Prevalence of bacterial vaginosis in pregnancy in a tertiary health institution, south western Nigeria.

INTRODUCTION: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. Bacterial vaginosis has emerged as a global health issue due to the adverse outcome in pregnancy and in the puerperium. The study determined the prevalence of BV and outcome of delivery among pregnant women. METHODS: Socio-demographic data and vaginal swab samples were obtained from 362 consecutive pregnant women with abnormal vaginal discharge attending antenatal clinic in Ekiti State University Teaching Hospital, Ado-Ekiti. Data were analysed using SPSS statistical software 21 and association between variables was compared using Chi square. RESULTS: The prevalence of BV among pregnant women with abnormal vaginal discharge in this study was 16.6%. Age group 25-34yrs, multiparity and higher education were significantly associated with BV, p < 0.05. Symptoms such as vulvar itching, dyspareunia, lower abdominal pains and characteristic of vaginal discharge such as colour and consistency were significantly associated with BV, p < 0.05. Women with bacterial vaginosis significantly had prelabour rupture of fetal membrane and their babies were born prematurely with low birth weight and Apgar score of less than 5 at one minute, p < 0.05. However, there was no difference statistically in rate of admission into special care baby unit among the women, p > 0.05. CONCLUSION: The findings of this study suggest that there should be screening for BV in pregnant women presenting with abnormal vaginal discharge so that they could be treated accordingly. This will mitigate the complications arising from bacterial vaginosis.

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.

Pattern and medical care of child victims of sexual abuse in Ekiti, south-western Nigeria.

BACKGROUND: Child sexual assault (CSA) is a global health problem which affects many children and is often under-reported in developing countries. Data on CSA are few in these countries. AIMS AND OBJECTIVES: This study aimed to review the pattern and medical care of victims of CSA in a tertiary hospital over a 39-month period. METHODS: This is a retrospective, descriptive study. Case files of 28 cases of CSA were retrieved from those of 6535 patients seen in the paediatric out-patient department of Ekiti State University Teaching Hospital between 1 January 2010 and 31 March 2013. RESULTS: Victims of CSA accounted for 0.43% of new patients seen during the period under review with a yearly increase over that time. Victims were all female with a median age of 11.5 years and the age range was 4-17. They all had genito-urinary findings and 3.6% had an anal tear. The assailants were all male, mostly adults. A school-teacher and school-friends were the perpetrators in 3.6% and 10.8% of cases, respectively. All were screened for HIV, but only 60.7% were screened for hepatitis B and C. Only 60.7% received HIV post-exposure prophylaxis and none was given prophylaxis against viral hepatitis B and C. Of those eligible for post-exposure emergency contraception, only 43.8% received it. Antibiotics and analgesics were routinely given in 89.3% cases. Only one of the patients attended for follow-up. None had repeat serological screening tests. The police were involved in 60.7% of cases but there was no prosecution. CONCLUSION: Perpetrators of CSA are protean and, in the study area, there are gross inadequacies in the care provided for victims. Standard treatment protocols and additional training for health-care providers involved in the management of CSA victims are required.

Effect of different modes of delivery on cord blood oxidative stress markers.

BACKGROUND: Normal pregnancy has been associated with oxidative stress injury. Oxidative stress has been linked with poor perinatal outcome and birth asphyxia. The severity of this oxidative stress in newborn may be related to stress of different modes of delivery. METHODS: Eighty seven newborn babies were recruited in both labour ward and operating theatre of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Fourty one of them was delivered via spontaneous vertex delivery, 26 via emergency caesarean section and the rest, 20 were delivered through elective caesarean section. Cord blood sample was collected from new born babies immediately after delivery. Plasma was extracted and used for the laboratory measurement of total antioxidant status, malondialdehyde and Uric acid. RESULTS: There were no significant (P>0.05) changes among the studied groups in mean plasma levels of malondialdehyde, total antioxidant status and uric acid. However, a trend was observed in these parameters. Mean plasma total antioxidant status/mmol/l was observed to be highest in subjects delivered through ECS (2.35 ± 0.05) and lowest in subjects delivered through SVD (2.03 ± 0.08). Similarly mean plasma UA/mg/dl was also observed to be highest in subjects delivered through ECS (3.61 ± 0.16) lowest in those delivered through SVD (3.49 ± 0.71). The highest mean plasma level of MDA/µmol/l was found in subjects delivered through SVD (5.78 ± 1.56) while the lowest was found in subjects delivered through ECS (5.01 ± 1.21). CONCLUSION: There is no significant relationship between oxidative stress markers in neonate and the mode of delivery.

Herniation of Small Bowel Loop through a Broad Ligament Defect Masquerading as Torsion of Ovarian Cyst.

Torsion of ovarian cyst is a common cause of acute abdomen especially in women of reproductive age-group. It commonly presents with colicky abdominal pain associated with nausea and vomiting. It could however mimic acute intestinal obstruction. The patient was a 32-year-old multipara with no previous history of pelvic or abdominal surgery. She was admitted with colicky lower abdominal pain associated with repeated episodes of vomiting and nausea. Laboratory investigations were essentially normal. Abdominopelvic USS showed a hypoechoic mass lesion in the left adnexium measuring 7.1 × 5.5 cm; surrounding bowel loops were hypoactive, dilated, and fluid filled. Diagnosis of acute abdomen secondary to suspected torsion of ovarian cyst was made. Management began for acute abdomen with intravenous hydration, prophylactic antibiotics, and analgesics. An emergency laparotomy revealed about 6 cm defect in the left broad ligament in which a 20 cm segment of terminal ileum was encased. Liberation of the ileal segment was done and the broad ligament defect closed. Bowel obstruction requires high index of suspicion in a patient with acute abdomen due to suspected torsion ovarian cyst most especially in the absence of previous pelvic or abdominal surgery.