Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria.

BACKGROUND: Caesarean section (CS) is a potentially lifesaving obstetric procedure. However, there are concerns about the rising CS rate in many countries of the world including Nigeria. The Ten-Group Robson classification system is presently recommended as an effective monitoring tool for comparing CS rates and identifying target groups for intervention aimed at reducing the rates. The aim of this study was to evaluate the cesarean section rate and the groups with the highest risk of CS at the obstetric unit of Babcock University Teaching Hospital (BUTH), using the Robson classification system. METHODS: A cross-sectional study involving 447 women who gave birth at the obstetric unit of BUTH between August 2020 and February 2022. Relevant information was retrieved from the delivery records of the study participants. Data were analyzed using the IBM-SPSS Statistics for Windows version 23.0 (IBM Corp., Armonk, NY, USA). RESULTS: The overall CS rate was 51.2%. Multiparous women with previous CS, single, cephalic, term (group 5); nulliparous women, single cephalic, term, with induced labour or pre-labour CS (group 2); women with preterm single cephalic, term (group 10); and single cephalic term multiparous women in spontaneous labour (group 3) were the largest contributors to CS rate accounting for 34.5%, 14.0%, 12.6%, and 10.0% respectively. The commonest indication for CS was previous CS (87; 38.0%), followed by poor progress in labour (24; 10.5%). CONCLUSIONS: The CS rate in BUTH is high and Robson groups 5, 2 10 and 3 were the major contributors to this high rate. Interventions directed at reducing the first CS by improving management of spontaneous and induced labours; and strengthening clinical practice around encouraging vaginal birth after CS will have the most significant effect on reducing CS rate.

Peritoneal adhesion findings during laparoscopy: Determinants of occurrence and effect of severity on operative outcomes in a Nigerian Hospital.

Context: Peritoneal adhesions unlike other immediately recognizable complications of the surgery may produce long-term consequences, which include infertility and intestinal obstruction. Aims: The study aimed to determine the prevalence, the determinants, and the outcomes of laparoscopic surgery associated with intraperitoneal adhesion findings. Settings and Design: This was a retrospective observational study. Materials and Methods: The study included all laparoscopic gynecological surgeries done between January 2017 and December 2021. Adhesion severity was graded, using the peritoneal adhesion index (PAI), by Coccolini et al. Statistical Analysis: The data were analyzed using the SPSS version 21.0. Binary logistic regression was used to assess the factors associated with adhesion finding during laparoscopy. Results: There were 158 laparoscopic surgeries with 26.6% prevalence of peritoneal adhesions. The prevalence of adhesions among women with previous surgery was 72.7%. Previous peritoneal surgery was a significant determinant of occurrence of adhesions (odds ratio = 8.291, 95% confidence interval [CI] = 4.464-15.397, P < 0.001), and such patients had significantly (P = 0.025, 95% CI = 0.408-5.704) more severe adhesions (PAI = 11.16 ± 3.94) than those without prior surgery (PAI = 8.10 ± 3.14). Abdominal myomectomy (PAI = 13.09 ± 2.95) was the most important primary surgical determinant of adhesion formation. There was no significant relationship between adhesion occurrence and conversion to laparotomy (P = 0.121) or mean duration of surgery (P = 0.962). Greater adhesion severity was, however, observed in individuals with operative blood loss <100 ml (PAI = 11.73 ± 3.56, P = 0.003) and those hospitalized for ≤2 days (PAI = 11.12 ± 3.81, P = 0.022). Conclusion: The prevalence of postoperative adhesions during laparoscopy in our center is comparable to what has been earlier reported. Abdominal myomectomy is associated with the greatest risk and severity of adhesions. Laparoscopy in patients with more severe adhesions resulted in less blood loss and shorter duration of hospitalization, suggesting an association of better outcomes with a cautious approach to adhesions.

Résumé Contexte: Les adhérences péritonéales, contrairement aux autres complications chirurgicales immédiatement reconnaissables, peuvent avoir des conséquences à long terme, notamment la stérilité et l'occlusion intestinale. Objectifs: L'étude visait à déterminer la prévalence, les déterminants et les résultats de la chirurgie laparoscopique associée aux résultats des adhérences intrapéritonéales. Paramètres et conception: Il s'agissait d'une étude d'observation rétrospective. Matériaux et méthodes: L'étude a inclus toutes les chirurgies gynécologiques laparoscopiques réalisées entre janvier 2017 et décembre 2021.La gravité des adhérences a été évaluée, en utilisant l'indice d'adhérence péritonéale (PAI), de Coccolini et al. Analyse statistique: Les données ont été analysées à l'aide de SPSS version 21.0. Une régression logistique binaire a été utilisée pour évaluer les facteurs associés à la recherche d'adhérences pendant la laparoscopie. Résultats: Il y a eu 158 chirurgies laparoscopiques avec une prévalence de 26,6 % d'adhérences péritonéales. La prévalence des adhérences chez les femmes avec une chirurgie antérieure était de 72,7 %. La chirurgie péritonéale antérieure était un déterminant important de l'apparition d'adhérences (rapport de cotes = 8,291, Intervalle de confiance [IC] à 95 % = 4,464-15,397, P < 0, 001), et ces patientes avaient significativement (P = 0,025, IC à 95 % = 0,408-5,704) des adhérences plus sévères (PAI = 11,16 ± 3,94) que celles sans chirurgie préalable (PAI = 8,10 ± 3,14). La myomectomie abdominale (PAI = 13,09 ± 2,95) était le déterminant chirurgical primaire le plus important de la formation de l'adhérence. Il n'y avait pas de relation significative entre l'occurrence de l'adhérence et la conversion en laparotomie (P = 0,121) ou la durée moyenne de la chirurgie (P = 0,962). Cependant, une plus grande sévérité de l'adhérence a été observée chez les personnes ayant une perte de sang opératoire <100 ml (PAI = 11,73 ± 3,56, P = 0,003) et celles hospitalisées pendant ≤2 jours (PAI = 11,12 ± 3,81,P=0,022). Conclusion: La prévalence des adhérences postopératoires lors d'une laparoscopie dans notre centre est comparable à ce qui a été précédemmentRapporté. La myomectomie abdominale est associée au plus grand risque et à la plus grande sévérité des adhérences. La laparoscopie chez les patients souffrant d'adhérences plus sévères a entraîné une perte de sang moins importante et un séjour hospitalier plus court, ce qui suggère une association de meilleurs résultats avec une approche prudente des adhérences. Mots-clés: Fertilité, laparoscopie, myomectomie, adhrérences péritonéales.

Comparison of Zuspan regimen and its 12-hour modification in women with severe pre-eclampsia and eclampsia in two hospitals in Abeokuta.

BACKGROUND: Hypertensive disorders in pregnancy (HDP) are leading causes of maternal mortality (with severe pre-eclampsia/eclampsia [SPE/EC] being causes of death). Magnesium sulphate (MgSO4) has proven to be the drug of choice for SPE/EC management. However, its availability and cost remain a drawback to its use in developing countries. This study aimed to compare Zuspan regimen with its 12-hour modification for SPE/EC management in two major hospitals in Abeokuta, Ogun state, South Western Nigeria. METHODS: A randomized controlled trial of non-inferior parallel design carried out at Federal Medical Centre and Sacred Heart Hospital, Abeokuta involving 148 consenting women who were randomized into two groups A and B. Both groups had 4 g loading dose of MgSO4, but the duration of maintenance was reduced to 12-hours in Group A (intervention) while Group B received the standard Zuspan regimen (control). Outcome measures were the occurrence/recurrence of convulsions (primary), maternal side effects and perinatal outcomes (secondary). RESULTS: There was no statistically significant difference in the occurrence/recurrence of seizures between the two groups for both SPE/EC. No signs of maternal toxicity were observed in both arm of the study. There were no statistically significant differences in the perinatal/neonatal death and Apgar scores at 1 and 5 min. However, there was a significant increase in the number of days on admission in the control group of those neonates delivered to mothers with eclampsia. CONCLUSION: A 12-hr modification of Zuspan regimen was found to be non-inferior to the standard Zuspan regimen in the management of SPE/EC.

Effect of hyoscine-N-butylbromide on labor duration among nullipara in a southwestern Nigerian teaching hospital: A randomized controlled trial.

OBJECTIVE: To assess the effectiveness of hyoscine-N-butylbromide on the duration of the first stage of labor among nulliparous women. METHODS: A randomized double-blind placebo-controlled study among 126 nulliparous women admitted in the active phase of labor to a teaching hospital in Sagamu, Nigeria, from January to August 2018. Based on the inclusion criteria, women were recruited and randomized to the study or control group, and given intravenous hyoscine-N-butylbromide 20 mg (1 mL) or sterile water (1 mL), respectively, during the active phase. Labor progress and outcomes were compared between the groups. RESULTS: The mean ± SD duration of active phase of first stage of labor was significantly shorter in the hyoscine-N-butylbromide group (324.9 ± 134.6 min) than in the control group (392.7 ± 119.6 min) (P = 0.004). The rate of cervical dilatation was 1.4 ± 0.8 cm/h in the hyoscine-N-butylbromide group and 1.0 ± 0.5 cm/h in the control group (P = 0.004). There were no significant differences in fetal heart rate, maternal vital signs, or Apgar scores between the two groups. CONCLUSION: Hyoscine-N-butylbromide was found to be effective in shortening the duration of the first stage of labor without adverse outcomes for mother or neonate. The trial was registered with the Pan African Clinical trials Registry (PACTR), protocol number: PACTR201808146688942 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3532).

Maternal and perinatal outcomes of birth preparedness and complication readiness in recently delivered women of a Southwestern Nigerian Town.

Context: Birth preparedness and complication readiness (BPCR) have been shown to increase knowledge of danger signs and enhance access to skilled obstetric care. Previous studies have focused on intermediate outcomes of BPCR such as utilization of skilled care for pregnancy and delivery. Aims: This study aims to determine the maternal and perinatal outcomes associated with birth preparedness and complication readiness. Settings and Design: A cross-sectional study involving 827 recently delivered women, attending selected health facilities in Ikenne, southwestern Nigeria. Materials and Methods: BPCR was determined from a set of eight indicators that were developed by the John Hopkin's Bloomberg School of Public Health. Statistical Analysis: The data were analyzed using SPSS version 21. Bivariate analysis was done using Chi-square test, and binary logistic regression model was used to assess factors related to BPCR practice among respondents. The level of statistical significance was set to P < 0.05. Results: BPCR was observed in 470/827 (56.8%) of the participants. Only a minority had knowledge of financial - 125/827 (15.1%) and transportation assistance - 56/827 (6.8%). Knowledge of ≥ 5 danger signs of pregnancy was also low, 286/827 (34.6%). Institutional delivery was in only 331/827 (40%), and it depended on being birth prepared and complication ready (adjusted odds ratio [AOR] =0.534, 95% confidence interval [CI] =0.319-0.893). Significantly more perinatal deaths occurred to women who were not birth prepared (AOR = 2.951, 95% CI = 1.436-6.062), although no difference existed for perinatal (AOR = 1.202, 95% CI = 0.653-2.214) and maternal (AOR = 0.744, 95% CI = 0.452-1.226) morbidities. Conclusion: The knowledge and practice of key indicators of BPCR that reflect utilization of community resources in Ikenne Local Government Area is very poor. BPCR was an important determinant of perinatal survival.

RésuméContexte: Il a été démontré que la préparation à L'accouchement et la préparation aux complications (PAPC) permettent d'accroître la connaissance des signes de danger et d'améliorer l'accès à des soins obstétriques spécialisés. Des études antérieures ont mis l'accent sur les résultats intermédiaires du PAPC, comme l'utilisation de soins spécialisés pour la grossesse et l'accouchement. Objectifs: Cette étude vise à déterminer les résultats maternels et périnatals associés à la préparation à la naissance et à la préparation aux complications. Paramètres et Design: Une coupe transversale de l'étude impliquant 827 récemment livré des femmes, fréquentent les établissements de santé sélectionnés dans Ikenne, sud-ouest du Nigéria. Matériel et Méthodes: la PAPC a été déterminée à partir d'un ensemble de huit indicateurs élaborés par la John Hopkins Bloomberg School of Public Health. Analyse statistique: Les données ont été analysées à l'aide de la version 21 du SPSS. Une analyse bivariée a été effectuée à l'aide du test du Chi carré, et un modèle de régression logistique binaire a été utilisé pour évaluer les facteurs liés à la pratique du PAPC chez les répondants. Le niveau de signification statistique a été fixé à P < 0.05. Résultats: le PAPC a été observé chez 470/827 (56,8%) des participants. Seule une minorité avait une connaissance de l'aide financière ­ 125/827 (15,1%) et de l'aide au transport ­ 56/827 (6,8%). La connaissance de ≥ 5 signes de danger de grossesse était également faible, 286/827 (34,6%). Le taux d'accouchement en établissement n'était que de 331/827 (40%), et il dépendait de la préparation de la naissance et de la complication (rapport de cotes ajusté [RAO] =0,534, intervalle de confiance à 95% [IC] =0,319­0,893). Il y a eu beaucoup plus de décès périnataux chez les femmes qui n'étaient pas préparées à la naissance (RAO = 2,951, IC à 95% = 1,436­6,062), bien qu'aucune différence n'ait été observée pour les morbidies périnatales (RAO = 1,202, IC à 95% = 0,653­2,214) et maternelles (RAO = 0,744, IC à 95% = 0,452­1,226). Conclusion: la connaissance et la pratique des indicateurs clés du PAPC qui reflètent l'utilisation des ressources communautaires dans la zone de Gouvernement Local D'Ikenne est très faible. Le PAPC a été un déterminant important de la survie périnatale.

Emerging statistics on the epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease

Background:Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to beput in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS-Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations.Main body:Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy.Conclusion:The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes

Hypertensive disorders of pregnancy: A five-year review in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria

Objective: To determine the prevalence and outcome of hypertensive disorder of pregnancy in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State Nigeria Method: This was a retrospective descriptive study of all documented cases of hypertensive disorder of pregnancy between the 1st of June 2012 and 31st May, 2017. Information such as age, parity, booking status, level of education, blood pressure at presentation, urinalysis at presentation, gestational age at presentation, and delivery, mode of delivery, baby's birth weight was extracted from patients' case files. Result: There were 1,118 deliveries during the study period out of which 55 (4.9%) patients had hypertensive disorders in pregnancy. The mean age was 31.5years ±48.1 and mean parity, 1.2± 1.1. The mean systolic and diastolic blood pressures were 180.4 ± 1.88mmHg and 105.1± 1.5mmHg, respectively. Thirty-four (75.5%) of the women had preeclampsia/ eclampsia, while 7 (15.5%) had gestational hypertension. Most women were delivered preterm (22 patients, 48.7%). The majority of them (33, 73.3%) were delivered by cesarean section, out of which 2 (4.4%) were elective cesarean section and 31 patients (68.8%) were emergency cesarean section. The case fatality rate was 1.8%. Conclusion: Pre-eclampsia was the most prevalent t hypertensive disorder of pregnancy. It was more prevalent among primigravidae patients and the most common complication was preterm delivery. Strengthening antenatal care services will enable early identification of cases. Prompt referral of cases for specialist care will help in reducing the adverse outcomes associated with the condition.

Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial.

OBJECTIVE: Hyoscine butyl bromide (HBB) is known for its antispasmodic action and has been in use for over five decades, there is however no consensus on its effectiveness in the labor process. The aim of this study was to determine the effect of HBB on the duration of the active phase of labor. MATERIALS AND METHODS: A randomized double-blind placebo-controlled clinical trial involving 160 parturient who received either intravenous Hyoscine butyl-bromide (20 mg in 1 ml; n = 80) or intravenous normal saline (1 ml, n = 80). The mean duration of active phase of labor was compared between the two groups. RESULTS: The observed mean duration of the active phase of labor was significantly shorter (P = 0.001) in the Hyoscine butyl-bromide group (365.11 ± 37.32 min, range = 280-490) than in the Placebo group (388.46 ± 51.65 min, range = 280-525). There was no significant difference between the two groups in the mean duration of the second and third stages of labor (20.46 ± 10.46 vs. 23.38 ± 18.95 min, P = 0.43 and 8.96 ± 4.34 vs. 9.23 ± 5.92 min, P = 0.75, respectively). The mean 1-min APGAR scores were also comparable (8.08 ± 1.54 vs. 7.64 ± 1.60, P = 0.08). The mean postpartum blood loss was significantly less in the Hyoscine butyl-bromide group (303 ± 96.52 vs. 368 ± 264.19 ml, P = 0.04). CONCLUSION: Hyoscine butyl-bromide was effective in shortening the duration of the active phase of labor. It was also associated with significantly less postpartum blood loss.

Group B streptococcus colonization and HIV in pregnancy: A cohort study in Nigeria.

BACKGROUND: Group B streptococcus (GBS) is a leading cause of maternal and neonatal infectious morbidity. HIV is prevalent among pregnant women in Nigeria. AIM: To determine the rates of anogenital GBS colonization in our institution and compare GBS colonization rates between HIV positive and negative pregnant women. METHODS: A cross-sectional comparative study was conducted over 6 months. Patients were separated according to their HIV status: positive and negative. GBS colonization was assessed by vaginal and anal swabs collected at 35-37 weeks of gestation and cultured in Todd-Hewitt broth, followed by a confirmatory test. Socio-demographic characteristics and CD4 count were extracted from patient medical records. Secondary outcomes were identification of risk factors for GBS colonization, antibiotic sensitivity, and any association between CD4 count and GBS colonization. Appropriate statistical analysis was done. RESULTS: A total of 200 patients attended the clinic; 67 HIV positive and 133 negative. Analyzed samples were 198; the overall prevalence of GBS was 18.2%. No significant difference in GBS colonization was noted between HIV positive (19.4% [13]) and negative patients (17.6% [23/131]). Most GBS isolates were susceptible to ampicillin (87%) and penicillin (81%). A high body mass index (BMI) was independently associated with GBS colonization (OR = 1.25, 95% CI: 1.04-1.51). No association was observed between CD4 counts and GBS colonization. CONCLUSION: A high prevalence of GBS colonization was observed in our institution. Colonization rates were independent of the HIV status but associated with a high BMI in HIV positive women.

Demographic factors related to male involvement in reproductive health care services in Nigeria.

OBJECTIVES: Men play a well-recognised role in reproductive health care. They are pertinent to the achievement of female reproductive health. This study assessed male involvement in reproductive health issues in Nigeria and identified relevant factors. METHODS: This was a cross-sectional study of 1530 married men aged 25 to 45 years selected by a multi-stage sampling procedure. Bivariate and logistic regression analyses were performed, with male involvement in reproductive health care as the dependent variable. RESULTS: The mean age of the respondents was 38.64 (± 5 SD) years. Although 65.9% of the respondents discussed reproductive health issues with their wife, only 39.6% accompanied them during visits to clinics. Less than one-third (30.9%) of the respondents were involved in reproductive health care. Male involvement in reproductive health care is predicted by having completed at least secondary education (OR 4.337; p = 0.007), having one or no living child (OR 2.002; p = 0.001), and approval of family planning (OR 2.637; p = 0.000). CONCLUSIONS: Male involvement in reproductive health care is predicted by level of education, number of living children and approval of family planning. There is a need to focus on the identified factors in order to strengthen and increase male participation in reproductive health care.