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Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concentration was higher in Nigerians compared with Caucasians and was significantly higher also in pregnancy. Hypoalbuminemia and dietary consumption of cyanogenic substances in pregnancy probably contributed to the higher thiocyanate levels. This may have a possible significant bearing on the fetal well-being, particularly fetal birthweight.

Analysis of 31 cases of gestational trophoblastic neoplasms at the University of Benin Teaching Hospital, Benin City, over a 7 1/2 year period (1/1/75 to 6/30/82) was carried out. The incidence of this disease was 1:656 deliveries. Although it was more prevalent in grandmultipara, it occurred in all parities and ages. The main clinical features were secondary amenorrhea, vaginal bleeding, uterine enlargement, and vaginal secondaries. The most common gestational antecedent event of gestational trophoblastic disease was a normal pregnancy. This was believed to have contributed to the high overall mortality of 35.5%. Numerous shortcomings during the management of these cases (inadequate laboratory facilities, shortage of reagents, shortage of drugs) were highlighted.

The three major immunoglobulin (IgG, IgA and IgM) concentrations were measured in 118 Nigerian women during normal pregnancy. IgG was found to decline progressively throughout gestation with a very highly significant decrease between the first and second trimester (0.01 greater than P greater than 0.005) and between the second and third trimesters (P = 0.01). The mean concentrations of IgM were significantly lower in sera from first-trimester pregnant women than those of age-matched non-pregnant control subjects (P less than 0.001), and there was a further significant decrease between second and third trimester groups (0.005 greater than P greater than 0.001). No statistical difference was observed for IgA levels throughout normal pregnancy. The significance of these results is discussed in relation to other observations elsewhere.

Of 13,500 deliveries in a 6-year period, 326 cases of antepartum hemorrhage (2.4%) were encountered. Fifty-six (0.42%) of these patients had abruptio placentae while 130 (0.96%) had placenta previa. An inverse ratio of placenta previa and abruption placentae was observed in this study, which may be due to a racial difference--probably a result of the late onset of preeclampsia among Nigerians. A high perinatal mortality of 643/1000, influenced mainly by the high prematurity rate, was observed; cesarean section resulted in the lowest perinatal mortality (154/1000). There was one maternal death, giving a maternal mortality rate of 18/1000.

Five hundred sixty grandmultiparous women were interviewed as to their contraceptive awareness, desirability and use in the three major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was high level of awareness of contraceptive availability and usefulness (65%), but low level of practice (27.1%). The main causes of the low practice level included opposition from husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. We believe that with more concerted effort at family planning counseling, the community will be rid of the hazards and menace of grandmultiparity.

One hundred and eighty cases of uterine fibroids out of the two hundred treated in a gynaecological unit in a 7-year period are reviewed. The incidence of uterine fibroids among gynaecological conditions was 3.2% and it accounted for 3.6% of the operations. The peak age incidence was at 31-40 years (46%). Twenty per cent of those affected were grand multiparae. The commonest clinical features were abdominal swelling, infertility, abdominal pain, menorrhagia and dysmenorrhoea. Most of the patients were treated surgically with myomectomy (68%), mainly on account of the low parity and age. There was increased morbidity among those who had hysterectomy; 2 deaths occurred in this group. We have advocated liberal use of myomectomy , with its preservation of menstrual and reproductive function.

The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in Benin City has been reviewed. Although the incidence is 2.6% of all deliveries, it accounts for 14.3% of the overall perinatal mortality. The factors of importance in relation to perinatal loss included preterm delivery, low birthweight, birth order, malpresentation, mode of delivery, and failure to diagnose multiple pregnancy before labor. Bedrest is advocated. Health education is important in encouraging parturients to avail themselves of available antenatal facilities. A high index of suspicion for multiple pregnancy and referral of such patients to major units equipped to manage such high risk pregnancies will reduce fetal wastage.

Induced adolescent abortion is a major cause of maternal and gynecologic death in the University of Benin Teaching Hospital, where 244 out of 349 such cases seen from January 1, 1974 to December 31, 1979 were reviewed. Ignorance and lack of contraceptive facilities were contributory factors. To deal with this problem that has been pervasive throughout Nigeria for the past decade, the authors advocate sex education, systematic dissemination of information for planned and conscientious parenthood as well as free availability of alternative methods of contraception. Interruption of early pregnancy should be an essential component of a national family planning program.