C. M. Chama

Sex and reproduction among HIV-infected people in Maiduguri, Nigeria

Summary For HIV-infected people, prevention of transmission of the virus to their spouses and other sexual partners can only be achieved through abstinence and safer sex practices using condoms. New drugs and technologies are now available that can prevent vertical transmission of the virus. A total of 262 people living with HIV/AIDS (PLWHA) were interviewed to explore their sexual and reproductive desires and practices. About 75.6% of them were sexually active and 62.2% never used condoms. Although only 26.3% had no living child, the majority of these (71.4%) wanted to have children. Their knowledge of mother-to-child transmission of HIV and how to prevent it was good. PLWHA engage in unprotected sexual intercourse with the desire to have more children. It is expected that more paediatric HIV infections will be seen in the future in a poor-resource setting like ours.

Prevention of mother-to-child transmission of HIV at Maiduguri, Nigeria

The human immunodeficiency virus (HIV) can be transmitted vertically through the placenta in utero, during labour and delivery and through breast milk. In Nigeria, about 5.8% of women attending antenatal clinics were HIV infected as of December 2002. It was projected that by the end of the year 2002, there were about 849 000 orphans resulting from AIDS and about 755 000 established paediatric AIDS in this country. Interventions to prevent mother-to-child transmission of HIV include voluntary counselling and testing (VCT), administration of antiretroviral drugs (ARV), modification of obstetric practices and infant feeding options in HIV infection. Over the period July 2002 – June 2003, 262 pregnant women received VCT at the antenatal clinic of the University of Maiduguri Teaching Hospital, and 207 (79%) agreed to be tested. Thirty-one (11.8%) were HIV positive. The majority of the HIV positive mothers received nevirapine in labour while 35% had combination ARV drugs in pregnancy. All the infants received nevirapine suspension within 72 hours of delivery. Expensive and slow testing facilities, insufficient and inconsistent counsellors, lack of ARV drugs for both mother and baby as well as unaffordable caesarean delivery were some of the constraints being faced at this centre. It is recommended that the governments at various levels should show more commitment to the programme of preventing mother-to-child transmission of HIV.

Cervical dysplasia in HIV infected women in Maiduguri, Nigeria

The human immunodeficiency virus (HIV) infection has been shown to be a risk factor for premalignant and malignant conditions of the cervix. Patients attending the gynaecological clinic of the University of Maiduguri Teaching Hospital received voluntary counselling and testing (VCT) for HIV. All patients who were screened for HIV also had their pap smear taken. Cervical dysplasia was significantly commoner among HIV infected women than those that were HIV negative (31.3% vs 7.8%, respectively). The incidence of cervical dysplasia was also proportional to the degree of immunosuppression as women with low CD4 count had higher incidence of cervical dysplasia. The population studied was generally promiscuous irrespective of their HIV status, with over 90% of them having multiple sexual partners. It is recommended that health education in this population should be aimed at discouraging multiple sexual partners. Gynaecologists should be co-care providers to all HIV + women in view of the menace of cervical dysplasia.

Severe burn injury in pregnancy in Northern Nigeria

A total of 21 cases of severe burns in pregnancy managed at the University of Maiduguri Teaching Hospital, Maiduguri, over a 10-year period, spanning January 1991-December 2000 inclusively were reviewed. The pregnancy loss was 92·9%, with the pregnancies spontaneously terminated within 10 days of sustaining the injury. Maternal mortality was 47·6% with sepsis as the most common cause of death. It is advocated that viable pregnancies should be terminated as soon as the mother is resuscitated following severe burn injury. Prophylactic systemic antibiotics should be given to minimise the development of sepsis. Patients are best managed in the obstetrics ward during the first 2 weeks of injury. A multidisplinary approach is encouraged in managing cases of severe burns in pregnancy.

The value of the secondary yolk sac in predicting pregnancy outcome

One hundred and five consecutive women had transvaginal sonography (TVS) at less than 12 weeks gestation to establish the normal size and shape of the secondary yolk sac (YS) and to assess the YS measurements in predicting pregnancy outcome in the first trimester. A yolk sac diameter more or less than two standard deviation (2SD) from the mean predicted abnormal pregnancy outcome with a sensitivity of 91.4%, specificity of 66% and a positive predictive value of 88.8%. A normal YS size predicted normal pregnancy outcome with a sensitivity of 66%, specificity of 91.4% and a positive predictive value of 95.6%. It is recommended that patients at risk of poor pregnancy outcome should have routine TVS before 12 weeks gestation to assess their YS and those with an abnormal yolk sac should be followed-up closely to exclude fetal abnormalities before 24 weeks gestation.

Hydatidiform mole as seen in a university teaching hospital: A 10-year review

Summary Hydatidiform mole (HM), is a known cause of early pregnancy wastage and has the risk of malignant potential. This is a retrospective study of 71 patients who were managed for hydatidiform mole at the University of Maiduguri Teaching Hospital, (UMTH) Maiduguri over a 10-year period, from January 1996 to December 2005, inclusive. The objective of the study was to determine the incidence, risk factors, clinical presentations and histological types of HM. Case records of 71 histologically confirmed HM were studied. Their sociodemographic characteristics, clinical presentations and histology reports were obtained and analysed. The institutional incidence of molar pregnancy was 3.8/1,000 deliveries. Histological findings showed partial mole in 51 (71.8%) cases and complete mole in 20 (28.2%) cases. The peak age-specific incidence rate was 17.5 years. The leading presenting clinical feature was abnormal vaginal bleeding seen in 100%. No case of invasive mole was found. Maternal complications included severe haemorrhage requiring blood transfusion (30.0%) and infections (15.5%). There was no maternal death. In conclusion, the incidence of partial hydatidiform mole was found to be higher than that of complete variety in our environment and the identified risk factors were young age, low parity and previous history of HM.

The safety of elective caesarean section for the prevention of mother-to-child transmission of HIV-1.

Summary The benefits of elective caesarean section (ELCS) for the prevention of mother-to-child transmission (PMTCT) of HIV are now well known. However, the benefits of such a procedure must be weighed against the risks involved. This study examines the risks of ELCS for PMTCT at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, from January–December 2006 inclusive. A total of 52 HIV-positive mothers who opted for ELCS for PMTCT were prospectively followed-up for any intra- and postoperative complication. A total of 52 cases of ELCS of HIV-negative mothers during the same period of study were used as controls. The HIV-positive mothers were found to be younger and of lower parity than the uninfected women. Unlike the uninfected mothers, they did not have co-morbid conditions, such as diabetes mellitus and severe pregnancy induced hypertension. There was no significant difference in intra- and postoperative morbidities between the two groups of mothers. The fetal outcome in terms of Apgar scores and birth weight was significantly better among the HIV-infected women. It is recommended that HIV-infected mothers in this environment should be offered the option of ELCS for the purpose of prevention of HIV from mother to child.

Diagnostic features of cervical incompetence among women in Maiduguri.

The study was a review of the clinical features used to diagnose cervical incompetence. One hundred and forty-one clinical records of patients who had cervical cerclage inserted for cervical incompetence at the University of Maiduguri Teaching Hospital over a 5-year period, were studied retrospectively. Previous mid-trimester abortion occurred in 80.1% of the patients and was consecutive in 98 patients (69.5%). Sixty-eight (50.7%) patients had previous preterm deliveries, while 65 (46.1%) had a cervical cerclage inserted in a previous pregnancy. They had associated characteristic rapid painless expulsions of the fetus in previous pregnancies. One hundred and thirty-six patients had the McDonalds method of insertion (96.5%). There was a significant association between histories of previous midtrimester abortions, consecutive mid-trimester abortions and preterm delivery, with a significantly greater proportion of women with a previous history of preterm delivery having a recurrence in spite of the insertion of the cervical cerclage.

Transvaginal ultrasound scan versus laparoscopy in the diagnosis of suspected ectopic pregnancy

This is a prospective study comparing the performance of transvaginal ultrasound scan with laparoscopy as the last diagnostic tool in a clinically suspected ectopic pregnancy. Both diagnostic methods have the same sensitivity of 100%. Transvaginal ultrasound scan had a specificity of 73·7% and a positive predictive value of 89·8%. Laparoscopy had a specificity of 84·8% and a positive predictive value of 94·6%. The use of laparoscopy could avoid laparotomy in only 3·4% of patients. Since transvaginal ultrasound scan is easier, safer and cheaper than laparoscopy, more emphasis should be laid on its use in our environment than laparoscopy.This is a prospective study comparing the performance of transvaginal ultrasound scan with laparoscopy as the last diagnostic tool in a clinically suspected ectopic pregnancy. Both diagnostic methods have the same sensitivity of 100%. Transvaginal ultrasound scan had a specificity of 73.7% and a positive predictive value of 89.8%. Laparoscopy had a specificity of 84.8% and a positive predictive value of 94.6%. The use of laparoscopy could avoid laparotomy in only 3.4% of patients. Since transvaginal ultrasound scan is easier, safer and cheaper than laparoscopy, more emphasis should be laid on its use in our environment than laparoscopy.