Assessment of Significant Bacteriuria, Bacterial Profile and Pyuria among Pregnant Women with Urinary Tract Symptoms in Enugu, South-Eastern Nigeria: A Cross-Sectional Study.

BACKGROUND: Urinary tract symptoms are common in pregnancy; thus, symptom-based diagnosis of urinary tract infection (UTI) might not be accurate. Such women are often exposed to antibiotics without urine culture and antibiotics sensitivity. Identification of pyuria on urine microscopy of pregnant women with urinary tract symptoms may predict significant bacteriuria and guide such women's treatment in under-resourced settings. METHODS: A cross-sectional study of 233 consecutive consenting pregnant women with UTI symptoms at theantenatal clinic of the University of Nigeria Teaching Hospital ItukuOzalla, Nigeria. Participants' mid-stream urine specimens were sent for microscopy, culture, and antibiotics sensitivity. Data analysis was descriptive and inferential at 95% confidence level. RESULTS: The prevalence of symptomatic UTI among pregnant women with urinary tract symptoms was 33.5% (78/233). Coliform bacilli were the most common isolates (82.0%) from participants' urine. Ceftriaxone and ampicillin-cloxacillin had the highest (76.9%) and least (12.8%) sensitivity, respectively. Using urine culture as the standard, pyuria on microscopy showed a sensitivity of 43.6% and a specificity of 93.5% for predicting symptomatic UTI. CONCLUSION: The prevalence of UTI among pregnant women with urinary tract symptoms was low, and the most common isolate was coliform bacilli. Though pyuria had reasonably good accuracy for diagnosing symptomatic UTI, it should not be used for this purpose because of the risks associated with misdiagnosis.

CONTEXTE: Les symptômes des voies urinaires sont fréquents pendant la grossesse; ainsi, le diagnostic basé sur les symptômes de l'infection des voies urinaires (IVU) pourrait ne pas être exact. Ces femmes sont souvent exposées à des antibiotiques sans culture d'urine ni sensibilité aux antibiotiques. L'identification de la pyurie par microscopie urinaire chez les femmes enceintes présentant des symptômes des voies urinaires peut prédire une bactériurie importante et orienter le traitement de ces femmes dans les milieux défavorisés. BUT: Déterminer la prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires et évaluer l'exactitude de la pyurie pour prédire les infections urinaires symptomatiques pendant la grossesse à Enugu, au Nigéria. MÉTHODES: Une étude transversale de 233 femmes enceintes consentantes consécutives présentant des symptômes d'infection urinaire à la clinique prénatale de l'hôpital universitaire d'Ituku, à Ozalla, au Nigéria. Les échantillons d'urine à mi-parcours des participants ont été envoyés pour microscopie, culture et sensibilité aux antibiotiques. L'analyse des données était descriptive et inférentielle à un niveau de confiance de 95. RÉSULTATS: La prévalence des infections urinaires symptomatiques chez les femmes enceintes présentant des symptômes des voies urinaires était de 33,5% (78/233). Les bacilles coliformes étaient les isolats les plus courants (82,0%) des urines des participants. La ceftriaxone et l'ampicilline-cloxacilline avaient respectivement la sensibilité la plus élevée (76,9%) et la moins élevée (12,8%). En utilisant la culture d'urine comme norme, la pyurie à la microscopie a montré une sensibilité de 43,6% et une spécificité de 93,5% pour prédire les infections urinaires symptomatiques. CONCLUSION: La prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires était faible et l'isolat le plus courant était les bacilles coliformes. Bien que la pyurie ait une précision raisonnablement bonne pour diagnostiquer une infection urinaire symptomatique, elle ne doit pas être utilisée à cette fin en raison des risques associés à un diagnostic erroné. MOTS CLÉS: Grossesse, infection symptomatique des voies urinaires, culture d'urine, microscopie d'urine.

Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria.

BACKGROUND: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. AIM: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. PATIENTS AND METHODS: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. CONCLUSION: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.

Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country.

BACKGROUND: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. AIM: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. SUBJECTS AND METHODS: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. RESULTS: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). CONCLUSION: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.

Prevalence and predictors of placental malaria in human immunodeficiency virus-positive women in Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV)-infected pregnant women have alterations in cellular and humoral immunity that increase the risks to placental malaria infection. AIM: This study aimed at determining the prevalence and predictors of placental malaria among HIV-positive women in Nigeria. MATERIALS AND METHODS: It was a longitudinal cohort study of pregnant women receiving antenatal care at a tertiary hospital in Nigeria. Peripheral blood sample for packed cell volume estimation and placental blood sample for malaria parasite estimation were collected from each participant at a presentation in labor and upon delivery, respectively. RESULTS: The Prevalence of placenta malaria (68.6%) and anemia (66.7%) in HIV-positive women were significantly higher than the prevalence of placental malaria (35.3%) and anemia (44.1%) in HIV-negative control (P < 0.001 and P = 0.001 respectively). The employment status was the only sociodemographic factor significantly associated with the development of placental malaria in HIV-positive women (odds ratio: 21.60; 95% confidence interval: 7.1-66.2; P< 0.001). CONCLUSION: The prevalence of placental malaria is very high among HIV-positive women in Nigeria. Scaling up free distribution of insecticide treated nets in the short term and employment opportunities of HIV-positive women, in the long run, may reduce the prevalence of placental malaria in our population.

Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria.

BACKGROUND: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under-resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists. OBJECTIVE: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term. MATERIALS AND METHODS: Clinical and ultrasound fetal weights were estimated on 200 consecutive term pregnancies (37 completed weeks of gestation - 41 weeks and 6 days) at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1 st April to 30 th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight. RESULTS: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001). CONCLUSION: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.

Cervical cancer: socioeconomic implications of management in a developing nation.

This study, which assesses the economic, social and psychological implication of radiotherapy treatment of cervical cancer involved interviews with cervical cancer patients (and their relatives) seen at the University of Nigeria Teaching Hospital Enugu, Nigeria and subsequently referred for radiotherapy at other centres. Of the 95 cervical cancer patients referred for radiotherapy, only 19% (n = 18) actually underwent the procedure. The remaining 81% (n = 77) did not go due to financial reasons. All the patients that underwent radiotherapy were in the upper social class and spent almost 30% of their annual income on the treatment. The patients and their accompanying relatives encountered economic, emotional and social problems during the radiotherapy treatment because of absence of social health protection. There is a need to enhance institutional capabilities for preventing and treating cervical cancer through personnel training, establishment of special trust funds, regional screening and radiotherapy centres.

Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria.

This study retrospectively reviewed 476 cases of vesico-vaginal fistula (VVF) in the University of Nigeria Teaching Hospital Enugu, south-east Nigeria from 1981 to 2005. The majority (86.6%) of the VVFs were of obstetric origin, resulting from vaginal delivery (n = 330), caesarean section (n = 35), caesarean hysterectomy (n = 26) and instrumental delivery (n = 21). The remaining 13.4% (n = 64) resulted from pelvic surgery, malignancy and radiotherapy treatment. The contribution of obstetrics to VVF development showed a downward trend from 95% in 1981 to 60% in 2005. A success rate of 83% was recorded in the repair with large sized fistula and extensive fibrosis at the fistula site contributing mostly to failure. There is a need to increase access to trained delivery attendants to sustain the downward trend in the incidence of VVF.

Emergency contraceptive knowledge and practice among unmarried women in Enugu, southeast Nigeria.

BACKGROUND: With a high incidence of unwanted pregnancies and unsafe abortion especially among unmarried women in developing countries, there is need to promote emergency contraception (EC). OBJECTIVE: To assess the unmarried women's knowledge, attitude and practice of EC. METHODS: A random sample of a cross-section of 594 unmarried women in Enugu, southeast Nigeria, was surveyed with questionnaire between January and April 2004. RESULTS: Of the 1,160 unmarried women interviewed initially, 51% had heard of EC. One hundred (16.9%) knew the correct meaning of EC and these were mainly those with higher educational qualification, previous unwanted pregnancy, or had used modern contraception (p<0.05). Other respondents mentioned vaginal douching, application of traditional remedies to the vagina as effective emergency contraceptives. Although sixty percent (n=354) of respondents had used regular modern contraception, only 20% (n=119) had ever used EC. Few respondents knew correctly how EC function and the recommended timeframe for use. The two most common sources of information about EC were mass media (49.2%) and friends (28.8%). Seventy three percent (n=87) of emergency contraceptive users had some difficulties obtaining EC due to non-availability (n=42), attitude of health service providers to unmarried women demanding contraception (n=28) and cost (n=17). The attitude of the health service providers may have accounted for the dearth of information on EC even among users. Sixty-seven percent of respondents favored the use of EC by unmarried women. Opposition to the use of EC by unmarried women is because ofbeliefthat it has some health effect (n=72), induces abortion (n=80) and for religious reasons (n=42). CONCLUSION: Provision of appropriate information and access to EC, better service providers' attitude towards unmarried women is advocated.

HIV/AIDS: occupational risk, attitude and behaviour of surgeons in southeast Nigeria.

Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In addition, 79.5% were of the view that infected patients should not be discriminated against in treatment, provided necessary protective materials are available. To ensure provision of these protective materials, 91% (n = 240) and 89.4% (n = 236) of the respondents favoured involvement of government and insurance agencies, respectively. In order to achieve a greater commitment from surgeons in developing countries towards caring for HIV-infected patients, there is a need for a comprehensive AIDS management package that would offer specific preventive and psychological training in care of HIV patients and provide requisite funds and resources.

Twin pregnancy involving complete hydatidiform mole and partial mole after five years of amenorrhoea.

A case of twin pregnancy involving a single fetus and complete hydatidiform mole in a 56-year-old woman after 5 years of amenorrhoea is reported. The patient presented with threatened abortion and was managed with bed rest and blood transfusion. Six weeks after admission and at 20 weeks gestation, she had a spontaneous vaginal delivery of a molar pregnancy and a fresh stillbirth with molar degeneration of the placenta. The uterine cavity was evacuated by suction curettage after delivery and plasma, BHCG was negative 4 weeks subsequently. In a case of pregnancy after a long period of amenorrhoea in the older woman, molar degeneration is a strong probability.

Acquired gynetresia in eastern Nigeria.

A retrospective analysis of 78 patients who presented with acquired vaginal stenosis between January 1980 and December 1989 at the University of Nigeria Teaching Hospital Enugu was carried out. Ritual circumcision was a leading cause of this condition, followed by birth injuries and postoperative injuries. Urinary symptoms such as dysuria and urinary retention, as well as coital difficulty presenting as dyspareunia and apareunia featured prominently amongst the patients. The modified Fenton's operation was used in treating a majority of the patients, with good results. Occasionally more extensive surgery such as the McIndoe operation was used when the lesion was more severe. Recurrence rate was low and 11 women became pregnant during the period of follow up. The problem is of public health dimensions, and community based education to eliminate the etiological factors is recommended.

Obstetric complications of macrosomic babies in African women.

A prospective analysis has been made on 145 consecutive deliveries resulting in babies weighing 4.5 kg and above delivered at the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu, over a 1-year period (1985). Babies weighing 4.5 kg and over are regarded as macrosomic babies. The incidence of macrosomic babies in this study is 11 per thousand deliveries or 1 in 90. Factors that predisposed to the birth of macrosomic babies include: excessive weight gain during the course of pregnancy, tall height of the woman, multiparity and prolonged gestation. Diabetes mellitus was not a significant factor. Complications include prolonged labor, post-partum hemorrhage, ruptured uterus, shoulder dystocia and an increased perinatal mortality rate. Maternal mortality was also increased. Ninety percent of the multiparous women achieved spontaneous vaginal delivery while only 42% of the primigravidae achieved vaginal delivery. The implications are discussed.

Maternal mortality in Anambra State of Nigeria.

The maternal mortality rate (MMR) in 10 hospitals scattered all over Anambra State in a 5-year period was studied. The hospitals covered urban, semi-urban and rural areas. The MMR varied from 1.8 to 13 per thousand with a mean of 4.97 per thousand. The causes of and various factors influencing this high mortality rate are examined as well as the avoidable factors. Suggestions are made for its reduction based on accurate data collection, improved health facilities, improved socio-economic status and basic education.

PIP: The maternal mortality rate in 10 hospitals scattered all over Anambra State, Nigeria, in a 5-year period were studied. The hospitals covered urban, semi-urban and rural areas. The maternal mortality rate varied from 1.8 to 13/1000 with a mean of 4.97/1000. This mean is 45 times the rate in England in 1978 and also compared less favorably with some other figures from third world sources. Attributable causes included obstetric hemorrhage (23%), ruptured uterus (27.6%), obstructed labor (13%), sepsis (12.1%), eclampsia (7.9%), anemia (2.9%), septic abortion (2.1%) and other causes. 16.7% of deaths were among 16-20 year olds; 14.6% among 21-25 year olds, 27.2% among 26-30 year olds; 18.8% among 31-35 year olds; and 22.6% among women older than 35. 87.5% of the women were unbooked. Of the 239 cases, 51 delivered vaginally, 162 by cesarean section, 12 by breech, 5 by TOP and 5 by destruction. Parity and age were important influences; at highest risk were primigravida and the grandmultipara, especially between para 4 and para 5. All the major causes of death are avoidable--either by obtaining prenatal and intrapartal care or by anticipating fetopelvic disproportion or abnormal lie. Lack of access to health facilities, especially in the rural areas, poor transportation, great distances to nearest health facility, are all implicated in obstructed labor deaths. Most cases of hemorrhage are avoidable through early diagnosis and recognition of high risk cases, prophylactic measures and availablity of blood transfusion and surgical delivery. Lack of antibiotics and non-adherence to normal aseptic precautions were also problems, especially in the 5 deaths from illegal abortions. Changes in the mortality rate can be made by accurate data collection, improved health facilities, improved socioeconomic status and basic education.

Observations on molar pregnancy in Enugu, Nigeria.

Forty-one molar pregnancies seen at the University Teaching Hospital Enugu, Nigeria during the 10-year period 1976-1985 are analyzed. The incidence of hydatidiform mole was 0.82 per 1000 pregnancies. The incidence of molar pregnancy was lowest among teenage women and increased markedly with advancing age over 35 years. Hyperemesis gravidarum, a relatively uncommon finding in Nigerian women during normal pregnancy was a prominent feature of molar pregnancy in the women. The incidence of postmolar gestational trophoblastic disease was 17%; choriocarcinoma occurred in 7% of the subjects. Molar pregnancy and postmolar malignant trophoblastic disease occurred much less frequently among the Igbo women of Enugu than the Yorubas of western Nigeria. Earlier and better recognition and treatment of hydatidiform mole will probably result in a decrease in the high rate of complications found during this study.

Ureteral injury in obstetric and gynecologic operations in Nigeria.

Forty-eight cases of ureteral injuries resulting from obstetric gynecologic surgery were treated at the University of Nigeria Teaching Hospital between January 1978 and December 1987. Cesarean sections and cesarean hysterectomies were the leading causes of injury, being responsible for 18 (38%) and 12 (25%) of the cases, respectively. Ureteral transection was the commonest lesion observed, being noted in 29 (60%) of the patients. Attempt was made to reimplant the ureter into the bladder whenever possible, thus ureteroneocystostomy was performed in 27 (56%) cases while only 3 cases of end to end anastomosis were done. There was a case of mortality recorded from one of the referred patients. Forty patients recovered normal renal function after repair. Repair of ureteric injury as soon as the patient is fit for surgery is recommended.

Pattern of vulval warts at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

A retrospective analysis of 45 cases of condyloma acuminata seen at the gynecology clinic of the University of Nigeria Teaching Hospital between January 1976 and December 1985 was carried out. The prevalence of condyloma acuminata was found to be highest in the single, young and sexually active age group. There was no definite trend in the yearly incidence of vulval warts. Marked association with moniliasis and trichomoniasis was found. Gonorrhea was detected in two patients, but there was no confirmed case of syphilis seen. The mainstay of treatment was the application of 25% podophyllin resin in benzoin tincture either alone or in combination with cold knife excision or diathermy excision. The overall response to all methods of treatment was 64% while treatment with podophyllin alone gave a success rate of 80% and 60% in mild and moderate cases, respectively. The overall incidence of condyloma acuminata was 2.7 per 1000 women seen.

Morbidity and mortality from induced illegal abortion at the University of Nigeria Teaching Hospital, Enugu: a five year review.

Eighty-four cases of illegally induced abortion presented at the University of Nigeria Teaching Hospital (1982-1986), or 4 per 1000 deliveries. Seventy-one percent of the patients were 20 years or younger and 8 out of 10 were nulliparous. Medical practitioners were responsible for one-third of the cases. Presentation and treatment are described. Fifteen women died (179 per 1000 cases). The true number of deaths from abortion in the community is probably higher.

Maternal deaths associated with cesarean section in Enugu, Nigeria.

Maternal deaths from cesarean sections in Nigeria are exceptionally high and result from avoidable causes such as hemorrhagic shock, sepsis and hypertensive disorders in pregnancy. Increased involvement of specialists in the care and improved intra and post-operative management of cases are advocated to reduce the high maternal mortality rate.

The challenge of grandmultiparity in Nigerian obstetric practice.

A retrospective analysis of 733 Nigerian grandmultiparae seen at the University of Nigeria Teaching Hospital (UNTH) over a 3 year period was carried out. A high incidence of grandmultiparity (11%) was noted, and most of them (62%) belonged to the lower socioeconomic class. Anemia, hypertensive diseases, abruptio placentae, breech presentation and abnormal lie were significant complications of grandmultiparity. The incidence of multiple pregnancy, low birthweight babies, cesarean deliveries and perinatal deaths were markedly increased in the grandmultipara. Improvement in socioeconomic conditions of the populace, health education and widespread practice of family planning are suggested to reduce the incidence of grandmultiparity.

Diabetes mellitus in pregnancy in an African population.

OBJECTIVES: To compare the pregnancy outcome among diabetic and non-diabetic Nigerian women. METHODS: A retrospective case record review of 200 pregnant diabetic patients and control was carried out over a 10-year period (1990-1999) at the Maternity unit of the University of Nigeria Teaching Hospital Enugu, Nigeria. RESULTS: The prevalence of diabetes mellitus among pregnant mothers was 1.7%. Pre-gestational diabetes mellitus accounted for 39% of cases while gestational diabetes was responsible for 61% of them. Late antenatal booking and poor control of diabetes mellitus were common features, while maternal and fetal morbidity was high. Hypertension, vulvovaginitis, premature labor, polyhydramnios and ketoacidosis were significantly higher among diabetic mothers than controls. The perinatal mortality was also higher among diabetics than controls (12.5% vs. 3.5%) with stillbirth being the major contributor. Patients with gestational diabetes were at increased risk of fetal macrosomia than controls (28.7% vs. 5.5%). The overall cesarean section rate was high (36%) among diabetics with previous cesarean section and cephalopelvic disproportion being the commonest indications. CONCLUSIONS: Health education and provision of modern affordable methods of management of diagnosed cases such as uristix and hemastix will improve maternal and fetal outcome in pregnant diabetics in Africa.