Kikelomo T. Adesina

Domestic violence and obstetric outcome among pregnant women in Ilorin, North Central Nigeria

Pregnancy constitutes a period of heightened risk for domestic violence, which can be physical, sexual, psychological, or emotional. A woman may be at risk irrespective of race, age, socioeconomic status, or educational level [1]. The abdomen is the most common target for physical violence [1]. Women who experience violence during pregnancy have a higher risk of pregnancy loss, pretermdelivery, low birthweight neonates, premature rupture of membranes, stillbirth, and increased likelihood of cesarean delivery [1]. The main objective of the present study was to investigate pregnancy outcomes among women who had experienced domestic violence compared with women who had not been abused. The study was a prospective case–control study conducted at the Obstetrics and Gynecology department, University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1 to June 30, 2012. All pregnant women attending the prenatal clinic were informed about the study and those who provided written informed consent were screened for domestic violence using a modified version of the Abuse Assessment Screen [2]. Monogamous families had 1 wife and polygamous families had 2 or more wives. The sample size was determined by the formula for comparison of groups and the samplingmethodwas purposive sampling. Pregnantwomen recruited to the studywere required to affirm or refute whether they had experienced physical, sexual, emotional, or psychological violence during the preceding year or in the index pregnancy that had been perpetrated by an intimate partner. Physical violence included beating or using objects with intent to hurt, while sexual violence included unwanted fondling or forced sex. Emotional or psychological abuse included verbal abuse, humiliation, and isolation. The control group consisted of pregnant women who had not experienced domestic violencematched for parity, age, family type, education level, history of preterm birth, smoking, and ultrasound scan for exclusion of fetal congenital abnormalities. Womenwith previous uterine surgeries were excluded from the study. Maternal outcome measures included preterm labor or delivery, operative vaginal or cesarean delivery, puerperal pyrexia, breastfeeding problems, anxiety, and depression. Presentation with cervical dilatation greater than or equal to 8 cm was termed late presentation. All instrumental deliveries were performed by the same individual. Neonatal outcomes included prematurity, low birth weight, birth asphyxia, intrauterine fetal death, and perinatal mortality. Ethical approvalwas obtained from the ethics and research committee of the University of Ilorin Teaching Hospital before commencing the study. Data were analyzed using SPSS version 18 (IBM, Armonk, NY, USA). P b 0.05 was considered statistically significant. A total of 200 pregnantwomenwere included in the study, comprising 100 womenwho had experienced domestic violence (subjects) and 100 pregnant women who had not (controls). The age range for both groupswas 18–42 years (mean30.18±4.78 years). For other variables, comparisons between the subject and control groups were: 82% vs 89% monogamous families, 25% vs 28% primiparity, 16% vs 12% late booking, and 96% vs 97% married couples. The perpetrator was the woman’s husband in 96% of cases of domestic violence. Women who had experienced domestic violence were significantly more likely to have preterm labor (P = 0.037), instrumental vaginal delivery (P = 0.024), cesarean delivery (P b 0.001), breastfeeding problems (P = 0.015), postpartum depression (P b 0.001), and anxiety disorders (P = 0.008) (Table 1). The neonates of the subject group had statistically significant low birth weight (P b 0.001), and higher rates of birth asphyxia (P b 0.001) and neonatal death (P = 0.008) compared with neonates of the control group (Table 2). All instrumental vaginal deliveries were performed because of a prolonged second stage of labor. Cesarean deliveries were performed for fetal distress in 52% compared with 27% of the subject

Double-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital

To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL).

Evaluation of parturient perception and aversion before and after primary cesarean delivery in a low-resource country

To determine the perception of and aversion to cesarean delivery (CD) and their determinants before and after primary CD.

Spontaneous abortions (miscarriages): Analysis of cases at a tertiary center in North Central Nigeria.

Background: Spontaneous abortion (miscarriage) is a source of pregnancy loss globally. Its management, especially in low resource countries remains hampered by inadequate facilities for evaluation. Objectives: To assess the clinical presentation, diagnosis, and treatment of cases of spontaneous abortion at a tertiary hospital in Ilorin, Nigeria. Methodology: A descriptive study of all spontaneous abortions (miscarriages) managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 1, 2007 and December 31, 2011. The records were retrieved from the medical records department and necessary information retrieved. Results: There were 603 miscarriages with a prevalence of 4.2%; incomplete miscarriage was the most common 254 (42.1%), 356 (59.0%) had no identifiable risk factor; 434 (72%) of the women were <35 years; 361 (59.9%) had first trimester miscarriages, 272 (45.1%) were of low parity (Para 0-1) and 223 (37%) were having a repeat miscarriage. Of the 141 managed for threatened miscarriage, pregnancy was salvaged in 90 (63.8%), 244 (40.5%) had surgical evacuation with 100% success rate while 218 (36.2%) had medical management with 90.8% success rate. The mean duration of admission was shortest with surgical management (2.03 ΁ 1.1 days) and post-abortion infection rate was 11 (2.6%). Histology confirmed product of conception in 98% and molar gestation in 2% of the samples; no mortality was recorded in this study. Conclusion: More than half of women with miscarriages had no identifiable risk factors mainly due to limitation in facilities for evaluation; there is a need to improve facilities for investigating women with spontaneous abortions in developing countries to identify the causes of the losses.

Pre-HSG microbial isolates from endocervical swabs in infertile women in Ilorin, Nigeria

Background: Genital infections contribute significantly to infertility by causing tubal disease in our environment. This can be worsened by any instrumentation of the genital tract such as hysterosalpingography (HSG), which is the most common and affordable investigation by infertile couples for tubal factor. Materials and Methods: A prospective study of 53 women who presented for HSG on account of infertility was done in a radio-diagnostic centre In Ilorin, Nigeria. Endo-cervical swabs were taken aseptically prior to standardized HSG in all clients. The swabs were sent for microscopy, culture, and antibiotic sensitivity and the HSG findings of patients were documented. Results: The age ranged between 25 and 52 years with a mean of 34.26 + 5.762 years. Both fallopian tubes were patent in 10 patients and blocked in 14 cases. There were 14 cases of unilateral hydrosalpinx and 10 (18.9) bilateral hydrosalpinges. Either pelvic or cervico-uterine cavity adhesions were observed in 35 (66.0%) of the cases. Mild to heavy growth occurred in 67.9% of the cases. Gram stain was positive in 54.7% of cases. The most common organism was Staphylococcus spp (28.3%). Forty-five percent of yields were sensitive to more than two antimicrobials. There was statistical significant relationship between the presence of pathogens in the endo-cervix and the frequency of tubal disease (x 2 = 2.71, P ≤ 0.05). Conclusion: There was a positive or significant statistical relationship between presence of pathogens in the cervix and tubal disease. Pre-HSG endo-cervical swab for microscopy, culture and sensitivity is advisable to prevent genital infections after HSG.

An observation of umbilical coiling index in a low risk population in Nigeria

Abstract Objectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study.

Oral health status of pregnant women in Ilorin, Nigeria

Abstract Oral diseases have been shown to negatively affect pregnancy outcomes, yet, routine oral health care is not a component of the antenatal care package in Nigeria. This study was designed to describe the pattern of the oral conditions in pregnancy compared to the non-pregnant controls. Two hundred and twenty-five pregnant women and 166 non-pregnant controls were studied from two healthcare facilities in Ilorin. Oral-related complaints were assessed in the pregnant population while both of the groups had an oral cavity examination. The mean age of the respondents was 28.24 years ±4.77 and 80% had at least a secondary school level of education. The prevalence of oral complaints among the pregnant women was 19.1%. Gingivitis was more common among the pregnant women than the non-pregnant women, and more demonstrable on examination. Oral healthcare should be a component of the antenatal care in our environment. Impact statement What is already known on this subject? Women experience oral disorders in pregnancy, which may be worsened by the physiological changes in pregnancy. What do the results of this study add? This study has demonstrated a higher prevalence of gingivitis in the pregnant women than in the non-pregnant women on oral examination. The signs of gingivitis were higher than its related complaints. What are the implications of these findings for clinical practice and/or further research? Therefore, dental care and an examination should be part of a routine antenatal care package to prevent the unwanted pregnancy outcomes that are related to oral disorders.

Graded epidural anaesthesia for caesarean section in a parturient with severe left ventricular dysfunction from dilated cardiomyopathy: A case report

Dilated cardiomyopathy (DCM) is a primary disorder of heart muscle characterised by left ventricular (LV) or biventricular dilatation and impaired ventricular contractility. During pregnancy, women with DCM have a higher incidence of cardiac events than the non-pregnant patient. When DCM is associated with severe LV dysfunction, anaesthetic management is particularly challenging, because severe LV dysfunction is a predictor of sudden cardiac death and poor quality of life. The goals of anaesthetic management in DCM consist of maintaining normovolaemia, and avoiding myocardial depression and drug overdose during induction (as circulation time is slow). It also includes preventing increases in ventricular afterload and sudden hypotension when regional anaesthesia is a choice. This case report describes the successful anaesthetic management of a parturient with DCM and a severely low LV ejection fraction of 20%, wherein the child was delivered via caesarean section using a graded epidural anaesthesia technique.

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria.

BACKGROUND The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVE To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. METHODS A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant. RESULTS Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C.

Physicians' prescribing pattern, perceived safety of asthma medications and management of asthma during pregnancy in Nigeria

Background: Under-treatment of asthma in pregnancy can result in adverse fetal and maternal outcomes. The potential risk of teratogenicity may limit prompt and adequate management of medical disorders in pregnancy. Objectives: The objective of this study was to investigate the physicians′ prescribing pattern, their perceived safety of asthma medications and management of asthma during pregnancy in obstetric care units of a developing country. Materials and Methods: A self-administered questionnaire containing case vignettes and multiple choice questions were used to evaluate the physicians prescribing practices, their perceived safety of medications and approach to asthma management in pregnancy. Result: Of the 144 doctors that participated in the study; 76 (52.8%) would prefer inhaled long-acting β2 agonist and inhaled corticosteroids combination (LABA/ICSs) while 10 (6.9%) would prefer leukotriene antagonists (LTA) as a controller medication in the first trimester of pregnancy. Short-acting β2 agonists, LABA, and theophylline were perceived to be safest throughout pregnancy, corticosteroids and cromoglycates were considered unsafe in first trimester while LTA were considered unsafe in all the trimesters by a majority of respondents. To gain asthma control in a patient already on low dose LABA/ICS, 94 (65.3%) of the doctors would refer their to a respiratory specialist instead of increasing the dose of LABA/ICS. Less than half (42.3%) were willing to address medication compliance in nonconforming patients. The majority (72.2%) of the doctors′ self-reported nonadherence to the asthma treatment guideline. Conclusion: Even though, most of the physicians caring for pregnant women seem to prefer LABA/ICS combination for asthma control, there exist a knowledge gap in the stepwise management of asthma, perceived safety of most asthma medications and tackling poor medication adherence.