Head circumference, as predictor of cephalopelvic disproportion: A prospective analysis of cases of spontaneous vaginal delivery and caesarean section in Ekiti State, Nigeria.

Cephalopelvic disproportion (CPD) is a previously undiagnosed anatomical misfit between maternal pelvis and the fetal head. It is one of the major indications for cesarean section (CS), especially in sub-Saharan Africa. Early diagnosis, could avert events that can increase maternal and perinatal morbidity and mortality associated with this condition. This study was designed to determine the mean head circumference of the fetus in relation to CPD as an indicator for caesarean section. A total of 350 parturients who had spontaneous vaginal deliveries (group A) were compared with another 350 parturients who had cephalopelvic disproportion leading to CS (group B). The socio-demographic characteristics, delivery parameters, head circumference, fetal weight and length were recorded in a proforma and analyzed using SPSS version 21. P value was set at 0.05. The mean head circumference for the all the babies delivered in this study was 34.6 ±1.7cm. The mean head circumference of babies delivered to women with CPD via caeserean section compared to those who had vaginal delivery was significantly greater (35.15±1.5 vs 34.1±1.8, mean difference 1.9±0.1, X2,0.308 p <0.001). The cut-off for diagnosis of cephalopelvic disproportion was head circumference 34.8cm which has a specificity of about 74% and sensitivity of 88% with area under the curve being 66%. The study demonstrated that when the head circumference of a baby is 34.8cm and above, the risk of having cephalopelvic disproportion leading to a CS is high with sensitivity of 88% and specificity of about 74%.

Preliminary report of sexual assaults at Ekiti Sexual Assault Referral Centre, Ado-Ekiti, Southwest, Nigeria (Moremi Clinic).

There has been a surge in the incidence and severity of sexual assaults globally with the insurgence of COVID-19 owing to lockdown restrictions. Ekiti Sexual Assault Referral Centre, Ado-Ekiti also known as Moremi Clinic was established in June 2020 as a multisectoral response centre to this surge. Seventy-four survivors accessed medical services from June 2020 to May 2021. Adolescents made up 54.1% while the median age was 14.5 years. Only seven survivors were seen within 24 h of the event and around a quarter had follow-up visits. A quarter of survivors reported repeat episodes of sexual assault. Complications documented were sexually transmitted infections (13.5%), depression (4.1%) and posttraumatic stress disorder (5.4%). There was a failure of contraception in 4.5% of survivors who had taken emergency contraceptive pills. For improvements in quality of care, strategies to ensure early presentation and encourage follow-up visits must be introduced.

A Nested Case-Control Study of Serum Fasting Lipid Profiles in Pre- Eclamptic Primigravidas in Ile-Ife, Nigeria.

BACKGROUND: Pre-eclampsia contributes significantly to both maternal and perinatal morbidities and mortalities. One of the identified pathophysiologies of pre-eclampsia is the deranged serum lipid profile of which some components have been found to be elevated early in pregnancy in women destined to develop pre-eclampsia. OBJECTIVES: To compare the serum fasting lipid profiles of pre-eclamptic primigravidas with normal primigravidas at week 20, 28, and 34. METHODS: We conducted a nested case-control study at Obafemi Awolowo University, Ile-Ife between November 2016 and April 2018. A cohort of 290 primigravidas was recruited at week 20 and followed up until delivery. Serum fasting lipid profiles were quantified at weeks 20, 28 and 34 for all participants. Twenty four women that developed pre-eclampsia were compared with 48 women that had a normal pregnancy. Data were analyzed with SPSS version 22. We used a linear mixed-effect regression model with random intercept and slope. Significance was established using p<0.05. RESULTS: Serum lipid profiles showed an average weekly increase in both groups. Primigravidas that developed pre-eclampsia had a weekly increase of 0.2(SE0.14) mmol/l in serum total cholesterol more than those with normal pregnancies. (p<0.001) Serum low-density lipoprotein also showed a differential weekly increase of 0.1(SE0.05)mmol/l in primigravidas that developed pre-eclampsia over primigravidas with normal pregnancies. (p<0.001). CONCLUSION: The average weekly increase in serum total cholesterol and low-density lipoprotein was significantly higher in primigravidas that developed pre-eclampsia when compared to the control group. These findings depicted an association between serum lipid profile and pre-eclampsia among the primigravidas.

Comparison of weight gain between levonorgestrel and etonogestrel implants after 12 months of insertion.

OBJECTIVE: To compare weight gain between women using etonogestrel implants and those using levonorgestrel implants 12 months after insertion. METHODS: A multicenter prospective cohort study was performed on women recruited from family planning clinics between July 2016 and August 2017. The main study outcome was mean weight gain after 12 months of insertion of the implants. RESULTS: The present study included 150 women (age range 18-45 years) using levonorgestrel implants and 167 women using etonogestrel implants. The women recruited had been using implants for less than 6 months; implants had been inserted 6-12 months after their last pregnancy. Participants were followed up until 12 months after insertion through telephone conversations. Baseline parameters were obtained from the clinic records and weight was measured within 6 weeks of the 12-month anniversary of insertion of the implants. Data were analyzed with SPSS version 23. Weight gain in the levonorgestrel group was significantly higher than in the etonogestrel group (3.16 ± 4.08 vs 0.77 ± 3.76, P = 0.013; relative risk 1.69, 95% confidence interval 1.46-1.96). There were no differences in the occurrence of menstrual irregularities and client satisfaction. CONCLUSION: Women using levonorgestrel implants were more likely to gain weight compared to those using etonogestrel implants after 12 months of insertion.

Prevalence and risk factors for urinary incontinence in pregnancy in Ikere-Ekiti, Nigeria.

AIMS: The objective of this study was to determine the prevalence and associated risk factors for urinary incontinence (UI) among antenatal clinic attendees in a low resourced setting in Nigeria. METHODS: This study was a cross-sectional study involving pregnant women aged 18-45 years. Data was obtained from 442 pregnant women using the English version International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short form (ICIQ-UI-SF) from July 2017-September 2017. The questionnaires were self-administered. Data was analyzed with SPSS version 20. Logistic regression was also used to derive the adjusted odds ratio for risk factors of urinary incontinence among the respondents. A P-value <0.05 was taken as statistically significant. RESULTS: The prevalence of urinary incontinence in this study was 28.1%. UI prevalence among the nulliparous and multiparous women were 28.7% and 27.7% respectively. Stress urinary incontinence was the commonest (17.4%) while sexual relation was the most affected lifestyle (22.6%). Overweight (AOR 1.39, P = 0.03), obesity (AOR 1.60, P = 0.009), third trimester (AOR 2.09, P = 0.011), previous instrumental vaginal delivery (AOR 11.54, P < 0.001), Ibo tribe (AOR 3.29, P = 0.006); and Ebira tribe (AOR 8.86, P = 0.028) were associated with UI in pregnancy. CONCLUSION: Urinary incontinence affects more than a quarter of pregnant women; with substantial lifestyle changes; and sexual relation is the most affected activity. Health care providers should endeavor to enquire about symptoms of UI among pregnant women. Efficacy of interventions needs to be investigated in this population.