Comparative diagnosis of premature rupture of membrane by nitrazine test, urea, and creatinine estimation.

OBJECTIVE: The study compared the reliability of nitrazine, urea, and creatinine in the diagnosis of premature rupture of membrane (PROM). Nitrazine strip measures pH levels while urea and creatinine are produced mainly in amniotic fluid and not in the maternal vagina. METHODS: Sixty-four pregnant women with demonstrable passage or pooling of liquor par vaginum on speculum examination and 64 with no liquor drainage at 28-42 weeks gestation were studied. Vaginal fluid aspirates from both groups of patient were tested for urea, creatinine, and pH levels using nitrazine strip. Receiver Operating Characteristic (ROC) curves were plotted to determine cutoff values for urea and creatinine. Statistical analysis was done using SPSS version 23.0 and setting statistical significance at P ≤ 0.05. RESULTS: Nitrazine test showed high level of specificity (100%) but a sensitivity of 87.5%. Predictive ability of urea at >12.7 mg/dl obtained as cutoff value from the ROC curve showed a sensitivity of 19.64% and specificity of 94.44% while for creatinine the cutoff value was at >0.8 mg/dl with sensitivity of 48.21% and specificity of 65.28%. CONCLUSION: Nitrazine strip was the most reliable of the three in the diagnosis of PROM. This was followed by creatinine and then urea. In view of the gaps in sensitivity and accuracy and the importance of precise diagnosis to prevent maternal and fetal complications, there is still the need to find other affordable, more sensitive and more accurate biochemical marker/s that will help in diagnosing PROM especially in difficult cases.

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.

Adjunctive use of tranexamic acid to tourniquet in reducing haemorrhage during abdominal myomectomy - A randomized controlled trial.

BACKGROUND: Uterine fibroids are the commonest tumour of the female genital tract; about one third are symptomatic and require management. The treatment of uterine fibroids may be medical, surgical, conservative or expectant. Myomectomy is the common surgical treatment option for women failing medical management and desiring to preserve fertility and/or their uterus. The tourniquet is shown to be effective in reducing blood loss during myomectomy and tranexamic to a less extent. However, the adjunctive use of tranexamic acid with tourniquet to further reduce blood loss has not been studied. AIM: The aim of the study was to determine the efficacy of perioperative intravenous tranexamic acid in further reducing blood loss at abdominal myomectomy when used as an adjunct to tourniquet. METHODS: The study was a randomized double-blind controlled study involving women who underwent abdominal myomectomy. Participants were randomized to either tourniquet plus intravenous tranexamic acid or tourniquet plus placebo groups using simple random sampling. The primary outcomes were the intra-operative blood loss, post-operative haematocrit values and need for intra-operative blood transfusion. The data was analyzed using the SPSS software version 23.0 and p value < 0.05 was significant. RESULTS: The mean intra-operative blood loss (998.72 ±â€¯607.21 ml vs 907.25 ±â€¯529.85 ml, p = 0.475), intra-operative blood transfusion rate (45% vs. 30%; p = 0.166) and mean unit of blood transfused (1.13 ±â€¯1.64 vs. 0.75 ±â€¯1.28; p = 0.256) were higher for tourniquet plus placebo group compared to tourniquet plus tranexamic acid group. The estimated blood loss per 100 g of fibroid removed was reduced significantly in the tranexamic acid plus tourniquet group (139.80 ±â€¯2.28 ml vs 104.09 ±â€¯1.97 ml; p = 0.001). STRENGTH AND LIMITATIONS: The strength of the study include randomization and blinding. The limitations included non-uniformity of sizes and locations of fibroids, as well as the different surgeons with possibly different skills, techniques and experiences, though they were statistically not significant. CONCLUSION: The adjunctive use of tranexamic acid to tourniquet significantly further reduces intraoperative blood loss during abdominal myomectomy when compared to tourniquet alone. RECOMMENDATIONS: Adjunctive use of tranexamic acid is recommended for further reducing intra-operative blood loss during abdominal myomectomy.

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.

Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries.

BACKGROUND: Gross examination of the placenta may provide useful insight into the aetiology of newborn and maternal complications. A review of literature revealed only a few epidemiological studies that determined the relationships between placental abnormalities, gestational age and occurrence of adverse outcome in babies of healthy pregnant women in our region. PATIENTS AND METHODS: A prospective cross-sectional study was conducted at the Department of Obstetrics and Gynecology of University of Ilorin Teaching Hospital, between 1 st February and August 2013. Pregnant women in labour at ≥28 weeks' gestational age with singleton pregnancies were recruited. Gross examination of the placenta and umbilical cord after delivery were performed. RESULTS: Four hundred and twenty-eight singleton deliveries were studied. The average placental weight was 580.8 ± 130.6 g (range = 125-1500 g). The mean values of the umbilical cord length and width were 52.7 ± 10.5 cm and 1.96 ± 1.11 cm, respectively. Placental abnormalities occurred in 1.2%. The umbilical cord was centrally inserted in 290 (67.8%), marginally in 31% of cases. There was significant but weak positive correlation between the placental weight, birth weight and gestational age at 40 weeks (P ≤ 0.001, r = 0.356). Placental weight was directly related to birth weight (P < 0.0001, r = 0.244) and greater in babies with congenital abnormalities (P = 0.002). CONCLUSIONS: There was an association between placental parameters and foetal outcome at birth. Placental weight was positively correlated with birth weight, gestational age and occurrence of congenital abnormalities.

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.

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

Ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in South West Nigeria.

INTRODUCTION: Malaria has proven to be the most horrendous and intractable amongst the health problems confronting countries in the sub-Saharan Africa. This study aims to determine the ownership and utilisation of long lasting insecticide treated nets following free distribution campaign in a state in South West Nigeria. METHODS: Multi-stage sampling technique was used to recruit 2560 households spread across the 16 LGAs of the state. Interviewer administered standardized questionnaire was used for the survey. Data analysis was done using Stata 10 software. RESULTS: Sixty eight point six percent (68.6%) of the households had at least one under-five child living in the household while 32.6% had at least one pregnant woman living in the household. A total of 2440 (95.3%) households received LLIN during the campaign. Overall, the utilization rate for all respondents was 58.5%. Despite the fact that 2440 households received LLINs during the campaign, only 84.3% of them were seen to have hung theirs during the survey. CONCLUSION: Coverage and ownership of LLINs increased significantly following the free distribution campaign. There was a discrepancy between net possession and net use with rate of use lower than possession. Post distribution educational campaign should be incorporated into future distribution campaigns to help increase net utilisation.

Determinants of sexual function among women with type 2 diabetes in a Nigerian population.

INTRODUCTION: Sexual health is an important but often neglected component of diabetes care. Unlike erectile dysfunction, female sexual dysfunction has not been well studied among Nigerian diabetics. AIMS: To assess the sexual function of women with diabetes, and to determine its clinical correlates. METHODS: The sexual performances of 51 women with type 2 diabetes mellitus attending the Diabetes Clinic, University of Ilorin Teaching Hospital were assessed using the Female Sexual Function Index (FSFI) questionnaire. The Female Sexual Function (FSF) scores in each domain of sexual function were then compared with those of 39 nondiabetic controls. The associations between the FSF scores and certain clinical variables, as well as some diabetic complications, were also determined. MAIN OUTCOME MEASURES: Sexual performance of the women as measured by the FSF scores using the FSFI questionnaires. Results. The FSF score in the diabetic women was 20.5 (+/-8.3) compared with a score of 31.2 (+/-8.8) in the control (P value = 0.00). The FSF scores in the arousal, pain, orgasm, and overall satisfaction domains were all lower in the diabetic women (P value < 0.05). There was no significant difference in the scores for "desire" domain in the two groups (P value > 0.05). Women with diabetes attempted sex less frequently (P < 0.05). There was a negative correlation between the ages of the women and all the domains of sexual function (P value < 0.05). Duration of diabetes correlated negatively with comfort (P value = 0.04), lubrication (P = 0.03), frequency (P value = 0.05), as well as orgasm (P value = 0.04) domains. There was no significant relationship between the FSF score and body mass index, blood pressure, and glycemic control. There was no significant difference between the FSF scores of diabetic women with complications and those without (P value > 0.05). CONCLUSIONS: Diabetes significantly impairs the sexual performance of the Nigerian women afflicted with the disease. Determinants of FSF include age, duration of diabetes illness, and presence of menopause.