Abiodun S. Adeniran

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

Duration of labor with spontaneous onset at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

BACKGROUND/OBJECTIVE Duration of labor varies from one pregnancy to another and a period of less than 12 hours is regarded as normal. Modern obstetric practice involves active management of labor with the aim of preventing prolonged labor and its sequelae. The main objective of this study was to determine and compare the average duration of labor of spontaneous onset between nulliparas (Po) and multiparas (P ≥ 1) and to determine factors affecting duration of labor. MATERIALS AND METHODS This study was a prospective study carried out between 15 May and 14 June 2004 at the Labor Ward of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Two hundred and thirty-eight women who satisfied the inclusion criteria were studied. The inclusion criteria were term pregnancy with vertex presentation, labor with spontaneous onset, live fetus at presentation and spontaneous vertex delivery. RESULTS The mean ± SD admission-delivery interval in labor ward was shorter (3.77 ± 2.88 hours) among multiparas than that of nulliparas (5.00 ± 3.17 hours) (P = 0.235). The mean ± SD duration of labor (from the onset of labor to delivery) was shorter among multiparas (8.73 ± 4.17 hours) than that of nulliparas (11.23 ± 4.29 hours) (P = 0.426). The differences were not significant (t-test, P > 0.05). Maternal age and individual parity had significant correlation with the duration of labor in this study (Pearson correlation = -0.019, -0.027, respectively, P < 0.05). CONCLUSION Interestingly, duration of labor was not significantly different among multiparas and nulliparas although it was shorter. Correlation existed between duration of labor and maternal age and individual parity.

Evaluation of parturient perception and aversion before and after primary cesarean delivery in a low-resource country

To determine the perception of and aversion to cesarean delivery (CD) and their determinants before and after primary CD.

Spontaneous abortions (miscarriages): Analysis of cases at a tertiary center in North Central Nigeria.

Background: Spontaneous abortion (miscarriage) is a source of pregnancy loss globally. Its management, especially in low resource countries remains hampered by inadequate facilities for evaluation. Objectives: To assess the clinical presentation, diagnosis, and treatment of cases of spontaneous abortion at a tertiary hospital in Ilorin, Nigeria. Methodology: A descriptive study of all spontaneous abortions (miscarriages) managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 1, 2007 and December 31, 2011. The records were retrieved from the medical records department and necessary information retrieved. Results: There were 603 miscarriages with a prevalence of 4.2%; incomplete miscarriage was the most common 254 (42.1%), 356 (59.0%) had no identifiable risk factor; 434 (72%) of the women were <35 years; 361 (59.9%) had first trimester miscarriages, 272 (45.1%) were of low parity (Para 0-1) and 223 (37%) were having a repeat miscarriage. Of the 141 managed for threatened miscarriage, pregnancy was salvaged in 90 (63.8%), 244 (40.5%) had surgical evacuation with 100% success rate while 218 (36.2%) had medical management with 90.8% success rate. The mean duration of admission was shortest with surgical management (2.03 ΁ 1.1 days) and post-abortion infection rate was 11 (2.6%). Histology confirmed product of conception in 98% and molar gestation in 2% of the samples; no mortality was recorded in this study. Conclusion: More than half of women with miscarriages had no identifiable risk factors mainly due to limitation in facilities for evaluation; there is a need to improve facilities for investigating women with spontaneous abortions in developing countries to identify the causes of the losses.

Bacterial vaginosis: Prevalence and associated risk factors among non-pregnant women of reproductive age attending a Nigerian tertiary hospital

Aim To determine the prevalence and risk factors associated with bacterial vaginosis (BV) among non-pregnant women of reproductive age group. Methods A cross-sectional study among non-pregnant asymptomatic women aged 19 to 45 years, attending the gynaecological clinic at University of Ilorin Teaching Hospital, Ilorin, Nigeria. Participants were counselled and an informed consent was obtained. This was followed by vaginal swabs for microscopy, culture and sensitivity. Diagnosis of BV was by Nugents criteria. Data analysis was by Statistical Package for Social Sciences (SPSS) version 20.0. Chi-square and Yates corrected chi-square were calculated, and p value <0.05 was significant. Results Among the 212 participants, prevalence of BV was 40.1%; it was common among women aged 25–34 years (50; 58.8%), the married (77; 90.6%) and those with tertiary education (39; 45.9%). The risk factors for BV were common among women with laboratory evidence of the infection, however statistically significant risk factors were the use of intrauterine device (OR 1.61, 95%CI 0.543–4.759; p0.020) and previous voluntary termination of pregnancy (OR 1.04, 95%CI 0.600–1.808; p0.047). Conclusion There was high prevalence of bacterial vaginosis in the study population. Universal screening and treatment of cases may assist in lowering the associated morbidity.

An observation of umbilical coiling index in a low risk population in Nigeria

Abstract Objectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study.

Snake bite in third trimester of pregnancy with systemic envenomation and delivery of a live baby in a low resource setting: A case report

Background Snake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting. Case We present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby. Conclusion In resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment.

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria.

BACKGROUND The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVE To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. METHODS A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant. RESULTS Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C.

Haematological and biochemical effects of etonogestrel subdermal implant (Implanon) in Ilorin Nigeria

OBJECTIVES To evaluate the effect of etonogestrel subdermal implant (Implanon) on haematological and biochemical parameters of its users. METHODOLOGY A prospective observational study among healthy women using Implanon for contraception. The study site was the family planning clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Informed consent was obtained and participants were followed up for three years. Follow up parameters were haematological and biochemical evaluation at insertion (baseline), first and third years post-insertion. Statistical analysis was with SPSS-version 20.0; p value <0.05 was significant. RESULTS 124 participants of age 20-44 years were included in the study. During the period of study, a progressive increase in the weight as well as in the level of alanine transaminase and systolic blood pressure was recorded. As compared to the baseline values, statistically significant difference in the mean values of systolic blood pressure (p<0.01), alanine transaminase (p<0.01) and weight (p=0.001) were recorded at the first year. Packed Cell Volume (p=0.001), weight (p=0.001), alanine transaminase (p=0.001) and alkaline phosphatase (p<0.05) were significant at the third year. Between the first and third year post-insertion, there was statistically significant difference in Packed Cell Volume (p=0.001), urea (p<0.05), aspartate (p=0.001) and alanine transaminase (p=0.001) and weight (p=0.001). However, there were no clinically detectable abnormalities or pregnancy during the study period. CONCLUSION Haematological and biochemical parameters change with Implanon use but they were not significant to cause clinical sequelae. Implanon remains a safe long term contraceptive.