James A Osaikhuwuomwan

Adolescents' perspective regarding adolescent pregnancy, sexuality and contraception

Abstract Objective To investigate the attitudes and perceptions of youths regarding adolescent pregnancy, in order to appraise their understanding of sexuality, contraception and why adolescents failed to use contraceptives. Methods This is a descriptive survey of a group of 163 students in their junior clinical postings in the Department of Obstetrics and Gynaecology, University of Benin. The participants completed an anonymous self-administered questionnaire which elicited information on perceptions, attitude, beliefs and their knowledge about adolescent pregnancy, prevention and utilization of contraception. Results Overall, majority of the participants held a negative attitude about adolescent pregnancy with over 85% regarding it as wrong and considered it to be associated with medical, socio-economic and educational problems. Peer pressure to have sex (71.8%%) had the highest rating on participants perceptions pertaining to the causes of adolescent pregnancy, other items rated were ignorance on basics of sexuality and pregnancy (60.1%) and being forced or coerced/refusal by boys/men to use condoms (52.1%). Condom was reported as the most common method youths/adolescents used in attempting to prevent pregnancy (38.1%), albeit, majority (69.3%) reported poor uptake of contraception by adolescents. Common reasons cited why adolescent/youths do not use contraceptives were: feeling embarrassed or ashamed to use or purchase condom/contraceptives (68.7%) and male partner dislikes for condoms (50.3%). An overwhelming majority (87.1%) of respondents thought that private access to condoms would increase uptake. Conclusions Although youths have a negative attitude towards adolescent pregnancy, their perception and understanding of sexuality and contraception is poor. Useful strategies for empowering youth and changing perception/behavior should include peer education and access to simple non-judgmental information on family life. Adoption of strategies tailored to our socio-cultural background to make condoms accessible privately may improve uptake and consequently reduce the menace of adolescent pregnancy.

Reappraisal of ruptured uterus in an urban tertiary center in the Niger-delta region of Nigeria

Objective. To determine the incidence of ruptured uterus as well as the clinical profile and management options in a tertiary hospital setting. Methods. Thirty-three cases of ruptured uterus managed at University of Benin Teaching Hospital (UBTH) from 1 January 2003 to 31 December 2007 were identified and retrospectively studied. Results. The incidence of ruptured uterus was 4.2 per 1000 deliveries (0.4%). Majority (87.9%) of the patients were unbooked. Injudicious use of oxytocics (63.7%) and prolonged obstructed labor (60.6%) were the main associated risk factors. All 33 patients had laparotomy and 51.2% had repair of the uterine rupture only. The type of surgery performed was influenced by the site and extent of rupture. There were two cases of maternal deaths in this study, giving a case fatality rate of 6.1%. Conclusion. Rupture of the gravid uterus is still a problem in Nigeria. A proactive approach to preventing prolonged obstructed labor and curbing the injudicious use of oxytocics through education and utilization of modern antenatal and intrapartum care is advocated.

Cervical cerclage in a Nigerian tertiary hospital: A review

Aim: The aim of the following study is to document the outcome of cervical cerclage in pregnancy. Materials and Methods: A retrospective analysis was undertaken of patients who had cervical cerclage for cervical incompetence at the Obstetrics and Gynecology Department of the University of Benin Teaching Hospital, Benin-City, Nigeria from January 2007 to December 2012. The cerclage was termed successful if the pregnancy was carried to term. Multiple demographic and clinical characteristics and their relationship to cerclage outcome were analyzed. Results: The records of 123 patients who underwent cerclage over the 6 years period reviewed were analyzed. The mean age was 33.3 ± 3.9 and majority (68.3%) were multiparous, with most of them (90.2%) having had a previous miscarriage. Majority (90.2%) had elective cerclage and 4 (3.3%) had emergency cerclage. Overall majority of patients delivered at 37 and 38 weeks gestation 23.6% and 19.5% respectively. Outcome of cerclage was adjudged successful in 92 (74.8%) of cases and failed in 31 (25.2%) cases. The most frequent complication was pre-viable or preterm rupture of membranes (14.6%). Cerclage outcome was not influenced by age, parity, gestational age at cerclage or experience of the surgeon. The mean duration for which pregnancy was prolonged after an emergency cerclage was 2.6 ± 2.4 weeks and emergency procedure was significantly associated with a failed cerclage. Of the 111 patients with previous miscarriages who had cerclage procedure, 68 (61.3%) had term deliveries and 23 (20.7%) preterm births. Fetal salvage rate of 98 (79.7%) was observed. Conclusion: Use of cerclage for suspected cases of cervical incompetence can have an important beneficial effect in carefully selected cases of cervical incompetence even amongst pregnant black African women.

Ovarian hyperstimulation syndrome in a spontaneous pregnancy: A potential for missed-diagnosis

Ovarian hyperstimulation syndrome (OHSS) with the natural ovulatory cycle is extremely rare. We report a case of severe OHSS associated with a spontaneous normal singleton pregnancy in a 23-year-old woman presenting with severe abdominal pain, vomiting, and dyspnea. Ultrasonography revealed 10 weeks viable intra-uterine single fetus with bilateral multilocular cystic ovarian masses and ascites. She had supportive therapy inclusive of oral bromocriptine with complete resolution of OHSS and an eventual uncomplicated normal vaginal delivery at 39 weeks of pregnancy.

Transabdominal follicular aspiration in an in vitro fertilization cycle: experiences with an unusual but necessary intervention in a resource-limited setting

Controlled ovarian hyperstimulation is one of the major steps of in vitro fertilization. The inaccessibility or non-visualization of developing follicles on transvaginal sonography (the preferred imaging method) may be misjudged as a poor response, resulting in cycle cancellation. It is necessary to scrupulously appraise proxy indicators for ovarian response, such as estradiol levels, endometrial thickness, and other individual clinical characteristics. This can prompt meticulous transabdominal ultrasound follicular monitoring and oocyte retrieval with the goal of averting cycle cancellation and improving treatment outcomes.

Successful triplet pregnancy in an African with pure gonadal dysgenesis: A plus for assisted reproduction

Abstract Gonadal dysgenesis represents a congenital developmental disorder of the reproductive system, with its main gynaecologic manifestations being amenorrhea and infertility. We present a unique case of pure gonadal dysgenesis in an ‘about to be’ married lady resident in a society where high premium and success in marriage is dependent on childbirth. With astute evaluation and counseling, assisted reproductive technology (ART) was safely and successfully used in this case with eventual triplet pregnancy and delivery. Our index experience shows that situations with compromised fertility the availability and access to ART aids effective treatment planning and births a re-invigorated hope for family life.

Maternal characteristics and timing of presentation following pre-labour rupture of membranes.

Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from October 2011 to December 2012. Interval from onset of PROM to presentation to hospital was used as dependent variable. From the study population, two groups were identified based on time interval (≤24 hours or >24 hours) from PROM to presentation to hospital and their relationship to socio-demographic characteristic examined. Results: Over the study period, records of 110 women met the inclusion criteria and were selected for analysis. Their mean age was 29.26 ± 0.67 years; they were all married with 41.8% being nulliparous women. The mean gestational age at presentation with PROM was 38.5 ± 1.2. Over 50% had tertiary level of education. Overall, 38.2% were in social class 1. With regard to maternal response behaviour to PROM, 65.5% presented to the hospital within 24 hours while 34.5% presented after 24 hours of rupture of membranes. Majority of those that presented within 24 hours of PROM were in (upper) social class 1 and 2 and this differed significantly from those that presented after 24 hours, most of whom were in (lower) social class 3,4 and 5; [56 (77.8%) vs 16 (22.2%) and 14 (36.8%) vs 24 (63.2%)] P = 0.0001. Conclusion: Delay in presentation after PROM, illustrative of maternal under utilisation of BPACR package, is associated with being in a lower social class. Socio-economic and educational empowerment of women is advocated, while prospective research on maternal perception and attitude towards ANC is proposed.

Age at menarche among secondary school girls in an urban population of Nigeria

Background: Menarche signals the beginning of reproductive years in women. In recent times, the age at menarche has shown a downward trend, and this may be potentially influenced by biosocial factors. Objective: The objective was to determine the current mean age at menarche among secondary school girls in Benin-city and the influence of biosocial factors. Materials and Methods: The study was a cross-sectional descriptive study of secondary school girls in Benin-city. Data collection was by use of pretested self-administered questionnaires. Biophysical parameters of the respondents were also obtained. Age at menarche was compared with social and biophysical indices. Results: Of the 1,408 respondents, 952 (67.6%) had attained menarche. Mean age at menarche of 12.3 ± 1.18 years was estimated. About 16.0% of the respondents attained menarche while still at primary school. Mean menarcheal age was influenced by the social status of parents, being lowest among girls from social class 1 (11.8 ± 1.25 years) and highest among girls from social class 5 (14.1 ± 1.14 years), P = 0.0001. Other factors that influenced mean menarcheal age included family type and size. Anthropometric parameters of postmenarcheal girls were also higher than those of their premenarcheal colleagues. Conclusion: In line with a global trend the age at menarche in Benin-city is lower in this study with reference to previous reports. This was positively influenced by some biosocial factors (such as higher weight/body mass index and mid-arm circumference). Furthermore, the observation of menarche even among primary school girls suggests a need for early initiation of enlightenment and education in adolescent reproductive health.