Adedapo Babatunde Ande

Myomectomy during cesarean section

Objectives: To assess the intra‐ and post‐operative complications of cesarean myomectomy. Methods: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, intra‐ and post‐operative complications and duration of hospital stay. Results: Eighty‐four fibroids of various sizes (2–10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub‐serous or intramural, and only few (five) sub‐mucous. The mean blood loss was 876±312 ml, range 400–1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post‐operative morbidities mainly of anemia [15 (60%); hematocrit 26±2.9%). The average duration of post‐operative hospital stay was 7.4±2.2 days (range 3–12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. Conclusions: With adequate experience and the use of high dose oxytocin infusion (intra‐ and post‐operatively), myomectomy at cesarean section is not as hazardous as many now believe.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p = 0.024) and unmarried women (p = 0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

Trends and determinants of pregnancy-related domestic violence in a referral center in southern Nigeria

To describe the trend and identify associated risk factors for pregnancy‐related domestic violence.

Ruptured uterus in a Nigerian community: a study of sociodemographic and obstetric risk factors

Background.  Ruptured uterus is a common obstetric emergency in Nigeria, associated with high maternal and perinatal morbidity and mortality. There is a need for definitive identification of the risk factors to guide effective interventions to curb its scourge.

Prevalence and correlates of intimate partner violence against HIV‐seropositive pregnant women in a Nigerian population

Objective. To evaluate the prevalence and correlates of intimate partner violence among HIV‐positive pregnant Nigerian women. Design. Cross‐sectional study using an anonymous semi‐structured interviewer‐administered questionnaire. Setting. The antenatal clinic at the University of Benin Teaching Hospital, Nigeria, from June 2008 to December 2009. Population. 305 HIV‐positive women receiving antenatal care. Methods. An anonymous semi‐structured World Health Organization modified questionnaire that elicited information on the experiences of intimate partner violence, was administered to the women by trained female interviewers. Main Outcome Measures. Prevalence, pattern and risk factors associated with experiencing intimate partner violence. Results. The prevalence of intimate partner violence among the women was 32.5%, with psychological violence being the most common form of violence reported (27.5%) and physical violence the least reported (5.9%). Identified risk factors for experiencing violence were multiparity (Odds ratio 9.4; CI 1.23–71.33), respondents with an HIV‐positive child (Odds ratio 9.2; CI 4.53–18.84), experience of violence before they were diagnosed HIV‐positive (Odds ratio 44.4; 10.33–190.42) and women with partners without post‐secondary education (Odds ratio 2.3; CI 1.40–3.91). Conclusion. Intimate partner violence is a prevalent public health problem among HIV‐infected pregnant women in our community and it may hinder efforts to scale up prevention of mother–child transmission programs, especially in developing countries. Screening for intimate partner violence to identify abused women should be incorporated into these programs to offer these women optimal care.

Fertility preferences, condom use, and concerns among HIV-positive women in serodiscordant relationships in the era of antiretroviral therapy

To assess preferences and concerns about infecting partner or child among HIV‐positive women undergoing antiretroviral therapy and whose partners are HIV‐negative.

Repeat myomectomy at caesarean section

IntroductionThe recurrence of uterine fibroids after a myomectomy is not an uncommon finding. With the growing evidence in support of the safety of myomectomy at caesarean section, more cases are being reported. Although there is no documented recurrence rate of uterine fibroids after myomectomy at caesarean section, it is likely to be higher than after myomectomy in the non-pregnant state. This is due to the changes that occur in fibroid(s) during pregnancy as a result of the effects of pregnancy hormones.Case reportWe present the first case of repeat myomectomy at caesarean section in our series. This is probably the first of such cases ever reported. The significance of this case report in support of the safety of myomectomy at caesarean section and the possibility of a repeat procedure due to recurrence of uterine fibroid(s) are discussed.

Features and perceptions of menopausal women in Benin City, Nigeria

BACKGROUND/OBJECTIVE The features of menopause have always been assumed to occur only to a minor degree of significance in Nigerian women. Perceptions of menopausal symptoms are greatly influenced by social, cultural and economic settings and may influence the mode of treatment for menopausal symptoms. The aim of this study was to determine the features and perceptions of natural menopause among menopausal women in Benin-City, Edo State, Nigeria. METHODS A descriptive cross-sectional study of 533 randomly selected Nigerian women in Benin City, Edo State who had experienced at least 24 continuous months of amenorrhea using a structured questionnaire. RESULTS The ages of the women studied ranged between 47 and 78 years; mean 57.4 ± 6.3 years. The mean menopausal and menercheal ages were 49.8 ± 2.6 and 15.2 ± 2.0 years. Most (80.7%) were currently married with 63.6% in monogamous relationships. Three hundred and fifty-six women (66.8%) have heard of the word menopause and correctly described it. Menopause was considered a normal event by 97.4%. Majority (407; 77.6%) adjusted very well to the events of menopause with none revealing any serious maladjustment. Three hundred and forty-six women (64.9%) were no longer sexually active. Joint pains (287; 53.8%), hot flushes (272; 51%) and night sweats (22; 42%) were the most common symptoms believed to be related to menopause. Three hundred and two women (56.7%) actually suffered at least one of the menopause symptoms. Joint pains (52.9%), hot flushes (43.3%) and night sweats (29.8%) were the commonest symptoms experienced. Freedom from monthly bleeding (50.7%) was the most commonly reported advantage of menopause. Only thirty nine (7.3%) were aware of hormone replacement therapy (HRT) and none were on /ever had HRT. CONCLUSION Although menopause is well-tolerated by women in our environment, it needs further investigation. Research priorities include the influence of socio-cultural beliefs on sexuality at menopause and evaluation of HRT benefits.

Stillbirth in cases of severe acute maternal morbidity

To determine the incidence and correlates of stillbirths among women with severe acute maternal morbidity (SAMM).

Prevalence of helminth infestation during pregnancy and its association with maternal anemia and low birth weight

To determine the prevalence of helminth infestation during pregnancy and the associated risks of adverse maternal and infant outcomes.