Johnson Akuma Obuna

Perception of labor pain and utilization of obstetric analgesia by Igbo women of Southeast Nigeria

Context: Pain is subjective and labor pain perception is said to be influenced by personality, culture, parity, educational status and maternal weight. Objectives: This study assessed the Igbo Womens perception of labor pain and evaluated factors influencing their perception of labor pain as well as ascertained the level of utilization of obstetric analgesia by parturients. Materials and Methods: This was a cross-sectional study that spanned 6 months (January 1, to June 30, 2011) and involved parturients of Igbo extraction who delivered by vaginal route in 3 different referral hospitals. They were interviewed with self-administered questionnaires within the first 24-48 hours postpartum. Labor pains were rated using a 3-pont verbal rating scale (VRS). Data were analysed with MathCAD 7 statistical soft ware package. Results: A total of 530 parturients were interviewed but only 500 were analysed. Fifty-two percent of parturients rated labor pain as severe. While 67.6% of parturients desired labor pain alleviation, only 38% actually requested for analgesia, and only 27% of parturients received pain relief during labor. The commonest pain relief available was intramuscular injection of Pentazocine Hydrochloride (92.6%) The influence of age, parity, educational status, maternal weight and companionship, on pain perception was statistically significant. Conclusion: Though most Igbo women found labor painful, they tend to cope with it. Most Igbo parturients did not request for pain relief and only a fraction of those who did request received it. Adequate antenatal preparation for the birthing process is necessary.

Clinical Presentation of Infertility in an Outpatient Clinic of a Resource Poor Setting, South-East Nigeria

Aim: To identify the prevalence, common symptoms, signs, partner contribution, common diagnosis and outcome of infertility in a resource poor setting. Study Design: Descriptive retrospective study.

Outcome of Teenage Pregnancy at a Tertiary Hospital in Abakaliki Southeast Nigeria

Background: Teenage pregnancy is a high risk pregnancy associated with obstetric, fetal, neonatal and psycho‑social complications. These complications are worsened by poverty, ignorance and lack of special care during pregnancy. Aim: The objective of the following study is to determine the obstetric and neonatal outcome of teenage pregnancy. Materials and Methods: A retrospective case control study was carried out over a 6 years period, 2006‑2011. All teenage pregnancies (aged 13‑19 years) at Federal Medical Center Abakaliki, Ebonyi were taken as cases. Pregnancy deliveries from mothers aged 20 to 29 that met the inclusion criteria were selected as controls. A total of 137 teenage pregnancies were analyzed and compared with 948 controls. Statistical analysis was performed using 2008 Epi‑info statistical software version 3.5.1 (Atlanta, Georgia, USA). Results : The incidence of teenage deliveries over the period of the study was (137/8020) 2.25%. Single mothers were commoner (40.9% [56/137] vs. 3.1% [29/948], P < 0.01) among the teenagers. Low educational status was more common among teenage mothers (P < 0.01). Unbooked pregnancies were significantly common among teenage mothers (23.4% [32/137] vs. 12.3% [117/948], P < 0.01). Anemia in pregnancy (18.1% [41/226] vs. 11.2% [65/579], P = 0.01), human immunodeficiency virus (HIV) in pregnancy (4.9% [11/226] vs. 1.7% [10/579], P = 0.01) and malaria in pregnancy (26.1% [59/226] vs. 12.4% [72/579], P < 0.01) were significantly common in teenage pregnancies than the control. Teenage mother had significantly increased cesarean deliveries (23% [31/137] vs. 14.8% [140/948], P < 0.02), male deliveries (64.3% [90/140] vs. 52.1% [502/963], P < 0.03) and low birth weight (19.3% [27/140] vs. 12.7% [122/963], P < 0.03). Fetal loss (22.1% [31/140] vs. 3.3% [32/963] P < 0.01) and birth asphyxia (19.3% [27/140] vs. 6.8% [65/963], P < 0.01) were significantly common among teen mothers in the 1st min American Pediatric Gross Assessment Records score. Conclusion : Teenage pregnancies were associated with a significantly higher risk of anemia in pregnancy, HIV in pregnancy, malaria in pregnancy, cesarean deliveries and poor fetal outcome. Health education, women enlightenment and empowerment will be essential in reducing the problems of teenage pregnancy. Keywords : Abakaliki, outcome, teenage pregnancy, tertiary hospital

Evaluation of obstetricians’ surgical decision making in the management of uterine rupture

BackgroundUterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony.This study aims to evaluate obstetricians’ perspectives on surgical decision making in managing uterine rupture.MethodsA questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics.ResultsSeventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients’ conditions and obstetricians’ surgical skills.ConclusionObstetricians’ distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians’ surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician’s surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.

The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria

INTRODUCTION Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. AIM This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. MATERIALS AND METHODS This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. RESULTS A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. CONCLUSION Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment.

Plasma cadmium and zinc and their interrelationship in adult Nigerians: potential health implications

Abstract Zinc (an essential trace element) and cadmium (a ubiquitous environmental pollutant with acclaimed toxicity) have been found to occur together in nature, with reported antagonism between the two elements. The present study aimed at determination of plasma levels of zinc (Zn) and cadmium (Cd) and their interrelationship in adult Nigerians. The series comprised adults (n=443) aged ≥18 yrs (mean ± SD 38.4±13.7 yrs), consisting of 117 males, 184 non-pregnant and 140 pregnant females. Sociodemographic data were collected by questionnaire while anthropometrics were determined using standard methods. Plasma Cd and Zn were determined by using an atomic absorption spectrophotometer. The mean plasma zinc and cadmium were 94.7±18.1 μg/dl and 0.150±0.548 μg/dl, respectively. Age, sex, pregnancy, and parity had no effect on either plasma Zn or Cd. Although educational level had no effect on plasma Zn, it had a significant effect on Cd; subjects possessing either secondary or tertiary education had significantly lower plasma Cd than subjects without formal education. Moreover, there seemed to be an inverse relationship between Cd and Zn, but this was not statistically significant (r=–0.089; p=0.061). Although plasma Zn was not related to BMI (r=0.037; p=0.432), Cd was significantly negatively correlated with BMI (r=–0.124; p=0.009). It may be concluded that adult Nigerians in Ebonyi State have elevated plasma levels of Cd, with apparent impact on the levels of plasma Zn. This has important public health implications considering the essential roles of Zn in the protection of Cd mediated adverse health effects. While food diversification is recommended to improve plasma Zn, efforts should be made to reduce exposure to Cd to mitigate partially its possible adverse effects.

Determinants of Delivery Outcomes in Teenage Mothers at a University Teaching Hospital, South-Eastern, Nigeria

Aim: This study aims at identifying some delivery outcome determinants in teenage mothers and evaluating the effect of booking in light of these parameters. Study Design: A retrospective study. Place and Duration of Study: Teenage mothers who delivered in a teaching hospital in Nigeria over a 5-year period (between 1