Ectopic pregnancy in Nigeria's federal capital territory: a six year review.

BACKGROUND: Ectopic pregnancy is a major public health issue and remains a major challenge to the reproductive Performance of women worldwide. The incidence and management approach to ectopic pregnancy over the past few decades has been revolutionized with various modalities of treatment currently in practice. The objective of the study was to determine the incidence, mode of presentation, diagnosis and treatment of ectopic pregnancy at the University of Abuja teaching hospital, Gwagwalada. METHOD: This was a retrospective study of ectopic pregnancy cases managed in the hospital between January 2001 and December 2006. RESULTS: There were 186 ectopic pregnancies out of 6,865 deliveries giving an overall incidence of 2.7%. Ectopic pregnancy accounted for 6.86% of all gynaecological admissions. Presentation was mainly as acute emergencies. Majority, 83.1% had ruptured while 16.9% were unruptured at presentation. The commonest finding on physical examination was abdominal tenderness which occurred in 90.4% of cases. Diagnosis was made solely on clinical findings in 36.7%. All cases had laparotomy and 95.0% had radical tubal surgery. CONCLUSION: Ectopic pregnancy is still a major health problem amongst women of reproductive age group presenting in the gynaecological unit of the University of Abuja teaching hospital. Laparotomy for salpingectomy is the mainstay of treatment as the patients present acutely, haemodynamically unstable and unfit for conservative management.

Accuracy of ultrasound estimation of fetal weight at term: A comparison of shepard and hadlock methods.

Background: Ultrasound measurement provides a noninvasive means of obtaining information about fetal weight and may help in necessary preparations at and after delivery. Although some ultrasound methods include only one or two fetal indices, others, to improve accuracy, incorporate either three or all the four fetal indices. The aim of this report is to assess the accuracy of two different methods for fetal weight estimation. Materials and Methods: This was a prospective study of 170 consecutive pregnant women at term. Ultrasound was used to estimate fetal weight by the Shepard and Hadlock methods, and the actual birth weight (ABW) was determined at birth. The ultrasound-estimated fetal weights (EFWs) and ABW were analyzed. Results: The women were aged 21-42 years (mean 31.3 ± 7 years). The EFW using the Shepard method was 1.9 kg-5.0 kg (mean 3.6 ± 0.5 kg) and 1.8 kg-4.4 kg (mean 3.3 ± 0.4 kg) for Hadlock method, and ABW was 2.0 kg-4.5 kg (mean 3.4 ± 0.5 kg). The mean EFW using the Shepard method was significantly higher than that of ABW (P < 0.001). The Shepard method significantly overestimated macrosomia compared to that by the ABW. There was no significant difference in microsomia rate between the two methods and ABW. Conclusion: The Hadlock method was more accurate at estimating fetal weight compared to the Shepard method and is recommended for the ultrasound estimation of fetal weight in our setting and similar settings.

Résumé Contexte: La mesure par ultrasons fournit un moyen non invasif d'obtenir des informations sur le poids du fœtus et peut aider à préparations nécessaires à et après l'accouchement. Bien que certaines méthodes d'échographie n'incluent qu'un ou deux indices fœtaux, d'autres, pour améliorer précision, incorporent trois ou tous les quatre indices fœtaux. Le but de ce rapport est d'évaluer l'exactitude de deux méthodes différentes pour estimation du poids fœtal. Matériels et méthodes: Il s'agissait d'une étude prospective de 170 femmes enceintes consécutives à terme. Ultrason a été utilisé pour estimer le poids fœtal par les méthodes Shepard et Hadlock, et le poids réel à la naissance (ABW) a été déterminé à la naissance. le les poids fœtaux estimés par échographie (EFW) et ABW ont été analysés. Résultats: Les femmes étaient âgées de 21 à 42 ans (moyenne 31,3 ± 7 ans). le EFW utilisant la méthode Shepard était de 1,9 kg à 5,0 kg (moyenne 3,6 ± 0,5 kg) et de 1,8 kg à 4,4 kg (moyenne 3,3 ± 0,4 kg) pour la méthode Hadlock, et ABW était de 2,0 kg à 4,5 kg (moyenne 3,4 ± 0,5 kg). L'EFW moyen en utilisant la méthode Shepard était significativement plus élevé que celui d'ABW (P < 0,001). le La méthode Shepard surestimait significativement la macrosomie par rapport à celle de l'ABW. Il n'y avait pas de différence significative dans la microsomie taux entre les deux méthodes et ABW. Conclusion: La méthode Hadlock était plus précise pour estimer le poids fœtal par rapport à la La méthode de Shepard est recommandée pour l'estimation échographique du poids fœtal dans notre contexte et dans des contextes similaires. Mots-clés: Précision, poids de naissance, poids fœtal, Hadlock, Shepard, échographie.

Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014-2018.

BACKGROUND: Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. OBJECTIVES: The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. METHODS: This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). RESULTS: The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25-34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. CONCLUSION: Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria.

Early Versus Delayed Oral Feeding after Uncomplicated Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study is to compare the safety of early versus delayed oral feeding after uncomplicated cesarean section (CS) under spinal anesthesia. METHODS: This was a randomized, controlled trial that enrolled 152 women who had uncomplicated CS under spinal anesthesia between January 2014 and June 2014. Women in the early feeding group had sips of oral fluid 6 h postoperatively while those in the delayed feeding group were on nil per oral for the first 24 h after surgery before commencement on liquid diet. Primary outcome measure was development of symptoms of paralytic ileus while secondary outcome measures included time interval to return of bowel sound, duration of hospital stay, and patients satisfaction which was determined using a visual analog score. RESULTS: The incidence of mild ileus symptoms was similar in both groups. Early-fed group had significantly shorter mean postoperative time intervals to return of bowel sound, (7.3 h vs. 11.5 h [P = 0.005]), passage of flatus, (30.7 h vs. 37.5 h [P = 0.009]). Hospital stay was also significantly shorter in the early feeding group, (4.2 days vs. 4.9 days [P < 0.001]). Early-fed women had higher levels of satisfaction. CONCLUSION: Early initiation of oral feeding after uncomplicated CS under subarachnoid block is not associated with increased incidence of gastrointestinal symptoms or paralytic ileus.

Unintended pregnancy among antenatal women in a tertiary hospital in North Central Nigeria.

BACKGROUND: Unintended pregnancy is a pregnancy that is either unwanted or mistimed. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinic at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. MATERIALS AND METHODS: This was a descriptive, cross-sectional study of 300 women attending the antenatal clinic of the Teaching Hospital. Information on sociodemographic characteristics, desirability of the current pregnancy at the time of conception, and knowledge and practice of contraceptive methods were collected using a pretested questionnaire. The data obtained were analyzed using SPSS version 20. Chi-square test was used for tests of associations with the level of significance set at P < 0.05. RESULTS: The average age of the respondents was 30.0 ± 4.7 years. Overall, 33.3% and 58.3% of the respondents attained secondary and tertiary levels of education, respectively. The prevalence rate of unintended pregnancy was 16%. Contraceptive awareness was quite high (259, 86.3%). However, contraceptive usage was low as 192 (61.9%) had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unwanted pregnancy (χ2 = 68.56, P < 0.001), as well as between parity and unwanted pregnancy (χ2 = 39.92, P < 0.001). CONCLUSION: The prevalence of unintended pregnancy among women attending antenatal clinic is high, possibly due to low contraceptive usage. Adequate information, education, and communication materials should be provided during antenatal health talks. Advocacy visits for community sensitization should also be increased.

Knowledge and perception of human papilloma virus vaccine among the antenatal women in a Nigerian tertiary hospital.

BACKGROUND: Cervical cancer is a major health problem globally, especially in sub-Saharan Africa, Nigeria inclusive. One of the preventive measures is the vaccination of teenagers against oncogenic human papilloma virus. The aim of this study was to find out the level of knowledge mothers possess about these vaccines and their willingness to administer vaccination to their teenage girls. MATERIALS AND METHODS: This was a cross-sectional descriptive study of 255 consecutive women attending antenatal clinic at the University of Abuja Teaching Hospital, Abuja. They were given either a self-administered questionnaire or interviewer-administered questionnaire containing both closed and open-ended questions. Information recorded includes socio-demographic variables, knowledge of cervical cancer, knowledge of HPV/HPV vaccines and acceptance of these vaccines for their adolescent girls. The data was analysed using descriptive statistics. RESULTS: The mean age of the respondents was 26.9 years. Over 90% had at least secondary education. A total of 102 (40%) had the knowledge of cancer of the cervix while 153 (60%) had never heard about it. Overall, 236 (92.5%) of them had no idea about the predisposing factors. The study showed that only 23 (9.0%) out of the total respondents had heard about human papilloma virus (HPV) infection. In the same vein, 20 (7.8%) had knowledge about HPV vaccine. Among the respondents, who had the knowledge of HPV and vaccination, 18.2% and 23.4% of them had secondary and tertiary levels of education respectively. Overall, 160 (62.8%) accepted that the vaccines could be administered to their teenage girls. CONCLUSIONS: Awareness of cervical cancer, HPV infections, and HPV vaccines is low among antenatal clinic attendees in Gwagwalada, Abuja. However, majority of them would want their girls vaccinated against HPV infections. There is a need for all stakeholders to step up awareness creation for improved HPV vaccination project in Nigeria.