Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: Upsurge or increased recognition?

BACKGROUND: Hydrometrocolpos (HMC) is a clinical condition in which there is a cystic distension of the vagina (hydrocolpos), uterus and sometimes, fallopian tubes (hydrosalpinx) with fluid. This study described our experience with cases of HMC seen in our practice, and highlighted the flare in our practice. PATIENTS AND METHODS: A retrospective study of cases of HMC managed at the University of Port Harcourt Teaching Hospital between September 2010 and August 2012. RESULTS: There were seven cases; their ages ranged from 2 to 27 days (median 13 days). All the patients had abdominal distension but abdominal mass was obvious only in four. Other features varied depending on the presence of sepsis or other associated anomalies. The diagnosis of HMC was missed in all cases by the referring clinicians. One patient was referred with the diagnosis of tracheoesophageal fistula and esophageal atresia, 2 with bladder outlet obstruction, 1 with intestinal obstruction, 2 with anorectal malformation, and 1 with neonatal sepsis. Ultrasound identified bulky uterus in two cases and upper urinary tract dilatation in 3 patients. Six patients had laparotomy, 1 had hymenotomy only. Postoperative complications were basically wound sepsis and rectovaginal fistula resulted. CONCLUSION: Diagnosis of HMC should be considered as a differential in newborn girls presenting with lower abdominal mass. Attention to clinical detail is necessary to avoid a misdiagnosis.

TRANSMIGRATION OF INTRA-UTERINE DEVICE, EXPLORATORY LAPAROTOMY, RETRIEVAL AND REPAIR OF PERFORATED UTERUS.

BACKGROUND: Perforation of the uterus following transmigration of Intra-uterine devise (IUD) is an uncommon finding of insertion of IUD. There is associated increased risk of accidental pregnancy,morbidity and mortality. AIM: To report a rare clinical condition in which there was uterine perforation following migration of IUD and to increase awareness of this condition in our environment. CASE REPORT: A 37 year old para 6⁺° woman (all alive) who presented with a ten day history of lower abdominal pains following IUD insertion. Examination revealed tenderness in the suprapubic region and non-visualization of IUD thread per vaginam. Pelvic USS showed an empty uterine cavity while an abdominopelvic x-ray following tracer IUD insertion showed the IUD to be outside the uterine cavity. She had an exploratory laparotomy for retrieval of transmigrated IUD and repair of perforated uterus. CONCLUSION: Transmigrated IUD with uterine perforation is distressing uncommmon clinical condition, and it is reported with the hope of increasing the awareness and possibly prevent this avoidable uncommon complication.

Jadelle subdermal implants. Preliminary experience in a teaching hospital in the Niger Delta Region of Nigeria.

BACKGROUND: The reproductive health hazards of unwanted pregnancies and unsafe abortions have been reduced with modern contraceptive use. The purpose of this review is to highlight the acceptability and side effects of Jadelle; a modern subdermal contraceptive implant in Port Harcourt. METHODS: Case files of acceptors of Jadelle:" subdermal implants between 4th January 2008 and 30th June 2010 were retrieved. Information obtained were sociodemographic characteristics, insertion and post insertion complications. Data analysis was done with Microsoft Excel and EPI info statistical software 14.0. RESULTS: Of the seven thousand, eight hundred and eighty four (7884) clients who accepted contraceptive during the study period; 75 chose Jadelle constituting 0.95% of acceptors. The mean age and parity of acceptors were 33.1 years and 4.05 respectfully. Majority of the clients (89.33%) were married while 10.67% were single mothers. Similarly most of the acceptors had secondary and tertiary education, 26.67% and 69.33% respectively. Prevalent side effects were amenorrhoea (41.33%), intermenstrual bleeding (6.67%), intermenstrual spotting (4.00%). None of the acceptors discontinued the method. There was no accidental pregnancy. CONCLUSION: Jadelle appears to have been accepted in our centre. About two third of the clients switched from their other methods to Jadelle; with a zero percent discontinuations rate among acceptors.

Perception of Undergraduates of University of Port Harcourt towards Use of Condom

Background: Unintended pregnancy and sexually transmitted infection especially human immunodeficiency virus pose major challenges to the reproductive health of young adults in developing countries. Appropriate use of contraceptives such as condom may play a significant role in reducing the problems. Aim: To assess the perception of undergraduates in University of Port Harcourt towards the use of condom. Methods: A cross-sectional questionnaire survey on the knowledge and use of condom among undergraduates of University of Port Harcourt. A systematic random sampling method was employed. Data collected was analyzed using SPSS version 11. Results: Of the 601 respondents involved in the study; 319 (53.1) were males and 282 (46.9) were females. While 98.9respondents displayed high level of knowledge of condoms; only 59.3of respondents use condoms. Similarly electronic media and peer group provided the major sources of information about condom. Unmarried people use the condom more than married ones. (p= 0.001). The main reasons for condom use for all age groups were prevention of unwanted pregnancies and sexually transmitted infections (STI).While most unmarried respondents purchased their condoms from patent medicine stores and pharmacy; the married ones procured theirs from clinics and hospitals. Conclusion: The perception of these undergraduates towards use of condom is good. Prevention of STI and unwanted pregnancies were the major reasons for condom use among them while peer group and electronic media were important sources of information

Male involvement in family planning: women's perception.

OBJECTIVES: To assess the knowledge of mothers of under-five children brought to immunisation centres of contraceptive methods applicable by males and their perceptions of the roles of males in family planning. SUBJECTS AND METHODS: This cross-sectional descriptive study involved a questionnaire interview of mothers who came to immunise their children at five public immunisation centres in Port Harcourt. Data entry and analysis employed EPI-Info version 6. RESULTS: Amongst the 558 mothers interviewed, the contraceptive prevalence rate was 5.6% and 85.6% of them knew at least a family planning method for males. About 15.8% would depend on their spouses for choice of contraceptive methods and 52.7% would discontinue family planning if their spouses objected. About 33.5% of the spouses had used some form of contraception while only 22.1% of the females recognised that male involvement could impact on the acceptance rate of family planning services. Despite their knowledge of safe child spacing, about 53% of the respondents delivered within shorter intervals and had significantly more pregnancies/children that they would have had if they were in 'control' of their reproductive health decisions. The spouses, despite being significantly older, more educated, with higher level jobs, and in-charge of the reproductive health decision in the home, did not contribute to the knowledge of the women and their practices of family planning. CONCLUSION: Despite the advantaged position of males in family matters, their roles in family planning remains largely unutilised. If the acceptance of family planning must improve, males should also be targeted by family planning programmes.

Contraceptive Prevalence amongst Women Attending Infant Welfare Clinic at the University of Port Harcourt Teaching Hospital

Background: Low contraceptive prevalence in Sub-Sahara Africa has increased the burden of unwanted pregnancies and continued population explosion thus hampering the economic development of the sub-region. This should not happen considering availability of modern family planning methods. Objectives: To determine the contraceptive prevalence; types of contraceptive used and factors affecting the latter amongst women attending infant welfare clinic at the University of Port Harcourt Teaching Hospital (UPTH). Methods: A cross sectional questionnaire survey of contraceptive prevalence amongst women attending the infant welfare clinic at UPTH. A systematic random sampling method was employed. Data collected was analyzed using SPSS version-11 and Microsoft Excel. Results: A total of 250 questionnaires were administered and 240 retrieved .The most commonly used contraceptive was the condom (28.4). Majority (55.4) of the respondents were aware of the oral contraceptive pill. About 41of the respondents were informed of contraception via the health centres while the commonest reason for non -use was the fear of complications. Conclusion: The contraceptive prevalence rate amongst women attending the infant welfare clinic in the UPTH is low though higher than the national figure. Prompt education of eligible women and men on the use effectiveness of the most commonly used contraceptive should be encouraged

Episiotomy and perineal trauma prevalence and obstetric risk factors in Port Harcourt, Nigeria.

BACKGROUND: Perineal trauma sustained during vaginal delivery may predispose to short and long-term complications such as postpartum haemorrhage and sexual dysfunction. Most published literature on perineal trauma and episiotomy come from developed countries and there is limited information from developing countries. The objective of this study was to determine the rate and risk factors for episiotomies and perineal trauma at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. METHODS: A retrospective review of vaginal deliveries at the UPTH between 1st January 1996 and 31st December 2000. RESULTS: The episiotomy rate in 4720 vaginal deliveries during the period of study was 39.1% in all parturients, while in primigravidae, it was 77.1%. Rates for first and second degree perineal tears in all women were 10.6 and 25% respectively. The incidence of episiotomy decreased with increasing parity while the incidence of perineal tears slightly increased with parity. Nulliparity, vaginal breech deliveries and instrumental vaginal deliveries were identified as risk factors for episiotomy. CONCLUSION: Episiotomy rate at the UPTH is high but the procedure appears to have prevented the occurrence of third degree and complete perineal tears.

Postpartum perineal pain in primiparous women: a comparison of two local anaesthetic agents.

BACKGROUND: Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to enhance vaginal delivery. This study was to compare the effect of two local anaesthetic agents on postpartum perineal pain and time for demand for oral analgesics. METHODS: A randomized double-blinded controlled clinical trial was conducted in primiparous women who had spontaneous vaginal delivery, comparing 1% plain lidocaine and 0.25% plain bupivacaine infiltration for the repair of selective episiotomy or perineal injury. RESULTS: The two groups were comparable in sociodemographic characteristics. At 2 and 4 hours, women who had perineorraphy under lidocaine had significantly higher pain scores on the Visual Analogue Scale (VAS) than those who had the repair under bupivacaine, (4.0 v. 2.0)and(6.0 v. 3.0)respectively. At the 6h hour, the mean pain score for the bupivacaine group was 4.0 on the VAS while the lidocaine group had already received a dose of oral analgesic (Ibuprofen 400 mg) following severe pain from the repair. There was however no statistically significant difference in the pain score on the VAS between the two groups at the time of request for oral analgesics. The mean time lapse before demand for oral analgesics for the lidocaine group was 2.25 +/- 0.46 hrs (Mean+Standard deviation) while that for the bupivacaine group was 7.13 1.56 hrs (Mean Standard deviation). The P value was P < 0.0000 (Student's t-test) and statistically significant. CONCLUSION: It is concluded that the patients in the bupivacaine group had a prolonged analgesia and needed fewer doses of oral analgesics in the immediate postpartum perineal repair period.