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Background: The decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria. Methods: We conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021. Results: Out of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059). Conclusion: This study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications. [ABSTRACT FROM AUTHOR]

AbstractSurrogacy is increasing in African countries such as Nigeria as more people who are unable to have children rely on this practice to become parents. The unregulated nature of surrogacy in Nigeria has resulted in several cases of human rights violations due to the lack of legal frameworks to oversee the practice, as well as significant problems related to the well-being of surrogates owing to the associated reproductive risks. It is imperative to regulate surrogacy and establish legal frameworks that protect the rights and interests of all parties involved, especially surrogate mothers. Although the mere existence of laws regulating surrogacy does not guarantee widespread compliance, these laws can serve as a reference point for the protection of women’s human rights. Regulating surrogacy in Nigeria will improve standards of practice and monitor agencies’ activities, thereby protecting the rights and interests of all participants. This article argues that legislation is the only way to address issues of informed consent and legal representation in human reproduction. Surrogacy agreements should include mechanisms to ensure that surrogate mothers have adequate legal representation and receive the necessary information to make informed decisions and consider potential psychosocial vulnerabilities. By addressing surrogates’ vulnerability, legislation can protect them from being unfairly exploited and subjected to health risks, in addition to fostering thoughtful and insightful policymaking in this area. [ABSTRACT FROM AUTHOR]

Background: Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. Objective: This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility. Materials and Methods: A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P < 0.05. Results: The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P < 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery. Conclusion: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological. [ABSTRACT FROM AUTHOR]

Cesarean sections have become increasingly common globally, including in Nigeria. This qualitative study explores the perceptions and experiences of postpartum women who underwent cesarean sections within the distinct contexts of Ibadan in Oyo State, Nigeria. In-depth interviews and focus group discussions were conducted with 24 postpartum women in selected health facilities in urban and rural areas. A diverse sample was purposively selected to capture a range of experiences based on age, residence, education, and cultural backgrounds. Thematic analysis was employed to identify patterns and themes within the data. The findings revealed diverse emotional responses among participants, ranging from relief and gratitude to disappointment and feelings of loss for not experiencing a vaginal birth. Societal pressures and cultural expectations played a significant role in influencing women's perceptions and experiences of cesarean sections. Future childbirth preferences and support systems, including healthcare provider–patient relationships and community support, were identified as crucial factors impacting postoperative recovery. This study contributes to the understanding of women's perceptions of cesarean sections within the local context of Ibadan, Nigeria. The findings underscore the importance of culturally sensitive healthcare practices, clear communication, and support systems to enhance the birthing experiences of women undergoing cesarean sections. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage remains a leading cause of maternal mortality especially in developing countries. The majority of previous trials on the effectiveness of tranexamic acid in reducing blood loss were performed in low-risk women for postpartum hemorrhage. A recent Cochrane Systematic Review recommended that further research was needed to determine the effects of prophylactic tranexamic acid for preventing intraoperative blood loss in women at high risk of postpartum hemorrhage. Objective: This study aimed to evaluate the effectiveness and safety of tranexamic acid in reducing intraoperative blood loss when given prior to cesarean delivery in women at high risk of postpartum hemorrhage. Study design: The study is a double-blind randomized controlled trial. Methods: The study consisted of 200 term pregnant women and high-risk preterm pregnancies scheduled for lower-segment cesarean delivery at Enugu State University of Science and Technology, Teaching Hospital, Parklane, Enugu, Nigeria. The participants were randomized into two arms (intravenous 1 g of tranexamic acid or placebo) in a ratio of 1:1. The participants received either 1 g of tranexamic acid or placebo (20 mL of normal saline) intravenously at least 10 min prior to commencement of the surgery. The primary outcome measures were the mean intraoperative blood loss and hematocrit change 48 h postoperatively. Results: The baseline sociodemographic characteristics were similar in both groups. The tranexamic acid group when compared to the placebo group showed significantly lower mean blood loss (442.94 ± 200.97 versus 801.28 ± 258.68 mL; p = 0.001), higher mean postoperative hemoglobin (10.39 + 0.96 versus 9.67 ± 0.86 g/dL; p = 0.001), lower incidence of postpartum hemorrhage (1.0% versus 19.0%; p = 0.001), and lower need for use of additional uterotonic agents after routine management of the third stage of labor (39.0% versus 68.0%; p = 0.001), respectively. However, there was no significant difference in the mean preoperative hemoglobin (11.24 ± 0.88 versus 11.15 ± 0.90 g/dL; p = 0.457), need for other surgical intervention for postpartum hemorrhage (p > 0.05), and reported side effect, respectively, between the two groups. Conclusion: Prophylactic administration of tranexamic acid significantly decreases postpartum blood loss, improves postpartum hemoglobin, decreases the need for additional uterotonics, and prevents postpartum hemorrhage following cesarean section in pregnant women at high risk of postpartum hemorrhage. Its routine use during cesarean section in high-risk women may be encouraged. The trial was registered in the Pan-African Clinical Trial Registry with approval number PACTR202107872851363. [ABSTRACT FROM AUTHOR]

Background: Twohundred and seventy out of every thousand live births died in Nigeria in 2019. These deaths were attributable to infections, complications of preterm birth, and intrapartum-related conditions. The World Health Organization recommends withholding bathing of neonates until 24 h after birth or until their vital signs become stable to prevent hypothermia. Despite the link between neonatal bathing and thermal control, the subject is understudied in Nigeria. This study aimed at investigating the factors associated with late neonatal bathing practices in Nigeria. Methods: The study adopted a cross-sectional design and extracted data from the women's file of the 2018 Nigerian Demographic and Health Survey. The unit of analysis was limited to 12,972 women who had complete data for the study. We applied chi-square test of independence to ascertain the association between the outcome variable and explanatory variables. At 95% confidence interval, two logistic regression models were built with Model I consisting of only maternal factors whilst Model II contained both maternal and child factors, and results were presented in adjusted odds ratio. Results: Descriptively, 12% (CI = 0.122–0.134) of the women bathed their neonates after 24 h of delivery. Inferentially, women with secondary/higher education [AOR = 1.30, CI = 1.05–1.61], the rich [AOR = 1.24, CI = 1.03–1.50], those with access to mass media [AOR = 131, CI = 1.15–1.50], women that professed other religions [AOR = 9.28, CI = 4.24–17.56], those who delivered in a health facility [AOR = 1.93, CI = 1.66–2.25], whose child was small in size at birth [AOR = 1.46, CI = 1.21–1.77] and delivered by caesarean section [AOR = 2.50, CI = 1.97–3.18] had higher odds of bathing their neonates 24 h after birth. Conclusions: The proportion of women who practised late neonatal bathing was generally low. To improve the practice of late neonatal bathing, much-concerted effort should be directed to women's education and approaches to increasing receptivity of late neonatal bathing among pregnant women through the media. The Nigerian Ministry of Health should incorporate routine counselling on the risks of bathing newborns prematurely into antenatal and postnatal care services. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: Robson classification can be used to analyze and audit other indices of delivery outcome besides cesarean section (CS). The objective is to analyze low fifth-minute APGAR scores according to Robson's classification and present deducible conclusions. STUDY DESIGN: A cross-sectional dataset of 584 neonates of parturients at the Federal Medical Centre Yenagoa (FMCY), Bayelsa State, Nigeria between July 2020 and April 2021 was analyzed. Neonates were classified by the corresponding Robson group with subgroup modification of their mothers. Data was analyzed using IBM SPSS Statistics version 25. Descriptive statistics and association between low fifth-minute APGAR Score and the Robson group are presented. The statistical significance is a p value <0.05. RESULTS: The largest contribution (29.6%) to the low fifth-minute APGAR score was from Robson group 3. Group rate was high in groups 10b (66.7%), 7a (61.1%), 10a (53.6%), 9a (50.0%), 6a (50.0%), 5.2a (33.3%) and 10c (30.3%) relative to others. Neonates of parturients in Robson groups 6a (OR - 11.00; 95% CI-1.27-95.18; p Value-0.029), 7a (OR-17.29; 95% CI-3.06-97.52; p value-0.001), 9a (OR-11.00; 95% CI-1.48-81.61; p Value-0.019), 10a (OR-12.69; 95% CI-2.49 - 64.58; p value-0.002) and 10b (OR-22.00; 95% CI-1.33 -362.92; p value-0.031) had significantly higher odds of low fifth minute APGAR score relative to 8c with the lowest group rate. CONCLUSION: Meaningful deduction is possible with use of the Robson's classification for audit of low APGAR Score. By this study, parturients in Robson groups 3, 5.2a, 6a, 7a, 9a, 10a, 10b, and 10c are identified for focused interventions towards improving APGAR score outcomes at FMCY. [ABSTRACT FROM AUTHOR]

Background: Over 80,000 pregnant women died in Nigeria due to pregnancy-related complications in 2020. Evidence shows that if appropriately conducted, caesarean section (CS) reduces the odds of maternal death. In 2015, the World Health Organization (WHO), in a statement, proposed an optimal national prevalence of CS and recommended the use of Robson classification for classifying and determining intra-facility CS rates. We conducted this systematic review and meta-analysis to synthesise evidence on prevalence, indications, and complications of intra-facility CS in Nigeria. Methods: Four databases (African Journals Online, Directory of Open Access Journals, EBSCOhost, and PubMed) were systematically searched for relevant articles published from 2000 to 2022. Articles were screened following the PRISMA guidelines, and those meeting the study's inclusion criteria were retained for review. Quality assessment of included studies was conducted using a modified Joanna Briggs Institute's Critical Appraisal Checklist. Narrative synthesis of CS prevalence, indications, and complications as well as a meta-analysis of CS prevalence using R were conducted. Results: We retrieved 45 articles, with most (33 (64.4%)) being assessed as high quality. The overall prevalence of CS in facilities across Nigeria was 17.6%. We identified a higher prevalence of emergency CS (75.9%) compared to elective CS (24.3%). We also identified a significantly higher CS prevalence in facilities in the south (25.5%) compared to the north (10.6%). Furthermore, we observed a 10.7% increase in intra-facility CS prevalence following the implementation of the WHO statement. However, none of the studies adopted the Robson classification of CS to determine intra-facility CS rates. In addition, neither hierarchy of care (tertiary or secondary) nor type of facility (public or private) significantly influenced intra-facility CS prevalence. The commonest indications for a CS were previous scar/CS (3.5–33.5%) and pregnancy-related hypertensive disorders (5.5–30.0%), while anaemia (6.4–57.1%) was the most reported complication. Conclusion: There are disparities in the prevalence, indications, and complications of CS in facilities across the geopolitical zones of Nigeria, suggestive of concurrent overuse and underuse. There is a need for comprehensive solutions to optimise CS provision tailor-made for zones in Nigeria. Furthermore, future research needs to adopt current guidelines to improve comparison of CS rates. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Prior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women's prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change. Objective: To describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD. Method: This cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis. Results: The modal maternal and gestational age groups were 30–39 years (68.1%) and 29–34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery. Conclusions: Antenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate. [ABSTRACT FROM AUTHOR]

Background: Unprescribed and herbal medicines use among pregnant women is a public health concern in low and middle-income countries because of the potential teratogenic effects, insufficient safety and weak drug regulatory systems. Unprescribed and herbal medicines are common among pregnant women in Nigeria, and only a few researchers have documented the prevalence and the risk factors. However, evidence on the associated pregnancy outcomes is still lacking. We assessed the prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicines use among pregnant women in Ibadan, Nigeria. Methods: This study was a component of the Ibadan Pregnancy Cohort Study, a prospective cohort study, among pregnant women in Ibadan, Nigeria, who were enrolled at ≤ 20 weeks gestation at their first antenatal visit and followed up till delivery. In all, 571 women participated in the maternal drug use assessment during the third trimester using a pretested interviewer-administered questionnaire. The primary outcomes were unprescribed and herbal medicines use and pregnancy outcomes, secondary outcomes, were abstracted from medical records. The predictors assessed included sociodemographic, obstetric, antenatal care utilization, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to evaluate the predictors and relative risk for the pregnancy outcomes of unprescribed and herbal medicines at 5% significance. Results: The prevalence of unprescribed and herbal medicine use was 31.9% and 21.7%, respectively. On bivariate analysis, the significant predictors of unprescribed medicine (which were protective) were tertiary education, increasing income, adequate antenatal care (≥ 4 visits), and at least two doses of sulfadoxine-pyrimethamine. However, high parity and having an antenatal admission increased the risk. However, after adjusting for confounders, the significant factors associated with unprescribed medicines were; tertiary education (AOR) = 0.23; 95% CI: (0.06 – 0.95); p-value: 0.043] and obtaining at least two doses of sulfadoxine-pyrimethamine [AOR = 0.33; 95% CI: (0.29 – 3.60); p-value: 0.048]. For herbal medicines, the predictors were similar to unprescribed drugs. However, after adjusting for confounders, none was significant for herbal medicines. Unprescribed and herbal medicines were not significantly associated with pregnancy outcomes. Conclusions: Unprescribed and herbal medicines use were common among pregnant women in Ibadan, Nigeria, particularly among women with low economic status and those with poor utilization of antenatal care services. These significant predictors can be targeted for public health intervention. Specifically, health education that discourages the use of unprescribed and herbal medications to pregnant women during antenatal care. [ABSTRACT FROM AUTHOR]

Background: While the rate of Cesarean Section (CS) has been increasing in developed countries, the same cannot be said about developing countries, especially Nigeria. Despite the various indications of CS that may arise, the CS rate in Nigeria has remained as low as 2.7% as against the 15% acceptable upper limit according to the World Health Organization. The level of knowledge, perception, and attitude toward CS among pregnant women have been found to significantly influence the women's decision to utilize this life-saving means. Hence, the researchers conducted this study among pregnant women attending the antenatal clinic at Babcock University Teaching Hospital (BUTH), Ogun State, to assess their level of knowledge, perception and attitude toward CS. Methodology: A descriptive cross-sectional design was utilized. A questionnaire designed by the researchers was used to collect data from 200 respondents, and the data were analyzed with Statistical Package for the Social Sciences version 25. Results were reported with frequencies, mean scores and percentages. Results: Findings of the study showed that 78.5% had a high level of knowledge of CS, 67.5% had a good perception of CS, and 93% had a positive attitude toward CS. Around average (52.5%) considered CS a safe procedure, and 78.5% would agree to have CS if medically indicated. The majority (76.5%) believed that opting for a CS could save the life of the mother or the child. Discussion: In conclusion, the findings of this study show that although majority of the respondents had good knowledge and perception of CS, and were willing to accept CS when medically indicated, around one-third had poor perception of CS and around two-tenths would not agree to have it if medically indicated. Hence, nurses and other stakeholders are thus encouraged to always include CS lessons in antenatal teachings to ensure that every woman is knowledgeable enough to accept CS, especially when medically indicated. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to evaluate the trend of effect of prior caesarean delivery (CD) on obstetric outcomes; and to investigate the existence of a threshold for order of CD associated with geometrical increase in complications. Materials and methods: We performed a retrospective cohort study of 942 parturients who undergone CD between June 2012 and May 2015 in a teaching hospital in Nigeria. The participants were stratified by the order of caesarean deliveries. We used linear-to-linear association to assess presence of a trend between the order of CD and categorical variables while Jonckheere-Terpstra was used to investigate whether a trend exist between order of CD and continuous variables. We also used multivariate logistic regression to evaluate the relative risk ratio of the outcome variables for each order of CD. Results: Composite adverse maternal outcome depicted a significant increasing trend from 1st CD (5.2%) to the 5thCD (50%). The relative risk ratio for composite adverse maternal outcome increased arithmetically from 1st CD to 3rd CD: RRR2.21, 95%CI 1.2-3.98 for 2ndCD; RRR3.39, 95%CI 1.60-9.27 for 3rdCD; followed by a geometric increase between 3rdCD and 4thCD (RRR11.64, 95%CI 3.20-18.86). In contrast, composite adverse fetal outcome did not depict a significant trend. However, perinatal death increased significantly from primary CD (4.6%) to 5thCD (33.3%). Conclusion: Maternal and fetal complications of repeat CD increase with increasing order of CD; and this trend became astronomical after the third CD. Couples should be counselled that both maternal and fetal complications increase with each additional CD and advised strongly to forgo future pregnancies after the 3rd CD. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) describes the abnormal adherence of the placenta trophoblast to the myometrium and is associated with high foeto-maternal morbidity and mortality. This study was aimed at determining the prevalence, and trend of placenta accreta spectrum (PAS), as well as its association with sociodemographic/obstetrics factors at the Rivers State University Teaching Hospital (RSUTH). Methodology: An analytical cross-sectional study of all recorded cases of placenta accreta spectrum managed at RSUTH from 1st January 2016 to 31st December 2021. Descriptive and inferential statistics were derived using IBM, Statistical Product and Service Solution (SPSS) version 25.0 Armonk, NY. Results: There were 14195 deliveries, 137 cases of placenta praevia and 39 cases of placenta accreta spectrum. The prevalence of PAS at the RSUTH was 0.27% or 2.7 /1000 deliveries or 1in 370 deliveries. The rate of PAS among cases of placenta praevia was 28.5% or 1 in 4 cases. More than half of the variants of PAS were accreta 23 (59.0%) while 13(33.3%) and 3(7.7%) were increta and percreta respectively. The mean (SD) age and gestational age of the participants were 32.28 (± 5.13), [95% Confidence Interval (CI): 30.63, 33.92] and 36.43(±2.01), (95%CI: 35.18, 37.07) respectively. The modal age group was 35-39 years. The median blood loss was 650mls range of 450-2000mls. The majority of the study participants were booked 34(87.2%) and had secondary level education 17(43.6%). History of a previous caesarean section was statistically significantly associated with PAS P<0.001 while other factors did not attain significance. Conclusion: Placenta accreta spectrum is not uncommon among women with pregnancies complicated by placenta praevia at the RSUTH. PAS occurred more among booked multiparous women with secondary level education and with an increasing trend. History of previous caesarean section is strongly associated with PAS. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Laparoscopic myomectomy for removal of uterine fibroid in resource-limited settings is cost prohibitive. Open abdominal myomectomy is unarguably more affordable, despite the drawbacks. OBJECTIVE: The study aimed to determine fertility and obstetric outcomes after an open abdominal myomectomy. MATERIALS AND METHODS: A retrospective descriptive study that involved the retrieval of medical records, and analysis of the data of women who had open abdominal myomectomy due to uterine fibroid and unexplained infertility, in a private health facility in Abraka, Delta State, Nigeria, from 1 February 2014 to 31 January 2021. The age, duration of infertility, location of fibroid masses within the uterus, history of previous pregnancy, pregnancy after myomectomy, pregnancy outcome and amongst other variables were captured and analysed using IBM SPSS version 23. RESULTS: The data for 69 (88.5%) out of the 78 patients who had myomectomy was available for analysis. The mean age of patients was 33.3 ± 4.7 years; about 2/3 (65.5%) of the patients were <30 years. The pregnancy rate after myomectomy was 55.1% (38/69), most (44.9%) of the pregnancies occurred in the 1st year after myomectomy and about half (46.4%) of the patients were delivered by caesarean section. Patient's age, shorter duration of infertility and fewer fibroid masses were significantly associated with favourable fertility outcomes (P < 0.001, P < 0.001 and P < 0.05, respectively). Age ≤ 30 years was most predictive of pregnancy after myomectomy, P < 0.017. CONCLUSION: The study showed that women with uterine fibroid and unexplained causes of infertility at age ≤ 30 years have good fertility and obstetric outcome after open abdominal myomectomy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses the study of the effects of perinatal and facility-based factors on Neonatal Intensive Care Unit (NICU) admission after cesarean delivery in northern Nigeria. It concludes that prematurity and indications for cesarean section were associated with an increased likelihood of neonatal admission following cesarean delivery. These findings could inform ongoing quality enhancement initiatives to improve NICU admission outcomes at the study site and other similar settings.

There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study's ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value= <.05). In conclusion, CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them. What is already known on this subject? There is an increasing trend of CAM use among pregnant women in the world. Pregnancy is associated with certain conditions that predispose women to CAM use. The clinical indications for CAM use by the pregnant women are nausea and vomiting, labour pain, induction of labour, pedal oedema and waist pain. What the results of this study add? CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of the babies when compared with non-CAM users. What the implications are of these findings for clinical practice and/or further research? CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of carbetocin and regular oxytocin on blood loss during Caesarean section under spinal anaesthesia. Design: Randomized prospective comparative study. Setting: University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Participants: Eighty parturients undergoing Caesarean delivery under spinal anaesthesia Main outcome measure: The primary outcome was defined as the volume of intraoperative blood loss. Secondary outcomes were incidence of hypotension, need for blood transfusion, number needed for more treatment with blood, and neonatal outcome. Results: Parturients in both groups were demographically comparable. Haemodynamic changes were similar, however there was a statistically significant difference in the mean change in heart rate; carbetocin group was 14.5±5.2 beats per minute versus 23.4±7.8 beats per minute in the oxytocin group (p=0.04). The mean EBL for the oxytocin group was 700±50.55 ml while 280±40 ml for the carbetocin group; p=0.03. The APGAR scores and umbilical pH were comparable in the two groups. Conclusion: It was observed that carbetocin significantly reduced blood loss with minimal side effects than oxytocin in the women studied. The routine use of carbetocin could be the way forward in preventing obstetric haemorrhage in the vulnerable parturient. [ABSTRACT FROM AUTHOR]

Background: The Robson ten group classification is recommended for classifying and comparing Caesarean Sections. This study aimed to review and classify all CS done at Obio Cottage hospital in 2018 using the Robson classification and to also identify areas of possible intervetions in reducing the CS rates. Methodology: A retrospective review of all caesarean sections at Obio Cottage hospital from January to December 2018 using the Robson classification. Results: The CS rate was 32.4%. Three groups - Groups 1 (27.% ), 2 (11.2%) and 5 (30.1%) contributed 68.5% to the overall CS rate. Group 8 had the least contribution to CS with 3.4%. Women in Robson group 3 had the lowest group CS rate of 6.86%, while the group CS rate for group 1, and 5.1 were 26.34% and 70.49% respectively. Conclusion: The CS rate of 32.4% is comparatively high. This analysis of the CS using the Robson classification system has revealed areas for further scrutiny and intervention. There is need to review the package of care provided to women in labour and increase the number of women offered a trial of labour after a Caesarean birth. [ABSTRACT FROM AUTHOR]

Background: There is evidence that women who have had their genitals cut suffer substantial difficulties during and/or after childbirth, including the need for a caesarean section, an episiotomy, an extended hospital stay, post-partum bleeding, and maternal fatalities. Whether or not women in sub-Saharan Africa who have undergone female genital mutilation utilize the services of skilled birth attendants during childbirth is unknown. Hence, we examined the association between female genital mutilation and skilled birth attendance in sub-Saharan Africa.Methods: The data for this study were compiled from 10 sub-Saharan African countries' most recent Demographic and Health Surveys. In the end, we looked at 57,994 women between the ages of 15 and 49. The association between female genital mutilation and skilled birth attendance was investigated using both fixed and random effects models.Results: Female genital mutilation and skilled birth attendance were found to be prevalent in 68.8% and 58.5% of women in sub-Saharan Africa, respectively. Women with a history of female genital mutilation had reduced odds of using skilled birth attendance (aOR = 0.91, 95% CI = 0.86-0.96) than those who had not been circumcised. In Ethiopia, Guinea, Liberia, Kenya, Nigeria, Senegal, and Togo, women with female genital mutilation had reduced odds of having a trained delivery attendant compared to women in Burkina Faso.Conclusion: This study shed light on the link between female genital mutilation and skilled birth attendance among sub-Saharan African women. The study's findings provide relevant information to government agencies dealing with gender, children, and social protection, allowing them to design specific interventions to prevent female genital mutilation, which is linked to non-use of skilled birth attendance. Also, health education which focuses on childbearing women and their partners are necessary in enhancing awareness about the significance of skilled birth attendance and the health consequences of female genital mutilation. [ABSTRACT FROM AUTHOR]

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 1st October 2018 and 30th 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 5th or 7th 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. [ABSTRACT FROM AUTHOR]

Huge ovarian masses in pregnancy can have significant impact and effect on pregnancy outcome. Mucinous cystadenoma is a benign tumour of the ovary, which sometimes can undergo significant growth in pregnancy, thereby posing certain challenges in management. A case of a 26-year-old G4P1 +2 with huge mucinous cystadenoma is presented, who had an elective caesarean section at term and right salpingo-oophorectomy. Ovarian mass measured 40 cm x 30 cm. The challenges in management are highlighted and discussed. [ABSTRACT FROM AUTHOR]

Background: Mother and newborn skin-to-skin contact (SSC) is an immediate postpartum intervention known to improve the health of newborn and mothers alike. Albeit, there is paucity of data that explored the coverage or factors associated with SSC in Nigeria. Therefore, we aimed to explore the coverage and hierarchical nature of the factors associated with SSC among women of reproductive age in Nigeria.Methods: The 2018 Nigeria Demographic and Health Survey (NDHS) data was used for this study. Data on 29,992 women who had ever given birth were extracted for analysis. SSC was the outcome variable as determined by women's report. A multivariable multilevel logistic regression model was used to estimate the fixed and random effects of the factors associated with SSC. Statistical significance was determined at p< 0.05.Results: The coverage of SSC was approximately 12.0%. Educated women had higher odds of SSC, when compared with women with no formal education. Those who delivered through caesarean section (CS) had 88% reduction in SSC, when compared with women who had vaginal delivery (OR= 0.12; 95%CI: 0.07, 0.22). Women who delivered at health facility were 15.58 times as likely to practice SSC, when compared with those who delivered at home (OR= 15.58; 95%CI: 10.64, 22.82). Adequate ANC visits and low birth weight significantly increased the odds of SSC. Women from richest household were 1.70 times as likely to practice SSC, when compared with women from poorest household (OR= 1.70; 95%CI: 1.04, 2.79). There was 65% reduction in SSC among women with high rate of community non-use of media, when compared with women from low rate of community non-use of media (OR= 0.35; 95%CI: 0.20, 0.61).Conclusion: SSC coverage was low in Nigeria. Moreover, individual, household and community level factors were associated with SSC. More enlightenment should be created among women to bring to limelight the importance of SSC specifically to newborn's health. [ABSTRACT FROM AUTHOR]

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Introduction and hypothesis: Female sexual function disorders (FSFDs) have received less attention than male sexual function disorders, despite being more prevalent. Furthermore, most available literature is on the effect of vaginal delivery (VD) on sexual function, and studies on the effect of caesarean section (CS) are generally lacking. This study determined the comparative effect of CS and VD on FSFDs. Methods: A prospective cohort of postnatal mothers at two hospitals in Nigeria was studied. In the intervention group women delivered via CS whereas women in the control group had a VD. Both groups were followed up to 3 months to determine the time to first coitus and other FSFs using a validated questionnaire. Results: At 6 weeks postpartum, mean time (days) to first coitus was shorter in the CS than in the VD group (29.2 ± 4.3 vs 32.1 ± 4.9; t = 2.38; p = 0.02). However, no difference was observed at 3 months (37.3 ± 8.7 vs 40.9 ± 9.9; t = 1.83; p = 0.07). Also, there were no differences in mean Female Sexual Function Index (FSFI) total scores at 6 weeks and 3 months (p > 0.05). Mean FSFI domain scores at 6 weeks for orgasm, satisfaction, and pain were significantly higher in the CS group (p < 0.05). However, there were no differences in any of the domain scores at 3 months (p > 0.05). Conclusion: Mode of delivery does not affect time to resumption of coitus after childbirth, and FSF disorders by 3 months postpartum. Caesarean section should therefore not be recommended to women merely for early resumption of coital activity or preservation/maintenance of sexual function after childbirth. [ABSTRACT FROM AUTHOR]

Objectives: Caesarean section (CS) can be life‐saving for both mother and child, but in Nigeria the CS rate remains low, at 2.7% of births. We aimed to estimate the rate of CS and early neonatal mortality in Nigeria according to obstetric risk and socio‐economic background and to identify factors associated with CS. Methods: We used the 2018 Nigeria Demographic and Health Survey, encompassing 33 924 live births within the last 5 years, to estimate the CS rate and early neonatal mortality rate (ENMR) by obstetric risk group, informed by the Robson classification. The CS rate and ENMR were assessed within each Robson group and stratified by socio‐economic background. Logistic regression analyses were used to explore determinants of CS. Results: Almost three‐quarters (72.4%) of all births were to multiparous women, with a singleton baby of normal birthweight, thus a low‐risk group similar to Robson 3, and with a CS rate of 1.0%. CS rates in the two high‐risk groups (multiple pregnancy and preterm/low birthweight) were low, 7.1% (95% CI: 5.2–9.7) and 1.8 % (95% CI: 1.4–2.4), respectively. The ENMR was particularly high for multiple pregnancy (175 per 1000 live births; 95% CI: 131–230). Greater number of antenatal visits, unwanted pregnancy, multiple pregnancy, household wealth, maternal education, Christians/Others versus Muslims and referral during childbirth were positively associated with CS. Conclusion: Inequitable access to CS is not limited to socio‐economic determinants, but also related to obstetric risk factors, calling for increased efforts to improve access to CS for high‐risk pregnancies. [ABSTRACT FROM AUTHOR]

Gauze is commonly used in surgery. Sometimes strands of gauze are left in situ during surgery. These gauze strands could cause problems later. We report a case of bladder stones secondary to migratory gauze strand postcesarean section. We present a 62-year-old widow who presented with lower urinary tract symptoms of 13-year duration following a cesarean section 15 years before presentation. She had a radiologic diagnosis of multiple bladder stones which on surgical removal, a gauze strand was found to be the nidus for stone formation. A migratory gauze strand from surgery done 15 years before presentation served as a nidus for bladder stone formation in a 62-year-old patient. Surgeons should be careful during pelvic surgeries/procedures not to leave behind foreign bodies like gauze strands that could migrate and cause bladder stones and its attendant sequelae. [ABSTRACT FROM AUTHOR]

Background: In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment., Aim: This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria., Methods: This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp., Results: The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each., Conclusions: The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Neonatal mortality remains a major health concern in sub-Saharan Africa. We conducted a cross-sectional, population-based, retrospective analysis of 31,828 births between 2009 and 2013 to explore the relationship between socio-demographic variables and post-caesarean neonatal mortality in Nigeria. We calculated the caesarean section (CS) rates, the odds of having a CS and post-CS neonatal mortality within variable subgroups. The national average CS rate was 2.1%. The CS rate increased with the increasing wealth index, educational attainment, maternal age, higher among urban residents and among those from the Southern part of Nigeria. The odds of experiencing post-CS neonatal mortality was significantly higher in the Northern regions (OR 2.51-3.17) among rural residents (OR 2.63), economically poorer groups (OR 3.68), with no formal education (OR 3.01) and older maternal age groups (OR 1.76-2.0). Efforts to increase the rate and quality of peripartum services delivered to pregnant women are needed among both advantaged and disadvantaged groups.Impact statementWhat is already known on this subject? In sub-Saharan Africa, a caesarean section is a lifesaving procedure for both the women and their unborn babies. The neonatal mortalities that occur following the procedure need to be explored and quantified.What do the results of this study add? Socioeconomic differentials exist in the access to a caesarean section. However, these differentials have a limited influence on neonatal mortality post-caesarean section in Nigeria.What are the implications of these findings for clinical practice and/or further research? While socio-demographic variables influence access to health care services, timeliness and quality of care are factors to be considered in ensuring societies get the benefits of caesarean section as a lifesaving procedure. [ABSTRACT FROM AUTHOR]

Intra-parturient uterine torsion is a rare condition in bitches with multifactorial aetiologies. It is a cause of obstructive dystocia and is difficult to diagnose with most imaging techniques. Medical management of dystocia in parturient bitches with oxytocin often result in uterine rupture with severe consequences on maternal and foetal health. A three-year-old German shepherd (31kg) bitch presented to the Veterinary Teaching Hospital (VTH), University of Ibadan, Oyo State, Nigeria was diagnosed, after a caesarean section, with intra-parturient right horn torsion (180- degrees intracornual and 360-degrees at the ovarian end) and a near-complete rip of the affected horn from the uterine body. Before presentation, the bitch was said to have whelped three puppies but discontinued apparently due to perceived uterine inertia even when injected with three doses of oxytocin by a caregiver. The bitch's vital signs were abnormal and reflected signs of progressive shock. Haemogram showed severe anaemia, moderate neutrophilia with left shift, normal plasma protein level and platelet counts. An ultrasound examination revealed the presence of two foetuses in-utero but un-engaged at the bitch's birth canal. Following patient's stabilisation, a caesarean section unveiled an empty, involuting, left uterine horn, a 180 degrees intracornual twist of the right horn (separating the foetuses into two closed compartments) and a 360 degrees torsion at the ovarian end, which severely strangulated the vessels and ligament. The affected horn, vessels, and ligament were congested. The gravid horn was nearly ripped from the uterine body at the bifurcation. The torsion was corrected, foetuses evacuated and a hemicornuectomy performed. The bitch's recovery was uneventful. The diagnosis and management of obstructive dystocia is a challenge, especially in poor resource settings. The option of surgical intervention should be considered as an emergency by both pet owners and clinicians to preclude further complications, including those caused by oxytocin. [ABSTRACT FROM AUTHOR]

Worldwide, eclampsia remains one of the major causes of maternal and perinatal morbidity and mortality. Pre-eclampsia/eclampsia is a multisystem disease and despite extensive research, no definitive etiology has been identified. This disease therefore continues to pose a challenge in obstetric practice, especially in developing countries like ours. This study therefore set out to determine the prevalence, associated factors, and outcome of eclampsia at the University of Abuja Teaching Hospital, Abuja, Nigeria. It was a descriptive retrospective review of cases of eclampsia managed at the University of Abuja Teaching Hospital, Abuja over a 10-year period. The case notes of these women were retrieved and relevant data obtained included age, parity, booking status, type of eclampsia, gestational age at presentation, mode of delivery, maternal and perinatal outcome variables. Data was analysed using the statistical package for social sciences (SPSS Inc, Chicago) version 20 and outcome variables represented in simple percentages. Of the 22,945 deliveries conducted during that period, 257 cases of eclampsia were managed, putting the prevalence of eclampsia at 1.12%. Of these, 90.5% were unbooked, 67.6% were primigravidae and 88.2% were below 30years of age. Antepartum eclampsia was the commonest form, occurring in 67.6% of the patients. Caesarean section was the mode of delivery in 82.2% of cases. Maternal and perinatal mortality were 4.6% and 11.1% respectively. In conclusion, eclampsia is a major cause of maternal and perinatal morbidity and mortality. Interventions suggested include widespread health education on the need for patients to have antenatal care. [ABSTRACT FROM AUTHOR]

Background: In 2015, Nigeria's estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria.Methods: This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall).Results: There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery.Conclusion: We conclude that the rate of stillbirth is high in Nigeria's referral hospitals largely because of patients' related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients' education and emergency obstetric care would reduce the rate of stillbirth in the country.Trial Registration: Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016. [ABSTRACT FROM AUTHOR]

This study develops a Binary Logistic Model, local to the Maria Goretti hospital Anyigba, Kogi State, Nigeria for predicting infant birth survival outcomes. Model results shows that the odds of infant survival for normal delivery are 5 times the odds of survival by caesarean delivery, keeping the weight of the infant constant and also that the odds of infant survival increases 3 times for every unit increase in the weight of an infant when the delivery method is kept constant. It was concluded that though, mother's age which incorporate a maternal characteristic into the model was insignificant in this hospital, there is a chance that it might be significant alongside other maternal characteristics elsewhere. Hence the emphasis on developing localized models of this nature. [ABSTRACT FROM AUTHOR]

Background: Caesarean section is recommended in situations in which vaginal birth presents a greater likelihood of adverse maternal or perinatal outcomes than normal. However, it is associated with a higher risk of complications, especially when performed without a clear medical indication. Since labour attendants have no standardised clinical method to assist in this decision, statistical tools developed based on multiple labour variables may be an alternative. The objective of this paper was to develop and evaluate the accuracy of models for caesarean section prediction using maternal and foetal characteristics collected at admission and through labour. Method: This is a secondary analysis of the World Health Organization's Better Outcomes in Labour Difficulty prospective cohort study in two sub-Saharan African countries. Data were collected from women admitted for labour and childbirth in 13 hospitals in Nigeria as well as Uganda between 2014 and 2015. We applied logistic regression to develop different models to predict caesarean section, based on the time when intrapartum assessment was made. To evaluate discriminatory capacity of the various models, we calculated: area under the curve, diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity. Results: A total of 8957 pregnant women with 12.67% of caesarean births were used for model development. The model based on labour admission characteristics showed an area under the curve of 78.70%, sensitivity of 63.20%, specificity of 78.68% and accuracy of 76.62%. On the other hand, the models that applied intrapartum assessments performed better, with an area under the curve of 93.66%, sensitivity of 80.12%, specificity of 89.26% and accuracy of 88.03%. Conclusion: It is possible to predict the likelihood of intrapartum caesarean section with high accuracy based on labour characteristics and events. However, the accuracy of this prediction is considerably higher when based on information obtained throughout the course of labour. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality remains one of Nigeria's most significant public health challenges. In order to address this issue sustainably, it is necessary to consider the perceptions of all stakeholders involved, including midwives., Objectives: To examine the determinants of maternal mortality in south-western Nigeria from the midwife's perspective., Design: A cross-sectional study was employed using mixed methods with a semi-structured questionnaire and an in-depth interview guide., Participants: Quantitative data were obtained from 215 midwives using a convenience sampling technique. Qualitative data were obtained from 25 midwives from five government health centres, selected using a stratified sampling technique., Methods: Quantitative data were analysed using SPSS Version 20 using descriptive and inferential statistics with 95 % confidence intervals, while qualitative data were analysed using thematic analyses., Findings: The mean age and work experience of the participants were 35.2 ± 9.3 years and 8.4 ± 7.0 years, respectively. The midwives perceived that the main determinants of maternal mortality were postpartum haemorrhage (86.5 %), hypertensive disorder in pregnancy (80.9 %), mismanagement at mission homes/traditional birth attendant centres (MH/TBAs) (79.1 %) and sepsis (70.1 %). Some of the priority target areas to improve the well-being of pregnant women as identified by the midwives, were increased awareness of pregnancy danger signs (97 %), destigmatising caesarean section (CS) (96 %), regulation of MH/TBAs (92 %), and increased accessibility of hospitals (84 %). Findings from the qualitative data also affirmed that regulating MH/TBAs, destigmatising CS and subsidising healthcare expenses were prerequisites to curbing maternal mortality. Inferential analysis revealed that determinants such as unsafe abortion (p < 0.001), ectopic pregnancy (p = 0.001), domestic violence (p = 0.023), malaria (p = 0.029), short interbirth interval (p = 0.03), and patients' negative perceptions of CS delivery (p = 0.036) were more commonly perceived to be associated with maternal mortality by younger midwives (age 17-34 years) compared with older midwives., Key Conclusion: The results indicate that resolving the maternal mortality crisis sustainably in Nigeria will require increased accessibility to basic health care and health promotion campaigns to counteract unhelpful sociocultural norms., Implications for Practice: Future interventions must be tailored to address both traditional and emerging causes of maternal mortality in southwestern Nigeria., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice., Design and Settings: A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria., Participants: Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey., Main Outcome Measures: TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics., Methods: Descriptive statistics were reported and graphically presented. Bivariate χ 2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17., Results: 44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9)., Conclusions: CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Maternal deaths are far too common in Nigeria, and this is in part due to lack of access to lifesaving emergency obstetric care, especially among women in the poorest strata in Nigeria. Data on the extent of inequality in access to such lifesaving intervention could convince policymakers in developing an appropriate intervention. This study examines inequality in access to births by caesarean section in Nigeria. Methods: Data for 20,468 women who gave birth in the five years preceding 2013 Nigerian Demographic and Health Survey (DHS) were used for this study. Inequality in caesarean delivery was assessed using the concentration curve and multiple logistic regression models. Results: There was a high concentration in the utilisation of caesarean section among the women in the relatively high wealth quintile. Overall, delivery by caesarean section was 2.1%, but the rate was highest among women who had higher education and belonged to the richest wealth quintile (13.6%) and lowest among women without formal education and who belonged to the poorest wealth quintile (0.4%). Belonging to the poorest wealth quintile and having no formal education were associated with lower odds of having delivery by caesarean section. Conclusion: In conclusion, women in the richest households are within the WHO’s recommended level of 10–15% for caesarean birth utilisation, but women in the poorest households are so far away from the recommended rate. Equity in healthcare is still a promise, its realisation will entail making care available to those in need not only those who can afford it. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the association between cesarean section and neonatal mortality Nigeria. METHOD: A retrospective analysis using Nigeria Demographic Health Survey 2013 national population-based cross-sectional survey. The national prevalence of cesarean section was calculated, and logistic regression was used to estimate the odds of neonatal mortality outcome following cesarean delivery. RESULTS: The national cesarean section rate for the 2009–2013 period was 2.1% among 31,495 deliveries. The odds of having a neonatal death was twice as high in cesarean deliveries in comparison to noncesarean deliveries (aOR = 2.56, 95% CI 1.75 to 3.74). CONCLUSION: Cesarean section increases the odds of neonatal mortality in Nigeria. There is a need to scale up the quality and timeliness of emergency obstetric services offered to pregnant women. [ABSTRACT FROM AUTHOR]

Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved. [ABSTRACT FROM AUTHOR]

BACKGROUND: The World Health Organization estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic squeal. Majority of cases are in sub-Saharan Africa. This study aimed at determining the prevalence, associated factors, and hospital outcome of term neonates hospitalized for perinatal asphyxia. METHODOLOGY: This was a descriptive cross-sectional observational study of term neonates with low Apgar scores and outborn babies with no Apgar score but with features of asphyxia admitted over a period of 12 months into the Special Care Baby Unit of the Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria. Case files of the patients were retrieved, and relevant information was obtained. RESULTS: Forty-nine of 212 babies admitted had perinatal asphyxia giving a prevalence of 23.1%. Majority of the babies were males and presented within the first 12 h of life with a mean birth weight of 2.66 ± 0.52 kg. Most of the mothers of the asphyxiated babies were primiparous and booked and had prolonged obstructed labor. Thirty-six (73.4%) of the babies were discharged home, eight (16.3%) left against medical advice, and five died to give the case fatality rate of 10.3%. CONCLUSION: Perinatal asphyxia is a common cause of neonatal morbidity. It was common among babies delivered through emergency cesarean section whose mothers are primiparous and had prolonged labor and/or eclampsia. [ABSTRACT FROM AUTHOR]

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur., Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard., Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section., Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre., Competing Interests: None