Idris Sulaiman Abubakar

Contraceptive choices among grand multiparous women at Murtala Mohammed Specialist Hospital, Kano

Background: Grand multiparity is known to be associated with pregnancy complications. Nigeria with a contraceptive prevalence of <15% and culture of early marriage in the northern part of the country, many women get to grand multiparity early in their obstetric carriers. These women contribute significantly to the bad obstetric performance indices in the country. The present study was to explore the contraceptive choices among grand multiparous women. Methods: This study was a descriptive cross-sectional study among grand multiparous women attending an antenatal clinic. Data were collected on sociodemographic characteristics, contraceptive choices, and factors that influence such choices. The data were analyzed using Statistical Package for the Social Sciences version 18. Results: There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83. Most of the respondents (208, 95.50%) were aware of modern contraceptive methods, and oral contraceptive was the method of most of the respondents (197, 90.00%). Only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the lifestyle was the reason for the choice of a contraceptive method by many of the respondents (42, 19.10%). Conclusion: There was high awareness of modern contraceptive methods; however, there was low use prevalence among respondents, and the desire for more pregnancy was the reason for the nonuse.

Knowledge, attitude and practice of contraceptives among grand multiparous women attending antenatal clinic in a specialist hospital, Kano, Nigeria

Background: Nigeria is the most populous country in Africa. Worldwide the country has the second highest maternal mortality ratio. The fertility rate is 5.38 children per woman. Grand multiparity with its associated risks contributes to the high maternal mortality ratio. This study was conducted to find out the knowledge, attitude and practice of contraception among grand multiparous women attending the antenatal clinic in a specialist hospital, Kano. Methods: It was a descriptive cross-sectional study conducted among grand multiparous women attending antenatal care clinic at Murtala Muhammed Specialist Hospital, Kano from 1st September to 31st December 2013. All consenting grand multiparous women were recruited within the study period. Data were collected on a predesigned questionnaire and analysed using SPSS version 17 (SPSS Inc., IL, Chicago, USA). The descriptive statistics was used for categorical variables and Chi-square was used for test of significance. A P ≤0.05 was considered statistically significant for inference. Results: Three hundred and thirty four grand multiparas were recruited. The mean age was 37.23 ± 3.17 years. Majority of them (80.20%) got their contraceptive knowledge from the nurses and/or midwives. Up to 88.60% agreed have used contraceptives. The most popular and used contraceptive among the grand multiparous women was oral contraceptive pills (OCP) (89.80%). The major cause of the non-use of contraceptives was the fear of side effects (77.20%). Conclusion: Grand multiparous women mainly obtain their contraceptive knowledge from the nurses/midwives. OCP was the most used methods. Major causes of non-use of contraceptives were the fear of side effects and desire for more children.

Ritual hot bath (wankan jego) in Kano: Are they still practicing? What are the implications?

Background: Postpartum ritual hot bath is one of the harmful cultural beliefs commonly practiced in Northern Nigeria. It is linked with health hazards especially among women with hypertensive disorders of pregnancy. Methodology: It was a cross-sectional study conducted among 199 pregnant women over the period of 3 months. Ethical approval was obtained from The Kano State Ethical Committee. Questionnaire was administered among consenting pregnant women. Information on sociodemographic characteristics and practice of hot bath was obtained. Data were analyzed with SPSS version 17 computer software (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Results: One hundred and ninety-nine pregnant women were recruited for the survey. The mean age ± standard deviation was 28.09 ± 5.55 years. The rate of hot bath was 56.80% and the days spent taking the hot bath ranged from 4 to 40 days. An average of 195.41 ± 96.050 Naira was spent on firewood per day for the hot bath. The method of boiling the water was mainly the use of firewood 87 (78.40%). They mainly used leaves 76 (68.50%) and towel 35 (31.50%) for bathing. The responsibility of the cost of the hot bath was mainly on husband 102 (91.90%). The hot bath was enforced mainly by the parents 68 (61.30%). Up to 82 (73.90%) of the respondents were ready to abandon the hot bath if alternatives such as drugs are provided. Conclusion: The prevalence rate of hot bath was 56.80%. The burden of its financial implications lies mainly on husbands leading to other social and financial problems.

Surgical management of uterine fibroids at Aminu Kano Teaching Hospital

Background: Uterine fibroid is one of the most common pelvic tumours of the female genital tract. Surgery offers long-term relief of symptoms but is associated with complications, hence, the aversion for it in our environment. Therefore, understanding the factors associated with the complications will help to reduce morbidity and mortality. Objective: To determine the surgical options, socio-demographic characteristics, clinical presentations and post-operative complications associated with uterine fibroids at Aminu Kano Teaching Hospital, Kano. Methods: A retrospective review of case notes of 132 surgically managed cases of uterine fibroids at Aminu Kano Teaching Hospital over the study period. Results: Surgical operations for uterine fibroids constituted 21.4% of all gynaecological operations. Most of the cases were seen in 30–39 age group (41.5%) and 51.2% of them were nulliparous. Menorrhagia (53.7%), infertility (26.3%) and abdominal swelling (40.4%) were the common presenting symptoms. Myomectomy was performed in 75.6% of the cases while abdominal hysterectomy accounted for 24.6% of cases. Anaemia was the most common post-operative complication seen in this study (31.7%). Conclusion: Uterine fibroid is common in our environment. The main-stay of management of uterine fibroid is surgery which is associated with post-operative complications. The surgical options used in the management of uterine fibroids in this study were hysterectomy and myomectomy due to lack of requisite skills for the more technical procedures. Improvements in surgical skill will help reduce the frequency and severity of the complications.

Obstetric outcome of teenage pregnancy at Aminu Kano Teaching Hospital: A 3-year review

Background: Teenage pregnancy is generally considered to be a high-risk event. Teenage mothers are physically and psychologically ill-prepared for reproduction. Low socioeconomic status and lack of prenatal care are among the factors influencing pregnancy outcome in these patients. Objective: To assess the obstetric outcome of teenage pregnancy, its current trends, sociodemographic determinants, and incidence in Aminu Kano Teaching Hospital. Materials and Methods: A retrospective study of 540 teenage primigravidae who delivered in Aminu Kano Teaching Hospital between 1st of January 2009 and 31st of December 2011. Results: The incidence of teenage pregnancy over the study period was 5.8% (58/1000 deliveries). Majority of the patients (78.9%) belonged to low socioeconomic class. Pregnancy complications prevalent in these patients included anemia (33.5%), low birth weight (17.8%), preeclampsia/eclampsia (12.4%), preterm labor (11.5%), and stillbirth (2.5%). Cesarean section rate among them was 18.9%. Conclusion: Teenage pregnancy is a high-risk pregnancy because of the associated pregnancy complications which are more prevalent in the unbooked patients. Access to health care services, girl-child education, and improvement of the socioeconomic status of the patients will reduce its incidence.

Episiotomy at Aminu Kano Teaching Hospital, Kano, Nigeria: A 3-Year Review

Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X2 = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X2 = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X2 = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.

Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism. Objective: To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae. Materials and Methods: The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Students t-test was used for continuous variables. Results: The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishops score were the factors found to be associated with high success rate of IOL (P < 0.001). Conclusion: Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishops scores were the factors found to be associated with the success of IOL.

Umbilical artery Doppler velocimetry study on prediction of adverse pregnancy outcomes among pregnant women with hypertensive disorders in Kano, Nigeria

Background: Doppler velocimetry studies have been widely used to predict adverse pregnancy outcomes in hypertensive disorders of pregnancies. Objective: To identify the pregnant women with hypertensive disorders for umbilical artery Doppler velocimetry to predict adverse pregnancy outcomes. Methods: This was a prospective study among 264 pregnant women with hypertensive disorders. The umbilical artery Doppler velocimetry study was conducted using 3.5 m Hz convex of the Mindry Digital Ultrasound Imaging System (Model DP-8800Plus; Shenzen Mindray Biomed Electronics, China). Results: A total of 264 pregnant women within the age of 18–40 years with a mean ± standard deviation of 31.33 ± 5.92 were studied. One hundred and twenty-four (29.90%) presented with pregnancy-induced hypertension (PIH), 72 (58.06%) had abnormal resistive indices (RIs) of at least 0.58 of which 4 had diastolic notches. The remaining 52 (41.94%) had normal RIs with no diastolic notch. Twenty (4.80%) presented with preeclampsia, 12 (60.00%) had abnormal RI of which four had diastolic notches. One hundred and twenty (28.90%) women presented with chronic hypertension, 72 (60.00%) had abnormal RI of which 16 had diastolic notches. Abnormal RI was associated with low Apgar scores and early neonatal death among the patients with PIH, low Apgar scores among patients with preeclampsia and low birth weight among chronic hypertensive pregnant women. Conclusion: We found abnormal umbilical artery Doppler velocimetry RI to be associated with adverse pregnancy outcomes. However, diverse nature of the hypertensive disorders and adverse pregnancy outcomes revealed different optimum cut-off points for various hypertensive disorders following ROC analysis.

Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria

Background: There is a global concern about poor awareness of fertility. Knowledge of fertility period even among fertile women will reduce the burden of infertility. The objective of this study was to determine the awareness of fertility period among fertile women at Aminu Kano Teaching Hospital (AKTH). Patients and Methods: It was a descriptive study among 220 consenting women at AKTH over a period of 3 months, following approval by the hospital management. Structured pretested questionnaires were administered. Data were analyzed with a computer using Statistical Package for Social Sciences (SPSS) version 17 computer software. Results: Two hundred and twenty women were recruited. The mean age ± standard deviation (SD) were 28.47 ± 5.91. One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, while 36 (16.36%) were unaware. Menstrual intervals of 30 days was the model (24.50%) followed by 28 days (20.50%). One hundred and seventy-one (77.70%) respondents were aware that pregnancy is related to menstrual cycle, while 49 (22.30%) were not aware. Also, 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not. One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not. Conclusion: The study revealed good knowledge of fertility awareness among fertile women, but awareness of fertility period was lacking.

Umbilical artery Doppler velocimetry study on prediction of adverse pregnancy outcomes among pregnant women with recurrent miscarriage at Aminu Kano Teaching Hospitals

Background: Pregnant women with previous history of recurrent miscarriage have higher risks of adverse pregnancy outcomes. Management of current pregnancies in patients with recurrent miscarriage is distressing for the patient and frustrating for the health care provider, especially where treatment options are limited. Doppler velocimetry studies of pregnant women in second trimester with recurrent miscarriage can predict adverse pregnancy outcomes. In this paper, we predict pregnancy outcomes using Doppler velocimetry among women with recurrent miscarriage. Patients and Methods: It was a prospective study among pregnant women with history of recurrent miscarriage. The umbilical artery Doppler velocimetry was carried out in second trimester using 3.5 mHz convex of the Mindry Digital Ultrasound Imaging System (Model DP-8800Plus; Shenzen Mindray Biomed electronics, China). Results: A total of 67 pregnant women with history of recurrent miscarriage were recruited for the study. The mean age ± standard deviation was 28.94 ± 5.59. Thirty-nine (58.21%) had abnormal resistive indices of which 15 (22.39%) had diastolic notches. Others had normal resistive indices. There were significant associations between high resistive index (RI) and the occurrence of preterm birth, low Apgar scores, low birth weight, and intra uterine fetal death. Conclusion: Majority of high risk pregnant women with history of recurrent miscarriage have high umbilical artery RI in second trimester of gestation. RI of at least 0.715 of the umbilical artery Doppler velocimetry is associated with adverse pregnancy outcomes following receiver operating characteristic analysis. Abnormal umbilical artery Doppler velocimetry among pregnant women with recurrent miscarriages predicted adverse neonatal outcomes.