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This study aimed to determine the incidence of, and identify independent risk factors to retained placenta in Ile-Ife, southwestern Nigeria.This was a prospective case-control study involving 120 women with retained placenta after vaginal birth at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, southwestern Nigeria over a period of seven years. Two consecutive normal deliveries after each retained placenta served as controls. Following a bivariate analysis, a multivariate logistic regression model was constructed in order to define independent risk factors for retained placenta while controlling for confounding variables.During the study period, there were 120 cases of retained placenta, and the total number of deliveries was 6,160, making the incidence 1.9 percent. Independent risk factors associated with retained placenta include non-use of antenatal care (odds-ratio [OR] 22.71, 95 percent confidence interval [CI] 10.5-49.12, p-value is less than 0.000), previous retained placenta (OR 15.22, 95 percent CI 3.30-70.19, p-value is less than 0.000), previous caesarean section (OR 12.00, 95 percent CI 2.05-70.19, p-value is less than 0.006), maternal age 35 years or more (OR 7.10, 95 percent CI 1.5-32.40, p-values is less than 0.012), grand multiparity (OR 6.63, 95 percent CI 1.88-23.40, p-value is less than 0.003), previous dilatation and curettage (OR 4.44, 95 percent CI 1.69-11.63, p-value is less than 0.002), preterm delivery (OR 3.12, 95 percent CI 1.12-8.68, p-value is less than 0.029) and placenta weight less than 501 g (OR 2.91, 95 percent CI 1.34-6.32, p-value is less than 0.007).Women with identifiable risk factors should be targeted for the prevention of retained placenta. There is a need for the training of birth attendants in the proper conduct of delivery and third stage of labour to prevent placenta retention and postpartum haemorrhage.

The magnitude of fallopian tube disease and their contribution to infertility in Nigeria and in Africa are gross among the cohorts of women presenting with difficulty in childbearing. The objective of the study is to assess the trend and pattern of tubal disease in infertility and pregnancy rate among patients undergoing tubal surgery at the Obafemi Awolowo University Teaching Hospital Complex. A descriptive retrospective study of all cases of tubal disease in infertility who admitted for surgery between January 1st 1993 and December 31st, 2000 at the Obafemi Awolowo University Teaching Hospital Complex. There were 6144 infertile women among 29,011 females of reproductive age group attending the hospital during the study period giving an overall incidence of infertility of 21.2%. Among this group, 1352(22%) were due to tubal disease. One hundred and twenty five (125) of these patients showed up for surgery and thirteen pregnancies were recorded giving an overall pregnancy rate of 10.8%. About one in four of these patients had had previous tubal surgery for infertility. Salopingolysis had the best pregnancy rate with about 19.3% success. Tubal disease is a common cause of infertility in South Western Nigeria and success rates following surgery are low. We advocate the establishment of regional fertility centres as a cost effective way of improving access to modern assisted conception techniques.

Background: Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus. Objective: To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution. Design: Retrospective review over a 12 year period from January 1988 to December 1999. Setting:Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria. Subjects:All cases of retained second twin managed during this period. Main outcome measures:Causes, sources of referral, perinatal and maternal complications. Results:The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively. Conclusion: The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres. (East African Medical Journal: 2003 80(2): 110-113)

This was a cross-sectional population survey carried out to determine utilization of approved health facilities for delivery by mothers in Ile-Ife and factors influencing the observed utilization. A total number of 117 mothers who had delivered once or many times were selected using the systematic sampling method. Information was collected using pretested structured interview administered questionnaire. Data collected was analyzed using frequency tables and statistical test of significance. Of the 117 mothers interviewed, 70 (59.8%) booked in approved health facilities while 51 eventually delivered in the approve health facilities. The prominent reasons given for non utilization of health facilities were time of occurrence of labor, difficulty with transportation, fear of surgical operation, husband/family influence and delivery assistance by TBA's and relatives. Educational status of the mother, religious beliefs, distance from approved health facilities more than 5 km and attitude of health workers were amongst factors significantly influencing choice of place of delivery by the mothers.

Caesarean section among the Yoruba of western Nigerian is surrounded by a lot of fears, miseries, aversion, guilt and misconceptions for reasons varying from the desire by women to have a natural vaginal birth, fear of surgery, morbidity and deaths from the operation and prolonged hospital stay.To examine issues of reduced hospital stay following Caesarean section with a view of making the operation more acceptable and proffering solution to some of the problems faced by women when Caesarean section is indicated.A prospective case control study.Wesley Guild Hospital, Ilesha, Nigeria from 1st July, 1997 to 30th June, 1998.One hundred consecutive patients who had uncomplicated Caesarean section, randomised into two groups of short (three days) and prolonged (seven to eight days) hospital stay respectively.Observations of patients in both groups were made by an independent observer on day seven post-operation and the main outcomes measured included: wound infection rates, ability to maintain erect posture, mood changes, neonatal sepsis rate, immunisation rate of the neonates and average hospital bills.The findings revealed that wound infection rates of six per cent and ten per cent among the short and prolonged hospitalised patients respectively are not significantly different. Patients with short stay have better erect posture, lower incidence of depressive mood, lower neonatal sepsis rate, lower hospital bill and are more satisfied with early home discharge.Embracing the concept of early home discharge after Caesarean section in uncomplicated cases may remove some of the psychological upsets and economical impediments associated with the operation and make the operation more acceptable.

An unusual presentation of a ruptured uterus with extrusion of twin fetuses into the urinary bladder is described. A routine pelvic ultrasound to confirm pelvic collection from a suspended criminally induced abortion revealed a rupture of the anterior wall of the uterus with communication to the urinary bladder and this finding was confirmed at laparatomy. While a high index of suspicion is important in the diagnosis of ruptured uterus, a subtle place for pelvic ultrasound in patients with vaginal bleeding, suprapubic pain and haematuria may be of help.

A rare case of faecal fistula resulting from undiagnosed abdominal pregnancy that had earlier co-existed with intrauterine conception. Both the extrauterine and intrauterine foetuses were well developed. Normal baby was delivered by emergency lower segment caesarian section 9 months before presentation with enterocutaneous fistula and sepsis.

The incidence of umbilical cord prolapse at Obafemi Awolowo University teaching hospital complex, Ile-Ife over a ten year period was 0.42% (one in 240 deliveries). The incidence was observed to be higher among the unbooked patients (76.7%). Analysis of the 60 cases reveals that multiparity, unengaged presenting part from cephalo-pelvic disproportion, prematurity, prelabour spontaneous rupture of membranes, breech presentation, and multiple pregnancy were the major contributory factors. The perinatal mortality (36.7%) was significantly higher than that of the hospital which was 8% (P0.05). The perinatal mortality rate was higher among the unbooked patients (86.4%). Caesarean section gave better results except when the cervix was fully dilated. Early resort to Caesarean section, proper and adequate antenatal care and properly supervised hospital delivery is recommended.