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Background: Magnesium sulphate (MgSO 4 ) administered for twenty-four hours is the drug of choice for seizure prophylaxis in patients with preeclampsia with severe features. Due to its narrow therapeutic index, a reduction in the duration of MgSO 4 administered in the postpartum period may not only prevent the occurrence of seizures but also reduce the adverse effects associated with this drug. This study aimed to compare the efficacy of the 12-hour and 24-hour Pritchard's MgSO4 maintenance regimen on the occurrence of seizures and maternal outcomes in patients with preeclampsia with severe features., Methodology: A triple-blind randomized controlled trial was conducted among women with preeclampsia with severe features between 1st June 2022 and January 31st, 2023. The primary outcome measure was the occurrence of seizure in either arm of the study. One hundred and forty-six women were randomized into two groups, those who received a 12-hour MgSO 4 regimen and placebo for the remaining twelve hours (Group I) and those who received a 24-hour MgSO 4 regimen in the postpartum period (Group II). The collected data was coded and analyzed using Statistical Product and Service Solutions (SPSS) version 26 and p<0.05 was considered significant., Results: There was no statistically significant difference between the two groups concerning the occurrence of seizures, the need to recommence MgSO 4 , clinical evidence of toxicity and adverse effects of MgSO4. There was also no statistically significant difference between the two groups in the total dose of MgSO4 administered, duration of urethral catheterization and duration of hospital admission. No maternal mortality was recorded in this study., Conclusion: The results of this study suggest that the 12-hour MgSO 4 maintenance regimen is as efficacious as the traditional 24-hour regimen in preventing seizures without worsening maternal outcomes., (Copyright © 2024 Nigerian Medical Association.)

Objective: To compare cervical ripening time with the use of vaginal Misoprostol plus Hyoscine-N-Butylbromide, with vaginal Misoprostol alone., Design: A double-blind randomized controlled trial with Pan-African Clinical Trials Registry (PACTR) approval number PACTR202112821475292., Setting: Federal Medical Centre, Asaba, Nigeria., Participants: A total of 126 eligible antenatal patients for cervical ripening were enrolled., Interventions: Participants in Group A had 25µg of vaginal misoprostol with 1ml of intramuscular placebo, and those in Group B had 25µg of vaginal misoprostol with 20mg of Intramuscular Hyoscine (1 ml). Oxytocin infusion was used when indicated, and the labour was supervised as per departmental protocol., Main Outcome Measure: Cervical ripening time., Results: The mean cervical ripening time was statistically significantly shorter in the hyoscine group (8.48±4.36 hours) than in the placebo group (11.40±7.33 hours); p-value 0.02, 95% CI 0.80-5.05. There was no statistically significant difference in the mean induction-delivery interval in Group A (7.38±5.28 hours) compared to Group B (7.75±5.04 hours), with a value of 0.54. The mode of delivery was comparable. However, women in Group B (53, 84.1%) achieved more vaginal deliveries than women in Group A (50, 79.4%); p-value 0.49. Thirteen women in Group A (20.6%) had a caesarean section, while ten women (15.9%) in Group B had a caesarean section (p-value 0.49, RR 0.94, CI 0.80-1.11). Adverse maternal and neonatal outcomes were not statistically significant between the two groups., Conclusion: Intramuscular hyoscine was effective in reducing cervical ripening time when used as an adjunct to vaginal Misoprostol, with no significant adverse maternal or neonatal outcome., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Intrauterine foetal death (IUFD) is an unpleasant pregnancy outcome and prompt delivery of the dead foetus is usually desired by mothers. Unfortunately, spontaneous labour and delivery may not occur early and prolonged retention of the dead foetus in utero is life-threatening. Many of the agents currently used for the induction of labour may result in a prolonged delivery process., Objectives: To compare the efficacy and safety of mifepristone and misoprostol versus misoprostol alone for induction of labour in women with intrauterine foetal death., Materials and Methods: This was a triple-blind randomized controlled trial. Eighty women were randomized into two groups. The intervention group received a single oral dose of 200 mg mifepristone, followed by 6-hourly 50 μg misoprostol vaginal insertion, after 24-hour intervals. The control group received a placebo, followed by 6-hourly 50 μg misoprostol vaginal insertion, after 24-hour intervals. The primary outcome measure was the induction to delivery interval., Results: Maternal age, gestational age, parity and pre-induction bishop's score were comparable between the two groups. The mean induction to the delivery interval in the intervention group was significantly less in the intervention group than the control group (18.78 ± 6.51 hours versus 37.10 ± 10.10; P < 0.001). The total dose of misoprostol required for induction of labour; the need for oxytocin augmentation of labour; and the observed side effects of misoprostol were all significantly less in intervention group than control group (P < 0.001; P < 0.01; and P = 0.03, respectively)., Conclusion: The combination of mifepristone and misoprostol has greater efficacy and better safety profile than the use of misoprostol alone for induction of labour. This combination should be considered when induction of labour is indicated for IUFD., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Background: Cervical ripening is one of the most important determinants of the outcome of induction of labor. The findings of studies on the most efficacious inflatable catheter balloon volume for pre-induction cervical ripening have been inconclusive., Aim: To compare the efficacy of the use of different intracervical Foley catheter balloon volumes (30-, 50-, and 60-mL) on cervical ripening., Subjects and Methods: This study was a triple-blind randomized controlled trial. Two hundred and sixteen women with a Bishop score ≤5 at term were randomly assigned into three groups (1:1:1) to receive an intracervical single size eighteen Foley balloon catheter inflated either with 30-mL (control arm) or 50-mL and 60-mL (intervention arm) of sterile saline which was retained for a duration of 12 h. The primary outcome measures were the mean change in Bishop score and achieving a Bishop score of ≥6 at the twelfth-hour post-Foley catheter balloon insertion., Results: In the total study population and among nulliparous women, the 50-mL and 60-mL balloons compared with the 30-mL Foley catheter balloon achieved a statistically significantly greater mean change in Bishop scores at the twelfth hour\post-insertion (P = 0.005 and P = 0.001), while the 60-mL balloon compared with the 30-mL and 50-mL balloons achieved statistically significant higher mean change in Bishop scores among multiparous women (P = 0.047 and P = 0.003) and cervical dilatation irrespective of parity (P = 0.003 and P = 0.002), at the twelfth-hour post-insertion. The larger catheter balloons were also associated with a statistically significant greater chance of having an induction to delivery interval of <12 h in nulliparous women P = 0.003., Conclusion: The findings of this study showed that the larger single Foley catheter balloon volumes (50-mL and 60-mL) aside from being well tolerated and acceptable have the ability to induce faster changes in Bishop score, produce higher cervical dilation, and thus likely reduce significantly the total labor induction process compared to the 30-mL single catheter balloon volume irrespective of parity., Competing Interests: None

Background: Detection of malaria in pregnancy poses a huge challenge in Sub-Saharan Africa. Accurate diagnosis enables timely and appropriate clinical management., Aims: This study aimed to compare the accuracy of peripheral venous blood smear microscopy (PVBSM) and a rapid diagnostic test detecting histidine-rich protein 2 in the blood (RDT-HRP2) with placental histology as the control in the diagnosis of malaria in pregnancy in Nigerian women., Materials and Methods: This was a comparative, cross-sectional study conducted between January and July 2017. Asymptomatic pregnant women who presented to the labor ward and who gave informed consent had peripheral venous blood samples as well as placental tissue obtained following delivery. The blood samples obtained were tested for malaria parasites using PVBSM and RDT-HRP2 in blood, while the placenta was subjected to histology., Results: A total of 326 patients participated in the study. The prevalence of malaria in pregnancy was 13.8%, 17.8%, and 32.8% using PVBSM, RDT-HRP2, and placental histology. The sensitivity, specificity, and accuracy of PVBSM were 40.2%, 99.1%, and 79.8% and the corresponding values for RDT-HRP2 were 49.5%, 97.7%, and 81.9%. The positive predictive value was 95.6% for PVBSM and 91.4% for RDT-HRP2 and the negative predictive value was 77.2% for PVBSM and 79.9% for RDT- HRP2., Conclusions: The diagnostic performances of both tests were comparable; however, RDT-HRP2 had a higher sensitivity and accuracy than PVBSM for the diagnosis of malaria in pregnancy., Competing Interests: None

Background: The amniotic fluid index (AFI) is one of the parameters used to assess fetal well-being and predict perinatal outcomes. There is, however, a dearth of studies on the pregnancy outcomes of women with borderline AFI in Nigerian and African women., Aim: To compare the pregnancy outcomes of Nigerian women with borderline and normal amniotic fluid index., Subjects and Methods: This was a prospective cohort study conducted at two health facilities in Delta State, Southern Nigeria. A total of 114 pregnant women attending the antenatal clinics with singleton pregnancies at gestational age 37 to 41 + 6 weeks were recruited over a 5-month period. Fifty-seven subjects with borderline amniotic fluid index were matched with an equal number of subjects with the normal amniotic fluid index for gestational age, age of the parturient, and parity. These women were followed up till delivery, and pregnancy outcomes were determined. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22 software., Results: The results showed that borderline amniotic fluid index was associated with increased risk of adverse pregnancy outcomes including intrapartum fetal distress, Appearance, Pulse, Grimace, Activity, and Respiration (Apgar) score <7 in 5 min, and birthweight <2.5 kg, and these were statistically significant (P = 0.04, 0.01, and 0.04, respectively)., Conclusions: Borderline AFI is associated with an increased risk of adverse pregnancy outcomes in low-risk Nigerian women., Competing Interests: None

Background: A stable tear film with normal flow is essential for preserving a clear cornea. When the tear film becomes insufficient to support the surface of the eye due to a lack of production of tears or a decrease in stability of tears, dry eye syndrome (DES) occurs. DES is a common disorder of the tear film. It affects a significant percentage of the population, especially women. The onset of dry eye is very common during menopause and may result from the loss of hormonal support., Objective: The purpose of this study was to assess the effect of sex hormone on tear volume and stability in postmenopausal Nigerian women., Method: This study was a cross sectional experimental study. Twenty postmenopausal women aged 50 to 55 years (mean age 52 ± 2.32) and twenty premenopausal women aged 45 to 52 years (mean age 50 ± 2.13) were selected by systematic random sampling. Schirmer's tear test and the noninvasive tear break up time (NITBUT) test were performed on the women. Serum levels of estradiol, progesterone and testosterone were determined., Results: The differences in mean tear volume, (t = 14.74, p < 0.0001) and tear stability, (t = 11.28, p < 0.04) between the postmenopausal and premenopausal women were statistically significant. Tear volume was positively correlated with testosterone (r = 0.276, p ≥ 0.05) and progesterone (r = 0.227, p ≥ 0.05) but negatively correlated with estradiol (r = 0.141, p ≥ 0.05) in the postmenopausal group, with no statistically significant associations., Conclusion: Changes in hormone levels that occur in menopause affect tear volume and tear stability.

Background: A number of hormones are known to affect intra ocular pressure (IOP). Of these, the female sex hormones are the predominant ones to cause variations in IOP. During menopause, a changing hormone profile in the body causes important shifts in the levels of these hormones. Studies on the effect of menopause on visual function, cardiovascular and ocular hemodynamics showed that menopausal women had significantly higher IOP as compared to premenopausal women. The purpose of this study was to determine the influence of serum levels of sex hormones on IOP in postmenopausal Nigerian women., Method: This study was an experimental, cross sectional study. Twenty postmenopausal women aged 50 to 55 years (mean age 52 +/- 2.32) and twenty premenopausal women aged 45 to 50 years (mean age 50 +/- 2.13) were selected by systematic random sampling. The women were free from systemic or ocular diseases. IOP was measured and serum levels of progesterone, estradiol and testosterone were determined by hormone assay for all subjects. Data was analyzed by correlation analysis., Results: Mean IOP between the postmenopausal (16.00 +/- 5.81 mmHg) and premenopausal women (15.50 +/- 3.28 mmHg, p = 0.24) was not statistically significant. Although there was a positive correlation between IOP and estradiol level in the postmenopausal women (r = 0.567, p = 0.009), no significant correlation was found between IOP and serum levels of sex hormones among the premenopausal women., Conclusion: Our result suggests a relation between levels of estradiol and IOP in postmenopausal Nigerian women. However further studies may be required to determine a direct cause and effect relationship.

Aims and Objectives: Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system., Methods: A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done., Results: Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable., Conclusion: There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

Objective: Pregnancy results in a lot of hormonal changes in the body and the eyes are no exception. These ocular changes could be physiologic, pathologic or a modification of a pre-existing condition. The aim of this study was to determine physiologic ocular changes that are associated with pregnancy in healthy Nigerian women., Materials and Methods: A total of 100 women were followed longitudinally through out the course of their pregnancy and 6 weeks postpartum. The women were recruited at 8 weeks of pregnancy at the anti-natal clinic in the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Nigeria. The women were aged between 20 and 35 years. Tests carried out included visual acuity, ophthalmoscopy, retinoscopy, and tonometry. The tests were carried out in each of the three trimesters of pregnancy and 6 weeks postpartum., Results: There was a fall in intraocular pressure across the trimesters and this was very significant (P<0.0001). Postpartum, the intraocular pressure began to rise. The difference between the third trimester and post-partum values was also statistically significant (P< 0.0001). The difference in visual acuity through out the pregnancy was not significant (P= 0.8477). Although, there was a fall in refractive error across the different trimesters, it was not statistically significant (P=0.3). There was also no difference in the third trimester and the 6 weeks postpartum values of both visual acuity and refractive error., Conclusion: Ocular changes associated with pregnancy are transient and most tend to resolve postpartum, with values returning to near pre-pregnant state.

Objective: Intraocular pressure (IOP) has been reported to be associated with systemic blood pressure (SBP) in population based studies. The aim of this study was to determine the relationship between IOP and arterial blood pressure in pregnant and menopausal Nigerian women., Method: A longitudinal study of a hundred pregnant women aged 20 to 35 years (mean +/- SD 27 +/- 2.10) was done. The pregnant women were recruited by systematic random sampling from the antenatal booking clinic of the Department of Obstetrics and Gynaecology of the University of Benin Teaching Hospital (UBTH). Tests were carried out in the first, second and third trimesters of pregnancy as well as 6 weeks postpartum. Thirty-three normotensive post menopausal women and 33 hypertensive postmenopausal women aged 45-55 years old (mean +/- SD 51.09 +/- 2.34 and 52.30 +/- 1.52 respectively) were also recruited for this study., Results: There was a significant positive correlation between IOP and systolic BP (r = 0.68) and IOP and diastolic BP (r = 0.75) in hypertensive postmenopausal women. There was a weak negative correlation between IOP and systolic BP (r = 0.12) and IOP and diastolic BP (r = -0.20) in normotensive postmenopausal women. However, IOP did not correlate with SBP throughout the course of pregnancy (r = -0.20). The difference in IOP between pregnant and post menopausal women was statistically significant, p < 0.05, t = 16.47. There was a statistically significant difference (p < 0.05, t = 12.03) in systolic blood pressure between the pregnant and postmenopausal women. Also, the difference in diastolic blood pressure between the pregnant and postmenopausal women was statistically significant (p < 0.05, t = 11.07)., Conclusion: IOP does not correlate with SBP throughout the course of pregnancy.

A number of hormones are known to affect intraocular pressure. Of these, the female sex hormones are the predominant ones to cause variations in intraocular pressure. The aim of this study was to determine if variation in sex hormones in pregnancy affects intraocular pressure. This study was a longitudinal one. 117 pregnant women aged 20 to 35 years in their first trimester of pregnancy were followed longitudinally throughout the course of pregnancy, and six weeks post partum. One hundred non pregnant women with a regular menstrual cycle of 26-29 days were also recruited and examined for changes in intraocular pressure. Intraocular pressure was measured with the handheld Kowa applanation tonometer. Mean Intraocular Pressure (MIOP) was 14.7 +/- 2.2 mmHg, 13.2 +/- 2.0 mmHg and 11.0 +/- 1.3 mmHg in the three trimesters respectively. There was thus a fall in Intraocular Pressure during pregnancy and this was highly statistically significant (P<0.0001). At 6 weeks postpartum MIOP increased to 14.2 +/- 1.8 mmHg. The difference between the mean values of Intraocular Pressure in the third trimester and 6 weeks postpartum was also statistically significant P<0.0001. Intraocular pressure decreased as pregnancy advanced. Postpartum, there was increase in intraocular pressure to near pre pregnant level. The difference in mean IOP between the pregnant and non pregnant women was statistically significant (P<0.05).

Objectives: Previous Nigerian studies show widespread ignorance and low acceptance of vasectomy among the male population. The objectives of this study were to determine the level of knowledge of, attitudes to, counselling pattern and acceptance of vasectomy among Nigerian Resident Gynaecologists., Design: A cross-sectional questionnaire based survey., Method: Resident Doctors attending a national update course in obstetrics and gynaecology., Results: Most of the doctors had good knowledge of Vasectomy. More than four-fifth of the doctors were convinced that the average Nigerian male will not accept vasectomy when indicated while more than three-fifth consider BTL a more appropriate option for permanent contraception in our setting. Forty one point three percent of the doctors will opt for vasectomy or urge their husbands to. Reasons for opposition to vasectomy were socio-cultural (21.3%), religious (13.1%) and psychological (41.0%), 24.6% had no specific reasons. While 89.4% of the doctors counselled often for BTL only 5.8% did for vasectomy., Conclusion: The Doctors showed good knowledge of vasectomy but most were poorly disposed towards use of vasectomy. The findings suggest a need for effective national training programmes targeted at resident doctors to enhance their knowledge of vasectomy as well as break barriers to personal use of, and counselling for vasectomy.

Background: Nigeria has one of the worst maternal and child health indices globally., Aims: The objective of this study was to assess the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South East Nigeria., Subjects and Method: This was a cross-sectional descriptive study of pregnant women selected by systematic random sampling. The study instrument was a pre-tested semi-structured interviewer-administered questionnaire., Result: The age range of the women in the study was 16-43 years. The mean age was 25.3 ± 1.3 years. According to the scoring system used, about one-fourth of the women (26%) had a high risk pregnancy while about a tenth (9.1%) had very high risk pregnancy. The vast majority of the women with at-risk pregnancies registered for antenatal care late: 58.9 % registered for antenatal care in the second trimester and 37.0 % registered for antenatal care in the third trimester of pregnancy. Of the women with an at-risk pregnancy, 79.5% had their last delivery at home and 67.1 % of them preferred to deliver at home in their current pregnancies., Conclusion: This study revealed that a substantial proportion of rural women with at-risk pregnancies go through their pregnancy period without significant modern antenatal care. The local government health department should intensify efforts through health enlightenment campaigns to educate rural pregnant women of the benefits of utilizing modern antenatal care services.

Background and Objective: To document bilateral tubal ligation (BTL) rates and highlight the need to improve on the rates., Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group., Results: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ± 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL., Conclusions: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section.

Context: Pregnancy - induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focused on early onset pregnancy induced hypertension/eclampsia in Nigerian women., Objectives: To determine the incidence, clinical features and outcome of cases of early onset pregnancy-induced hypertension /eclampsia in a Nigerian tertiary hospital, and compare maternofetal outcome in early and late onset disease. Methods : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital., Main Outcome Measures: Severity of disease, rates of induction of labour, caesarean section rate, maternal mortality, abruptio placenta, still births, severe birth asphyxia and early neonatal deaths., Results: Early onset pregnancy induced hypertension/eclampsia contributed 6.3% of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate was 34.0%. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia, having induction of labour and worse perinatal outcome than late onset disease., Conclusion: Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease.

This study aimed at determining the knowledge and perception of physicians in Nigeria on abortion related deaths, and also to find out if they will support the liberalization of abortion as a means of reducing deaths from unsafe abortion. Physicians' willingness to offer abortion services was also explored. A self-administered questionnaire was distributed to a convenience sample of physicians in Delta state of Nigeria. Physicians were equally divided on whether legal liberalization of abortion would significantly reduce maternal mortality in Nigeria. Only 13.4% of the doctors were willing to offer abortion services if legally liberalized. The majority of the doctors considered promoting abstinence from pre-marital sex and contraceptive use as best effective strategies for reducing abortion-related deaths. However, liberalization of abortion law in Nigeria was not considered a very effective strategy.

Background: Many studies show that the vast majority of Nigerian women register for antenatal care late and that the determinants may differ from those found in developed countries., Objective: To determine the reasons for late booking among women presenting at the antenatal clinic of a major tertiary hospital in the Niger Delta, Nigeria, Design: A cross sectional questionnaire based survey., Setting: A large tertiary hospital in the Niger delta, Nigeria, Participants: Pregnant women registering for antenatal care after 14 weeks gestation., Results: The majority of respondents were aged 20-39 years (97.1%), quarters were primigravidae and 25 % of the women belonged to the upper socioeconomic class. Seventy three point six percent booked in the second trimester and 26.4% in the third trimester. Of the women who had given birth before, 80% had booked late in at least one previous pregnancy. More than three-fifth of the women (65.6%) booked late due to ignorance or misconceptions of the purpose of, and right time to commence antenatal care., Conclusion: The findings of this study suggest that most women book late because of a belief that there are no advantages in booking for antenatal care in the first three months of pregnancy. This seems to be because antenatal care is viewed primarily as curative rather than preventive in the study population. Research is needed to determine the best approaches for health education programmes to correct the misconceptions about antenatal care.

A prospective survey of symphysiofundal height (SFH) was undertaken in 202 Nigerian pregnant women in Uromi, Edo State, Nigeria, with the objective of constructing an SFH growth chart for the pregnant population in the community. A customised gravidogram and a growth velocity curve were also constructed and compared with those derived in other regions of the world. The average SFH growth rate between 20 and 40 weeks was 0.8 cm/week. The gradient of the curve was not constant and the SFH growth rate changed with the progression of pregnancy. While the average SFH growth rate between 20 and 36 weeks was 0.9 cm/week, from 36 to 40 weeks there was a marked deceleration to 0.3 cm/week. The average deviation from the mean SFH was 1.96 cm. It is recommended that regional customised gravidograms be derived for different pregnant populations which should be reviewed periodically. With this, routine SFH assessments can help in early detection of fetal growth rate anomalies based on an understanding of the peculiarities of fetal growth patterns in each community.

Background: Caesarean section rate is rising worldwide and Nigeria is no exception., Methods: This was a descriptive study. The data from case notes, antenatal and theatre records of patients who had caesarean delivery over a ten year period in the Baptist medical center, Eku were extracted and analysed., Results: The total delivery for the period under study was 5,153 and the total number of caesarean deliveries was 1,777 giving a caesarean section rate of 34.5%. There was no definite trend in the yearly caesarean section rates. Majority of the cases were aged 25-29 (32%). Grandmultipara constituted 26.4% of the patients while 70.1% of cases presented at a gestational age range of 37-42 weeks. Majority of the patients (59.5%) where unbooked for antenatal care. Dystocia (27.1%) was the commonest indication for caesarean section. Emergency abdominal delivery constituted 63.3% of cases while the common complications included wound breakdown, anaemia and endometritis. There were a total of 25 maternal deaths giving a case fatality rate of 1.4%. The leading causes of deaths were haemorrhage (36%), infections (24%), severe preeclampsia/eclampsia (24%), cardiac arrest (12%) and anaesthesia related complication (4%)., Conclusion: This study found a very high caesarean section rate with majority of cases presenting as unbooked emergency cases. High caesarean section rate in this region was due to increase in primary caesarean delivery for dystocia, elective repeat caesarean deliveries and caesarean deliveries for preeclampsia/eclampsia. Future studies should be extended to rural areas and be targeted at determining whole population Caesarean section rates.

Background: The presence of proteinuria in pregnancy induced hypertension has been shown to increase maternal and perinatal morbidity and mortality. Hence early and accurate screening for proteinuria with prompt management holds one of the keys to reducing the morbidity and mortality associated with the disease., Objective: To examine the options for detection of proteinuria in hypertensive pregnancy available to the obstetrician in the light of current evidence in literature. METHOD OF LITERATURE SEARCH: A review of journal articles identified through a search of the following electronic databases: Medline, Cinahl, Biomed Central and Ajol., Conclusion: There is overwhelming evidence that urinary dipstick results correlate poorly with 24-hour urinary protein excretion values in pregnant women with hypertension. In the light of current evidence, the random urine protein:creatinine ratio quantitatively or test strips offers the best option for screening for proteinuria in hypertension in pregnancy.

Background: Anterior abdominal wall fibroid are uncommon and could be a cause of pain and discomfort. Very few cases have been reported in the literature but none in our region., Case Presentation: We present an uncommon case of a 31 year old para 2+2 trader from the Itsekiri tribe of the Niger Delta region of Nigeria who presented with a one year history of a periumbilcal mass, had surgical removal of the mass and histology revealed leiomyoma., Conclusion: Abdominal wall fibroid is a good differential diagnosis to be considered in any woman of reproductive age with an anterior abdominal mass and previous uterine surgery, including laparoscopic surgeries.

Twin pregnancy is associated with an increased risk of pre-term deliveries, perinatal morbidity, mortality and maternal complications, especially in developing countries. A descriptive study of all women who had twin pregnancies in a rural mission tertiary hospital over a 7-year period was undertaken. There were a total of 3,351 deliveries and 99 cases of twin deliveries during the study period giving an incidence of 29.5/1,000 or one in 33.8 deliveries. Some 60% of the twins were delivered by caesarean section, while 36.4% had vaginal delivery. A total of 4% had vacuum delivery and a combination of vacuum and caesarean delivery. Twinning rate increased with increasing age and parity. The majority of the patients were unbooked (65.7%). The study could not detect any differences in the birth weights of twin 1 compared to twin 2. There were more females (52%) than males (48%). Low birth weight babies constituted 57.1% of twins. There were 26 perinatal deaths giving rise to a perinatal mortality rate of 131/1,000 and there was no difference in the perinatal mortality rate in the unbooked (131/1,000) and the booked (132/1,000). ). Booking status had no significant effect on perinatal mortality of twins and singletons, p value = 0.65. Singletons had significantly more caesarean section and vaginal delivery than twins, p value < 0.0001. Prematurity was the chief cause of perinatal death (65.4%). The most common mode of presentation was cephalic/cephalic (58.6%), followed by cephalic/breech (29.2%), breech/cephalic (7.1%) and breech/breech (5.1%). There was no maternal death.

Unsafe abortion remains a major cause of maternal morbidity and mortality in developing countries including Nigeria. We report a 10-year descriptive review of 118 consecutive cases of complicated induced abortions. At our centre, complications of induced abortion constituted 2.3% of maternal admissions, 5.6% of gynaecological admissions and 22.6% of maternal deaths. Fifty-nine percent of the women were married and the mean age was 25.6 +/- 7.9 years. Doctors performed 51.7% of the induced abortion and nurses performed 13.9%. Of the mortalities, medical doctors did 61 of the abortions in which 18 died (29.5%); traditional medical practitioners were responsible for 13 of the abortions in which two died (15.4%); of the 16 abortions performed by nurses, two died (12.5%). Sepsis was the most common cause of death (73%). There is an urgent need to improve the knowledge and utilization of modern contraception by rural women in order to prevent unwanted pregnancies. Doctors need to be continuously trained inn the basic principles of postabortion care.

Objective: To determine the incidence and associated risk factors of postpartum depression in a tertiary hospital in Nigeria., Patients and Methods: A survey of 206 consecutive women who were 6 weeks postpartum was done, using the Edinburgh postnatal depression scale (EPDS), in a tertiary hospital in Nigeria. Fisher's exact test was used to determine significance between proportions . The Odd ratio and 95% Confidence Intervals were also determined., Results: The incidence of postpartum depression was 27.2%. Preterm delivery was found to be a risk factor for postpartum depression in the study population (P<0.0001, OR=8.0, CI=2.9-22.1)., Conclusion: It is recommended that the EPDS should be used routinely to screen for postnatal depression in puerperal Nigerian women and that mulltidisciplinary approach involving Obstetricians and Mental health professionals should be adopted in the screening for, and care of women with postpartum depression.

Almost two decades after the safe motherhood initiative, maternal mortality figures remain very high in Nigeria. Very few studies are available on the features of maternal mortality in rural Nigeria. The objective of this study was to determine the incidence and causes of maternal mortality in a rural referral hospital in the Niger Delta, Nigeria. An audit of 115 consecutive maternal mortalities over a 10-year period at a rural-based tertiary hospital was undertaken. There were 5,153 deliveries and 115 maternal deaths during the study period, with a maternal mortality ratio of 2,232/100,000 live births. The most common causes of maternal mortalities were puerperal sepsis, abortion complications, pre-eclampsia/eclampsia, prolonged obstructed labour, haemorrhage accounting for 33%, 22.6%, 17.4%, 13.0% and 7.8%, respectively. The percentage mortality for unbooked was 10 times that for booked patients. Unbooked status is a risk factor for maternal mortality as this was statistically significant p < 0.0001. Traditional birth attendants were involved in the initial management of at least two-fifths (38.2%) of the non-abortion mortalities while half had been managed in private hospitals and maternities. Maternal mortality will continue to increase unless appropriate steps are taken to improve the use of antenatal care, thereby reducing unbooked emergencies. Hospitals need to be equipped with facilities for emergency obstetric care. Continuous programmes that will integrate TBAs and orthodox practices should be put in place as this will reduce delays and improve referral systems.

An audit to determine the incidence of births to teenage nullipara, pregnancy complications, obstetric intervention rates, maternal and fetal outcomes in 114 teenage nullipara compared with 700 randomly selected older nullipara (age 20-29 years), was undertaken in a tertiary Institution. Births to teenage nullipara contributed 1.7% of all deliveries. Teenagers were significantly more likely to be unbooked for antenatal care (P < 0.0001), book late (P < 0.0001) and be single mothers (P < 0.0001). Teenagers were also significantly more likely to have primary education (P < 0.0001), secondary education (P < 0.001) or be apprentices (P < 0.0001). Teenagers had a significantly higher incidence of caesarean sections (P = 0.0002). There were no significant differences in the incidence of pregnancy complications, induction or augmentation of labour, preterm delivery, instrumental deliveries and fetal outcome. The maternal mortality ratio for teenagers was 1835 per 100,000 live births. There were no deaths among the older nullipara. It is concluded that the differences in obstetric intervention rates and maternal outcome are due to poor utilization of antenatal care and other social disparity.

Eclampsia is a major cause of maternal and perinatal morbidity and mortality in developing countries including Nigeria. However, most studies on eclampsia have been in urban communities. The objective of this study was to determine the incidence, pattern of clinical presentation and maternal and fetal outcomes of cases of eclampsia in a rural tertiary hospital in Nigeria. A descriptive review of all cases of eclampsia seen between 1 January 1994 and 31 December 2003 in a tertiary hospital was undertaken. The incidence of eclampsia was 1 in 43 deliveries (2.3%). Most of the women (86.2%) were unbooked for antenatal care in our centre; 58.5% were nullipara, and the onset of seizures was in the ante-partum period (68.3%). Patients presenting were mostly from the traditional birth attendants (46.3%). The time interval between the onset of convulsions and hospital admission was less than 12 h in 52% of cases. The majority of the women had premonitory symptoms (78.8%) with headache being the most frequent (78%). The major route of delivery was abdominal (66.7%). The case fatality rate was 15.4%. Most of the deaths (89.5%) were in unbooked women and the most common causes of death were acute renal failure, cardiopulmonary failure, disseminated intravascular coagulopathy and cerebrovascular accident. The perinatal mortality rate was 195 per 1000 births. This study found a high incidence of eclampsia. It is recommended that community-based health education programmes should be pursued with vigour to enhance early utilisation of modern antenatal care services in rural areas. Traditional birth attendants need to be trained and integrated into the healthcare team. Appropriate mechanisms should be put in place to improve clinic referrals. The capacity of tertiary health institutions to provide intensive care for eclamptics need to be improved with continuous training of heathcare personnel and provision of necessary equipment.

Background: Ruptured uterus is a common obstetric emergency in Nigeria, associated with high maternal and perinatal morbidity and mortality. There is a need for definitive identification of the risk factors to guide effective interventions to curb its scourge., Objective: To identify the sociodemographic and obstetric risk factors for ruptured uterus in Benin City, Nigeria, and based on this, make appropriate recommendations toward curbing the incidence and morbidity and mortality associated with it., Materials and Methods: Sociodemographic and obstetric variables in 51 women with ruptured uterus and 300 randomly selected hospital controls from the general obstetric population were compared. Fisher's exact test was used to determine statistical significance between proportions., Results: The incidence of ruptured uterus was 1 in 426 deliveries. The risk factors found were low socioeconomic class (OR = 6.8, CI = 3.6-12.9), being unbooked for antenatal care (OR = 10.4, CI = 5.4-20.0), grand multiparity (OR = 8.7, CI = 4.0-19.1), and prolonged obstructed labor (OR = 35.3, CI = 15.3-81.6)., Conclusion: Measures that promote education and economic empowerment of women and the utilization of modern antenatal care will reduce the prevalence of rupture of the uterus in the community.

Background: The utilization of modern antenatal care is poor in most parts of Nigeria and studies indicate that the majority of those who present for antenatal care do so late., Material/methods: This was a retrospective study involving 303 consecutively booked pregnant women over a 6-month period (March 1 to August 31, 2004) in a suburban tertiary hospital practice. The objectives were to determine the incidence of late booking for antenatal care and to compare the demographic and obstetric characteristics of women who booked late with those who booked early for antenatal care. The Fisher's exact test, odds ratio, and the 95% confidence interval were used for statistical analysis., Results: Most (79.9%) of the women booked late for antenatal care. It was found that age, parity, level of education, social class, previous fetal loss, and previous obstetric complications did not differ significantly between women who booked early and those who booked late., Conclusions: The majority of the study population booked late for antenatal care. Socio-demographic and obstetric factors do not appear to be responsible for late utilization of antenatal care in the Niger Delta, Nigeria. Further studies are needed to explore the contribution of cultural factors to late presentation for antenatal care. Community-based health education programs on the importance of early presentation for antenatal care need to be put in place to address the anomaly of late utilization of antenatal care in Nigerian women.

Ectopic pregnancy still remains a leading cause of maternal mortality and morbidity in the first trimester of pregnancy and also a significant cause of reproductive failure in Nigeria. A descriptive review of 211 consecutive cases of ectopic gestation over an 11-year period was undertaken. Ectopic pregnancy constituted 9.5% of gynaecological admissions. In all, 86% were nulliparous and 62.6% were married. Abdominal pain and tenderness were the most consistent modes of presentation. Also, 95.3% presented as ruptured ectopic pregnancy. Induced abortion (72%) was the most common factor associated with ectopic pregnancy. Anaemia was the most common post-operative complication. In all, 21% had prior dilatation and curettage as a result of misdiagnoses. The case fatality rate was 2.5%. Ectopic pregnancy presents a major public health challenge among women of reproductive age in this region. Community-based comprehensive health education programme focusing on contraception, sex education, prevention and treatment of postabortal sepsis, pelvic inflammatory disease and puerperal sepsis are urgently needed.

Pregnancy-induced hypertension/pre-eclampsia and its sequelae eclampsia are major causes of maternal and perinatal morbidity and mortality in Nigeria. A retrospective review of 1200 deliveries in women who booked for antenatal care before the 20th week of gestation was done in a tertiary hospital. This was aimed at determining if a raised mid-trimester mean arterial blood pressure was predictive of subsequent development of pregnancy-induced hypertension/pre-eclampsia in Nigerian women, and if it is, to assess its sensitivity, specificity, positive predictive value and negative predictive value. There was a statistically significant higher incidence of Pregnancy-induced hypertension/pre-eclampsia in women with an elevated mid-trimester mean arterial blood pressure (P< 0.0001,OR=3.7). The sensitivity of the screening test was 22.9% , specificity 92.5% , positive predictive value 25.0% and negative predictive value 91.7% . The relative risk of developing Pregnancy-induced hypertension in women with elevated mid-trimester mean arterial blood pressure was 3 times that of those with a normal mid-trimester blood pressure. It is concluded that the test shows a high specificity and negative predictive value and allows apportioning of relative risks of developing the disease among booked antenatal patients. The calculation of the mid-trimester mean arterial blood pressure should become a routine part of antenatal care in Nigerian women.