Abiodun P. Aboyeji

Ruptured Uterus: A Study of 100 Consecutive Cases in Ilorin, Nigeria

Objectives: To determine the incidence, aetiology, trend, management maternal and fetal outcome of uterine rupture at University of Ilorin Teaching Hospital, Ilorin, Nigeria. To compare the results with previous reports from this centre.

Prevalence of sexually transmitted diseases among pregnant women in Ilorin, Nigeria

In a cross-sectional study, 230 pregnant women attending the antenatal clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria from January 2000 to December 2000 were screened randomly to determine the prevalence of common STDs among them, using conventional methods. One hundred and fourteen (49.4%) of the subjects harboured various agents including Candida spp. (37.8%), Trichomonas vaginalis (4.7%), Gardnerella vaginalis (3.9%), syphilis (1.7%) and Neisseria gonorrhea (1.3%). Risk factors associated with significant infection were young age and level of education. The importance of routine STD screening in pregnancy especially among the young and illiterate is advocated. It is recommended that routine screening for STDs should be incorporated into antenatal care.

Analysis of 348 consecutive cases of primary postpartum haemorrhage at a tertiary hospital in Nigeria

A retrospective analysis of 348 cases of primary postpartum haemorrhage (PPH) that occurred at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between 1 January 1993 and 31 December 1996 was carried out. The incidence of PPH was 4.5%. Booking status of the patients had no relation with occurrence of PPH in this study (P > 0.05). The risk of PPH in advanced maternal age (over 35 years) and grandmultiparity (para 5 and over) was twofold higher than low maternal age (< 25 years) and low parity (para 0–1), P < 0.05, respectively. The incidence of PPH was higher in deliveries conducted by midwives than doctors (P < 0.05). Anaemic patients (PCV ⩽ 30%) were more at risk than non-anaemic patients (P < 0.05). Uterine atony, 183 (53.8%) was the most common cause of PPH and a combination of uterotonic agents and uterine massage were effective in controlling PPH in 171 (49.1%) of the cases. Seven (2.0%) patients required hysterectomy. One-third of the patients had a blood transfusion. To reduce the incidence of PPH, we recommend that doctors should supervise the delivery of parturients at risk of PPH and advocate health education against high parity.

Asymptomatic Bacteriuria in Antenatal Patients in Ilorin, Nigeria

OBJECTIVE To determine the prevalence of asymptomatic bacteriuria, bacteriology and sensitivity pattern in Ilorin using the gold standard of urine culture. METHODS A prospective study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital (UITH) on 125 consenting asymptomatic pregnant women. A structured proforma was used to collect information from the women and a midstream urine specimen collected for bacteriological culture. RESULTS Of the 125 pregnant women, 50 had bacteriuria on urine culture giving a prevalence of 40%. The mean age of the women was 28.5 years with a standard deviation of 4.95. The age ranged between 14 and 40 years. Staphylococcus aureus was the commonest pathogen isolated (72%), followed by Proteus spp (14%). Most of the organisms showed good sensitivity to Nitrofurantoin and gentamicin. CONCLUSION The prevalence of asymptomatic bacteriuria in Ilorin is high and routine urine culture is advocated for all pregnant women at booking.

Maternal mortality in a Nigerian teaching hospital - a continuing tragedy.

The aim of this review is to determine the maternal mortality ratio (MMR) in a Nigerian tertiary health institution (University of Ilorin Teaching Hospital, Ilorin, Nigeria). The review was done through a retrospective analysis of maternal mortality records. The MMR for the 6-year period (1997-2002) was 825 per 100,000 live births. The common causes of maternal mortality included severe pre-eclampsia/eclampsia, 30 (27.8%); haemorrhage, 22 (20.4%) and complications of unsafe abortion 16 (14.8%). Grandmultiparous and patients aged 40 years and above were at the highest risk. This hospital-based MMR is very high and when compared with previous reports showed a 150% increase. Most of the maternal deaths are, however, preventable. Increased efforts at educating women, improvement of the socioeconomic conditions of the populace and strong political commitment in making emergency obstetric care available in rural and district hospitals are some of the measures that need to be adopted to reduce this avoidable tragedy.

Rectovaginal fistula following sexual intercourse: a case report.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohns disease are also common etiological factors. The index case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband.

Trends in maternal mortality in Ilorin, Nigeria 1987)1996

This article indicates that the University of Ilorin Teaching Hospital in central Nigeria had 229 maternal deaths out of 42976 deliveries between January 1987 and December 1996. The general maternal mortality rate was 532/100000 total deliveries. The main causes of death were hemorrhage (20.3%) illegal abortion (19.4%) and puerperal sepsis (15.2%). Maternal mortality declined slightly during 1987-91 and increased gradually during 1992-95. The increases are attributed to a downturn in the economy and lower purchasing power among the people. People may have been unable to afford hospital fees for basic obstetric care and sought alternative therapies. It is urged that a Special Task Force be set up to ensure accurate data records and appropriate policies.

Pattern of cervical dilatation among parturients in Ilorin, Nigeria.

OBJECTIVE To evaluate the pattern of cervical dilatation in live singleton pregnancies with spontaneous onset of labor and to compare any differences among nulliparas (P ara 0) and multiparas (Para >or=1). MATERIAL AND METHODS Descriptive statistics are presented for 238 consecutive labor patients with spontaneous onset, >or=37 weeks gestation, live singleton pregnancy and who had spontaneous vertex delivery at the University of Ilorin Teaching Hospital, Nigeria, from May 2004 to June 2004. Pre-labor rupture of membrane and referred cases were excluded. RESULTS The mean cervical dilatation on presentation and duration of labor before presentation in labor ward among nulliparas were 5.40 cm and 6.66 hours; and among multiparas, 6.45 cm and 5.15 hours, respectively, the overall mean being 6.12 cm and 5.63 hours, respectively. The average time spent to achieve full cervical dilatation from time of arrival in labor ward was longer in nulliparas (4.80 hours) than in multiparas (3.60 hours) (t test not significant; P> 0.05). Overall mean total length of first stage of labor was 9.36 hours, while the total length of first stage of labor was 11.03 hours and 8.53 hours for nulliparas and multiparas, respectively (difference is significant; t test P< 0.05). Significant negative correlation existed between parity and total length of first stage of labor. Mean cervical dilatation rate in labor ward (active phase) was higher in multiparas (1.83 cm/h) than in nulliparas (1.76 cm/h), but the difference was not significant (t test P> 0.05). No significant correlation existed between rate of cervical dilatation and maternal age, gestational age and fetal size. CONCLUSION It is evident from this study that higher the parity the shorter the length of first stage of labor; however, significant difference existed only in the first half of first stage of labor between nulliparas and multiparas. Mean rate of cervical dilatation was greater than the WHO-specified and Philpotts lower limit of 1 cm/h in active phase of labor.

Domestic violence and obstetric outcome among pregnant women in Ilorin, North Central Nigeria

Pregnancy constitutes a period of heightened risk for domestic violence, which can be physical, sexual, psychological, or emotional. A woman may be at risk irrespective of race, age, socioeconomic status, or educational level [1]. The abdomen is the most common target for physical violence [1]. Women who experience violence during pregnancy have a higher risk of pregnancy loss, pretermdelivery, low birthweight neonates, premature rupture of membranes, stillbirth, and increased likelihood of cesarean delivery [1]. The main objective of the present study was to investigate pregnancy outcomes among women who had experienced domestic violence compared with women who had not been abused. The study was a prospective case–control study conducted at the Obstetrics and Gynecology department, University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1 to June 30, 2012. All pregnant women attending the prenatal clinic were informed about the study and those who provided written informed consent were screened for domestic violence using a modified version of the Abuse Assessment Screen [2]. Monogamous families had 1 wife and polygamous families had 2 or more wives. The sample size was determined by the formula for comparison of groups and the samplingmethodwas purposive sampling. Pregnantwomen recruited to the studywere required to affirm or refute whether they had experienced physical, sexual, emotional, or psychological violence during the preceding year or in the index pregnancy that had been perpetrated by an intimate partner. Physical violence included beating or using objects with intent to hurt, while sexual violence included unwanted fondling or forced sex. Emotional or psychological abuse included verbal abuse, humiliation, and isolation. The control group consisted of pregnant women who had not experienced domestic violencematched for parity, age, family type, education level, history of preterm birth, smoking, and ultrasound scan for exclusion of fetal congenital abnormalities. Womenwith previous uterine surgeries were excluded from the study. Maternal outcome measures included preterm labor or delivery, operative vaginal or cesarean delivery, puerperal pyrexia, breastfeeding problems, anxiety, and depression. Presentation with cervical dilatation greater than or equal to 8 cm was termed late presentation. All instrumental deliveries were performed by the same individual. Neonatal outcomes included prematurity, low birth weight, birth asphyxia, intrauterine fetal death, and perinatal mortality. Ethical approvalwas obtained from the ethics and research committee of the University of Ilorin Teaching Hospital before commencing the study. Data were analyzed using SPSS version 18 (IBM, Armonk, NY, USA). P b 0.05 was considered statistically significant. A total of 200 pregnantwomenwere included in the study, comprising 100 womenwho had experienced domestic violence (subjects) and 100 pregnant women who had not (controls). The age range for both groupswas 18–42 years (mean30.18±4.78 years). For other variables, comparisons between the subject and control groups were: 82% vs 89% monogamous families, 25% vs 28% primiparity, 16% vs 12% late booking, and 96% vs 97% married couples. The perpetrator was the woman’s husband in 96% of cases of domestic violence. Women who had experienced domestic violence were significantly more likely to have preterm labor (P = 0.037), instrumental vaginal delivery (P = 0.024), cesarean delivery (P b 0.001), breastfeeding problems (P = 0.015), postpartum depression (P b 0.001), and anxiety disorders (P = 0.008) (Table 1). The neonates of the subject group had statistically significant low birth weight (P b 0.001), and higher rates of birth asphyxia (P b 0.001) and neonatal death (P = 0.008) compared with neonates of the control group (Table 2). All instrumental vaginal deliveries were performed because of a prolonged second stage of labor. Cesarean deliveries were performed for fetal distress in 52% compared with 27% of the subject

Non-fistulous urinary leakage among women attending a Nigerian family planning clinic

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