The efficacy of magnesium sulphate as an adjunct to local anaesthetics for perineal pain relief after episiotomy.

BACKGROUND: Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia. AIM: To determine the efficacy of magnesium sulphate (MgSO4) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria. SUBJECT AND METHODS: This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO4 administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed. RESULTS: The pain score in the xylocaine + MgSO4 group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P < 0.001). There was no significant difference in the level of satisfaction, request for additional analgesia, and side effects between the two groups. CONCLUSION: Both xylocaine alone and xylocaine with MgSO4 provide adequate perineal pain relief during episiotomy repair. MgSO4 improves the analgesic effect of xylocaine at 2 h after episiotomy repair without any significant side effect.

Adolescent maternal mortality in North-west Nigeria.

BACKGROUND: Compared to women in their twenties, adolescents are more likely to die during childbirth. Moreover, more than half of women in sub-Sahara Africa deliver their first child before the age of 20 years. OBJECTIVE: To determine the institutional maternal mortality ratio among adolescents, its risk factors/causes and suggest ways of preventing or reducing the deaths. METHODS: A descriptive study based on hospital case records of all adolescent maternal deaths at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto between January 2000 and December 2009. RESULTS: There were 165 maternal deaths and 3,047 live births among the adolescent mothers within the period giving an adolescent maternal mortality ratio of 5415/100,000 live births. The main causes of death were eclampsia (53.9%), prolonged obstructed labour (15.3%), anaemia (14.5%) and haemorrhage (9.1%). Interestingly, abortion (2.4%) was an uncommon cause of adolescent maternal mortality in this study. Identified risk factors included lack of prenatal care/labour supervision and illiteracy. CONCLUSION: The adolescent maternal mortality ratio in the institution is remarkably high and is tragically due to preventable causes in most cases. The role of promotion of female education and utilization of family planning,prenatal and intrapartum services in reducing adolescent maternal death cannot be overemphasized.

Knowledge, attitude and practice of child adoption among infertile female patients in Sokoto north-west Nigeria.

AIMS AND OBJECTIVE: To determine the knowledge, attitude and practice of child adoption among infertile female patients at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. PATIENTS AND METHODS: Semi structured interview questionnaire was administered to 250 consecutive infertile female patients (between January 2008 and November 2009) at UDUTH Sokoto who agreed to participate in the study after counseling. The data was analysed by simple percentages, descriptive statistics, chi-square tests and regression equations at 95% confidence level. RESULTS: Knowledge of child adoption was high (74.8%). However only 1.2% of the respondents had adopted a child while 27.2% were willing to adopt. Willingness for child adoption was significantly higher in patients whose duration of infertility was greater than 5 years (OR=6.0, P<0.001), those with secondary/tertiary education (OR=4.1, P<0.001) and in those with no living child (OR=24.9, P<0.001) compared to their reverse counterpart. Majority of the respondents (71.6%) were not willing to adopt a child and their main reason was that child adoption would not allow them fulfill their conception role as women. CONCLUSIONS: Knowledge of child adoption was high among the respondents but the willingness to adopt a child was low due to the fact that it would not allow them fulfill their conception role as women. There is need to educate and encourage our infertile patients to utilise this cheaper and available option of managing infertility.

Ruptured uterus in a booked patient.

Ruptured uterus, a life-threatening obstetric complication, is a rare event among booked patients. We present a case of uterine rupture in a 28-year-old Gravida 2.para 1 +0 , 1 alive with previous lower segment Caesarean scar due to neglected obstructed labor from fetal macrosomia. She presented in labor at 40 weeks of gestation after declining the advice for an elective Caesarean section (C/S) and also signed against medical advice to receive care from a traditional birth attendant. She returned 30 hours later with a ruptured uterus. Findings at operation included a macerated stillbirth weighing 4.30 kg and a lower segment transverse scar rupture. Subtotal hysterectomy and peritoneal lavage were performed.

Giant mucinous cystadenoma: case report.

Mucinous tumours are the second most common type of epithelial ovarian tumours. Majority of these tumours are benign. However, some of these benign lesion can grow to enormous size, thus stimulating malignant neoplasia. This report presents the case of a 35 year old grand multiparous woman who came to our gynaecological clinic with 5 year history of abdominal swelling associated with weight loss. Abdomino-pelvic ultrasound scan revealed a large left ovarian cyst. She had laparotomy with left oophorectomy. A huge mucinous cystadenoma weighing 33.6 kg was removed. Her post-operative course was unremarkable.

Awareness and utilization of insecticide treated mosquito nets among pregnant mothers at a tertiary health institution in north-western Nigeria.

INTRODUCTION: Malaria in pregnancy is a formidable misery in Africa and contributes significantly to maternal death in Nigeria. The use of insecticide treated mosquito bed nets is one of the strategies of the Roll Back Malaria initiative. It is a form of vector control measure but there exists discordance between awareness and utilization of insecticide treated nets in Nigeria. This study set out to assess the level of awareness and utilization of insecticide treated nets among pregnant mothers attending antenatal clinic. METHODS: Using a structured questionnaire, a cross sectional study of 250 consecutive pregnant mothers attending antenatal booking clinic in Usmanu Danfodiyo University Teaching Hospital Sokoto between January and March 2008 was conducted. RESULTS: Seventy four percent of the clients were aware of Insecticide treated nets. Awareness of insecticide treated nets was significantly higher in clients with post primary education (66.8%) compared to those with at most primary education (33.2%); p < 0.05. Thirteen percent of the clients were using insecticide treated nets while 67.6% were not. The main reason for non-utilization of insecticide treated nets were non availability of the nets (58.8%) and inconvenience of the barrier to the clients (29.4%). CONCLUSION: There is high level of awareness of insecticide treated nets among the study population but very low utilization largely due to non availability. For Nigeria to achieve the millennium development goal target in combating the menace of malaria in pregnancy, more effort is required to increase the availability of insecticide treated nets. In addition, proper education on the benefits of insecticide treated nets may increase its utilization.

Family planning practice in a tertiary health institution in north-western Nigeria.

BACKGROUND: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymous with population control. OBJECTIVE: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information and methods of preference among others. MATERIALS AND METHODS: The record cards of all clients who attended the family panning clinic between January 1st 1998 and December 31st 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuation were extracted and analysed. Comparative percentage was used for the analysis. RESULT: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum.Over 75% of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were their main source(s) of information about family planning services. CONCLUSION: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious/traditional leaders along with improved dissemination of information using the mass media may go along way to increase contraceptive up take.

Abdominal pregnancy with a full term live fetus: case report.

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

Misoprostol use for cervical ripening and induction of labour in a Nigerian teaching hospital.

CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria.

BACKGROUND: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. AIMS: To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. METHODS: A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. RESULTS: Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. CONCLUSION: Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.

Twin births at University of Maiduguri Teaching Hospital: incidence, pregnancy complications and outcome.

In a five year retrospective study (between January 1990 and December 1994), there were 86 twin births out of 5,953 deliveries at University of Maiduguri Teaching Hospital giving a twin delivery incidence of 14.4/1000 birth. Only 82 case notes were available for this study. Dizygotic twins accounted for 80.5% of the cases while monozygotic twins represented 19.5% in the series. Increasing maternal age during the reproductive age and positive family history of multiple pregnancy were associated with increase twinning rate. The main complications encountered during pregnancy were hyperemesis gravidarum, pregnancy-induced hypertension and preterm labour. The frequency of preterm labour in this study was significantly higher than the observed among the singleton pregnancies within the period of study (P < 0.005). The perinatal mortality rate 85.4/1000 births was similarly significantly higher than that observed among the singleton deliveries (P < 0.005). Compared to singleton pregnancies there was a higher rate of caesarean section intervention (P < 0.005). The commonest mode of presentation and sex distribution were vertex-vertex and male-female respectively. The vertex-vertex presentation accounted for 48.8% of all the presentations while the male-female ratio was 1.2.

Reducing maternal mortality from ruptured uterus--the Sokoto initiative.

Uterine rupture is the most common cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with ruptured uterus and determine the success or otherwise of the scheme. The scheme was initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eighteen cases of ruptured uterus have been managed. Treatment was initiated within 30 minutes of admission. Admission-laparotomy interval averaged 3.5 hours (+/-1.2). There were two maternal deaths, giving a case fatality of 11% (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (P<0.05; confidence limits are-0.328 and -0.211). Of the seventeen patients that benefited from the scheme, 16 repaid the loan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria.

BACKGROUND: Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility. OBJECTIVE: The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation. MATERIALS AND METHODS: A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted. RESULTS: During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure. CONCLUSION: The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.