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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.

Background. Fetal fibronectin is a useful biomarker in the diagnosis and management of preterm labour. Objectives. To evaluate the relationship between cervical fetal fibronectin and preterm delivery and the association between cervical fetal fibronectin level and gestational age at delivery. Materials and Methods. A prospective cohort study was performed in a tertiary hospital in Nigeria, involving equal number of pregnant women with (96) and without (96) preterm labour. Fetal fibronectin assay was done using solid-phase immunogold assay. The data were analysed using IBM SPSS version 24. Descriptive and inferential statistical analyses were done. The level of significance was p-value

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was previous caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost two-thirds of the subjects (62.5%) had emergency caesarean section. The average birthweight was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication recorded 38.0%. There was direct maternal death in 2.0% of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. Conclusion: There is a high rate of caesarean section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with caesarean section rate of greater than 10% - 15%. Stakeholders and policy makers need to do more to mitigate this rising trend.

Background: Postmenopausal bleeding (PMB) is caused mainly by benign disorders; however it is sometimes caused by endometrial cancer. Aim: We here attempted to determine what conditions account for PMB in an outpatient clinic of a University hospital in London. Methodology: Study subjects consisted of 179 patients with PMB who were referred to us from July to December 2019. Sociodemographic data including patient’s age, risk factors, diagnosis and management were reviewed. Underlying conditions where determined. Results: Of 179 subjects, the following findings were made: 1) Age 59.63 ± 8.3 (mean and standard deviation). 2) Parity; multiparity, 57.0% (mean ± 1.67). 3) First episode of PMB, 77.1%. 4) The most frequently observed risk factor; obesity 34.6%. 5) The following accounted for PMB (diagnosis in order of incidence rate); genital atrophy 37.4%, submucosal fibroid 28.5%, endometrial polyp 20.7%, endometrial hyperplasia 6.7%, and endometrial cancer 5.6%. All patients were treated appropriately. We did not determine the prognosis of patients with endometrial cancer. Conclusion: Although the incidence of rate among women with PMB has already been reported, its reconfirmation in a single facility is important for making policies in the treatment of PMB.

Background: The application of invasive obstetric procedures has an end point of reducing the Caesarean section rate. The declining rate of use of these procedures is one of the reasons for increasing Caesarean section rates in our environment. Objective: The aim of the study was to determine the practice of operative vaginal deliveries among obstetricians practicing in Nigeria and to evaluate the reasons for non-use of these procedures. Methodology: It was a questionnaire based study. The questionnaires were administered to practitioners of Obstetrics in the various centres in Nigeria. Data was collated and analyzed with Epi-Info statistical software version 7.0 (Center for Disease Control and Prevention, USA), and conclusions were drawn by means of descriptive statistics. Results: A total of 1200 questionnaire were distributed but 1104 were returned and used for analysis. This gave a response rate of 92%. The age distribution of the respondents showed that the 20 - 30 year age group had the least number of respondents 22 (2%) while 41 - 50 age group had the highest number of respondents 486 (4%). The majority of the respondents were males 839 (76%). In terms of duration of practice, 449 (40.7%) of the respondents had more than 6 years duration of practice while 256 (23.2) had practiced for less than 3 years. Tertiary centres had highest number of respondents 71.8%. The distribution of the respondents according to the geopolitical zones in Nigeria are; South-East (57.6%), South-South (19.6%), South West (11.4%), North-West (4.9%), North-East (3.8%), North-Central (2.7%). The practice of these procedures among respondents were: External cephalic version (68.0%), Symphysiotomy (41.7), Forceps delivery (68.8%), Destructive delivery (60.1%), Vaginal breech delivery (85.5%), Vacuum extraction (84.8%). Reasons for the non-use included: Risk of perinatal/maternal morbidity and mortality greater than benefit (25.7%), Lack of equipment (22.4%), Lack of skills (16.6%), Decline by patients (6.5%), Not in the departmental protocol (26.2%), Not evidence based (34.6%), Patient preferred Caesarean section (5.6%), Outdated (32.6%), fear of litigation (32.7%). The mean rate of caesarean section according to rates reported from different centres was 25.2% while the individual centre rates ranged from 2% to as high as 51%. Conclusion: There is a decline in the practice of operative obstetric procedures among obstetricians practicing in Nigeria. There is an urgent need to reverse this trend by increased training and re-training of manpower, provision of necessary equipment, more research to provide supportive evidence of need and inclusion in protocols.

Paul O Ezeonu,1 Okechukwu Bonaventure Anozie,1 Fidelis A Onu,1 Chidi U Esike,1 Johnbosco E Mamah,1 Lucky O Lawani,1 Robinson C Onoh,1 Emmanuel Okechukwu Ndukwe,1 Richard Lawrence Ewah,2 Rita Onyinyechi Anozie3 1Department of Obstetrics and Gynaecology, 2Department of Anaesthesia, 3Department of Radiology, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria Background: The pain of childbirth is arguably the most severe pain that most women will endure in their lifetime. Epidural analgesia is widely used as an effective method of pain relief in labor. It provides almost complete relief of pain if administered timely, and does not affect the progress of the first stage labor.Objectives: The objective of this study was to determine the awareness and utilization of epidural analgesia in labor in pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki (FETHA).Methodology: This is a cross-sectional study involving 350 women attending the antenatal clinic between April 2016 and July 2016. A total of 335 questionnaires were correctly completed, and used for analysis.Results: The average age and parity of the respondents were 27.6±8.2 years and 2.4±1.8, respectively. About 58.2% of respondents were civil servants, 98.5% were married, and 74.6% had a tertiary level of education. About 43.3% of the respondents are aware of the use of epidural analgesia in labor, but only 7.5% had used it; 95% of these were satisfied and desired to use it again. The reasons responsible for the poor uptake were desire to experience natural labor, cost, and fear of side effects. However, 70% of those who had not used it expressed the desire to use it.Conclusion: Epidural analgesia is one of the most effective methods of pain relief in labor. However, the present study indicates that knowledge and practice of epidural analgesia among parturients are low. Efforts should be made to raise awareness, dispel misconceptions, and subsidize the cost of providing this invaluable care in modern day obstetrics. Keywords: epidural, labor pain, practice, obstetric analgesia, perception

Introduction: Maternal age is an important determinant of pregnancy outcome and women aged 35 years or more at their first pregnancy are considered high risk pregnancy due to increased risk of feto-maternal morbidity and mortality. Aim: To evaluate the outcome of pregnancy in primigravid women who were aged 35 years and above. Materials and Methods: A five-year retrospective study among elderly primigravidae was conducted. The study assessed 78 booked primigravidae aged 35 years or more who delivered at the Federal Teaching Hospital Abakaliki from 1st January 2012 to 31st December 2016. Each elderly primigravida was matched with two primigravid women aged 20-25 years who delivered during the same period. Postnatal visit was also assessed. Results: During the study period, there were 11,329 deliveries and 78 of these were elderly primigravidae giving an incidence of 0.69% or 1:145 deliveries. The mean age of the elderly primigravidae was 36.28±1.20 years. The study group had more antepartum complications with anaemia, antepartum haemorrhage, hypertensive disorders of pregnancies, diabetes mellitus and preterm labour (p

Background Menstruation has a variable pattern. Knowledge of age at menarche and providing accurate information to adolescent girls is necessary to allay anxiety, treat menstrual morbidities, and improve their quality of life. Objective To determine the age at menarche and menstrual characteristics of adolescent secondary school girls in Abakaliki. Materials and methods A cross-sectional descriptive study was conducted in seven secondary schools in Abakaliki among 960 female students. A total of 450 girls were randomly selected for the study. A pretested self-administered questionnaire was used in data collection. Four hundred questionnaires were properly filled and used for the final analysis. Results The age range of the students was between 10 - 21years. The mean age of the respondents was 16.2 ± 1.7years. The average age at menarche was 13 ± 1.0 years. Urban dwellers had menarche 0.2years earlier than rural dwellers. There is an association between menarche and social class (X [2] 372.9 (2), p = 0.001). About 87.75% of the respondents had an average cycle length. Most (88.3%) of the respondents had a menstrual flow duration of 3–5 days. Dysmenorrhoea was present in 82% of respondents and was severe enough to cause absence from school in 56.5% of students. Oligomenorrhea and menorrhagia occurred in 8.5 % and 6.25 % of the student studied. Mothers (80.0%), friends (75.0%) and teachers (74.5%) accounted for the bulk of the information on menstrual health. Conclusion The average age at menarche was 13 ± 1.0 years. Dysmenorrhea is a major cause of morbidity amongst this age group and should be empathically addressed. It is therefore important that the students, their parents, and school managers in the study area be educated on the issues of menstrual problems that can occur in an adolescent., Quality of Life; Obstetrics and Gynecology; Reproductive System; Pediatrics; Endocrine System; Abakaliki; Adolescent; dysmenorrhea; Menarche; menstrual health; menorrhagia; Student