Aniefiok J Umoiyoho

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Introduction Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a womans life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods The case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied. Results There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. Conclusion Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.

Obstetric fistula repair: experience with hospital-based outreach approach in Nigeria.

Background: The huge back-log of obstetric fistula and the increasing incidence of the condition in Nigeria is a cause for concern for all stake-holders. This worrisome trend requires concerted effort with innovative strategies to redress the situation. Methods: Hospital-based outreach programs sponsored by a non-governmental organization with volunteer medical and health personnel were used to repair selected cases of obstetric fistula in Nigeria. Results: Fifty-two relatively simple obstetric fistulas were selected out of 68 (selection rate 76.5%) that presented for repair at 12 outreach programs in 5 different states of Nigeria. All the cases were repaired by one trained gynecological surgeon with a cure rate of 100%. The majority (50.0%) of the women were aged between 16 and 20 years with a mean age of 23.8 years ± 3.6. Most (80.9%) of the women in the study population were primiparous. The majority (50.0%) of the women were divorced at the time of their presentation for repair. A vast majority (76.9%) of the women had either primary level of education or no formal education. There was a preponderance (53.8%) of juxtacervical VVF among women in the study population. Conclusion: The use of hospital- based outreach approach to repair simple cases of obstetric fistula if multiplied could help reduce the large number of women living with unrepaired VVF in Nigeria.

Intrauterine contraceptive device with rectal perforation and strings presenting at the anus

A 36-year-old grand multiparous midwife presented to the gynaecological unit of the University of Uyo Teaching Hospital with the string of an intrauterine contraceptive device (IUCD) protruding from her anus. She had had a copper IUCD inserted at a health centre 8 years earlier. However, 4 months later she noticed that she no longer felt its strings and had another IUCD inserted in the same facility when the first device was not located. Four months prior to presentation, she presented to a private clinic when she no longer felt the strings of the second IUCD. The device in the uterus was removed in the private clinic and she was referred to the teaching hospital. At the teaching hospital rectal examination and plain x-ray revealed the presence of a device. Under general anaesthesia, the device was successfully removed in theatre through the rectum with no postoperative complications.

Perceptions among the Annang women of South–South Nigeria regarding antenatal healthcare information

This article is based on a study aimed at evaluating the attitudes of pregnant Annang women toward orthodox antenatal care in 16 villages in the Obot Akara Local Government Area of Akwa Ibom State in Nigeria. The study also aims to evaluate their understanding and implementation of health advice given during the antenatal education sessions held at the clinics. Copyright

Motherhood Choices of women attending Antenatal Care in a Tertiary Level Hospital in the Niger Delta Region of Nigeria

Introduction: Human reproduction is the primary responsibility of women, so the choices they make in this regard will continue to shape obstetric practice in different parts of world. Methods: During the 2months period of the study of women attending antenatal care in the study centre, pretested, structured partly pre-coded questionnaires were used to sample a cross section of suitable consenting women’s motherhood preferences and the reasons for such choices. Results: Out of the 452 women in the study population, 96.7% preferred to deliver vaginally, positing that it was the natural route of delivery. A mere 14.4% of the respondents would demand labour anaesthesia, while the majority (67.6%) were not sure they would demand labour analgesia. Eighty-nine (20.3%) of the mothers would not accept a medically indicated caesarean section even as the only safe option for delivery, and 10 (2.3%) would not mind if their babies died in the course of such refusal. Among those who would refuse caesarean section, a vast majority (66.3%) felt it was against God’s plan for human procreation. Age, parity and booking status of the women did not influence their refusal of caesarean section, whereas women with lower levels of education (p=0.033) and those who engaged in less skilled occupations were more likely to decline medically indicated caesarean section (p= 0.000). Over half (55.0%) of the mothers preferred to have 4 children, while only 24.7% of the women felt 3 or less children were appropriate. Conclusion: Nigeria is a pronatalistic society where the majority of mothers prefer to deliver 4 or more children. Due to cultural and religious misconceptions, some Nigerian women decline medically indicated caesarean section with adverse maternal and perinatal consequences. The need for continued effort toward the education of the girlchild and public enlightenment on the need for Nigerians to embrace time tested maternity care interventions have become imperative.