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Objective: To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral‐level hospitals in Nigeria. Design: A cross‐sectional analysis of perinatal data collected over a 1‐year period. Setting: Fifty‐four referral‐level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. Population: A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out‐born babies), with information on jaundice between 1 September 2019 and 31 August 2020. Methods: Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. Main outcome measures: Incidence and risk factors of neonatal jaundice in the 54‐referral hospitals in Nigeria. Results: Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11–2.52) or post‐secondary education (aOR 1.17, 95% CI 0.99–1.38), previous caesarean section (aOR 1.68, 95% CI 1.40–2.03), booked antenatal care at <13 weeks or 13–26 weeks of gestation (aOR 1.58, 95% CI 1.20–2.08; aOR 1.15, 95% CI 0.93–1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14–1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74–2.63). Conclusions: Hospital‐level and regional‐level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice. [ABSTRACT FROM AUTHOR]

The article discusses a rare case of nonpuerperal uterine inversion complicating a large prolapsed submucous myoma in a 38-year-old woman in Nigeria. The patient presented with symptoms such as lower abdominal swelling, urinary retention, and offensive vaginal discharge, leading to a diagnosis of chronic uterine inversion secondary to an infected fibroid. Treatment involved transfusion, antibiotics, myomectomy, and total abdominal hysterectomy. The rarity of this condition, particularly in African women with large fibroids, highlights the need for a high index of suspicion and appropriate surgical management. [Extracted from the article]

Tuberculosis of the cervix is reported to be very rare with clinical features that are indistinguishable from that of invasive cancer of the cervix. We report the case of a 31 year old nulliparous lady that presented with intermenstrual bleeding and a persistent abnormal vaginal discharge after receiving several forms of treatment for cervical cancer. Vaginal examination revealed an extensive friable erythematous lesion affecting the entire ectocervix. Tuberculosis was confirmed following biopsy of the lesion and the patient was successfully managed with a course of anti-tuberculosis medication. [ABSTRACT FROM AUTHOR]

Abstract Background The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. Objective The primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. Methods This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels. Management Overall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria. Expected outcomes The outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Background: The use of prosthetics for open repair of incisional hernia is very recent in our practice. We highlight our experience repairing incisional hernias with polypropylene mesh. Patients and Methods: Patients presenting with incisional hernia >5 cm in length or width received open polypropylene mesh repair and were followed for two years. Data obtained included age, sex, primary surgery causing the hernia, the length of the fascial defect and previous attempts at repair. Post-operative wound complications were recorded. The integrity of the scar and patient satisfaction or concerns with the repair was assessed at each visit. Results: Nineteen females with a mean age of 35 years (range 30-54) underwent repair; most arising from obstetric or gynaecological procedures. Sixteen (82.2%) had midline, 2 (10.5) transverse and 1 (5.3) Pfannenstiel scars. One patient had no previous repair (R0), 7 had undergone one repair (R1), 9 had undergone two repairs (R2) and 1 had three previous repairs (R3). The length of fascial defects ranged from 8 to 18 cm and seroma collection and stitch sinus were the common problems encountered. Two (10.5%) recurrences were recorded in two years. Conclusion: Open mesh repair of incisional hernia carries a low risk of infection and recurrence in two years. [ABSTRACT FROM AUTHOR]

AIM: Use of effective contraceptive methods has been shown to improve health, sexual life and partner relations and also significantly reduce maternal and infant mortality by protecting against unplanned pregnancy, high fertility and high parity. The aim of this study is to determine the degree of awareness and practice of contraception by women in Uyo, Nigeria. METHOD: Semi-structured questionnaires were administered to three hundred and seventy women in the antenatal clinic of the University of Uyo Teaching Hospital. RESULTS: Majority of the respondents were 21-30 years old (64.1%), 53.8% were multiparous and 66.5% had tertiary level education. Three hundred and twenty women (87.6%) had heard about contraception while only 49.5% of the respondents had practiced contraception previously of which the male condom (40.0%) and the safe period/calendar method (31.1%) were the most commonly practiced methods. Majority of the respondents (68.9%) preferred to have 1 to 4 children and 78.4% of the respondents would want to used a method of contraception to either space their family or limit child bearing. Fear of side effects (20.0%) and previous bad experience (8.8%) were the most common reasons given by those respondents who would not want to practice contraception. CONCLUSION: This study reveals a high level of awareness of contraception but a significant unmet need among the respondents. There is need to intensify public enlightenment campaigns in our environment emphasizing the benefits and safety of modern contraceptive methods. Community leaders and heads of social groups and women organisations should be co-opted in the dissemination of accurate information on contraception. [ABSTRACT FROM AUTHOR]

Background: Depot medroxyprogesterone acetate is the most studied injectable contraceptive and also one of the most effective methods of contraception currently available. It is reversible, its use is independent of intercourse, and can be provided by trained non-medical staff making it particularly suitable for use in developing countries. The aim of this study is to determine the socio-demographic characteristics of its acceptors, the timing of use and complications at the University of Uyo Teaching Hospital, Uyo. Materials and Methods: The record cards of all clients who accepted medroxyprogesterone acetate injectable contraception over a nine-year period were studied. Results: There were 1065 new contraceptive acceptors out of which 166 (15.1%) accepted depot medroxyprogesterone acetate. The modal age group of the clients was 30-34 years (35.0%). Majority of clients were grandmultiparous (63.9%), married (82.0%), and 50.6% had primary level education. Majority of the clients (84.2%) derived their sources of information on contraception from clinic personnel and friends/relatives. All the clients received their injections within seven days of menstruation. The most common side effects were amenorrhea (12.0%) and spotting of blood per vaginam (10.8%). Conclusion: Depot medroxyprogesterone acetate is a safe form of contraception, which was mostly accepted by grandmultiparous women and those in their thirties. The involvement of the print and electronic media in the propagation of accurate information about depot medroxprogesterone acetate to members of the community and the introduction of post-abortal and puerperal administrations of depot medroxyprogesterone acetate and its new formulation; depo sub-Q provera in all our hospitals are advocated. [ABSTRACT FROM AUTHOR]

Herniation of the gravid uterus through an incisional hernia of the anterior abdominal wall is a rare but potentially grave obstetric condition. We present two cases at 32 and 20 weeks of gestation that successfully managed in our hospital. Conservative management at early gestational age and planned cesarean section after fetal maturity with herniorrhaphy using propylene mesh as a one stage procedure led to a good obstetric outcome in our patients. We also review the existing literature on the management. [ABSTRACT FROM AUTHOR]

Background: Twin pregnancy continues to be a focus of interest the world over due to its increasing incidence and also the high maternal and perinatal mortality and morbidity associated with it. Objective: To determine the incidence and mode ofdelivery of twin pregnancies at the University of Uyo Teaching Hospital, Uyo. Methodology: A 5-year retrospective review of twin deliveries at the University of Uyo Teaching Hospital. Results: There were 6,344 deliveries out of which 164 were twin deliveries resulting in an incidence of 2.6%. The modal age group of the patients was 20-29 years (66.5%), majority (71.3%) of the patients were multiparous, 79.3% booked and had regular antenatal care in the hospital while 49.4% of the patients delivered at term. Eighty-four patients (51.2%) were delivered by caesarean section and malpresentation of the first twin (18.2%) and hypertensive disorders of pregnancy (10.4%) were the most common indications. The perinatal mortality rate was 207/1000 and there was one maternal death which was from eclampsia. Conclusion: The incidence of twin pregnancy and its attendant perinatal mortality is high in our center. In addition, caesarean section is the most common mode of delivery with malpresentation of the first twin and hypertensive disorders of pregnancy as the most common indications. We advocate widespread public enlightenment on the increased risk associated with twin pregnancy. Community leaders should ensure that women with twin pregnancy should book early and obtain antenatal care in specialized units. [ABSTRACT FROM AUTHOR]

A 36-year-old grand multiparous midwife presented to the gynaecological unit of the University of Uyo Teaching Hospital with the string of an intrauterine contraceptive device (IUCD) protruding from her anus. She had had a copper IUCD inserted at a health centre 8 years earlier. However, 4 months later she noticed that she no longer felt its strings and had another IUCD inserted in the same facility when the first device was not located. Four months prior to presentation, she presented to a private clinic when she no longer felt the strings of the second IUCD. The device in the uterus was removed in the private clinic and she was referred to the teaching hospital. At the teaching hospital rectal examination and plain x-ray revealed the presence of a device. Under general anaesthesia, the device was successfully removed in theatre through the rectum with no postoperative complications. [ABSTRACT FROM AUTHOR]

A 50-year-old grandmultiparous petty trader presented in the gynaecological unit of the University of Uyo Teaching Hospital with a painless groin swelling of 8 years' duration, which had progressively increased in size. She had received several concoctions from a traditional healer who also made several incisions on her thighs and inguinal region. On examination, there were multiple scarification marks in the axilla, inguinal region and medial aspects of both thighs. There was a very huge, firm, non-tender mass involving the right vulva and measuring 40 by 35 cm (figure 1). The vaginal orifice was deviated to the left by the mass, the uterus was normal size and the adnexa were normal. She had an excision biopsy under general anaesthesia (figure 2) and the histology confirmed fibroma of the vulva (figure 3). She had an uneventful postoperative period and the wound healed well with good cosmetic results. [ABSTRACT FROM AUTHOR]

Background: Grandmultiparity is traditionally associated with increased risk of complications during pregnancy and delivery. Reports from developed countries where obstetric facilities are excellent and the standard ofperinatal care is high indicate that currently, obstetric complications among grandmultipara are now independently associated with progressive maternal age. In Nigeria and other developing nations however, grandmultiparity still contributes a significant proportion of the obstetric population. The aim of this study is to evaluate the outcome of delivery of grandmultiparous patients at the University of Uyo Teaching Hospital., Methods: The case records of all grandmultiparous patients who delivered at the University of Uyo Teaching Hospital, Uyo over a six-year period were studied., Results: Grandmultiparous women constituted 6.4% of the parturients who delivered in the hospital during the study period. Their ages ranged from 20-45 years with majority (71.5%) being 30-39 years. Majority (77.9%) were para 5 and 6 and 326 (80.1%) of the patients booked and received antenatal care in the hospital. Majority of the booked patients (79.8%) initiated antenatal care after 32 weeks of gestation while all the unbooked patients 68 (16.7%) and the antenatal clinic defaulters 8 (2.0%) were brought from unorthodox health facilities when they developed obstetric complications. Two hundred and forty three patients (59.7%) had spontaneous vaginal delivery, 15 (3.7%) of the patients had laparotomy for ruptured uterus and out of these ten of them (66.7%) had a subtotal abdominal hysterectomy while five (33.4%) had uterine repair and bilateral tubal ligation. The perinatal mortality rate was 128/1000 births. There were three maternal deaths, two from eclampsia while one followed postpartum haemorrhage resulting in a maternal mortality rate of 7.4/1000., Conclusion: The prevalence of grandmultiparity in our centre is relatively low. It is, however, associated with high perinatal and maternal morbidity and mortality. We advocate widespread community enlightenment on the importance of limitation of family size and number of child births. There is need for community based studies in our environment accessing the knowledge and attitude of women with high parity towards contraception.

Unlabelled: Injuries during coitus could result in considerable morbidity and mortality in women. Identifying their pattern of presentation and predisposing factors will aid in their prevention., Study Design and Setting: A descriptive study of patients with coital injuries seen in the University of Calabar Teaching Hospital (U.C.T.H) Calabar, between 1991 and 2000, with data obtained from case records., Results: Coital injuries constituted 0.7/1000 gynaecological emergencies. Rape (68.0%) was the commonest aetiological factor. It was more common in nulliparous patients (88.0%) and toddlers and teenagers formed the age group most affected. The lower vagina was the most common site of injury (44.0%). Vaginal bleeding was the commonest mode of presentation and hypovolaemic shock, the most common complication., Conclusion: Rape is the commonest cause of coital injury in Calabar. Coital injuries should be considered as a differential diagnosis in all cases of abnormal vaginal bleeding particularly in children.