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Background: Intimate partner violence (IPV) in pregnancy is a physical, sexual, psychological or economic harm by a current or former partner or spouse on a pregnant woman. It is a global public health problem that is common but underreported. Women are at increased risk of psychiatric illness in pregnancy and after delivery with the risk of major depressive disorder being highest during the postpartum period. Intimate partner violence in pregnancy may worsen this problem., Objectives: The objectives of the study were to determine the prevalence of intimate partner violence (IPV) in pregnancy, incidence of postpartum depression and the relationship between intimate partner violence, delivery outcomes and postpartum depression among booked pregnant women at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state, Nigeria (AEFUTHA)., Study Design: This study was a prospective cohort study., Setting: The antenatal clinic, antenatal ward, labour ward, postpartum clinic and under five clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state, Nigeria were used for the study., Method: One hundred and thirty-seven booked pregnant women that received antenatal care at AEFUTHA who met the inclusion criteria and consented to the study, were recruited from 37 weeks to 41 weeks gestation and screened for intimate partner violence and depression. Those with depression were referred for treatment while those that met the inclusion criteria were followed up to delivery and the delivery outcomes documented. They were also followed up to six weeks postpartum when they were screened for postpartum depression. Data were collated, tabulated and then statistically analysed using Statistical Package for Social Science (SPSS) software (version 25, Chicago II, USA). Numerical variables including participant's age, parity and gestational age were presented as mean, median, frequencies and standard deviation (Mean ± S.D), while categorical variables including occupation, level of education, social class and family type were presented as numbers and percentages. Chi-square test (X 2 ) and relative risk was used for comparison between groups for categorical variables while Fisher's exact test was used when Chi-square test (X 2 ) was not suitable. Binary regression analysis was used to determine the relationship between intimate partner violence and postpartum depression. A P value of ˂0.05 is considered statistically significant., Results: The prevalence of intimate partner violence was 52.6%, as 72 out of the 137 women recruited endured intimate partner violence. The major risk factors for intimate partner violence in the study were low level of education, low social class, polygamy and unemployment. The general incidence of postpartum depression was 29.93% while the incidence among women with intimate partner violence was 56.94%. Women with emotional violence and verbal abuse had a five-fold increase in the incidence of postpartum depression. Sexual violence and physical violence were not statistically significant risk factors for postpartum depression., Conclusion: Intimate partner violence is common as seen from the study. It is a significant risk factor for postpartum depression. Women that are emotionally and verbal abused are more likely to have postpartum depression. Screening pregnant women for intimate violence may identify those at risk and allow for proper interventions., (© 2024. The Author(s).)

Background: Myomectomy can be associated with life-threatening conditions such as bleeding. Excessive bleeding usually necessitates blood transfusion. Interventions to reduce bleeding during myomectomy will help reduce the need for blood transfusion with its associated complications. Tranexamic acid has been used to reduce bleeding in other surgical procedures, and its usage during myomectomy merits evaluation., Objective: To assess the efficacy of tranexamic acid in reducing myomectomy-associated blood loss., Materials and Methods: This is a prospective double-blinded randomized trial conducted on women who had abdominal myomectomy. Patients were randomized into two groups. The study group received perioperative intravenous tranexamic acid (TXA) while the control group received a placebo. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs. In addition, blood collected postoperatively from the wound drains and drapes were measured. Haemoglobin concentrations were determined preoperatively and on second postoperative day for all cases. Any adverse effect was noted in both groups. The data was processed using Epi Info software (7.2.1, CDC, Atlanta, Georgia). The relationships between categorical data were analyzed using X 2 and Student's t -test to determine relationships between continuous variables, with a P value of 0.05 considered statistically significant, and correlation coefficients were calculated using Pearson's formula, and probability of 0.05 was set for statistical significance., Results: Symptomatic uterine myomas constituted 17.3% of all gynaecological admissions and 21.3% of gynaecological operations at Federal Teaching Hospital Abakaliki. The mean intraoperative blood loss among patients that had perioperative tranexamic acid infusion was 413.6 ± 165.6 ml, while that of patients with placebo infusion was 713.6 ± 236.3 ml. Perioperative tranexamic acid infusion therefore reduced mean intraoperative blood loss by 300 ml, and this was statistically significant (SMD = -0.212, 95% CI: -403.932 to -196.067, P < 0.0001). Perioperative tranexamic acid reduced mean total blood loss by a value of 532.3 ml, and this is statistically significant (SMD = 30.622, 95% CI: 393.308 to 670.624, P < 0.0001). Tranexamic acid also improved postoperative haemoglobin concentration by 1.8 g/dl compared with placebo, and this is statistically significant (SMD = -0.122, 95% CI: 1.182 to 2.473, P < 0.0001). Tranexamic acid infusion decreased hospital stay by about 2 days, and this difference was statistically significant (SMD = -3.929, 95% CI: -3.018 to -0.983, P = 0.0003). There was no adverse drug reaction in the course of the study., Conclusion: The use of tranexamic acid during myomectomy reduced intraoperative and postoperative blood loss. It is also associated with decreased hospital stay. This trial is registered with NCT04560465., Competing Interests: There is no conflict of interest., (Copyright © 2024 Ayodele Adegbite Olaleye et al.)

Background: To our knowledge, there is no prior randomized trial on the efficacy of Mojeaga remedy (a special blend of Alchornea cordifolia, Pennisetum glaucum and Sorghum bicolor extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population., Methods: A pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and median hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat., Results: Ninety five participants were enrolled and randomly assigned to the Mojeaga group (n = 48) or standard-of-care group (n = 47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the median rise in hematocrit values from baseline (10.00±7.00% vs 6.00±4.00%;p<0.001) and median hematocrit values (31.00±2.00% vs 27.00±3.00%;p<0.001) were significantly higher in the Mojeaga group. There were no treatment-related serious adverse events, congenital anomalies or deaths in the Mojeaga group and incidence of other neonatal outcomes were similar (p>0.05)., Conclusion: Mojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes., Clinical Trial Registration: www.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Eleje et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cervical cancer is a preventable disease that contributes significantly to the death of women. This study is aimed at determining the level of knowledge and utilization of cervical cancer screening and its determinants among female undergraduates of Ebonyi State University., Methods: A structured questionnaire was used for a cross-sectional survey of the study population between January 1 and March 3, 2018. The data were analyzed using IBM SPSS Statistics version 20. Data were represented with frequency table, simple percentage, mode, range, Chi square and pie chart. The level of significance is at P-value < 0.05., Results: Majority (74.8%) of the respondents were aware of cervical cancer and it could be prevented (70.8%). More than three-fifths (68.30%) were informed via health workers, and 86.8% were aware that post-coital vaginal bleeding is a symptom. Less than half (49.8%) knew that HPV is the primary cause, and only 32.9% were aware of the HPV vaccine. One-quarter of the respondent were aware that early coitarche is a risk factor for cervical cancer. Only 41.8% of the women were aware of Pap smear, 9.2% had undergone screening, and 97.6% were willing to be screened. Marital status was the significant determinant of being screened while class level did not significantly influence uptake of cervical cancer screening. The most common reason (20.6%) for not being screened was lack of awareness of the test., Conclusion: Our study population had a good knowledge of cervical cancer, but utilization of cervical cancer screening was poor. Awareness creation through the mass media and provision of affordable screening services can promote the use of cervical cancer screening in the study area.

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a pandemic that has become a major source of morbidity and mortality worldwide, affecting the physical and mental health of individuals influencing reproduction. Despite the threat, it poses to maternal health in sub-Saharan Africa and Nigeria, there is little or no data on the impact it has on fertility, conception, gestation and birth. To compare the birth rate between pre-COVID and COVID times using selected months of the year., Materials and Methods: This was a secondary analysis of cross-sectional analytical study data from the birth registries of three tertiary hospitals, comparing two years [2019 (Pre-COVID)] versus [2020 (COVID era)] using three months of the year (October to December). The data relied upon was obtained from birth registries in three busy maternity clinics all within tertiary hospitals in South-East Nigeria and we aimed at discussing the potential impacts of COVID-19 on fertility in Nigeria. The secondary outcome measures were; mode of delivery, booking status of the participants, maternal age and occupation., Results: There was a significant decrease in tertiary-hospital based birth rate by 92 births ( P = 0.0009; 95% CI: -16.0519 to -4.1481) among mothers in all the three hospitals in 2020 during the COVID period (post lockdown months) of October to December. There was a significant difference in the mode of delivery for mothers ( P = 0.0096) with a 95% confidence interval of 1.0664 to 1.5916, as more gave birth through vaginal delivery during the 2020 COVID-19 period than pre-COVID-19., Conclusion: Tertiary-hospital based birth rates were reduced during the pandemic. Our multi-centre study extrapolated on possible factors that may have played a role in this decline in their birth rate, which includes but is not limited to; decreased access to hospital care due to the total lockdowns/curfews and worsening inflation and economic recession in the country., Competing Interests: Competing interests The authors declare no conflicts of interest.

Objective: The aim of this study was to determine the pattern and outcomes of higher-order multiple pregnancies in a tertiary hospital in Nigeria., Methods: This is a retrospective review of all cases of higher-order multiple pregnancies that were managed between 1 January 2012 and 31 December 2016 in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Data obtained were represented with frequency tables, percentages, bar charts, and odds ratio., Results: There were 22 higher-order multiple pregnancies over the study period and 12,002 deliveries, giving a higher-order multiple prevalence rate of 0.2%. Five of the mothers (four triplets and one quadruplet) had in vitro fertilization (0.4 per 1000 deliveries), while other mothers conceived naturally. Many of the women (12, 54.6%) were in the 30-34 years age group, and more than half (16, 72.7%) were multiparas. More than half of the neonates were delivered preterm (13, 59.1%). Being booked is associated with better neonatal outcomes although not significant (odds ratio = 3.06. 95% confidence interval: 0.55-16.83, p  = 0.197). Anemia was common in the antepartum and postpartum periods. Half of the women (11, 50%) were delivered by elective cesarean section and 7 (31.8%) by emergency cesarean section (C/S), while 4 (18.2%) had a spontaneous vaginal delivery. The neonates had a mean birth weight of 2.14 ± 0.35 kg. Overall, 61 neonates (91.0%) were born alive and 6 (9.0%) suffered perinatal deaths, giving a perinatal mortality rate of 89.8 neonates per 1000 live births., Conclusion: Our study shows that higher-order multiple pregnancies are high-risk pregnancies that are associated with fetal and maternal complications. Anemia is the commonest complication seen in our study. The majority had preterm delivery. Proper antenatal care and close feto-maternal monitoring are important in reducing adverse outcomes associated with these pregnancies., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Fetal fibronectin is a useful biomarker in the diagnosis and management of preterm labour., Objectives: To evaluate the relationship between cervical fetal fibronectin and preterm delivery and the association between cervical fetal fibronectin level and gestational age at delivery., Materials and Methods: A prospective cohort study was performed in a tertiary hospital in Nigeria, involving equal number of pregnant women with (96) and without (96) preterm labour. Fetal fibronectin assay was done using solid-phase immunogold assay. The data were analysed using IBM SPSS version 24. Descriptive and inferential statistical analyses were done. The level of significance was p -value <0.05., Results: Less than half (47.9%) of the women in the study group had preterm delivery while 13.09% of the women in the control group delivered preterm. Fetal fibronectin test had a sensitivity, specificity, positive predictive value and negative predictive value of 78%, 86.5%, 71.9%, and 89.0%, respectively, a positive likelihood ratio and negative likelihood ratio of 5.76(95% CI, 3.67 - 9.64) and 0.26(95% CI, 0.16 - 0.41), respectively., Conclusion: The findings in our study value of fetal fibronectin in predicting preterm delivery. Its use will support less intervention for patients with negative results., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022 Cyril C. Ikeoha et al.)

Objectives: The aim of this study is to determine the effect of interpregnancy interval (IPI) on the incidence of placenta previa and placenta accreta spectrum disorders in women with a previous cesarean section., Methods: A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18-36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann-Whitney U test, wherever appropriate, to examine the significance of the differences in clinical variables., Results: A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (odds ratios = 2.32; 95% confidence intervals = 0.78-6.88; p = 0.13), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (odds ratios = 2.02; 95% confidence intervals = 0.18-22.13; p = 0.57), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections ( p = 0.02) in women with short IPI., Conclusion: A short interpregnancy interval does not significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. There is a need for further study with large numbers to corroborate these findings in low- and middle-income settings., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Uchenna Anthony Umeh et al.)

Objective: To compare the analgesic efficacy and safety of paracervical block and conscious sedation in the surgical evacuation of the uterus following a first-trimester miscarriage., Methods: This is an open-label, randomised control trial comparing pain relief by paracervical block versus conscious sedation during manual vacuum aspiration of first-trimester incomplete miscarriages. One-hundred and sixty-two women were equally randomised into two groups. Group A (paracervical group) received a paracervical block of 4 ml of lidocaine each at the 4 and 8 o'clock positions. Group B (conscious sedation group) received intravenous 30 mg pentazocine and 10 mg diazepam. Data obtained were presented using a frequency table, student t-test, chi-square and Mann-Whitney test and bar chart. A P-value of ⩽0.05 was taken to be statistically significant., Results: The mean pain score was lower in the paracervical block group compared to the conscious sedation group (P < 0.05); however, there was no significant difference in women's satisfaction between the groups (P ⩾ 0.05). Conscious sedation had more negative side effects compared to paracervical block which was significant (P < 0.05)., Conclusion: Paracervical block has better pain control compared with conscious sedation and has a good side effect profile., Trial Registration: Pan African Clinical Trial Registry (registered trial no. PACTR202108841661192)., Synopsis: Paracervical block for manual vacuum aspiration (MVA) during first-trimester miscarriage is associated with less pain among women compared with conscious sedation., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that they have no competing interests. To avoid conflict of interest, the study population was randomly selected and allotted to each group that was sealed in an opaque envelope. Pain assessment was carried out by a trained research assistant separate from the authors. The medications used were sourced by the hospital pharmacist independent of the authors., (© The Author(s) 2022.)

Background: Obstructed labour is one of the common obstetric emergencies in Nigeria which is associated with an increased maternal and foetal complications., Objective: To determine the maternal and foetal outcome of obstructed labour and its determinants in a tertiary hospital in Ebonyi State University Teaching hospital Abakaliki., Methods: A retrospective review of all women with obstructed labour managed at Ebonyi State University Teaching hospital Abakaliki between January 2007 and December 2011 was carried out., Results: The prevalence rate of obstructed labour was 3.4% (95%CI 3.37 - 3.42) for the period under review. Women in their second and third decade of life formed 91.6% (196/214) of patients in the study. Majority of obstructed labour occurred in primiparous women (92/214, 42.9%) and the commonest cause of obstructed labour was cephalopelvic disproportion (106/214, 49.6%). The commonest maternal complication was wound infection accounting for 23.2% (48/214) of all the complications. Most of the babies delivered had a good Apgar score as was noted in 60.3% (129/214) of cases. Being unbooked, para 3 and above, maternal age of 30 and above, having no formal education and rural residence were strongly associated with parturient having maternal complication (P > 0.05) and abnormal APGAR score. The maternal and perinatal mortality rate was 191/100,000 live births and 168/1000 deliveries respectively., Conclusion: The commonest cause of obstructed labour in our review is cephalopelvic disproportion occurring more in primiparous women. Wound infection is the commonest maternal complication with majority of the neonates having a good outcome. Provision of free antenatal care services, education of women on the importance of antenatal care, early presentation in the hospital and early use of broad spectrum antibiotics would help to reduce the associated complications., (© 2022 Anikwe CC et al.)

Objective: To determine the efficacy of intravenous tranexamic acid versus rectal misoprostol in decreasing intraoperative blood loss during caesarean section (C/S)., Design and Setting: Randomised controlled study involving pregnant women undergoing C/S at Alex Ekwueme Federal University Teaching Hospital, Abakaliki in Nigeria., Participants and Interventions: Five hundred and fourteen women undergoing elective C/S were assigned randomly (257 patients per group) to receive either pre-operative 1000 µg rectal misoprostol or 1000mg intravenous tranexamic acid after spinal anaesthesia. Data from 248 patients were analysed in the misoprostol group, while data from 250 patients were analysed in the tranexamic acid group. Sixteen patients were excluded from analysis; nine had incompletely filled proforma, while seven were lost to follow-up., Main Outcome: Intraoperative blood loss., Results: The mean intraoperative blood loss was not significantly different between the misoprostol group and the tranexamic acid group (547 ± 183.75ml vs. 551.66 ± 21.74ml, P = 0.157). The mean difference in pack cell volume (PCV) changes was not significant between the groups (2.41±0.95% vs. 2.36±0.56%, P = 0.474). The side effects profile was similar for both groups except for shivering, which was statistically higher among the misoprostol group (RR = 0.70; 95%CI 0.40 - 0.91, P = 0.028)., Conclusion: Intravenous tranexamic acid was comparable to rectal misoprostol in the reduction of blood loss during C/S. Tranexamic acid could act as a good alternative to misoprostol for prophylaxis for blood loss during elective C/S., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Objectives: The objective of the study was to assess how the current COVID-19 pandemic has affected cesarean section (C-section) rates, indications, and peripartum outcomes., Methods: This was a retrospective cross-sectional study that compared a 3-month rates of and indications for C-sections at three tertiary health care institutions in Nigeria before (October 2019-December 2019) and during the first wave of COVID-19 pandemic (March 2020-May 2020). Primary outcomes were C-section rate and indications between the two periods. Data were analyzed using SPSS 26.0 IBM Corporation. Rates and odds ratios with 95% confidence intervals were used to quantify indications and peripartum outcomes and statistical significance was accepted when p value was <0.05., Results: The baseline characteristics of the two groups were similar. The C-section rate during the COVID-19 period was significantly less than the period prior to the pandemic (237/580, 40.0% vs 390/833, 46.8%; p = 0.027). The rates of postdatism (odds ratio = 1.47, 95% confidence interval = 1.05-2.05, p = 0.022), fetal distress (odds ratio = 3.06, 95% confidence interval = 1.55-6.06, p = 0.017), emergency C-section (odds ratio = 1.43, 95% confidence interval = 1.01-2.05, p = 0.042), and anemia (odds ratio = 1.84, 95% confidence interval = 1.12-3.03, p = 0.016) were significantly higher during the pandemic than prepandemic., Conclusion: The overall C-section rate during the first wave of COVID-19 was significantly lower than the prepandemic period. There were higher rates of postdatism, fetal distress, emergency C-section, and postpartum anemia. Further studies on this changing C-section trend during the pandemic are needed., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources., Objective: To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS., Materials and Methods: Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1 st October 2018 and 30 th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5 th or 7 th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22., Results: Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge ( χ 2 = 0.95, P = 0.329). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group ( χ 2 = 1.65, P = 0.649). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge ( χ 2 = 16.64, P = 0.0001, OR = 0.857, 95%CI = 0.59-1.25). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 ( χ 2 = 4.45, P = 0.108). Early hospital discharge did not have any significant negative impact on neonatal health ( χ 2 = 1.063, P = 0.303)., Conclusion: Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Fidelis A. Onu et al.)

Background: Pre-eclampsia (PET) is a potentially devastating multi-systemic disorder resulting in the generation of oxidative stress. Platelet activation causes vasoconstriction and release of inflammatory cytokines, resulting in an intensified inflammatory response, endothelial damage, and coagulopathy which culminate in adverse pregnancy outcomes., Aim: To compare the platelet parameters between preeclamptic and normotensive pregnant women and their relationship to adverse outcomes in women with pre-eclampsia., Materials and Methods: This was a case-control study of platelet indices of 60 pre-eclamptic and 60 normotensive pregnant women recruited at 28 weeks and followed till delivery. A blood sample was collected at entry into the study and just before delivery. The sample was analyzed within 1 h of collection using the Mythic 18 hematological auto-analyzer. Data were analyzed using IBM-SPSS version 22. A P-value of <0.05 was considered statistically significant., Results: The mean platelet count, Platelet distribution width (PDW), plateletcrit were statistically significantly different between normotensive and severe preeclamptic participants (p= <0.001). Statistically significant differences were not present in any of the platelet parameters between mild and severe PET. The odds of developing eclampsia was low at higher mean platelet count and plateletcrit levels above 161.36 ± 73.74 × 10 9 /L [p = 0.02, AOR = 0.27, 95% CI (0.08-0.88)] and 0.13 ± 0.05% [p = 0.001, AOR = 0.22, 95% CI (0.08-0.58)] respectively. Eclampsia was strongly associated with P-LCR (platelet-large cell ratio) above 23.15 ± 4.92% [p = 0.004, AOR = 11.00, 95%CI (1.48-89.02)]. Abruptio placentae had low odds at lower levels of mean plateletcrit. Pre-term birth was significantly lower at mean plateletcrit levels above 0.14 ± 0.05%; admission into neonatal intensive care unit was strongly associated with a mean PLC ratio above 22.73 ± 5.91%., Conclusion: This study demonstrated significant differences in platelet count, plateletcrit, platelet distribution width, and P-LCR between pre-eclamptic and normotensive women. Increase in P-LCR is a risk factor for eclampsia although the effect size is low., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Introduction: Nurses are the largest healthcare workforce and are not immune to intimate partner violence (IPV) and its consequences., Objective: This study is aimed at determining the prevalence, types of IPV, and its determinants among female nurses and nursing students in a tertiary teaching hospital in Abakaliki, Ebonyi State, Nigeria., Methods: This cross-sectional study was done in a teaching hospital in Abakaliki between 1st March 2018 and 31st May 2018 to evaluate the prevalence of IPV in the past 12 months among 460 female nursing students and 460 nurses in the facility. Data were obtained with a structured questionnaire and a Composite Abuse Scale. The data were analyzed using IBM SPSS Statistics version 20 and represented using frequency table, percentages, and odds ratios. The level of significance is at P-value < 0.05., Results: The prevalence of IPV was 48.2% for the nursing student and 58.7% for the nurses. The most common form of IPV among nursing students was Emotional and/or Harassment abuse (27.1%) while it was Severe combined abuse (23.9%) among the nurses. The significant determinants of IPV among nursing students were age [OR =  0.61(95%CI0.41-0.92)] and year of study [OR = 0.67 (95%CI 0.51-0.89)]. Male partner being unemployed was associated with increased odds of a female partner experiencing violence. Nurses' marital status and being in the low socioeconomic class were associated with increased odds of a nurse witnessing IPV., Conclusion: The prevalence of IPV in the studied group is unacceptably high. Efforts are therefore needed to prevent IPV in the study groups. Health care managers in the study area should make policies to support nurses/nursing students who have experienced IPV., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Feeding behavior is an important factor in the prevention and management of noncommunicable diseases, which are the leading cause of death globally., Objective: This study is aimed to investigate the feeding behaviors among health-care workers in a tertiary hospital in southeast Nigeria., Materials and Methods: The study was a cross-sectional survey. A total of 418 participants (186 males and 232 females) were involved in the study. The instrument is a sociodemographic questionnaire and a modified form of the British Heart Foundation's questions to assess the nutritional value of individuals. The participants were consecutively recruited from their workstations. Data were collected using self-administered questionnaires, which were hand distributed and collected back on the same day after completion., Results: The study showed that health workers in the teaching hospital had an overall "fair" feeding behavior (86.13 ± 8.52 out of 140). It also showed that females had a significant (P < 0.05) overall better feeding behavior (88.15 ± 9.00) compared to males (83.62 ± 7.18). The studied participants had poor feeding behavior in carbohydrates and fats and oil consumption and just fair behavior in fruits and vegetables, salt intake, and water consumption. The feeding behavior was inadequate, and there was no significant gender or profession-related differences in the overall behavior of the participants., Conclusion: The health-care workers in the tertiary health institution in southeast Nigeria have inadequate feeding behavior. They should join in the global call and awareness on healthy feeding behavior to prevent and reduce the burden of noncommunicable diseases., Competing Interests: None

Objectives: To compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping., Methods: A randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0-15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480)., Results: One hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported., Conclusion: Delayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities., Material and Methods: This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections., Results: Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P < .05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species., Conclusions: Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology.)

Introduction: antenatal care is a specialized pattern of care organized for pregnant women to improve their chances of a safe delivery. Assessment of patients' perception of healthcare services is one of the ways of measuring the quality of healthcare as satisfied patients are likely to come back for the services they need and to recommend the services to others., Methods: this is a cross-sectional study. Two hundred and eighty-four booked antenatal attendees were randomly selected at the antenatal clinic of Federal Teaching Hospital, Abakaliki in November 2016 and interviewed using semi-structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of amenities, total time spent, services and level of satisfaction. Data obtained were analyzed using Epi info TM 7.1.3.10 and presented with a simple percentage and chi-square. Main outcome measure: satisfaction with antenatal care., Results: the mean age of the respondents was 28.2 ± 4.2 years, majority 130 (45.8%) were within the 25-29 age bracket. Most had tertiary education (146, 51.4%) and less than 10% are grand multipara. In general, 89.4% of the respondents were satisfied with the quality of antenatal care services. Majority of the respondents 170 (59.9%) were unsatisfied with the water supply while 128 (45.1%) were unsatisfied with cervical cancer prevention discussion during the health talk. The mean total time spent in the antenatal clinic was 4.1 hours ± 1.2 hours (range 2-7 hours). Being married and multiparous significantly affected satisfaction with the quality of antenatal care services as represented by P-value of 0.015 and 0.005 respectively., Conclusion: majority of pregnant women were satisfied with the care they received. Health providers should, however, improve the state of sanitary facilities and ensure the provision of adequate information on cervical cancer screening during health talks., Competing Interests: The authors declare no competing interests., (Copyright: Chidebe Christian Anikwe et al.)

Objective: To determine the knowledge, attitude, and practice of antenatal attendees towards COVID-19 in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Methods: A cross-sectional survey was carried out among 430 consenting pregnant women attending antenatal clinics between March 1 and May 30, 2020, using pretested questionnaires., Results: The mean age and mean gestational age of the respondents were 30.04 years (95% confidence interval [CI] 28.9-31.1) and 26.3 weeks (95% CI 23.3-29.3), respectively. More than four-fifths (82%) of the women believed that COVID-19 is real and their main source of information was mass media. The majority had adequate knowledge of COVID-19. More than half of the respondents said COVID-19 is a curable disease and that chloroquine can be used. The majority showed a good attitude and preventive practice of COVID-19 disease; however, one-fourth (24%) thought that infected individuals should be killed to prevent the spread of the virus., Conclusion: The study population has good knowledge, attitude, and practice of COVID-19 disease. However, it is worrisome that some respondents thought that infected individuals should be killed. Proper education must be given to the populace to avert these negative attitudes while promoting a positive preventive attitude. The study population has adequate knowledge, good attitude, and preventive practice of COVID-19; however, community education is needed to reduce anxiety among the populace., (© 2020 International Federation of Gynecology and Obstetrics.)

Background: Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa., Aim: Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators., Methods: A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated., Results: Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole ( P =32.3%, T=29.2%), ceftriaxone ( P =28.4%, T=19.8%) and ciprofloxacin ( P =14.2%, T=14.6%) were the most common antimicrobials used., Conclusions: There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy., (© 2020 The Authors.)

Background: Birth preparedness and complication readiness (BP/CR) concept is based on the premise that preparing for birth and being ready for complications reduce all three phases of delay to a bad obstetric outcome., Objectives: To determine the knowledge of BP/CR with its determinants and BP/CR index among pregnant women in Abakaliki, southeast Nigeria., Methods: A cross-sectional survey was done between 1 st March 2019 and 31 st July 2019 among 450 randomly selected antenatal attendees at Mile Four Hospital, Abakaliki, Nigeria. The data were obtained using a pretested interviewer-administered structured questionnaire adapted from the maternal and neonatal health program handbook of the Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO). The data obtained were analyzed using percentages, chi-square, and odds ratios. The level of significance is at P value < 0.05., Results: The birth preparedness and complication readiness index was 41.9%. Only 44.9% and 36.9% of the study population had adequate knowledge of birth preparedness (BP) and complication readiness (CR), respectively. Upper social class, lower educational level, urban residence, and less than 30 years of age were associated with increased odds of respondents having adequate knowledge of BP and CR ( P > 0.05). However, only booking in the 1 st or 2 nd trimester was a significant determinant of the respondent's adequate knowledge of BP (AOR = 0.63, 95% CI 0.40-0.98) and CR (AOR = 0.62, 95% CI 0.39-0.97). Identification of transport and saving of money was the commonest birth plan while the commonest danger sign known to the participants was bleeding., Conclusion: This study revealed that knowledge of BP/CR is suboptimal. The determinant of this knowledge is antenatal booking. It is recommended that women should have adequate antenatal care education to improve their knowledge of BP/CR. This will help to increase the low BP/CR index seen in our study., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Chidebe Christian Anikwe et al.)

Background: Menstruation has a variable pattern. Knowledge of age at menarche and providing accurate information to adolescent girls is necessary to allay anxiety, treat menstrual morbidities, and improve their quality of life., Objective: To determine the age at menarche and menstrual characteristics of adolescent secondary school girls in Abakaliki., Materials and Methods: A cross-sectional descriptive study was conducted in seven secondary schools in Abakaliki among 960 female students. A total of 450 girls were randomly selected for the study. A pretested self-administered questionnaire was used in data collection. Four hundred questionnaires were properly filled and used for the final analysis., Results: The age range of the students was between 10 - 21years. The mean age of the respondents was 16.2 ± 1.7years. The average age at menarche was 13 ± 1.0 years. Urban dwellers had menarche 0.2years earlier than rural dwellers. There is an association between menarche and social class ( X [ 2 ] 372.9 (2), p = 0.001). About 87.75% of the respondents had an average cycle length. Most (88.3%) of the respondents had a menstrual flow duration of 3-5 days. Dysmenorrhoea was present in 82% of respondents and was severe enough to cause absence from school in 56.5% of students. Oligomenorrhea and menorrhagia occurred in 8.5 % and 6.25 % of the student studied. Mothers (80.0%), friends (75.0%) and teachers (74.5%) accounted for the bulk of the information on menstrual health., Conclusion: The average age at menarche was 13 ± 1.0 years. Dysmenorrhea is a major cause of morbidity amongst this age group and should be empathically addressed. It is therefore important that the students, their parents, and school managers in the study area be educated on the issues of menstrual problems that can occur in an adolescent., (© 2020 The Authors.)

Background: Induction of labour is not without risk, and it calls for a method that will be sensitive enough to predict successful labour induction., Aim: This study aims to evaluate the role of transvaginal ultrasonographic cervical length measurement at term in the prediction of successful induction of labour (IOL)., Materials and Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology of Federal Teaching Hospital Abakaliki between 1st of July and 30 th of November 2015. Preinduction Bishop score and cervical length were assessed before induction of labour. Intracervical, cervical, extraamniotic Foley catheter was used to improve the Bishop score. The data were analyzed using the IBM SPSS Statistics 20., Results: The mean maternal age of the study group was 30.68 ± 6.38 years with a range of 19-43 years. The mean gestational age and parity were 39.57 ± 1.49 and 1.85 ± 0.63, respectively. All the women studied had successful induction of labour with mean induction delivery time of 8.1 ± 3.0 hours and mean duration of labour of 7.4 ± 2.9 hours. Preinduction cervical length is a good predictor of a short duration of labour ( P = 0.001). Parturient with a preinduction cervical length of less than 3 cm was likely to have labour lasting less than 6 hours (RR = 4.20 (95% CI 1.85-9.529)., Conclusion: Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of duration of labour following the induction of labour. It is recommended that IOL should be considered and success anticipated in a parturient with a cervical length less than 3 cm., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Chidebe C. Anikwe et al.)

Background: The use of long-lasting insecticide-treated nets (LLITNs) is one of the effective strategies for the prevention of malaria, especially among pregnant women., Aim: This study is aimed at assessing the awareness and utilization of LLITNs during pregnancy among antenatal clinic attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki., Materials and Methods: This was a cross-sectional study among antenatal attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. A semistructured questionnaire was used to obtain relevant information from the participants. Data analysis was done using SPSS version 20., Results: The mean age of the women was 26.05 ± 5.76 years. About one-third (30%) of the respondents were nulliparous. Most of the respondents had at least a secondary education. More than ninety percent of the respondents had a good knowledge of malaria with 95.8% being aware of LLITNs. The main source of information was from hospitals (54.5%). The rate of utilization of LLITNs was 37.5%; however, consistent use was only reported by about a third of this proportion. The major reasons for not utilizing the nets include discomfort/heat and fear of the chemical content. Women with tertiary education were more likely to utilize mosquito nets during pregnancy compared with women with secondary or primary education. Women who live in rural areas (OR = 0.393 95% CI 0.602-0.073) were less likely to use LLITNs during pregnancy, while those who are aware of the aetiology of malaria (OR = 4.38 95% CI 0.983-19.591) were more likely to utilize LLITNs in pregnancy., Conclusion: The level of awareness of LLITNs is high; however, its utilization was discouragingly low. Rural dwellers and those without appropriate knowledge of the aetiology of malaria were less likely to use LLITNs in pregnancy., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Chidebe Christian Anikwe et al.)

Objective: To explore maternal experience following caesarean section., Methods: The study was a cross-sectional prospective study involving 250 women., Results: The mean age of the study population was 27.2 ± 5.5 years with fifty-three per cent (53.1%) of the women between the ages of 20-9 years. Majority of the participants (67.1%) were multiparous and 37.4% of the parturient had secondary school education. The majority (67.1%) were in social class 3-5. Emergency caesarean section accounted for 74.5% of the caesarean section and the commonest indication was foetal distress. One hundred and forty-four participants (59.3%) were satisfied with their caesarean section experience which was significantly associated with health care attention and foetal outcome. More than half of the study population would not accept caesarean section when indicated in a future pregnancy. The health care attention [AOR 0.53, 95% CI (0.32, 0.88)] and maternal age [AOR 3.05, 95%CI (1.43, 6.49)] were significant predictors., Conclusion: Majority of the women were satisfied with their caesarean section experience which is influenced by the hospital care and foetal outcome. Improvement in maternal caesarean section experience through quality health care is important in increasing uptake when indicated., (© 2019 Anikwe et al.)

Background: Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist., Objectives: The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki., Materials and Methods: This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart., Results: The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15-19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases., Conclusion: Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study., Competing Interests: There are no conflicts of interest.

Background: Cervical cancer is a preventable disease and the most common cancer among women in Nigeria., Objectives: To appraise the perception and utilization of cervical cancer screening services among female nurses in Federal Teaching hospital, Abakaliki., Materials and Methods: A cross-sectional study was done using semi-structured questionnaires on 408 consenting female nurses. Data was represented using simple percentages, charts, and Chi-square., Results: Of the 408 questionnaires shared, 388 were correctly and completely filled and analyzed. The respondents in this study showed good knowledge of cervical cancer as all (388) were aware that cervical cancer is a preventable disease of public health concern. Majority of them, 179 (46.1%) were between 21 and 30 years of age. The most common symptom of cervical cancer identified was postcoital bleeding (57%). Nursing training was the most common (73.5%) source of cervical cancer information. Utilization of cervical cancer screening was poor in this study as only 20.6% of the respondents had ever undergone screening. The most common reason for nonscreening was that they have not thought of it (28.4%)., Conclusion: Despite the high level of awareness of cervical cancer screening, utilization remains low. There is, therefore, the need for cervical cancer education for the nurses to help improve utilization.

Background: Female genital mutilation (FGM) is an assault on womanhood., Objective: To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation., Materials and Methods: This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05., Results: The mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17-2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05)., Conclusion: The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.