregnancy in Africa is scarce.Objectives: To determine the prevalence of asthma and respiratory symptoms in pregnancy in Ilorin, Nigeria.Methods: This study uses the European Community Respiratory Health Survey (ECRHS) questionnaire and definitions to screen 870 pregnant women attending three hospitals for asthma.Results: The prevalence of possible asthma (i.e. awakened by shortness of breath, asthma attack(s) in the last 12 months, or currently taking asthma medication) was 2.1% (95% CI: 1.3-3.1%), physician-diagnosed asthma was 1.0% (95% CI: 0.5-1.7%), and current asthma (asthma attack in the last 12 months and currently taking asthma medication) was 0.7% (95% CI: 0.2-1.3%). The prevalence of respiratory symptoms ranged from 0.6% (95% CI: 0.1-1.1%) for wheezing without cold to 12.9% (95% CI: 10.7-15.2%) for nasal allergies. Less than 1% reported an asthma attack and using asthma medication in the last 12 months. None of the pregnant women smoked tobacco during pregnancy. Pregnant women with possible asthma experienced more respiratory symptoms and worsening symptoms than those without asthma (15.8% vs. 3.9%), and the most reported symptom was being awakened by shortness of breath. The majority (55.6%) with physician-diagnosed asthma had suffered an asthma attack in the current pregnancy with a median of two attacks.Conclusion: The prevalence of asthma and respiratory symptoms in pregnancy in this sample was low, but we observed an increase and worsening of respiratory symptoms during pregnancy in those with asthma. Hence, the priority of clinicians should be disease control to prevent feto-maternal morbidity and mortality.

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital.

OBJECTIVES: This study aimed to compare the efficacy of oral misoprostol with manual vacuum aspiration (MVA) in first trimester incomplete abortions. METHODS: This randomised controlled trial study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between April 2014 and November 2015. Pregnant women who presented with clinical features of incomplete abortion at a gestational age of 13 weeks or less were included. Patients who had profuse vaginal bleeding, an intrauterine device in situ, signs of pelvic infections or who were younger than 18 years old and had no accompanying adults to give informed consent were excluded. A total of 200 participants were randomly and equally allocated to either the MVA or misoprostol treatment group. The treatment group were given 600 µg of misoprostol orally. The primary outcome measure was complete uterine evacuation, while secondary outcome measures included the need for additional surgical evacuation for failed treatment, adverse effects/complications, acceptability of and satisfaction with the treatment. RESULTS: Both misoprostol and MVA had high complete evacuation rates, yet MVA was significantly higher (99% versus 83%, relative risk [RR]: 0.84, confidence interval [CI]: 0.766-0.918; P <0.001). Significantly more women in the misoprostol group required additional MVA for failed treatment than in the MVA treatment group (17% versus 1%, RR: 16.67, CI: 2.260-12.279; P <0.001). No significant difference was found between the misoprostol and MVA treatment groups in terms of satisfaction (92.7% versus 89.8%, RR: 1.04, CI: 0.946-1.127; P = 0.473). CONCLUSION: Treatments with misoprostol and MVA had high complete uterine evacuation rates, as well as high rates of acceptability and satisfaction. However, MVA had a significantly higher complete evacuation rate than misoprostol.

Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy.

BACKGROUND: Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers' knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy. METHODS: This study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses. RESULTS: Face validity indicated that the questionnaire was quick to complete (10-15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546-0.897 (all P<0.001) and percentage agreement of 80-98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections. CONCLUSION: The designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses.

Oral health status of pregnant women in Ilorin, Nigeria.

Oral diseases have been shown to negatively affect pregnancy outcomes, yet, routine oral health care is not a component of the antenatal care package in Nigeria. This study was designed to describe the pattern of the oral conditions in pregnancy compared to the non-pregnant controls. Two hundred and twenty-five pregnant women and 166 non-pregnant controls were studied from two healthcare facilities in Ilorin. Oral-related complaints were assessed in the pregnant population while both of the groups had an oral cavity examination. The mean age of the respondents was 28.24 years ±4.77 and 80% had at least a secondary school level of education. The prevalence of oral complaints among the pregnant women was 19.1%. Gingivitis was more common among the pregnant women than the non-pregnant women, and more demonstrable on examination. Oral healthcare should be a component of the antenatal care in our environment. Impact statement What is already known on this subject? Women experience oral disorders in pregnancy, which may be worsened by the physiological changes in pregnancy. What do the results of this study add? This study has demonstrated a higher prevalence of gingivitis in the pregnant women than in the non-pregnant women on oral examination. The signs of gingivitis were higher than its related complaints. What are the implications of these findings for clinical practice and/or further research? Therefore, dental care and an examination should be part of a routine antenatal care package to prevent the unwanted pregnancy outcomes that are related to oral disorders.

An observation of umbilical coiling index in a low risk population in Nigeria.

OBJECTIVES: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. METHODS: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. RESULTS: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. CONCLUSION: The UCI was not associated with adverse perinatal outcome in this study.

Abdominal myomectomy: A retrospective review of determinants and outcomes of complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

BACKGROUND: The aim of this study was to describe the pattern, outcomes, and determinants of perioperative complications of abdominal myomectomy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. METHODS: This was a retrospective review of cases of abdominal myomectomy between January 2010 and December 2013. Data were obtained from ward and operating theatre case records and analysed using SPSS version 20. The continuous variables were analysed with Student's t-test. The categorical variables were analysed with the chi-square test. P-values of 0.05 or less was taken to be significant. RESULTS: Total sampling yielded 204 cases, of which 170 records (80%) were adequate for analysis. Using criteria developed by Garry et al., major and minor complications occurred in 43.6% and 32.9% of procedures, respectively, while 23.5% of the patients had no complications. The commonest complication was intraoperative haemorrhage requiring blood transfusion. Mean estimated blood loss was 630.88 ± 392.42 mL. There were no cases converted to hysterectomy, and no deaths were recorded. Uterine size equivalent to 16 weeks' gestation or more was significantly associated with heavier blood loss, blood transfusion, and fever (P = 0.034). Other significant determinants of major intraoperative haemorrhage with or without blood transfusion were menstrual flow of 6 days or more, preoperative anaemia, previous surgery, posterior incision, and surgery duration longer than 4 hours (P < 0.05). CONCLUSIONS: Outcome of abdominal myomectomy is generally favourable even if uterine size is greater than 16 weeks by palpation. Nevertheless, patients should be counselled preoperatively on the risk of blood loss and the possibility of blood transfusion.

Completeness of manual anaesthesia records in a tertiary facility in Nigeria

Introduction: The human brain, as efficient as it is, cannot remember everything.It is legally required by law that healthcare providers maintain a record for each of their patients. In anaesthesia, every aspect of the anaesthetic care from preoperative to postoperative care needs to be documented. It is, therefore, essential to review the efficiency of manual record keeping and explore possible ways of improving it. Materials and Methods: This was a retrospective study of all patients of obstetrics undergoing caesarean section between 1st July, 2013 and 30th June, 2014. Study participants were identified from Institutional Anaesthesia record books and clinical record (case notes). With the aid of a questionnaire, relevant information concerning patients' biodata, names of health personnel involved in the surgery and clinical information about vital signs and drug administration were documented from the records. Results: The chart completion rate was 63.88%. Emergency procedures had an average chart completion rate of 51.68% while the charts in elective procedures had a completion rate of 73.4%. The patients' name was the most frequently recorded item. The Apgar score was not recorded in any of the charts reviewed. Critical incidents were poorly charted with a chart completion rate of 36.59%. Conclusion: Manual recording of anaesthesia information is unreliable and results in incomplete anaesthesia records. It is poorer in emergency surgeries as compared to elective ones. A comprehensive approach that would include structured teaching on the importance of chart completion and the use of automated information systems in recording may correct this anomaly

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria.

BACKGROUND: The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVE: To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. METHODS: A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant. RESULTS: Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION: Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C.

Evaluation of parturient perception and aversion before and after primary cesarean delivery in a low-resource country.

OBJECTIVE: To determine the perception of and aversion to cesarean delivery (CD) and their determinants before and after primary CD. METHODS: A prospective cross-sectional survey of pregnant women undergoing primary CD (elective or emergency) was conducted in six health facilities in Ilorin, Nigeria. All participants completed an interviewer-administered questionnaire before the operation and 3-4days thereafter. The statistical analysis included the calculation of odds ratios (ORs) with 95% confidence intervals (CIs) and a logistic regression. RESULTS: Of the 254 participants, 182 (71.7%) and 53 (20.9%) had an aversion to CD before and after the procedure, respectively. A woman's personal decision was the overriding factor influencing acceptance of the operation. Preoperative predictors of aversion were prenatal admission (OR 2.86 [95% CI,1.07-7.66]; P=0.030) and a history of previous surgery (OR 0.42 [95% CI, 0.24-0.75]; P=0.003), whereas postoperatively a low number of prenatal clinic visits (less than four; OR 3.05 [95% CI,1.63-5.69]; P=0.001) and a history of previous surgery (OR 0.51 [95% CI, 0.27-0.96]; P=0.034) were significant. Postprocedure, 164 (64.6%) women said they would accept a repeat CD. CONCLUSION: Patient education, prenatal care, and previous surgical experiences were important in determining women's perception of and aversion to CD.

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objective. To determine knowledge about and attitudes to FGM/C among male adolescents; and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin; Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM; USA). A p-value of 0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years; range 14 - 19); 1 184 (77.1%) were aware of FGM/C; 514 (33.5%) supported female circumcision; 362 (23.6%) would circumcise their future daughters; 420 (27.3%) were of the opinion that FGM/C had benefits; mostly as a necessity for womanhood (109; 7.1%); and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C; and 42.2% recommended education as the most important intervention to achieve thisConclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Male Partner's Role during Pregnancy, Labour and Delivery: Expectations of Pregnant women in Nigeria.

OBJECTIVES: To evaluate the expectations of pregnant women on the role of the male partner during conception and delivery. METHODOLOGY: A prospective multi-centre observational study comprising 506 pregnant women at eight health facilities in Ilorin, Nigeria from January to June 2014. Consenting women were recruited at antenatal clinics using multistage purposive sampling and a self-administered questionnaire was administered with provision for interpreters in local dialects for those without western education. The data was analyzed using SPSS using percentages and chi-square test; p <0.05 was termed significant. RESULTS: Participants were aged 17 to 49 years (mean 30.23±4.81), 82.4% desire male partners company during antenatal clinic visits and 59.1% experienced this in index pregnancy. During labour and delivery, 427(84.4%) want company; 345(80.8%) chose the male partner with 211(57.7%) hoping men will appreciate the value of females afterwards although 27.9% feared the men may disturb the health workers, 72(14.2%) male partners attended previous delivery and 84.8% of the women were satisfied with the experience. Significant predictors of support for male partner's presence at delivery were maternal age (p=0.001), secondary or higher education (p=0.001) and parity less than four (p=0.001); religion (x(2)1.010; p>0.001) and social status (p>0.001) were statistically insignificant. Pregnant women wanted education for male partners on care of pregnant women (77.0%) and sex during conception (25.2%). CONCLUSION: Parturient desire male partners' presence at deliveries but their past participation was low; health facility modifications and education for men are required to meet the desires.

Double-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital.

OBJECTIVE: To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL). METHODS: A double-blind randomized control trial was undertaken at a center in Ilorin, Nigeria, between January and June 2013. Every other eligible patient (in the first stage of labor at term, to have a spontaneous vaginal delivery, and no/low risk of postpartum hemorrhage [PPH]) were randomly assigned with computer-generated random numbers to receive oral misoprostol (600µg) plus placebo injection or oral placebo plus oxytocin injection (1mL of 10IU) in the third stage of labor. The primary outcome was amount of blood loss during delivery. RESULTS: Mean postpartum blood loss was 325.85±164.72mL in the 100 patients given misoprostol and 303.95±163.33mL in the 100 patients given oxytocin (P=0.391). PPH (≥500mL blood loss) was recorded in 15 (15.0%) patients given misoprostol and 14 (14.0%) given oxytocin (P=0.841). Shivering, pyrexia, and diarrhea were all significantly more common in the misoprostol group (P<0.01 for all). CONCLUSION: The efficacy of oral misoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227.

Spontaneous abortions (miscarriages): analysis of cases at a tertiary center in North Central Nigeria

Background: Spontaneous abortion (miscarriage) is a source of pregnancy loss globally. Its management; especially in low resource countries remains hampered by inadequate facilities for evaluation. Objectives: To assess the clinical presentation; diagnosis; and treatment of cases of spontaneous abortion at a tertiary hospital in Ilorin; Nigeria. Methodology: A descriptive study of all spontaneous abortions (miscarriages) managed at the University of Ilorin Teaching Hospital; Ilorin; Nigeria between January 1; 2007 and December 31; 2011. The records were retrieved from the medical records department and necessary information retrieved. Results: There were 603 miscarriages with a prevalence of 4.2; incomplete miscarriage was the most common 254 (42.1); 356 (59.0) had no identifiable risk factor; 434 (72) of the women were 35 years; 361 (59.9) had first trimester miscarriages; 272 (45.1) were of low parity (Para 0-1) and 223 (37) were having a repeat miscarriage. Of the 141 managed for threatened miscarriage; pregnancy was salvaged in 90 (63.8); 244 (40.5) had surgical evacuation with 100 success rate while 218 (36.2) had medical management with 90.8 success rate. The mean duration of admission was shortest with surgical management (2.03 ? 1.1 days) and post-abortion infection rate was 11 (2.6 success rate. The mean duration of admission was shortest with surgical management (2.03 ? 1.1 days) and post-abortion infection rate was 11 (2.6). Histology confirmed product of conception in 98 and molar gestation in 2 of the samples; no mortality was recorded in this study. Conclusion: More than half of women with miscarriages had no identifiable risk factors mainly due to limitation in facilities for evaluation; there is a need to improve facilities for investigating women with spontaneous abortions in developing countries to identify the causes of the losses