Intraligamentary Extrauterine Pregnancy Delivered at Term: A Case Report and Review of Literature.

Intraligamentary pregnancy is extremely rare. Preoperative diagnosis is often difficult. We report a case of a 33 year old female who had an ectopic pregnancy in the right broad ligament. The pregnancy remained viable till term, but unfortunately resulted in a perinatal death prior delivery. Diagnosis was not made until laparotomy and a well formed still born was delivered. A high index of suspicion and prompt therapeutic intervention are necessary to prevent adverse fetal and or maternal outcome.

Human papilloma virus vaccine: determinants of acceptability by mothers for adolescents in Nigeria.

Vaccination of adolescent females against Human Papilloma Virus (HPV), the causative agent for cervical cancer has recently become available. As minors, parental acceptance of the vaccines for adolescent daughters requires exploration. This was a cross-sectional survey of 201 mothers attending the gynaecology clinic in a University Teaching Hospital in Nigeria on acceptability of the HPV vaccines and its determinants. Although 70% accepted vaccination of their daughters, 30% were unwilling and the commonest reason for unwillingness was that it may encourage sexual promiscuity (62.3%). Mothers with poor knowledge of STI were significantly more unwilling to accept HPV vaccines compared to those with average or good knowledge (p = 0.002). Furthermore, perception of susceptibility to HPV infection by daughters was significantly associated with acceptance of the vaccines (p = 0.0001). Increased advocacy and public enlightenment on cervical cancer control and the role of HPV vaccines in its prevention is still necessary especially in developing countries.

Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study.

OBJECTIVES: Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders. DESIGN: Population-level cross-sectional analysis. SETTING: This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. PARTICIPANTS: The sample included 23 200 women and 7087 men, aged 15-49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders. RESULTS: Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender. CONCLUSION: Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.

Pregnancy Desirability and Motivational Readiness for Postpartum Contraceptive Use: Findings from Population-Based Surveys in Eight Sub-Saharan African Countries.

This study examined the associations between pregnancy intention and motivational readiness for postpartum contraceptive use. Data for this cross-sectional analysis were derived from nationally representative surveys of the Performance Monitoring and Accountability 2020 (PMA2020) project conducted in eight sub-Saharan African countries. Participants included 9488 nonpregnant women of reproductive age (15-49 years) who had given birth in the last 2 years. Weighted multinomial logistic regression analyses were performed to estimate the odds ratios (OR) and their corresponding 95% confidence intervals (CIs) of the associations of motivational readiness for contraceptive adoption categorized as precontemplation, contemplation, and post-action with pregnancy intention. After adjusting for confounding factors, the findings revealed that women in Côte d'Ivoire and Nigeria who had mistimed pregnancies had significantly higher odds of being in the contemplation vs. precontemplation stage compared to those who had intended pregnancies. Similarly, women who had unwanted pregnancies in Ethiopia were also more likely to be in the contemplation stage. Furthermore, significant differences were observed for women in Burkina Faso, Côte d'Ivoire, and Nigeria regarding the association between mistimed pregnancies and being in the post-action stage. For women who had unwanted pregnancies, this association was significant only in Nigeria. Additionally, the odds of being in the contemplation stage, compared to the post-action stage, for women who had unwanted pregnancies were significantly higher in Ethiopia and Nigeria. These results indicate that recent unintended pregnancies in specific sub-Saharan African countries may motivate women to take action to prevent future unintended pregnancies. The findings underscore the importance of tailored and context-specific approaches in family-planning programs based on the stage of motivational readiness.

A multicenter prospective study of early gestational diabetes mellitus: Rates, severity, and risk factors based on IADPSG-defined fasting glycemia.

OBJECTIVE: To describe the epidemiology of early gestational diabetes mellitus (GDM) based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) defined fasting glycemia. METHODS: A prospective multicenter study testing fasting venous plasma glucose (FPG) in women aged 18-45 years between 6 and 23+6 weeks of pregnancy in secondary health facilities in Ondo State, Nigeria. Early GDM was defined using the IADPSG threshold for fasting hyperglycemia, and its severity was examined. Potential risk factors for early GDM were assessed using logistic regression analysis. RESULTS: Of the 8915 women who underwent FPG testing, the prevalence of early GDM was 12.5% (11.9%-13.3%). Multivariable analysis identified a dose-response association between body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and early GDM, with a BMI of 35 or more (adjusted odds ratio [aOR] 1.92, 95% confidence interval [CI] 1.03-3.55) associated with early GDM. Primiparity (aOR 1.49, 95% CI 1.25-1.76), multiparity (aOR 1.73, 95% CI 1.47-2.04), and a first-degree family history of diabetes (aOR 1.60, 95% CI 1.27-2.02) were associated with significantly higher odds of early GDM. CONCLUSION: This study established the prevalence, severity and risk factors for early GDM in a specific country that potentially represents a global region with no previous relevant data.

Prevalence and correlates of intimate partner violence against HIV-seropositive pregnant women in a Nigerian population.

OBJECTIVE: To evaluate the prevalence and correlates of intimate partner violence among HIV-positive pregnant Nigerian women. DESIGN: Cross-sectional study using an anonymous semi-structured interviewer-administered questionnaire. SETTING: The antenatal clinic at the University of Benin Teaching Hospital, Nigeria, from June 2008 to December 2009. POPULATION: 305 HIV-positive women receiving antenatal care. METHODS: An anonymous semi-structured World Health Organization modified questionnaire that elicited information on the experiences of intimate partner violence, was administered to the women by trained female interviewers. MAIN OUTCOME MEASURES: Prevalence, pattern and risk factors associated with experiencing intimate partner violence. RESULTS: The prevalence of intimate partner violence among the women was 32.5%, with psychological violence being the most common form of violence reported (27.5%) and physical violence the least reported (5.9%). Identified risk factors for experiencing violence were multiparity (Odds ratio 9.4; CI 1.23-71.33), respondents with an HIV-positive child (Odds ratio 9.2; CI 4.53-18.84), experience of violence before they were diagnosed HIV-positive (Odds ratio 44.4; 10.33-190.42) and women with partners without post-secondary education (Odds ratio 2.3; CI 1.40-3.91). CONCLUSION: Intimate partner violence is a prevalent public health problem among HIV-infected pregnant women in our community and it may hinder efforts to scale up prevention of mother-child transmission programs, especially in developing countries. Screening for intimate partner violence to identify abused women should be incorporated into these programs to offer these women optimal care.

Social induction of labour: experience in an urban teaching hospital in Nigeria.

PURPOSE: To document the experience with social induction of labour (IOL) and compare its outcome with electively induced labour for prolonged pregnancy. METHODS: A prospective matched case-control study. RESULT: Social IOL was significantly common in women of high social class (78.3 vs. 45.6%, P = 0.03) and the commonest indication was because the parturient was 'tired of pregnancy' (60.9%). There was no significant difference between both groups in the mean induction to delivery interval, caesarean section and instrumental delivery rates, 5-minute Apgar score <7 and early neonatal death. CONCLUSION: Social IOL in well-selected cases has comparable outcomes to elective IOL for prolonged pregnancy. There is still the need for evaluating the determinants of maternal request for social IOL and the development of guidelines to regulate its practice.

Obstetric and perinatal outcome in HIV positive women receiving HAART in urban Nigeria.

PURPOSE: To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls. METHODS: A prospective matched case-control study. RESULTS: HIV positive women were significantly more likely to have anaemia in pregnancy [p < 0.001, odds ratio (95% CI) 5.66 (3.0-10.5)], intrauterine growth restriction [p = 0.002, odds ratio (95%CI) 13.82 (1.8-106.7)], preterm labour [p = 0.03, odds ratio (95% CI) 2.89 (1.2-7.0)] and birth weight less than 2,500 g [p < 0.0001, odds ratio (95% CI) 5.43 (2.4-12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups. CONCLUSION: Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women.

Accuracy of 50-g glucose challenge test to detect International Association of Diabetes and Pregnancy Study Groups criteria-defined hyperglycemia.

OBJECTIVES: To determine the accuracy of the 50-g glucose challenge test (GCT) in detecting hyperglycemia in pregnancy (HIP) across a range of glucose thresholds relative to the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria, and to determine the accuracy of the 50-g GCT among patients with different risk status. METHODS: The present prospective cohort study included women aged 18-45 years at 24-31+6  weeks of pregnancy who presented at the Mother and Child Hospital, Akure, Nigeria, between September 1, 2015, and February 29, 2016. Patients underwent the 50-g GCT followed by the 75-g oral glucose tolerance test (OGTT). The accuracy of different 50-g GCT thresholds in diagnosing HIP was assessed based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria, with the 75-g OGTT used as a clinical reference standard. RESULTS: Of 280 patients enrolled, 46 (16.4%) had HIP. The sensitivity of the 50-g GCT to detect HIP decreased from 47.8% (95% confidence interval [CI], 32.9-63.1) at a 7.2-mmol/L threshold to 32.6% (95% CI, 19.5-48.0) at a 8.0-mmol/L threshold; the specificity improved from 84.2% (95% CI, 78.9-88.6) to 95.3% (95% CI, 91.7-97.6), respectively. CONCLUSION: The 50-g GCT performed poorly compared with the 75-g OGTT for detecting HIP. It appears to be an unsuitable replacement for the 75-g OGTT.

Maternal perspectives on gestational weight gain: Critical information on developing weight control interventions.

BACKGROUND: Our aim was to demonstrate what women reported being counselled about weight gain in pregnancy, their perceptions of inappropriate gestational weight gain (GWG), and plans for weight gain in pregnancy. MATERIALS AND METHODS: A cross-sectional survey of perceptions of prenatal attendees about inappropriate GWG was conducted at the prenatal clinic of a referral tertiary health facility in south western, Nigeria, between January 1, 2013 and June 30, 2013. Primary outcomes were the perceptions of women about risks involved with inappropriate weight gain and the proportion of women who self-reported being counselled at all on GWG, and had the right knowledge of risk(s) involved with inappropriate weight gain during pregnancy. RESULTS: Of the 348 women who completed the survey, approximately four-fifths (82.8%) reported GWG being discussed at all by health care provider. Fewer women (29.3%) believed there were maternal risks with excess weight gain compared to inadequate weight gain (34.8%). With respect to perception of risks of inappropriate weight gain to infants, 23.65 and 18.4%, respectively, believed there were infant risks with excess and inadequate GWG. Overweight women [OR 0.39 (95% CI 0.16-0.98)] and those who received GWG information from more than one type of health care provider [OR 4.71 (95% CI 1.64-13.78)] had significant increased rate of correct knowledge of risks involved with inappropriate GWG. CONCLUSION: The lack of awareness of risks involved with inappropriate GWG by over half of respondents underscores the need for improvement in educational intervention on GWG in our environment.

Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population.

OBJECTIVES: To investigate the impact of the new consensus diagnostic criteria on the prevalence of gestational diabetes, evaluate risk factors, and missed opportunities for diagnosis if selective screening strategy was employed. STUDY DESIGN: A prospective observational data of 1059 women with singleton pregnancy screened for gestational diabetes between 24 and 32 weeks gestation in a universal one-step screening and diagnostic strategy using 75-g oral glucose tolerance testing in an obstetric unit in Nigeria. Logistic regression was used to identify risk factors for GDM. RESULTS: The prevalence of gestational diabetes in accordance with 1999 WHO, new 2013 WHO modified IADPSG and IADPSG criteria was 3.8%, 8.1%, 7.5%, and 8.6%, respectively. Overt diabetes was diagnosed in 1.03% of the study population. Using the new consensus criteria, approximately 20% of GDM cases would have been missed if selective screening strategy was employed. Using multivariable analysis, glycosuria [aOR 8.60 (3.29-22.46)] and previous poor obstetric outcome [aOR 3.01 (1.23-7.37)] were significantly associated with GDM on 1999 WHO criteria. Glycosuria [aOR 2.54 (1.10-6.42)] was the only risk significantly associated with increased risk of developing GDM diagnosed based on new 2013 and IADPSG criteria. CONCLUSION: Using the new consensus screening and diagnostic guidelines, gestational diabetes is prevalent in our obstetric population. Missed opportunities exist with selective screening approach.

Prevalence of helminth infestation during pregnancy and its association with maternal anemia and low birth weight.

OBJECTIVE: To determine the prevalence of helminth infestation during pregnancy and the associated risks of adverse maternal and infant outcomes. METHODS: A cross-sectional study of women with a singleton pregnancy of at least 34 weeks was conducted at a teaching hospital in Benin City, Nigeria, between April 1 and September 30, 2010. Socioeconomic and clinical data were obtained. Stool samples were used to determine helminth infection. Birth weight was recorded at delivery. Multivariable analysis was used to assess the link between helminth infestation and maternal and perinatal outcomes. RESULTS: Among 178 women, 31 (17.4%) had a helminth infestation (15 [8.4%] had ascariasis, 8 [4.5%] trichuriasis, and 25 [14.0%] hookworm infestation). Multivariate analysis found that helminth infestations was associated with maternal anemia (adjusted odds ratio 12.4; 95% confidence interval 4.2-36.3) and low birth weight (adjusted odds ratio 6.8; 95% confidence interval 2.1-21.9). CONCLUSION: Approximately one in five women had a helminth infestation in the third trimester of pregnancy. Maternal helminth infestation significantly increased the risks of maternal anemia and low birth weight, indicating that routine administration of anthelminthic drugs during early pregnancy might improve perinatal outcomes.

Stillbirth in cases of severe acute maternal morbidity.

OBJECTIVE: To determine the incidence and correlates of stillbirths among women with severe acute maternal morbidity (SAMM). METHODS: In an observational study of 728 women who had SAMM between January 2007 and December 2010 at a referral tertiary health facility in Benin, Nigeria, the incidence of stillbirth, and the clinical and demographic correlates of stillbirth were evaluated. RESULTS: The rate of stillbirth among women with SAMM was 210 per 1000 deliveries. The rate among women who had uterine rupture (643 per 1000 deliveries) far exceeded other cause-specific rates of stillbirth. Unbooked status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.8), low maternal education (OR, 2.1; 95% CI, 1.2-4.0), vaginal delivery (OR, 8.1; 95% CI, 5.1-13.0), and maternal comorbidity (OR, 12.9; 95% CI, 6.2-26.9) were factors associated with stillbirth after adjusting for confounding variables. CONCLUSION: In Nigeria, SAMM was found to be associated with an unacceptably high rate of stillbirth. Strategies to improve fetal surveillance among women with SAMM are necessary to address the excessively high incidence of stillbirth among these patients.