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Background: Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria., Aim: To determine the prevalence and factors associated with AD in first half of pregnancy., Setting: Multicentric health facilities in Southern Nigeria., Methods: A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD., Results: The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6-32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00-13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48-8.38), poor social support (AOR 4.70; 95% CI 2.99-7.38), past history of depression (AOR 4.67; 95% CI 2.47-8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57-3.89), low socio-economic status (AOR 2.41, 95% CI 1.61-3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47-3.64)., Conclusions: The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Introduction: Two-Dimensional ultrasound (2DUS) has been the preferred screening method for fetal abnormalities for several decades. Three-dimensional ultrasound (3DUS) is a technique that converts standard 2D grayscale ultrasound images into a volumetric dataset which allows visualization of the fetus in all three dimensions at the same time. It provides an improved overview and a more clearly defined demonstration of adjusted anatomical planes. The use of 3D imaging is however limited to being an adjunct to 2DUS in the visualization of fetal anomalies. The objective of this study is to highlight the importance of adding three-dimensional ultrasound (3DUS) to two-dimensional ultrasound (2DUS) during fetal anomaly screening., Methodology: This is a descriptive study conducted at a private fetal diagnostic center, in Nigeria between January 2014 and December 2016. The diagnosis of fetal anomalies was first made with 2DUS after which they were evaluated with 3D ultrasound images displayed on the monitor., Results: Nine fetuses with various fetal anomalies diagnosed on 2DUS were selected for further evaluation with 3DUS. These anomalies include a neck mass, lumbar spinal abnormality, bilateral cleft lip, thanatophoric dysplasia, anencephaly, omphalocele, posterior urethral valve with anhydramnios and ambiguous genitalia diagnosed. These anomalies were better demonstrated on 3DUS., Conclusion: 2DUS remains the mainstay imaging modality in screening for fetal anomalies. However, 3DUS may complement 2DUS by allowing better delineation of anomalies and gives the parents a better visualization and understanding of identified anomalies, thereby assisting in informed decision making., (© Association of Resident Doctors, UCH, Ibadan.)

Aims and Objectives: This study aimed at predicting foetal birth weight using various clinical methods and to determine which of the methods is the most accurate in this population., Subjects and Methods: Parturients of all parities admitted into the labour ward of OAUTHC, Ile-Ife at term for delivery were recruited for this study. They had their symphysiofundal height, abdominal circumference at the umbilical level, height and weight measured. The body mass index was then calculated. The birth weight was calculated from these measurements using four clinical formulae. The weights of the babies were measured after delivery and compared with the individual estimated birth weights., Results: There were 400 women who met the inclusion criteria during the time of this study. Three of the methods [Johnson's Rule, Ojwang's Rule and 5% maternal weight] overestimated the birth weight while 10% BMI underestimated the birth weight significantly., Conclusion: There is a strong correlation between the birth weights predicted by the various clinical methods and the actual birth weight. The accuracy of the methods can be improved by using the derived modified formulae.

Introduction: Pregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women., Methods: This was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography., Results: Diastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P(2)), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants., Conclusion: Significant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroidpattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.

Objective: To assess the attitudes of Nigerian women regarding the presence of a husband/partner during labor., Methods: Women who were invited to participate in a randomized trial regarding companionship in labor at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, were interviewed in a qualitative cross-sectional survey. Demographic characteristics and opinions regarding the presence of a partner/husband as a support person during labor were assessed., Results: Of the 197 women interviewed, 69 declined all forms of social companionship during labor; of the remaining 128 participants--who did not object to having a social companion--71 declined to have their husband/partner present during labor because of: personal embarrassment (28 [39.4%]); fear of loss of sexual attractiveness (19 [26.8%]); concern for their husband/partner (17 [23.9%]); and lack of privacy (15 [21.1%]). Of the 57 women whose husband/partner accompanied them during labor, 38 (66.7%) said that they would repeat the experience in subsequent labor, and 34 (59.6%) would recommend it. However, 15 (26.3%) expressed dissatisfaction., Conclusion: The issue of husband/partner companionship during labor is viewed with concern by Nigerian women, who should be allowed to make an informed decision., (Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls., Methods: A prospective matched case-control study., Results: HIV positive women were significantly more likely to have anaemia in pregnancy [p < 0.001, odds ratio (95% CI) 5.66 (3.0-10.5)], intrauterine growth restriction [p = 0.002, odds ratio (95%CI) 13.82 (1.8-106.7)], preterm labour [p = 0.03, odds ratio (95% CI) 2.89 (1.2-7.0)] and birth weight less than 2,500 g [p < 0.0001, odds ratio (95% CI) 5.43 (2.4-12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups., Conclusion: Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women.

Our objective was to evaluate the association between clinical chorioamnionitis following preterm pre-labour rupture of membranes (PPROM) and adverse neonatal outcome. We compared retrospectively, adverse neonatal outcome of singleton pregnancies with documented PPROM who developed chorioamnionitis (cases) with those who did not (controls). Our result showed that poor neonatal outcome was significantly associated with chorioamnionitis (34% vs 13%; p = 0.008). This association was found on multiple logistic regression analysis to be independent (p < 0.05) of other risk factors for poor neonatal outcome, viz: latency period (p = 0.002) and gestational age at delivery (p < 0.001). We conclude that chorioamnionitis complicating PPROM worsen neonatal outcome. The implication of this on expectant management of PPROM is discussed.

Our objective was to examine pregnancy outcome in women age 35 and over. We compared pregnancy delivery complications in 207 women aged 35 years and older with 219 control women aged 25 - 29 years. Data was collected retrospectively and stratified by parity. Results of statistical analysis showed that the older women differed significantly in (1) antepartum factors (previous pregnancy experience, chronic and pregnancy-induced hypertension, maternal and gestational diabetes, placenta previa) (2) intrapartum factors (malpresentations, fetal disproportions, abnormal labour, caesarean and operative vaginal delivery) (3) neonatal outcomes (birth asphyxia, prematurity, low birth weight, neonatal intensive care unit admissions). However, birth trauma and perinatal mortality did not differ between the two groups. We concluded that pregnancies in older women are prone to complications, but when managed accordingly the overall perinatal outcomes were good.

Background: Interventions that may help shorten the duration of pregnancy in an African setting where facilities for fetal monitoring in post-term pregnancy are limited, and induction is not without its hazards, are needed., Aim: To determine whether outpatient administration of intravaginal misoprostol safely decreases the interval to delivery in postdate pregnancies., Design: Open randomized controlled trial., Setting: Zonal district hospitals, Kwale, Southern Nigeria (August 2000 to October 2001)., Methods: Seventy-seven women were randomized at 40 weeks gestation to receive either 25 microg misoprostol intravaginally (38) or gentle cervical assessment only (39) on an outpatient basis. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed., Main Outcome Measures: Interval to delivery, duration of labor, and incidence of side-effects., Results: Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects., Conclusion: Outpatient administration of low-dose misoprostol can safely shorten the length of gestation in postdate pregnancies.

Our objective was to study the pregnancy outcomes among teenagers in a rural Nigerian setting. Single births to 1394 nulliparous mothers aged

Background: The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined., Objective: To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley's catheter for cervical ripening., Design: A prospective randomized controlled trial., Setting: Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001., Methods: Candidates for pre-induction cervical ripening were randomized to receive either 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervical Foley's catheter (n = 61)., Main Outcome Measures: Failure to achieve cervical ripening within 24 hours, need for augmentation, maternal and foetal complications., Results: Failure to achieve cervical ripening within two hours was reduced with misoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Need for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64 to 0.91). No significant differences existed in rates for uterine hyperstimulation, Caesarean section, maternal and neonatal morbidity., Conclusion: Intravaginal misoprostol in a low dose was compared to intracervical balloon catheter for pre-induction ripening of the cervix.

We set out to compare a policy of two-layered postpartum perineal repair leaving the skin unsutured with a policy of three-layered repair, which involved skin closure. Parturients who sustained a second-degree tear or an episiotomy in four Nigerian centers were randomised to have either a two-layered repair (417 women) or a three-layered repair (406 women). Fewer women in the two-layered group reported perineal pain at 48 hours (57% vs. 65%, relative risk [RR] 0.87, 95% confidence interval [CI] 0.78-0.97) and 14 days postpartum (22% vs. 28%, RR 0.77, CI 0.61-0.98). The two-layered repair was also associated with reduced risk of suture removal (6% vs. 10%, RR 0.62, CI 0.39-0.99), and less superficial dyspareunia at 3 months (6% vs. 12%, RR 0.52, CI 0.33-0.81). The rates of wound healing were similar between the two groups. Leaving the skin unsutured during postpartum perineal repair reduces perineal pain and dyspareunia.

Our objective was to compare oral misoprostol with intramuscular oxytocin in the prevention of postpartum haemorrhage. Four hundred and ninety-six women were randomised to receive either 600 microg misoprostol orally or 10 IU oxytocin intramuscularly after delivery. There were no significant differences between the misoprostol and oxytocin groups with regard to the incidence of postpartum haemorrhage (1% vs. 0% respectively, relative risk (RR) 3.02, 95% confidence interval (CI) 0.32-28.88) or drop in haemoglobin concentration (0.71 g/dl vs. 0.68 g/dl, respectively, P = 0.699). The length of the third stage of labour and the percentage of women requiring manual removal of placenta, further oxytocics or blood transfusion were also similar. Shivering was significantly higher with misoprostol (57% vs. 14%; RR 4.06, CI 2.93-5.62), but there were no differences in other side effects. We conclude that oral misoprostol can replace intramuscular oxytocin in reducing postpartum haemorrhage in low-risk women, in developing countries, especially as it is administered orally and it is thermostable in tropical conditions.

The aim of this randomised trial was to determine the effect of the policy of active management of labour in all its components on the rate of caesarean section in a Nigerian district hospital setting. Two hundred and twenty-one nulliparous women fulfilling selected inclusion criteria were randomised to receive active management of labour, and 227 control women received routine labour management. Labour was significantly shortened by over 2 hours with active management of labour, and caesarean section reduced (9% vs. 16%, RR 0.57, 95% CI 0.34-0.95). There were no significant differences in maternal infectious morbidity, uterine hyperstimulation syndromes, ruptured uterus or neonatal Apgar scores between the two groups. We conclude that active management of labour shortens primigravid labour and reduces caesarean risk.

The aim of this study was to ascertain the prevalence of anaemia in pregnancy in South Southern Nigeria, and to identify an 'at-risk' group for targeted intervention. Antenatal women were screened for anaemia for 1 year (October 2000-September 2001) at the booking clinics of our three government hospitals in Kwale zone. Univariate and multivariate logistic regressions of risk factors for anaemia ([Hb] < 11 g/dL) and severe anaemia ([Hb] < 7.0 g/dL) were carried out. The prevalence of overall anaemia and severe anaemia was found to be 56.1% and 6.7%, respectively. Independent risk factors for anaemia and severe anaemia were primigravidity, booking in late pregnancy and wet season. We conclude that anaemia remains a common problem in our population, and additional intervention for the 'at-risk' group is recommended.

Background: Iatrogenic injuries to the ureter are hazardous complications of pelvic operations, causing severe morbidity and even mortality., Objective: To present our 10 years experience in the management of such ureteric injuries., Design: A retrospective study carried out between January 1990 and December 1999., Setting: Two busy health institutions, namely Ife State hospital and Wesley Guild Hospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex, Ile-Ife, Nigeria., Results: The incidence of iatrogenic injury was 0.4%. Ureteral transection was the commonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operated cases. Those diagnosed at the time of injury and treated with end-to-end anastomosis had the best results., Conclusion: The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries.

This study was carried out to evaluate the efficacy and safety of membrane stripping at term in reducing the incidence of post-term (41 weeks or greater) pregnancies. One hundred and thirty-seven pregnant women at 38 weeks gestation were randomised to receive either membrane stripping (69) or gentle cervical examination (68). Women who received stripping had earlier delivery (4.8 vs. 12.1 days; P<0.001) and less incidence of delivery at 41 weeks or greater (3% vs. 16%; P=0.009). No statistically significant difference was noted in incidence of premature rupture of membranes, clinical evidence of chorioamnionitis, intrapartum characteristics and perinatal outcome. We conclude that membrane stripping is a safe method to reduce the incidence of post-term pregnancy.