Friday E. Okonofua

Features of menopause and menopausal age in Nigerian women.

The age of menopause and the clinical features of menopause were investigated by questionnaire survey in 563 Nigerian women of Yoruba descent who have been menopausal for at least 5 years. The mean and median ages of menopause were 48.4 and 48.0 years, respectively. No relationship could be established between menopausal age and various biosocial factors such as age of menarche, social class, parity, smoking and place of residence. The commonest menopause related symptoms were joint pains and hot flush and only 42% of them still practiced sexual intercourse. These findings when compared to those from other populations indicate that there is need for more work on menopause in Nigerian women.

Risk factors for primary postpartum haemorrhage A case control study

The objective of the study was to determine which background factors predispose women to primary postpartum haemorrhage (PPH) at the Obafemi Awolowo University Hospital. The study consisted of 101 women who developed PPH after a normal vaginal delivery and 107 women with normal unassisted vaginal delivery without PPH Both cases and controls were investigated for sociodemographic risk factors, medical and obstetric histories, antenatal events and labour and delivery outcomes. Data were abstracted from the medical and delivery records and risks were estimated by multivariate logistic regression. The results of the unvariate analysis revealed a number of potential risk factors for PPH but after adjustment by logistic regression three factors remained significant. These were prolonged second and third stages of labour and non-use of oxytocics after vaginal delivery. Previously hypothesised risk factors for PPH such as grand multiparity, primigravidity and previous episodes of PPH were not significantly associated with PPH. We conclude that primary PPH in this population is mostly associated with prolonged second and third stages of labour and non use of oxytocics. Efforts to reduce the incidence of PPH should not only be directed at proper management of labour but also training and retraining of primary health care workers and alternative health care providers in the early referral of patients with prolonged labour.

Illegal Induced Abortion: A Study of 74 Cases in Ile-Ife, Nigeria

Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.

A study of the menstrual patterns of adolescents in Ile-Ife, Nigeria

Questionnaires and interviews with 768 female students in residence at the Obafemi Awolowo University, Ile‐Ife, Nigeria revealed that the mean and median ages of menarche were respectively 13.4 ± 1.4 and 13.5 years and 80.8% had menstrual cycles between 25 and 35 days. The duration of menstrual bleeding was 4.5 ± 0.8 days; 72.3% had dysmenorrhea and 17.8% complained of nausea and vomiting during menstruation.

Blood pressure changes during pregnancy in Nigerian women.

The purpose of this longitudinal study was to determine the pattern of blood pressure during pregnancy in Nigerian women. The blood pressure of 189 women from early pregnancy and up to term, during labor and 24 h after delivery were monitored. The mean systolic, diastolic and mean arterial blood pressure were computed and the blood pressure readings were correlated with parity and selected anthropometric and socioeconomic variables. The results showed a decline in blood pressure levels during the mid-trimester of pregnancy with a progressive increase towards term. The highest blood pressures were recorded during the third stage of labor. The mean (+/- 2 SD) of blood pressure was 130/80 mmHg. There was no significant correlation of blood pressure with parity but there was a significant positive correlation with maternal age and Quetelex index after 30 weeks of gestation. As compared to Caucasian women, Nigerian women showed higher levels of diastolic blood pressures. We conclude that: (1) the higher incidence of gestational hypertension in African women may be due to higher levels of resting baseline blood pressures in the women, and (2) pregnant women in our population with persistent elevation of blood pressures above 130/80 mmHg should be closely monitored.

Plasma zinc and copper in pregnant Nigerian women at term and their newborn babies

The concentration of copper and zinc was determined by atomic absorption spectrophotometry in 26 normal Nigerian women at term and their newborn babies. Cord zinc was significantly greater than maternal zinc. In contrast, cord copper was lower than maternal copper. There was only a weak correlation between cord copper and maternal copper but none between cord zinc and maternal zinc. There was no correlation between maternal and cord zinc and neonatal birthweight. However, an inverse correlation was found between maternal and cord copper and neonatal birthweight. These results indicate that: (1) zinc has no effect on fetal growth in Nigerian women but (2) copper may have a negative effect on fetal growth.

Ureteric injuries associated with gynecologic surgery

We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11‐year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra‐operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra‐operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries.

Ectopic pregnancy associated with tubal schistosomiasis in a Nigerian woman

A case of ruptured tubal ectopic pregnancy is presented. On histological examination of the fallopian tube involved, ova of Schistosoma haematobium were found in the submucosal and intramural parts of the tube. The case illustrates a rare preventable cause of ectopic pregnancy in this population.

Screening for cervical neoplasia in an African population: Simultaneous use of cytology and colposcopy

In many countries cytologic screening for cervical cancer has become firmly established and accepted. This has not been the case in some developing countries because of limited financial and manpower resources. In a series of 1564 patients, simultaneous colposcopy and cytology revealed 31 women with varying degrees of cervical intraepithelial neoplasia. We feel that an initial combination of colposcopy and cytology provides a more reliable diagnosis of cervical lesions and a case is made for the establishment of mass cytologic screening in Nigeria.

Hysterosalpingography versus laparoscopy in tubal infertility: comparison based on findings at laparatomy

One hundred ten infertile women underwent hysterography (HSG) and laparoscopy at the Obafemi Awolowo University, Nigeria. Both techniques showed normal tubal potency in 62 (56.4%) women and abnormal pelvic pathology in 48 (43.6%). All 48 women underwent laparotomy for tuboplasty. At laparotomy, HSG and laparoscopic assessments were compared. Both techniques were comparable in the diagnosis of intratubal and distal tubal occlusion. However, laparoscopy was superior in the diagnosis of non‐tubal factors and proximal tubal occlusion (P < 0.002). It is suggested that laparoscopy should be the first procedure in the investigation of tubal infertility and only followed by HSG if the results show some abnormality.