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Background: Complicated abortion is a major cause of maternal morbidity and mortality world-wide, the majority of which are due to unsafe induced abortions. This is particularly so in developing nations due to restrictive abortion laws and scarcity of post-abortion care services. Objectives: The objective of the study was to describe the nature of complications from unsafe abortions, associated factors, and its contribution to maternal mortality in the hospital. Materials and methods: This was a 10 year retrospective study of all complicated abortions admitted at the federal teaching hospital from 1st January 2010 to 31st December 2019. Data was extracted from the patients folders and analyzed. A proforma was used to obtain information on the nature and type of complication, factors associated with unsafe abortion and its contribution to maternal mortality during the period of the study. Chi-square was used to compare association with p value of less than 0.05 set for statistical significance. Results: Sixty-two cases of complicated abortions were admitted during the study period and 38.7% (24) were from unsafe induced abortions. The most common complication was hemorrhage (43.5%). Younger age was more associated with induced abortions-65.2% vs. 12.5% for ages 20-24 years and 30-34years respectively, 90.9% of those with induced abortions did not desire the pregnancy and 95% of the induced abortions were among singles ladies (p-value

Pregnancy outcomes; Vaccine effectiveness; Omicron Resultados del embarazo; Efectividad de la vacuna; Omicron Resultats de l'embaràs; Eficàcia de la vacuna; Omicron Background In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. Methods INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. Findings We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0–38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03–1·31]) and SPMMI (RR 1·21 [95% CI 1·00–1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88–1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12–1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84–3·43]), perinatal complications (RR 1·84 [95% CI 1·02–3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67–20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02–4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44–41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22–65) and 76% (47–89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48–87) and 91% (65–98) after a booster dose. Interpretation COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority.

Background: Preterm birth (PTB) is an important cause of perinatal morbidity and mortality in developing societies like Nigeria. It poses huge long-term medical and financial burdens for the affected children, their families, the health care system and society at large. Objective: The objective of this study was to determine the prevalence, risk factors and birth outcome of PTB at UMTH, Nigeria. Methodology: A two-year case-control study of cases of preterm births at the UMTH, from 1st January, 2016 to 31st December, 2017 was undertaken. For each PTB, the next term delivery was taken as control. Information on socio-demographic characteristics, risk factors, gestational ages at presentation and delivery, and birth outcome were obtained from the women’s case files with proforma and compared with that of the control. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software Version 23. The statistical significance was set at P

Background: The menace of sexual violence in our tertiary institutions is enormous with many female students been affected. Objective: The Objective of the study was to determine the prevalence, perception and pattern of sexual violence among female students of selected tertiary institutions in Gombe, Nigeria. Methodology: A structured pretested self-administered questionnaires were administered to female student in the departments selected across the three institutions in Gombe Metropolis. The study was conducted between 1st July 2019 and 30th January 2020. Information on Socio-demographic characteristics, sexual history, and history of sexual violence, information about the Perpetrator, time and place of the act, relationship with the perpetrator were taken. Results: Five hundred and fifty-two (552) self-administered questionnaires from students were obtained for analysis. Two hundred and fifty-seven (46.6%) of the respondents had a history of sexual violence and 197 (35.7%) reported been raped. Lecturers were responsible for 58 (22.6%) of the rape, while male students and male non-academic staff were responsible for 47(18.3%) and 39(15.2%) of the rape cases respectively. Less than half 197(35.7%) of the respondents acknowledged that sexual harassment, sexual assault and attempted rape were forms of sexual violence. Most of the sexual violence occurred at night, 154 (59.9%) and at the perpetrators home or office 45(22.9%). Conclusion: Sexual violence is common in institutions of higher learning and it is perpetuated by the lecturers and male students. Sexuality education, enhanced security and strict disciplinary measures are advocated as a means of curbing the menace.

Background: The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. Objective: To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. Study Design: In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. Results: A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. Conclusion: In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Background Among nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity. Objective This study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis. Study Design INTERCOVID was a multinational study conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women aged ≥18 years; a total of 2071 women were included in the analyses. For each woman diagnosed with COVID-19, 2 nondiagnosed women delivering or initiating antenatal care at the same institution were also enrolled. The main exposures were preexisting diabetes mellitus, high body mass index (overweight or obesity was defined as a body mass index ≥25 kg/m2), and gestational diabetes mellitus in pregnancy. The main outcome was a confirmed diagnosis of COVID-19 based on a real-time polymerase chain reaction test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined COVID-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and COVID-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. Furthermore, we conducted sensitivity analyses: (1) restricted to those with a real-time polymerase chain reaction test or an antigen test in the last week of pregnancy, (2) restricted to those with a real-time polymerase chain reaction test or an antigen test during the entire pregnancy, (3) generating values for missing data using multiple imputation, and (4) analyses controlling for month of enrollment. In addition, among women who were diagnosed with COVID-19, we examined whether having gestational diabetes mellitus, diabetes mellitus, or high body mass index increased the risk of having symptomatic vs asymptomatic COVID-19. Results COVID-19 was associated with preexisting diabetes mellitus (risk ratio, 1.94; 95% confidence interval, 1.55–2.42), overweight or obesity (risk ratio, 1.20; 95% confidence interval, 1.06–1.37), and gestational diabetes mellitus (risk ratio, 1.21; 95% confidence interval, 0.99–1.46). The gestational diabetes mellitus association was specifically among women requiring insulin, whether they were of normal weight (risk ratio, 1.79; 95% confidence interval, 1.06–3.01) or overweight or obese (risk ratio, 1.77; 95% confidence interval, 1.28–2.45). A somewhat stronger association with COVID-19 diagnosis was observed among women with preexisting diabetes mellitus, whether they were of normal weight (risk ratio, 1.93; 95% confidence interval, 1.18–3.17) or overweight or obese (risk ratio, 2.32; 95% confidence interval, 1.82–2.97). When the sample was restricted to those with a real-time polymerase chain reaction test or an antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation or controlling for month of enrollment, the observed associations were comparable. Conclusion Diabetes mellitus and overweight or obesity were risk factors for COVID-19 diagnosis in pregnancy, and insulin-dependent gestational diabetes mellitus was associated with the disease. Therefore, it is essential that women with these comorbidities are vaccinated.

The objectives were to compare the efficacy and safety of intravenous hydralazine and labetalol for acutely lowering severe hypertension in pregnancy.This was a superiority parallel double-blinded randomized controlled trial conducted from October 2018 to June 2019 in two hospitals in Gombe, Nigeria. Pregnant women with a live singleton fetus at gestational age of at least 28 weeks with severe hypertension were randomized (60 per group) to receive incremental doses of either intravenous labetalol (20 mg; 40 mg; 80 mg; 80 mg; and 80 mg) or 10 mg of intravenous hydralazine - up to a maximum of 5 doses - until the target blood pressure was achieved or the study was terminated.The main outcome measures were the mean reduction in mean arterial blood pressure and occurrence of persistent hypertension. Other endpoints were maternal side-effects, perinatal death, Apgar score at birth and SCBU admission.One hundred and thirteen patients' data were analyzed (fifty-six [56] in the hydralazine group and fifty-seven [57] in the labetalol group). There were no significant differences in the fall of the mean arterial blood pressure (labetalol; 24.19 mmHg/hydralazine; 27.68 mmHg) (p = 0.192), maternal side effects, perinatal deaths, Apgar scores and SCBU admission between the two groups. Hydralazine, however, produced a more marked reduction in diastolic blood pressure than labetalol (p = 0.012).Both labetalol and hydralazine are effective for acute blood pressure control in pregnancy with a similar safety profile. This study was self-funded and registered in the Pan African Clinical Trials Registry (www.pactr.orgPACTR202010738538062).

Background: Emergency contraception (EC) offers women a second chance to avoid unintended pregnancy after unprotected sexual intercourse. Besides its availability, requisite knowledge and positive attitude of the healthcare works will encourage its utilization by the Internally Displaced Persons (IDP) and host community. Objectives To determine the knowledge, attitude and practice of EC by healthcare workers (HCWs) in IDP camps and host community clinics in Jere and Maiduguri metropolitan local government areas (LGAs) of Borno state, Nigeria. Methodology: Self-administered questionnaires were issued to HCWs attending a workshop on child spacing counselling and service organized by the Society of Gynaecology and Obstetrics of Nigeria, North-East sector (SOGON-NE). The questionnaire inquired about knowledge, attitudes and practice of emergency contraception. Results: Eighty-nine (89.0%) of the respondents were aware of EC and 88.0% have approved of its provision. The most common indication for the EC was unprotected sexual intercourse (91.0%), followed by rape, failed contraception and missed pills. Sixty-five (84.4%) of Nurse/Midwives and CHEWs were willing to provide EC for prospective clients and 59(76.6%) of them had provided EC in the past. The commonest form of EC known to the respondents was Levonorgestrel (Postinor 2), followed by oral contraceptive pills (OCP) and intrauterine device (IUCD). Mifepristone and ulipristal were known to only 23.6% and 11.2% of the respondents respectively. Majority (79.6%) will give EC immediately after intercourse. Only 46.1% of the respondent would institute EC within 7 days of unprotected intercourse and among them, 50% were Nurse/Midwives and 46.4% were CHEWs. Conclusion: Both the knowledge and approval of EC among the HCWs in the IDP camps and host community clinics in Jere and Maiduguri metropolitan LGAs of Borno state are high. This can be harnessed to encourage the wide utilization of the EC by adolescents and other vulnerable womenin the IDP camps and Host communities.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hipertensió gestacional; Preeclampsia Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hipertension gestacional; Preeclampsia Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Gestational hypertension; Preeclampsia Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21 st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19. The study was supported by the COVID-19 Research Response Fund from the University of Oxford (Ref 0009083). A.T.P. is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the National Institute for Health Research (NIHR) Biomedical Research Centre funding scheme. The funding organization had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.

Maternal mortality continues to be a problem in the developing world, and unfortunately few pregnant women receive antenatal care (ANC) from skilled attendants in this region. It is known that men play a significant role in the health-seeking behavior of their families. Their involvement in ANC services may lead to improved women’s clinic attendance and maternal health. This descriptive cross-sectional study aimed to determine the proportion of husbands in Maiduguri, North-eastern Nigeria that accompanied their wives to ANC clinic, discussed issues related to pregnancy with them, and also the factors that influenced this role. A multi-stage sampling technique was used to recruit 307adult males, 18 years and above, who had fathered at least one child in the last two years preceding the study. Data were collected using pre-tested researcher-administered questionnaires designed from USAID Compendium of Indicators for Evaluating Reproductive Health Programs, and Health Belief Model of Health Behavioural Change Theory. The data was entered into the IBM SPSS software version 20.0 (New York, 2011). An analysis was performed to identify variables that suggest a significant association using Odds ratio and p-value

Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.

Background: Prelabor rupture of membranes (PROM) is a common obstetrics problem associated with maternal and perinatal morbidity and mortality.Patients and Methods: This was a hospital-based cross-sectional study to determine the risk factors for PROM among women presenting to the Department of Obstetrics and Gynecology of the University of Maiduguri Teaching Hospital, Maiduguri. It was conducted between 1st May 2016 and 28th February 2017. Sociodemographic and obstetrics variables were obtained from the patients, and risk factors such as previous preterm delivery, previous PROM, miscarriages, fever, abnormal vaginal discharge, urinary tract infection, abdominal distension, trauma, and coitus were sought. For each patient, an endocervical swab, high vaginal swab, and urine samples were taken for microbacteriologic studies. The next patient without PROM is used as control. Data were analyzed using SPSS 20. A total of 258 (129 with PROM and another 129 without PROM) were analyzed.Results: The mean age, gestational age, and parity were 27 ± 6 years, 33 ± 0.3 weeks, and 1 ± 0.92, respectively. A majority of the women (55%) had parity between 1 and 4. Term PROM recorded the highest frequency [49 (37.9%)]. Previous history of PROM [odds ratio (OR) 5.18, 95% confidence interval (CI): 2.31–11.62], history of Preterm Delivery (OR 3.26, 95% CI: 1.16– 9.19), low socioeconomic status (OR 1.95 95%, CI: 1.15–3.31), and genitourinary infection are highly predictive of PROM.Conclusion: The modifiable or treatable risk factors should be addressed during the antenatal care to reduce the risk of PROM. High-risk patients should be counseled and monitored closely to optimize pregnancy outcomes.Keywords: Maiduguri; morbidity; mortality; prelabor rupture of membranes; risk factors

Objective: To study the determinants of neonatal survival and outcome of preterm deliveries at the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.Materials and Methods: A retrospective case‑control study of women who had preterm delivery (PTD) at the UMTH, Maiduguri from January 1, 2014 to December 31, 2015 was conducted. Information on socio‑demographic characteristics, antenatal care and treatment, Apgar score, Special Care Baby Unit (SCBU) and Statistical Package for Social Sciences (SPSS) admission and perinatal mortality were collated. Statistical analysis was done with SPSS. Odd ratio was used to test for association and multiple logistic regression was computed to control for confounding variables at 95% confidence interval.Results: A total of 183 preterm births (with 195 babies) and 183 term births (with 184 babies) having complete information were analyzed. PTD occurred in 10.38% (19/183) of teenage mothers and 31.16% (68/183) of the PTD were before 32 weeks of gestation. Majority of the mothers have had at least basic education (63.69%). The mean duration of admission for the preterm babies was 1.9 + 8.4 days with neonatal survival and take home baby rate being 72.31% (141/195). Neonatal survival was independently associated with gestational age at delivery >32 weeks (OR = 12.24, CI: 5.67–34.76), antenatal dexamethasone (OR = 10.82, CI: 2.38–48.22), pre‑labour premature rupture of membranes (OR = 7.68, CI: 1.83–34.64), and delivery after at least 24 hour of commencement of dexamethasone (OR = 5.66, CI: 1.23–45.23). However, maternal febrile illness (OR = 0.25, CI: 0.11–0.56) and polyhydramnious (OR = 0.29, CI: 0.16–0.55) adversely affected neonatal survival.Conclusions: The neonatal survival following PTD is high. Survival is more likely in babies born after 32 weeks, PPROM, and after antenatal dexamethasone. We recommend routine use of antenatal dexamethasone injection in women at risk of PTD and planned delivery at the tertiary centre with equipments to cater for the special needs of the preterm babies.Key words: Antenatal corticosteroids; determinants; gestational age; preterm delivery; pre‑labour premature rupture of membranes; perinatal mortality.

Background: Many women are not aware of emergency contraception, which limits its use. Because increased risk of unwanted pregnancy and subsequent unsafe abortion have been well‑documented, research on the knowledge and usage of emergency contraception is appropriate.Materials and Methods: The present study was a descriptive cross‑sectional study conducted among 450 female undergraduate students of a University in northeast Nigeria from November to December 2014.Results: The age range of the respondents was 19–30 years, with a mean age of 21.4 ± 2.1 years. Most of them, 308 (68.4), were between the ages of 20 and 24 years. Majority of the students, 321 (71.3%), were single. Overall, 295 (65.5%) students were aware of emergency contraception, and 211 (71.5%) had utilized them. Among those who had utilized them, 174 (82.4%) were singles. The most common source of initial information about emergency contraception was health personnel, 148 (50.1%), followed by friends, 107 (36.3%). School, 11 (3.7%), and parents, 4 (1.4%), were the least utilized sources of information. Information from health personnel, news media and schools were the major influences of emergency contraceptive utilization. Levonorgestrel only pills (Postinor‑2R) and combined pills (Yuzpe) were the most commonly utilized emergency contraception by 91 (43.1%) and 85 (40.3%) of the respondents, respectively.Conclusion: There was good level of awareness and utilization of emergency contraception among female undergraduates. However, there is a need to educate the parents, students and staff or counselors at the family clinic section of the university health clinic on its importance to improve the awareness of the students.Keywords: Awareness; emergency contraception; Nigeria; University of Maiduguri; utilization

Although iatrogenic ureteral injuries are uncommon, but continues to poses a great challenge of potencial injuries to the gyanaecologists and young surgeons, especially during difficult abdominal and pelvic surgeries. We present two cases of ureteral injuries in our centre which occurred during challenging gynaecolgical procedures. Extensive abdomino-pelvic adhesions and large pelvic tumours were the main risk factors in the two index cases . Sites of injuries and the risk factors were discussed. Thorough preoperative evaluation in anticipation of iatrogenic injuries, sound knowledge of surgical anatomy with experience, ureteral stenting before the main procedure, meticulous dissections and discouraging "blind clamping" during bloody procedures among others can prevent such injuries. High index of suspicion is important for early detection of the injuries.

Tramadol is a synthetic analogue of codeine. Its mood elevation property and sex enhancement potentials are the main reason for its abuse. The aim of the study was to determine the short-term effect of tramadol administration on Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Testosterone (TEST) levels in Male Sahel Goats. This was an experimental study conducted from 1st October 2017 to 12th November 2017 at the Livestock Teaching and Research Farm, University of Maiduguri, Maiduguri, Borno State Nigeria involving 20 Male Sahel Goats. The goats were divided in to 4 groups of 5 each; group 1 served as control and groups 2, 3 and 4 were injected intramuscularly with 4 mg/kg (low dose), 8 mg/kg (medium dose) and 12 mg/kg (high dose) of Tramadol respectively. The injections were given intramuscularly, 3 times a week for 4 weeks. Blood samples were collected to determine the serum levels of FSH, LH and TEST at 0, 1 week, 2 weeks, 3 weeks and 4 weeks of tramadol injections. The Mean±SD of the hormones were computed using SPSS 20. The difference in mean was compared using t test and ANOVA with p < 0.05 set for statistical significance. The baseline levels of FSH, LH and TEST in Male Sahel Goat in Maiduguri were 2.91±5.74 Miu/ml, 0.29±0.72 Miu/ml and 3.92±6.39 ng/ml respectively. Only the goats in group 4 showed a significant increase in serum FSH and LH by the 4th week (P=0.01 and 0.03 respectively) while no significant change was noted in the other groups. The was a decline in the level of Testosterone from 1st week through 4th week in all the experimental group but the level in the control group remain fairly constant throughout the experiment. The decline is inversely proportional to the dose of tramadol injection and most marked in group 4.High dose and prolonged used of Tramadol should be avoided because of side effects of Hypergonadotrophic hypogonadism.

To determine the risk factors and microbial isolates of puerperal sepsis. A 12 year retrospective review of patients with puerperal sepsis from January 1999 to December 2010 at the University of Maiduguri Teaching Hospital (UMTH) was conducted. Information on socio-demographic characteristics, clinical presentations, place and mode of delivery and microorganism isolated from the endocervical swabs was collected and analysed. Comparison was also made with the other women that delivered during the period of study. The incidence of puerperal sepsis was 0.78%. Majority (88.0%) of the patients were unbooked, 59.1% delivered at home and 23.1% delivered in other peripheral hospitals. The major risk factors for developing puerperal sepsis were unbooked status, home delivery, perineal trauma, caesarean section (C/S) and maternal age

Introduction: Obstructed labor is a common cause of feto-maternal morbidity and mortality in Maiduguri, Nigeria. This study aimed to determine the prevalence, causes, risk factors, and outcome of obstructed labor at the University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: This was a retrospective observational study of all cases of obstructed labor managed from January 2012 to December 2014 at the UMTH, Maiduguri, Nigeria. For each case, the next woman who delivered without obstruction was used as a control. Data were analyzed for sociodemographic variables, labor, delivery and postdelivery events using SPSS version 20.0. The Chi-square test and odds ratio (OR) were used and statistical significance set at P < 0.05. Results: The prevalence of obstructed labor was 2.13%. Cephalopelvic disproportion, persistent occipitoposterior position, and malpresentation were seen in 65.37%, 16.58%, and 11.71%, respectively. The risk factors were teenage pregnancy (χ2: 26.96, P < 0.0001, OR: 4.44, 95% confidence interval [CI]: 2.45–8.05), nulliparity (χ2: 50.70, P < 0.0001, OR: 4.63, 95% CI: 2.99–7.15), illiteracy (χ2:53.91, P < 0.0001, OR: 5.26, 95% CI: 3.31–8.33), and unbooked status (χ2: 113.26, P < 0.0001 OR: 11.9, 95% CI: 7.24–19.61). Complications were observed in 37.56% of the women with obstructed labor. The common morbidities were wound sepsis, ruptured uterus, and puerperal sepsis, seen in 16.59%, 13.17%, and 7.81%, respectively. The case fatality rate was 0.98% and perinatal mortality was 34.15%. Conclusion: Obstructed labor is common in Maiduguri. We recommend amelioration of the risk factors through advocacy, girl child education, and public enlightenment on the need for antenatal care and hospital delivery, identification, and referral of high-risk patients.

Fetus papyracie in a triplet pregnancy is indeed rare and can pose serious management challenges. These challenges are more pronounced where facilities for monitoring are either inadequate or nonexistent. A 39‑year‑old, grand multipara multipara was referred to the University of Maiduguri Teaching Hospital at 27 weeks gestation with preterm contractions. Materno fetal monitoring did not reveal the cause of the preterm contractions. She was delivered via caesarean section, at 36 weeks of gestation, on account of decreased fetal movement and the products were a live female fetus weighing 2.3 kg and two male papyraceous fetuses weighing 150 g and 130 g, respectively.Keywords: Caesarean section, Fetus papyraceous, Preterm contractions, Triplet pregnancy

Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia Between January and June 2011, 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart. The maternal and fetal outcomes were compared. The primary outcome measure was recurrence of fits. The recurrence of fits and other maternal complications were similar in the two groups. The total dosage of magnesium sulphate in the shortened group was reduced by 40% in 66% of patients. The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia.

The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population- based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries.

Purpose: To determine the microbial isolates and their in vitro antibiotic sensitivity in puerperal sepsis. Methods: Two years records of all requests for endocervical swab microbial culture and antibiotic sensitivity tests for suspected cases of puerperal sepsis at the University of Maiduguri Teaching Hospital, Maiduguri, Borno state and Federal Medical Centre Azare, Bauchi state, both in North-East geopolitical zone of Nigeria were retrieved and analysed using the SPSS statistical package. Results: One hundred and thirty nine patient’s records were analysed. The most frequently cultured organism was Staphylococcus aureus in 43/139 (30.9%), followed by Eschericia coli which was isolated in 22/139 (15.8%) and Streptococcus Species in 8/139 (5.8%). Pseudomonas Species was cultured on one occasion only. Mixed growth occurred in 13 specimens (10.8%). In 30 cases (21.6%) there was either no growth (12/139) or the growth was not significant (18/139). Overall, the isolated micro-organisms had high susceptibility of >93% to Ofloxacin, Ciprofoxacin and cefuroxime while the susceptibility to Gentamycin and Augmentin were 68.8% and 51.6% respectively. In over 80% of the specimen there was marked resistance to Nalidixic Acid, Co-trimoxazole, Ampiclox and Amoxicillin. Conclusion: Staphylococcus aureus, Escherichia coli and Streptococcus species are the common bacteria isolates in puerperal sepsis in north-eastern, Nigeria and they are highly sensitive to Ofloxacin, Ciprofoxacin and Cefuroxime. Prompt treatment of cases with appropriate antibiotics will go a long way in reducing the associated morbidity and mortality.

Purpose: Sexual assault is a violent crime against both the individual and society but is largely underreported. The objective of this study was to determine the prevalence and nature of sexual assault among female students in the University of Maiduguri. Methods: A crossectional descriptive study using a close ended, self –administered questionnaire administered to female students of a tertiary institution in Maiduguri was used to survey 400 female students in University of Maiduguri. Results: Most of the respondents were single 349 (87.3%) and in the age range of 20-24 {202 (50.5%)}. 205 (51.3%) of them reported to have been sexually assaulted. In 154 (87.2%) of the cases, the respondents had a close relationship with the assailant. The commonest location of the assault was in a party 101 (49.3%), which was followed by classroom 45 (22%). Most of the sexual assault reported (57.6%) occurred in the evenings and nights. In 35.6% of the cases, the respondents sustained extra-genital trauma, while others had psychological (24.9%) and genital trauma (15.6%). Conclusion: Sexual assault rate among female students in the University of Maiduguri is high and is associated with physical and psychological traumas.Keywords: Sexual assault, Physical trauma, Psychological trauma, Maiduguri.

Background: About 30 million women living in malaria endemic area become pregnant each year. We determined the prevalence, determinants and consequences of malaria parasitemia in pregnancy inMaiduguri, North-eastern Nigeria. Method: Four hundred healthy pregnant women were randomly selected for the study. Packed cellvolume estimation and blood film examination for malaria parasite were done at booking and delivery. Cord blood and placental tissue were also examined for malaria parasite. Risk factors and consequences of malaria parasitemia were determined. Results: The prevalence of malaria parasitemia at booking was 60.3% with mean parasite density of 701.04+382.22 parasite/l. These dropped to 28.8% and 405.17+310.43 parasite/l, respectively at delivery. The factors associated with malaria parasitemia were young maternal age (p

Most of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period.

Background: Safe management of abortion with an easy, simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity, gestational age at presentation, indication for MVA use, duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period, out of which 251 were MVA procedures performed for various first trimester miscarriages, accounting for 13.2 % of the total gynaecological admissions. Sixty one (24.3%) of the patients who benefited from MVA were in the 25-29 years age group, while those in the age 20-24 and 30-34 years group constituted 21.5% and 20.7% respectively. Grandmultiparas (53.7%) constituted the majority. The procedure was performed for 50.2% of the patients at 9-11 wks of gestation. Most (88.0%) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0% were for check MVA after complete abortion and missed abortion. Most (67%) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre. Key words: Manual vacuum aspiration, Miscarriage, Experience, North eastern Nigeria

To determine the recurrence rate and risk factors for recurrence following myomectomy.Two hundred and thirty-two women who had open myomectomy were followed up for 3-10 years. Clinical features as well as pelvic ultrasound scan were used to evaluate the patients for recurrence. Recurrence rate was computed and the risk factors for recurrence were determined using Odd ratio comparing the Sociodemographic characteristics, preoperative symptoms, surgical and pathologic findings in the two groups of patients.The mean age and parity of the patients were 29.3 ± 3.8 years and 1.2 ± 1.1, respectively. The desire for procreation after surgery was noted in 183 (78.9%) of the patients while the rest desired resolution of symptoms. More than half of the patients had multiple symptoms. Intraoperatively, 63 (7.2%) had single fibroid removed while the rest were multiple varying from 2 to 67 pieces. The overall recurrence rate during the follow-up period was 20.7% (48/232) at 10 years and this increases with time. Positive family history of uterine fibroids, multiple uterine fibroids, and persistence or recurrence of three or more of the pre-myomectomy symptoms were significantly associated with the recurrence of uterine fibroids (OR = 21.83, 3.14, and 3.49, respectively) while pregnancy after myomectomy and the use of oral contraceptive pills (OCP) were protective.There is a high recurrence of uterine fibroid after myomectomy in our environment. The risk is higher among women with positive family history, multiple uterine fibroids, and in those with multiple symptoms. Pregnancy and use of OCP are protective.

This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms.

Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol.This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50 microg of misoprostol, 57 women had 100 microg of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion.Induction of labour constituted 6.6% (468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8%, followed by pregnancy induced hypertension in 33.5%. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (chi2 = 1.13, p = 0.57). The mean induction delivery time was shortest for those induced with 100 microg of misoprostol (6.38 +/- 2.25 hours), followed by 8.16 +/- 3.58 hours in those induced with 50 ug of misoprostol and 9.73 +/- 4.32. 43 hours in those induced with Foleys catheter/oxytocin (p0.001). The babies delivered to women induced with 100 microg of misoprostol were more asphyxiated 12.3% (7/57) compared to 9.2% (21/228) and 6.6% (12/183) in the 50 ug misoprostol and Foleys catheter/oxytocin respectively and was statistically significant (chi2 = 23.08, p = 0.01). The short induction delivery time in the group with 100 microg of misoprostol was advantageous but there was an associated higher risk of birth asphyxia, stillbirth, uterine hyperstimulation, perineal tear and uterine rupture. The normal delivery outcome was not significantly different from those induced with 50 microg of misoprostol and those induced with Foleys catheter/oxytocin (chi2 = 1.24, p = 0.94). Normal delivery rate was significantly higher in those induced with 50 microg of misoprostol compared with those induced with 100 microg of misoprostol (chi2 = 14.38, p = 0.01).Misoprostol appears to be safe and may be a suitable alternative for induction of labour by the traditional Foleys catheter/oxytocin protocol. The 50 microg dosing of misoprostol is safer than the 100 microg.

Vesico-vaginal fistula (VVF), an abnormal communication between the vagina and the urinary bladder, leads to continuous leakage of urine that is not just a severe medical problem but a great social...

Background: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. Materials and Methods: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. Results: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30–49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of

Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1–6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.Key words: Abdominal myomectomy, conception, in vitro fertilization, infertility, uterine fibroids