A. A. Odukogbe

Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malignancy index

Aims:  To test the accuracy of risk of malignancy index (RMI) in preoperative prediction of malignancy and treatment of adnexal masses.

Ovarian cancer in Ibadan: characteristics and management*

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.

Stressors and Counseling Needs of Undergraduate Nursing Students in Ibadan, Nigeria

Existing evidence suggests that nursing students have high levels of stress and that counseling and other support services should be made available to them. However, the stressors and counseling needs of undergraduate nursing students in Nigeria have yet to be explored. This study used a questionnaire to investigate the stressors, counseling needs, and desired counseling facilities of undergraduate nursing students at the University of Ibadan. Common stressors included excessive schoolwork, financial problems, inadequate recreational facilities, and overcrowded accommodations. There was an association between reporting inconsiderate, insensitive lecturers as stressors and evidence of psychological distress. Nearly 60% of the respondents felt counseling would help them, and most desired counseling for academics, finances, and relationships. Most (78%) of the respondents preferred an independent facility with trained counselors. Desired characteristics for the services included accessibility, affordability, confidentiality, and a friendly atmosphere. Educators and administrators should use this information to design counseling facilities for students.

Grandmultiparitytrends and complications: a study in two hospital settings

Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8.99% (10.90% in 1987 to 3.36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8.59% (12.75% to 6.07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91.6% vs. 94.9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85.8% vs. 69.7%, respectively). In Group B 85.9% had spontaneous vertex delivery as opposed to 66.3% in Group A. Caesarean section was the mode of delivery in 9.0% and 24.2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2.51-3.00 kg in both groups. Macrosomic babies formed 3.7% in Group A and 2.4% in Group B, while low birth weight babies formed 17.7% and 11.7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10.85/100 000 total deliveries in Group A and 35.42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3.4% and 6.1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8·99% (10·90% in 1987 to 3·36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8·59% (12·75% to 6·07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91·6% vs. 94·9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85·8% vs. 69·7%, respectively). In Group B 85·9% had spontaneous vertex delivery as opposed to 66·3% in Group A. Caesarean section was the mode of delivery in 9·0% and 24·2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2·51-3·00 kg in both groups. Macrosomic babies formed 3·7% in Group A and 2·4% in Group B, while low birth weight babies formed 17·7% and 11·7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10·85/100 000 total deliveries in Group A and 35·42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3·4% and 6·1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.

Urinary pathogens and drug susceptibility patterns of urinary tract infections among antenatal clinic attendees in Ibadan, Nigeria

Aim:  To determine the bacterial agents involved in urinary tract infections in pregnant women and their antibiotic susceptibility patterns in Ibadan, Nigeria.

Intravaginal misoprostol versus transcervical Foley catheter in pre-induction cervical ripening.

Cervical status undoubtedly correlates closely with the success of induction of labor and studies have shown the benefits of prostaglandin preparations in pre-induction cervical ripening and labor induction. Misoprostol (Prostaglandin E1 analogue) has a long shelf-life even in tropical climates. Undoubtedly intravaginal misoprostol has advantages over transcervical Foley catheter in pre-induction cervical ripening. This report outlines the three cervical factors -- length consistency and dilatation -- responsible for the comparative advantage of intravaginal misoprostol above the transcervical Foley catheter in pre-induction cervical ripening. (excerpt)

Correlates of knowledge of antenatal patients about HIV transmission in Ibadan, Nigeria.

The HIV pandemic started in about 1981 and in recent times no single disease has attracted as much attention in the international community as this. Several studies have addressed the use of antiviral drugs and other strategies for preventing or at least reducing perinatal transmission. It is also essential to assess the level of knowledge of transmission and the determinants of this level among antenatal patients. There have been a few reports about determinants of knowledge of transmission among antenatal patients. This study aims to evaluate the determinants of knowledge of transmission of HIV among an African population of antenatal patients. (authors)

Ultrasound assessment of the effect of parity on postpartum uterine involution.

A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearsons) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearsons) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.

Assessment of tubal factor contribution to female infertility in a low resource setting (southwest Nigeria): Hysterosalpingography vs laparoscopy

Female factor contribution to infertility in Africa is commonly due to tubal disease. The incidence of bilateral tubal occlusion among infertile African patients is about three times higher than in the developed countries. This is largely due to a high prevalence of pelvic inflammatory disease in Africa. Tubal patency can be investigated using hysterosalpingography laparoscopy and dye test and more recently hysterosalpingo-contrast sonography. However laparoscopy is largely thought to be the gold standard for tubal assessment. Hysterosalpingography or hysteroscopy has a complimentary role to laparoscopy in excluding endometrial pathology in the evaluation of infertile patients. (excerpt)

Microbiological pattern of the contents of pelvic abscess at the University College Hospital, Ibadan, Nigeria

A retrospective analysis of 49 cases of pelvic abscess over a 10-year study period spanning 1 January 1989 to 31 December 1998 was undertaken. Forty-one patients had laparotomy to drain the pelvic abscess, while eight had colpotomy. The volume of pus drained at surgery ranged between 10 ml and 3.5 l for laparotomy, with a median value of 500 ml and 100 ml to 1 l with a median of 200 ml for colpotomy. There was no significant difference in these values. Swabs for bacteriological cultures were taken at surgery and results available in 18 patients. In two patients (11%) the cultures were sterile. In the positive cultures, Esherichia coli was isolated in seven patients. Klebsiella species and Staphylococcus aureus were isolated in four patients each. It is important to know the causative organisms for this infection in our environment because pelvic abscess is the end stage in the progression of a treatable genital tract infection and is frequently an unnecessary complication that is very expensive to treat.