Biodun Olagbuji

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.

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.

Morbidity associated with failed vaginal birth after cesarean section

We investigated morbidity and factors associated with failed vaginal birth after cesarean delivery (VBAC). In a retrospective cohort study maternal and neonatal outcomes of women who underwent VBAC in three Nigerian University Teaching Hospitals were reviewed. Univariate, followed by multivariate analyses, were conducted. VBAC was successful in 683 of 1,013 women (67.4%), whereas 330 (32.6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities. Younger age, lack of previous vaginal delivery, induction of labor and fetal weight >4,000 g were risk factors for failed VBAC. A majority of women who try VBAC achieve a vaginal delivery. Failed VBAC is associated with increased maternal and neonatal morbidity and is somewhat predictable.

Perception and attitude of women with previous caesarean section towards repeat caesarean delivery

Objective. To explore the perception and attitude of women with previous caesarean section towards repeat caesarean section. Method. Observational study of women with prior caesarean delivery using an anonymous semi-structured questionnaire. Information elicited include the socio-demographic characteristics, outcome of the last caesarean delivery, experience of complications or domestic violence, acceptance of repeat caesarean section if advised by the doctor and the reason for any refusal. Results. One hundred thirty-nine parturients participated in the study. Seventy-seven percent had 1 previous caesarean delivery while 24.46% will decline a repeat caesarean section. Major reasons for refusal were postoperative pain, cultural aversion, fear of death, and cost of caesarean delivery. The rate of acceptance was significantly higher amongst those with more than one prior caesarean section while the rate of refusal was significantly higher amongst those who experienced perinatal death in the last caesarean delivery. Twelve percent experienced domestic violence (almost entirely psychological) mainly from the spouse or his relatives. Conclusion. A significant proportion of women with previous caesarean delivery will decline a repeat caesarean section if medically indicated. There is need for bahavior change communication involving the community, improved postoperative pain management, and better counseling especially on safety of the procedure.

Stillbirth in cases of severe acute maternal morbidity

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

Uterine rupture and risk factors for caesarean delivery following induced labour in women with one previous lower segment caesarean section

Objective: To determine the outcome of induction of labor, specifically incidence of uterine rupture and reliable predictors of repeat caesarean delivery, in women undergoing induction of labor after previous caesarean section. Methods: A review of obstetric and perinatal records of 167 women who had their labor induced after one transverse lower uterine incision performed at previous caesarean delivery in a referral tertiary hospital in Nigeria between January 2006 and December 2009. Results: The incidence of uterine rupture was 2.4%. Independent risk factors for repeat caesarean delivery were absence of prior vaginal delivery (OR 3.7; 95% CI 1.9–7.1), duration of latent phase >2 h (OR 4.3; 95% CI 1.7–11.2), postdated pregnancy (OR 2.2; 95% CI 1.1–4.0) and previous caesarean for non-recurrent indication (OR 2.1; 95% CI 1.1–4.0). Conclusion: Choice of appropriate delivery option for this cohort of women based on the identified risk factors is essential to minimize the incidence of failed vaginal birth and its associated adverse maternal and neonatal outcome.

Predictors of successful vaginal delivery after previous caesarean section in a Nigerian tertiary hospital

Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2–0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1–7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.

Induction of labour: determinants and implications of failure to keep an initial appointment in a developing country.

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the ‘spousal factor’ (23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.